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HomeMy WebLinkAbout0008 KERRY DRIVE - Health 8 Kerry Drive, Marstons Mills R t' 1rr� i ,I Y ,,l w O, M GE PITNEYBOWES 1 A I a� T OS .S. �� F arnstable Y _fB r�..wn o � ._ ~�t�ublic Health Division B• ARNSTABLE. �����J Y NA35. 200 Main Street •-� =-•v�� /� wmMiiiiiI© fFD MPyP Hyannis,MA 02601 , ,R ZIP 02601 006.90� $ _ � ,.� .• 0 2 41N 0000336455FEB. 21, 2020, 7015 1730 0001 4988 1.418 E MONIZ, WALTER C - RD_EN STREET -- UNABLE TO FORWARD WARD . - B'i`4 4-. I Lx`�.a ��.IE">gv#S''...�'^a`�G b.'ki'�5 :0 5'r is m"i7r�'Lb��"•.da,�.,`vi'r<'b fl lea►iitas„1s��t4l �b�ila9i�a �s� t9�i3t�'Ia�sa3� � un a 11 I11.1 111 11 1 1 1 to a it 111 / fill -111 •f a • e4. •MPLETE,THIS'SECTION ON DELIVERY e Complete items 1,2,and 3. A. Signature j I ❑Agent ■ Print your name and address on the reverse X t I so that we can return the card to you. ❑Addressee j ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery j j or on the front if space permits. I I dress different from item 17 ❑Yes I delivery address below: ❑No i MONIZ, WALTER - I i - 73 BORDEN STREET I i f NEW BEDFORD, MA 02740 I - I — s"aervice'iype ❑Priority Mail Expresso I II'II�III(�II III I(III�II II'II�I II I I I III II I�II ❑ dult Signature Restricted Delivery ❑Registered Mail Restricted Adult j I ertified Mail® elivery j 9590 9402 5357 9189 1905 62 Certified Mall Restricted Delivery etum Recelpt for ❑Collect on Delivery Merchandise ❑Collect on Delivery Restricted Delivery ❑Signature Confirmation 2_ Articla._Number!Transfer from service label) I \, _.__ ..,,a....;I ❑Signature Confirmation I i I Restricted Delivery Restricted Delivery 7015 .1730 0001 4988 1418 - 1 I = 3=£ I PS Form 3811,July 2015 PSN 7530 02-000-9053 Domestic Return Receipt I .5 � BIKE Town of Barnstable spec n tional Services Department I p .A STABLL9. » r 0039.A Public Health Division r�° s 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO 6 SECOND NOTICE CERTIFIED MAIL#7015 1730 0001 4988 1418 February 21, 2020 MONIZ, WALTER 73 BORDEN STREET NEW BEDFORD, MA 02740 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 8 Kerry Drive, Marstons Mills, MA was inspected on 08/04/2017 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20h.) You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPT%C\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\8 Kerry Drive Marstons Mills Second)`otice.doc t Town of Barnstable t;ax>v�rra ,I nspectional Services Department artment ee y b. ��� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO SECOND NOTICE CERTIFIED MAIL#7015 1730 0001 4988 1418 February 21, 2020 MONIZ, WALTER 73 BORDEN STREET NEW BEDFORD, MA 02740 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 8 Kerry Drive, Marstons Mills, MA was inspected on 08/04/2017 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: 0 Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20h.) You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER OF:DER OF THE BOARD OF HEALTH 4 Thomas McKean, R.S., CHO w Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\8 Kerry Drive Marstons Mills Second Notice.doc ��THE Tpk Town of Barnstable Barnstable Regulatory Services Department AlAmmicaNy •axivsrasLF r MASS. 039. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-630z- Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 3790 September 6, 2017 MONIZ, WALTER 73 BORDEN STREET NEW BEDFORD, MA 02740 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 8 Kerry Drive, Marstons Mills, MA was inspected on 08/04/2017 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20h.) You are ordered to repair or replace the septic system within two (2) years from the date r you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDE THE B YARD OF HEALTH Th as McKean, R.S., CH Agent of the Board of Health Q:\SEPTIC'Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\8 Kerry Drive Marstons Mills.doc f , - of 1"e ram, " Town of Barnstable arnstable :s�xxsreacE, : . Regulatory Services Department �Eb►A1��,� Public Health Division 200 Main Street,Hyannis MA-02601 Office: 508-862-4644 Richard Scali,Director FAX 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES TO REPAIR FAILED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ .An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground . ❑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 Ell 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 n e esspoo ❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level.,<12"below inlet(per Town Code §360-9.1) Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: XtSEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc OLf3 -o33 � Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Kerry Dr Property Address Walter Moniz Owner Owner's Name / information is required for every Marstons Mills V MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information a 5#9 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evalu by the Local Approving Authority 8-4-17 nspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board I f 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 .CD�G�VS • Commonwealth of Massachusetts ^+ f Title 5 Official Inspection Form Il Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Kerry Dr l J' Property Address Walter Moniz Owner Owner's Name information is required for every Marstons Mills MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described ' in 310 CMR 15.3037or 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 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a�• l -p.�,%✓ 8 Kerry Dr Property Address ,....... Walter Moniz Owner Owner's Name information is required for every Marstons Mills MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):. ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts - a=� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Kerry Dr Property Address Walter Moniz Owner Owner's Name information is Marstons Mills MA 02648 8-4-17 required for every ' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 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 flow t5ins•W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts .a� Title 5 Official Inspection Form ' 121 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 8 Kerry Dr Property Address Walter Moniz Owner. Owner's Name requi uired for every mation is Marstons Mills MA 02648 8-4-17 re page. City/Town State Zip Code Date of Inspection B. Certification (cont.) . a Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. rya t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form ,li;-1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a% 8 Kerry Dr Property Address Walter Moniz Owner Owner's Name information is required for every. Marstons Mills MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health r ❑ ® 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)] D.D System Information . Y Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 R y DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 , Commonwealth of Massachusetts �I p, Title 5 Official Inspection Form 71 pj' 4-I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 8 Kerry Dr _ Property Address Walter Moniz Owner Owner's Name information is required for every Marstons Mills MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2017Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts - laa Title 5 Official Inspection. Form ' 111.1 Subsurface Sewage Disposal System Form Not for Voluntary Assessments a� ,f!% 8 Kerry Dr Property Address Walter Moniz Owner Owner's Name information is required for every Marstons Mills MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts : Title 5 Official Inspection Form - - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments as' t 8 Kerry Dr s- Property Address Walter Moniz Owner Owner's Name information is required for every Marstons Mills MA 02648 8-4-17 page. City/Town, State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1988 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 8"feet Material of construction: E concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12 . t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts a=1 Title 5 Official Inspection Form f ' 1f;.I Subsurface Sewage Disposal System Form Not for Voluntary Assessments a" 8 Kerry Dr Property Address Walter Moniz Owner Owner's Name information is required for every Marstons Mills MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts :a=1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _�_��!✓ 8 Kerry Dr Property Address Walter Moniz Owner Owner's Name information is required for every Marstons Mills r' MA 02648 8-4-17 page. City/Town- State Zip Code Date of Inspection D. System Information(cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts �aql Title 5 Official Inspection Form 'i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a' 8 Kerry Dr Property Address Walter Moniz Owner Owner's Name information is required for every Marstons Mills MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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 had water at working level with stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' , 04 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 8 Kerry Dr Property Address Walter Moniz Owner Owner's Name information is required for every Marstons Mills MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-600 gal ❑ leaching chambers number: I - ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: z Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit had water level at 20" below inlet invert with stain lines above inlet invert and into riser. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form wIll., Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Kerry Dr Property Address Walter Moniz Owner Owner's Name information is required for every Marstons Mills MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): a• . t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts p Title 5 official Inspection Form ' ,..,lf�;I Subsurface Sewage Disposal System Form Not for Voluntary Assessments 8 Kerry Dr J' Property Address Walter Moniz Owner Owner's Name information is ' ` •required for every Marstons Mills MA 02648 8-4-17 . page. City/Town State Zip Code Date of Inspection _ D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form �, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 8 Kerry Dr Property Address Walter Moniz Owner Owner's Name information is required for every Marstons Mills MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record I ` If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health - explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at reater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' . ' I. Subsurface Sewage Disposal System Form Not for Voluntary Assessments >-�;!✓ 8 Kerry Dr Property Address Walter Moniz Owner Owner's Name information is required for every Marstons Mills MA 02648 8-4-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i CERTIFICATE OF ANALYSIS Page: ~ Barnstable County Health Laboratory Report Dated: 06/11/2002 x _ Report Prepared For: Order Number: G0214928 Kathy Kramer 8 Kerry Drive Marstons.Mills, MA 02648 R Laboratory 1D#: 0214928-01 Description: Water-Drinldng Water Sample#: 14928 Sampling Location: 8 Kerry Drive,Marstons Mills Collected: 06/10/2002 Collected by: Gael Kelleher Received: 06/10/2002 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates 0.7 mg/L 10 EPA 300.0 06/11/2002 LAB: Metals Copper 0.1 mg/L 1.3 SM 3111E 06/11/2002 Iron <0.1 mg/L 0.3 SM 3111B 06/11/2002 Sodium 8 mg/L 20 SM 3111B 06/11/2002 LAB: Microbiology Total Coliform Present P/A Absent P/A 06/10/2002 LAB: Physical Chemistry Conductance 101 umohs/cm EPA 120.1 06/11/2002 pH 5.7 pH-units EPA 150.1 06/11/2002 Note: Recommended maximum contamination level exceeded due to presence of Coliform Bacteria.Retesting is recommended. Approved By: — (Lab Director) C- IIt I'.-re'. { a T Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 _ f'S . .�\ CONYMONWEALTH OF N ASSACHt'SETTS {1� .:i. l Z tea. EXECUTIVE OFFICE OF EwIRONME\TAL IRS /Q DEPARTMENT OF EN-VIRO\'CIE\TAL PR ONE WINTER STREET. BOSTON. NIA 02IO6 61?-=4:•S`s€C( r 2 3199 T dp W ILLIAV F WELD Govemc, Sc:retar% ARGEO P.4liL CELLLCCI DAV 1D B STRL'}S .... ._ _ _ Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commission PART A _... CERTIFICATION .. . . Property Address: I& Sit-, ak"LSV"-% ~A%k Address of Owner: AC%.My`t>*r+W,%ptjA Date of Inspection. t(,\%tAn /1 Of different) Name of Inspector: H,LA eo am a DEP ap roved system inspector pursuant to Section 13.340 of Title 5 (310 CMR 15.000) 0�35 Company Name:f}/t4 m4u'e Eir rr'r+r-j., ^-1 p Mailing Address: ,R n Aepx e_32 H A`9d4eg- H /`- © 26'4-cl Telephone Number: r'5e 4Z �6 2 2— /Lf ZC7 CERTIFICATION STATEMENT I cer,if1 that I have personall\ respected the seAaee disposa! system a; this address and that the inio►mation reported belov, is true, accurate and complete as o-*the time of inspec,o- The inspection Nas penormed based on m% training and experience in the proper function and maintenance of on-s-te sev�age d,sposa sysiems Tne system Passes Conc-t,ona!;v Passes _ Neec, Furtne' E%a'uanon B\ the Loca! Apprpvrng Au:nor^ Fa.•s Inspector's Signature. Date: lb The lnspeco, sha" s:Jbmr: a cop% of this inspection reoor, to the Aporovrng Authority within thirty (301 days of completing this inspea-or.. It the system is a shared system o• ha; a design floN of 10.000 gpd or greater, the inspector and the system owner shall submit the repo^ to the appropriate reg,or.ai oiirce of the Department o: Environmenta; Protection. The origmai should be sent to the system owner and copes sen; to the buve'. N applicable. and the approving authorin INSPECTION SUMMARY: Check A, B, C, or D. A] SYSTEM PASSES: 4— 1 have not found any information which indicates that the system violates any:of the failure cii4ria as'defined in 310 CmR 15.303. 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. Indicate yes, no, or not determined (Y, N, or ND!. Describe basis of determination in all instances. If'not determined', explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co-:pliance (attached, indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not me:a!, is cracker:, structjra!!y unscun'd, shows sk;bs:antial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank w approved by the Board of Health. D.o• 1 of IC SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'.FORM PART A -< _ 1 �._.. _. CERTIFICATION (continued) - re♦. 5 r .i�jq... ... Property Address: Owner. Date of Inspection. BJ SYSTEM CONDITIONAL Y PASSES icontini-d _ Sewage bac p or breakout of high static water level observed in the distribution box is due to broken or obstructed prpe;s) or due o a broken, settled or uneven distribution box. 'The system will pass inspection if(with approva! of the Board of Healt Describe observations broken pipe(s) are replaced bstruction is removed stribution box is levelled or replaced The system required p mping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if twrth appr vat of the Board of Health): broke pipets-I are replaces obstru or. is removed C) FURTHER EVALUATION IS REQUIRED BY T BOARD OF HEALTH: Conditions exist which require furthe, evalu ion by the Board of Health in order to determine if the system is fa!Irng to protect the public health, safe-v and the environment 1) SYSTEM WILL PASS UNLESS BOARD OF HEAL DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH A 'D SAFETY AND THE ENVIRONMENT: Cesspool or prl,.-, ,s within 50 fee: of a surfa water Cesspoo! or pri„ is v,rthin 50 fee: of a border g vegetated wetland or a salt marsh. 2) SYSTEM KILL FAIL UNLESS THE BOARD OF HEALTH (A. 'D PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PR ECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The systerr has a septic tank and soil absorption system S) and the SAS is within 100 feet to a surface water supply or tributary to a suriace water suppl% The system has a septic tank and soil absorption system an the SAS is within a Zone I of a public water sup-)Iv well. The system has a septic tank and soil absorption system and a SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and th SAS is less than 100 feet but 50 feet or more from a private water supply well, uniess a we!I water analysis for colifo bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence f ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance roximation not valid). 3) OTHER _... wr (revised 0� ':S.'9"' f�c• o! 1C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM IPART A - CERTIFIUITIO'V (continued) Property Address: Owner: Date of Inspection: D) SYSTEM FAILS: You must indicate either `Yes" or "No' as to each of the following I have determined that the sys, m violates one or more of the following failure criteria as defined to 310 CMR 15.303 The casts for this deterrr:tnatton is identif; below. The Board of Health should be contacted to determine what will be necessar• to correct the failure Yes No Backyp of selvage into faci or system component due to in overloaded or clogged SAS or cesspool. Discharge or ponding of efflu t to the surface of the-ground or surface waters due to an overloaded or clogged SAS or cesspoolls _ 5ta:ic !to,;.d level to the distrib:,t; n box above outlet invert due to an overloaded or clogged SL or cesspool Lteufd death tr cesspoo' is less than 6" below invert or available volume is less than 1/2 day rlov. Recu,red pumping more than 4 times n the last year NOT due to clogged or obstructed pipe s NurnDer o'times pumped An% por:,0'l 0' the So!! Adsorption Svste , cesspool or privy is below the high groundwater eievatno- A^t por::or• of a cesspool or prn% is %%ith, . 100 feet of a surface•water suppiv or tributa-% to a suriace water supph An) Do^•ion of a cesspoo' or privy is within Zone I of a public well. " A-+� Pc-1c- e'a cesspoo' o' pr;%N- is within SO eet of a private water supply well An% po^.,or. o:a cesspoo! or prtv�• is less than 1 feet but greater than 50 feet from a private water supoly well with no acceo:able v ate' qualm anaiv5-s li the well has n analyzed to be acceptable. attach coc% of well water analysts for cohiorrr. bacteria vo!a:,le organic compounds, am onia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate e,:he• "Yes' or "No" as to each of the following. The io!;oN:ng c'ite'.a aop;% to large systems to addition to the crit ria above: The system serves a iacilm with a design flow- of 10,000 gpd or gre ter (Large System: and the systen is a significant threat to public hea!th and safety and the environment because one or more o the following conditions ezis: 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 ater supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area •IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full co pliance with the groundwater treatment program requirements of 314 CN1R 3.00 and 6.00. Please consult the local regional office of the partment for further information. (revised 04 —,5 '5— oar,. 1 n! t^ _ 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ;CHECKLIST :: Property Address: Owner. �r �►,, I Date of Inspection: (O�I�I97 . - .:. _ 4;xt �tnlJ.r ict'�Y act!_! ff p1:,mow n�i:.r�•-., ., .,:,.,.- . Check if the following have been done: You must indicate either "Yes" or'No"as to each of the following: Yes %0 Pumping information was provided by#?e,ovrrier, occupant, or,Board of Health. None of the system components have been pumped for at^least two weeks and the system has been receiving normal flow rates during that period. .large volumes of water have not been introduced into the system recent[% or as pan of this inspection As bull; plans have been oo:a:ned and examined. 'Note if the),are not available with h;A The iac:hN or d%eliing %%as inspected for signs o-sewage back-up. The s%-stern does not receive non-sanitam- or'industrlal waste flow. x _ The site %%as inspected for signs pi breakout. _ All s�sien- co nponents, excluding the Soil Aosorpaon System, have been located on the site. _ The sep:,c tangy manho;es %ere uncovered. opened. and the interior of the septic tank was inspected for cond.tior. of ba*ies or tees. mater;a; o construction, dimensions, depth of liquid,depth of sludge. depth of scum. The size and loca:,o., o the Sot' Absorption Svstem on the site has been determined based on The iac-i-it, om r+e• tanc occupants. r dineren: trorn ow•nen were provided with iniormation on the proper maintenance of Sub-Suriace Disposal Svsterr. _ �� Existing iniorrnation Ex Plan at 6 C)H � _ I _ Determined it the field sr' an,. of the failure criteria related to Pan C is at issue, approximation of distance is unaccexao-e Its 302 3;b? t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.m PART C SYSTEM INFORMATION Properts Address: cb jj!e_gpj Owner:�tPrMpracQ Date of Inspection: (IG�q(ej . FLOW CONDITIONS RESIDENTIAL: Design iloN�5g p.d.•rbedroorr. for S.A.S Number of becrooms Number ber or current residents aO _ � _. Garbage g•..-der (yes or no N _ . Laundry ccn-wed to system (yes or no' Seasonal use tyes or no-. 1J VYaier meter readings. if available (last two t2 year usage tgpdj. _NC> Sump Pump Ives or nor_ Las: da:e o'occupancs. f Q to2.4v "Gwsc.ToN . COMMERCI jkL'I%_DUSTRI AL: Type of establrshmen: Design fto%% _ ita►:ons�ca% Grease trap present rues or no_ Indus:na' \taste Holding Tani: presen; eves or no_ Nor+-sanitan. Haste d-scna•gec to the T::,e S sys:eT ise: or no_ %%ate- meter readings d ava,labie Las:Fa:e o: c OTHER: .Deicribe Last care ot.occuzanc• GENERAL INFOILIAATION PUMPING RECORDS and source ot• ,ntormanon System pumped as par, 6i tnspec:,on. Ives or no NO If yes, volume pumped _ gallons Reason io- pumping TYPE OF SYSTEM _ Septic tank/distribution box%soil absorption system Singe cesspool Ove-ficw cesspool Privy Shared syste-n (yes or not (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site. (,yes or no),�t7 • SIBSURfACE SE��AGE DI SPOSAL POSAI SYSTEM 1N PECTION FORM • •. PART C SYSTEM INFORMATIO% (continued) Property Address: Q Owner: Date of Inspection: 10 t BUILDING SEWER. (Locate on site plan) rt� Depth below grade. to Material of construction. _cast iron _40 PVC other (explains ;. ; Distance from private water supply well or suction Ire Diameter : Comments: (condition of joints, venting. evidence of leakage. etc.) I g B . .. .. SEPTIC TANK: S ... ... ......: (locate on site plan Depth beloM grade �� Material of construction- �concre.e _rne:a _Fioe'g!a« _Polve:hvlene _othenexplrn If tank is meta:. Its: age _ is age coni.rmec o% Ce-i•ticxe o' Compuance _Res.-No - Dime%isiora All Sludge depth 6" Distance from top o: s!udee to bonorn o'ou:ie: tee o• ba-•e Scum thickness c,15 _ Distance from top o' scum to too o' outle: tee or ba-.e Distance from bonom o; scu- to bo-on o;out)e: tee c- bz-•e how dimensions Mere dete•mmec &W- Imt t I Comments trecommendatton for pumping condition o r 'e: aid outlet tees or affles, depth °�f liquid le el in relation to outl%t inv rt6struau�a► integrity, evidence of leakage etc ED D0M s S {.1 U(t� t i U� if GREASE TRAP: (locate on site plan: Depth below grade Material of construction. _concrete _metal Fiberglass _Polyethylene —other(explain) ni n Dime s o s: 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: (recommendation for pumping, condition of inlet and outlet tees or baffles. depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR..m -PART C SYSTEM INFORMATION fcontinuedi PropemTAddress: � ONner: VIM�Ad Date of Inspection: tb TIGHT OR HOLDING TANK:,dD'Tank must be pumped prior to, or at time, of mspeaion: . . (locate on site plar., Depth below grade Material of construction _concrete _metal _Fibergiass _Polyethylene _,other(explaini _.. _...._..__.- Dimensions. _ Capacm galions Desig^ floes gal;ons-da. Alarm level A.a,rn in %%orking o•de'_ Yes. _ No Date of previous pumping _. Comments (condition of inlet tee. condititior. o- a'a,rr. and float s%itches. etc.) DISTRIBUTION BOX; S iiocxe on site p a- De--,: v Iicwd to e' aoo.e owtle: in%e,� Comments mote if leve' and d!s:•it:.:-or is erua evidence o'solics carryover, evidence of leakage into or out of boa, etc.) F5Ox (n&tl Sck 0 I o ry 11QA�w� PUMP CHAMBER:0 (locate on site plan. Pumps in working orcer. (Yes or No, Alarms in working order (Yes or No Comments: (note condition cf pump chamber, condition of pumps and appurtenances, etc.) 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ?,4wALj Owner:"t,)t PiMaji,4 Date of Inspection: col�a�g1 SOIL ABSORPTION SYSTEM (SAS):%tcC (locate on site.plan, if possible, exca7 a on not required, but may be approximated by non-intrusive methods. If not determined to be present, explain. Type leaching pits. number. (n)<y _ _- leaching chambers. number._ leaching galleries, number. leaching trenches, numbe,.length leaching fieids, numbe•• d,,+ensio^s over.'tow cesspool, numbe- Alternanve system. Name of Tecrinwop, Comments inote condition of so"* s+g^s o"hy failure. le,e' of on- di con tlol) f vegetation, etc.t CESSPOOLS: *" (locate on site plan Numbe' and cor:fig,;ra--cn Depth-top of liquid to inlet Inver. Depth of solids lave- Depth of scum layer Dimensions of cesspoo: Materials of constructio^ Indication of ground%a:e- inflow tcesspoo, must De pumper as par, of inspection Comments. (note condition of soil, signs of hydraulic failure, level of pondmg. 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.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO% FORM PART C SYSTEM INFORMATION (continued) Propert% Address: Owner:' 1 Date of Inspection:IC�le'Gt1 Depth to GroundNate• Fee: Please indicate all the methods used to determine Htg-ryGrouncl ater Elevation: Obtained iron Design Plans on record Observation of Site Abuning property. observation hole, basement sump etc.) Determine it from local conditions Cnec'K %%ith loca 5aard o• nea!:- Chec: FEMA macs Check pumping records Check local e.ca:a:o•s �r s:a'le•s L se L 5:5 Da•a r• Des&ibe in %ox o•+' %%xz5 ^:'•+ %c_ es:ao:-spec the Cround%xer Elevation. (Must be completed U. $,nwed°9Icc.-P 3uti/s, < q-ti OlgatsI I C_ 3IVC&S'fiel w-rjaNt�t 1*,A 6 5 Z SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR^1 PART C SYSTEM NFORMATION (continuedi Pro erri Address: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 (Locate where public water supply comes into house) t At-Za lkZ.-xb 6-2- Pt 3- `f,b - 63- ti3 TOWN O F B'1 RN�TA,BI:E A* ON / LADE _ `s a A SESSOn'S NW ai LOT _.. MST1 LLER'S NAIL �gYoldE NO SEMC TAk K CAP.AcITY 1 LEACH N0 IIl.TCY (typa) 'NO W-BED r k�ERIT�A'I7-7 'E .�: -. . CC�IrIRS10E AATF. M..,�........._. .. separation�a���a 8etv�aer�:t3�a' r Maxi►ytum l�cl}ust�cl Giaaitcfvdatet Tat�te�a tlac Banom pf aGhin�Na ility ..- ' lvaQc; Tat r Supp1Y:Vla&1 did Geacwteg%+acuity.(iCt*y VICHS exist icas 4a:s�ta ac w1tli►a 7AD gear of 1�aeEii�t�frtcility) �--�-- Fct811 dig /et�and and Leac�l'bigsii¢y{�E sty wetlands exist ivit��it�340 feat.4 #caaliitag fuciAA ') / to T�z u*MS' ui. y '"' , //,, �C K �, � r' � f ' t� r � r E 3 `� � � .� ��� as _��-aa�6 �. 'i t�f' , 1 P TOWN OF BARNSTABLE LOCATION,JJT'5�! 7 De SEWAGE # VII LAGE✓h/?j;roru T m r 115' ASSESSOR'S MAP & LOT 7.5 INSTALLER'S NAME & PHONE NO. M Feet y_. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) t0l / (size)660 0,A S� ' NO. OF BEDROOMS-_PRIVATE WELL OR PUBLIC WATER4j-r-,/ 1 BUILDER OR OWNER. yG DvIA rv^V y D DATE PERMIT ISSUED: �— DATE COLIPLIANCE ISSUED: r - i 7 - VARIANCE GRANTED: Yes No �� n i 6V44Gp r No.._�` :..� FEs.....,`2.5...'- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH row-4. ...................OF...... Glt'Y ... r�_/.....------.._...---------..._......----- Appliration for Disposal Works Tonstrudion rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• f 'A r, s...�il/s .........../ :Z'......1.z..................................................... 1., ...... Y1✓ _._al. dd5s------------•.......--- •--... lt� :/..��r Address . c�X..�?®Yet /y1� �! ... Owner a ..................•- -........... ..... ---.............. ... Installer Address Type of Building q Size Lot___ .`. �._._._S . feet U �/� Dwelling—No. of Bedrooms.............. ..__....................Expansion Attic �v,4 Garbage Grinder Other—Type T e of Buildili No. of ersons.._.. .. _____________ Showers a YP g --------------------•--•-•-- P ( <-j-- Cafeter�--� ) Other fixtures .----- ;� d_I'�,11------_ W Design Flow........... ........................gallons per pepsen,�erday. Total daily flow______.���__ ..........................gallons. WSeptic Tank—Liquid'ca.pacityl0�__gallons Length_1l__n5..... Width__5w..... Diameter._____F--_. Depth../--fZ?.... x Disposal Trench—No.____`.............. Width....._.—___:..... Total Length_________________-.. Total leaching area....... _.._...q. ft. / :-Seepage Pit No........ iameter_ �_ Depth below inlet_.�.c.�?�....... Total leaching area_. __sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by---••-•-•--------•---••...................••-•----------•......--------_. Date---•-------------•-•------------•-_-••-- Test Pit No. 1. _��.....minutes per inch Depth of Test Pit___! . ....... Depth to ground water_._/f ,�I._____..__. 44 Test Pit No. 2... ._minutes per inch Depth of Test Pit___/. ....._..._ Depth to ground water._�41___.._.. 9 ._....._----•-----•.......................••---......__......-•........ - O Description of Soil.......6.-_1.........?Uk7_P._ ... Y'. (xj ..... ......-- .. . ; .................................... ...... ------------------------------------------------------------------------ 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b i ued b theZ of health. 6 Signed - 1 +�-ar- -__ -------------------------- Date Application Approved By.._..i�...; ...Z)..Lhewear _______________________________________- ..........�', 9,.-x.'Ae_ U Date Application Disapproved for the following reasons:--••-------------•---------------------•-•-------._....-•-----•--...--•--••------.....----.....-•---•---•-- - ---------••-••••...............•-----.........-------•••---••-----•-•-•......-•------...---•-•••---------.---...._._.......----•--•-••••-----•----...._....--------._...--••••--•-------•-•-•-----•----•- Date PermitNo....... = -.f$.'�-..................._.._ Issued....................................................... J D- - -—.,_-__----------------- ---------- ----------------------------- ---- - ------------- ---------- ----- ( P No....E.$. Fizz......;2, ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..7,Z!_t)..................0F......, .» f' .`S.:..C9..�la.....--- Appliratinn for Disposal Works Tonstrudion rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• ) --•--:..... ..... r�.� r..... c� ...- ��.� •..---••---kc :...._..-1./..................................................... /Location-Add ss / //or •�No. Owner Address W ..... Installer Address II Type of Building Size Lot... ......Sq. feet aDwelling—No. of Bedrooms............... ........................Expansion Attic A/,4 Garbage Grinder WA_ p, Other—Type of Building ....:-.-_............. No. of persons......rr►► ............ Showers Cafeteria ) Q' Other fixtures ......`'" "` ---------------••- ._ W Design Flow..........AQ........................gallons per n per day. Total daily flow.......-�®........................gallons. WSeptic Tank—Liquid capacity/ig gallons Length.':. _._ Width..!5,.0..... Diameter. ... Depth........ x Disposal Trench—No. .':: --- Width.....:-:*tnT....... Total,Length.......-._..... Total leaching area....:-�.......sq. ft. Seepage Pit No......./----------- Diameter-. / Depth below inlet. '6:.�...._. Total leaching area..,�.��_...sq. ft. Z Other Distribution box � Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... "a Test Pit No. 1 .. !.....minutes per inch Depth of Test Pit...1.2-7.....__ Depth to ground water.._AIA........._.. Test Pit No. 2. ...4-..-minutes per inch Depth of Test Pit...f-Z-.......... Depth to ground water..A/.�........... pa ................................... ...(... ............ --------------------•----------------------------------.:. O Description of Soil......l,�--�'1.......V(, � . k ..... f ! : t ••-•--•--••------•..----- ------------------------------L: ........ ! ?... ..AI ! t 11V ---------------------....---•--------.....................-------------••------------------- -------•............... / ......._tt.467,4>._.�2LlA1Q....J C C11Z�X. 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. AApplication Approved B ....._.. Hate PP PP Y ..• 4.�-�..�.u.� ....... y ate' Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------_ ----------------------------------------------------------------------------------------••_^^----....--.................------------------------------............................ ......•-----. Date Permit No.......U - fZ_........................... Issued............................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G�GI�:(............OF. ......� :a:r.�:c;�? :.° '................................... Trrtifira-b of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (>) or Repaired ( ) bY------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-- �^ �q�Installer at------... 1 ------� -------� - 1.. --------�h+ r ........................................................_-------- . ------------------------ has been installed in accordance wi the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......4F45._:=J.R.;L........ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTI N SATISFACTORY. DATE..................... R---•-------------------- Inspector........................ ......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH pOF........... � C..........................••••........ _ No....Ii� �- .:......... FEE...7 S ... Disposal Works Tonotr ion rrmit Permissionis hereby granted...............................................•--........---•------•-•......•-----••-••-••--••-•............_....••----......--•----•-- to Construct ().t,) or Repair ( ) an Indi idual Sewage Disposal System at No.----••L.:.�..r.---/•-;7.....d.�.n r!Y �14..,- � /...................................................................................... Street as shown on the application for Disposal Works Construction Permit NoKe DL__.__ Dated.......................................... a_:��•----- ............................................ Board of Health DATE........................ '. ...0 1-.11........................ FORM 1255 A. M. SULKIN, INC.. BOSTON ENVIROTECH LABORATORIES t 449 Rte. 130• Sandwich,MA 02563• (617)888-6460 CLIENT: Henry Diamond LOCATION: Lot 17 Kerry Dr _ fi- ADDRESS: Marston s Mills " ox oro COLLECTED BY: Meehan SAMPLE DATE: 4/18/88 TIME: 5:15 PM DATE RECEIVED: 4719788 SAMPLE ID: BC 64A _ JOB #: New Well WELL DEPTH: 60 ft z' RESULTS OF ANALYSIS: Parameter Units Recommended limit Result c Coliform bacteria/100 ml (MF Method) 0 0 !F:: pH pH units 6.0-8.5 5.95 - Conductance umhos/cm 500 72 Sodium mg/L 20.0 9.4 Nitrate-N mg/L 10.0 .09 Iron mg/L 0.3 .05 >~ Manganese mg/L 0.05 �x E: Hardness mg/L as CaCO 3 500 r.... Sulfate mg/L 250 xi Potassium mg/L 20.0 _ �-x E Alkalinity mg/L 200 Chloride mg/L 250 E COMMENT: YES NO " gjl ❑ WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED - F i DATE =: r-- ��fiilililliiiiiilltilillitlil)11uf Utlitii1t111ti1ll11111Wi!llU11111u`Illlullu'll11WlhillUllliElilli#Ui11111111iliilllllililitlllll{11UlUltllitlllUli 1111111U11I!l11111111iitFluli111itUilllllU!llitlliliillliilf!!ltllliiilll`iiy: .y� a ly SI' Department of Environmental M6nagement%Division of Water Resources _ WATER WELL COMPLETION REPORT r WELL LOCA ON Address—Lk �� �P«'u—Qf/!� City/Town f hGr-stat S I /loll s G.S.Quadrangle Map Grid Locatio'n1 Owner Q—T'k%%17 t 0.KN-to)Itin Address WELL USE CONSOLIDATED WELL Domestic Ea'Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones 1) From To Method Drilled 21 From To Date Drilled 3) From Tc 4) From To CASING 1, Depth to Bedrock Length_Diameter Type S4-cL UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface O / Sand: fine[medium[oarse❑ Date measured 1 Gravel: fine❑ medium❑ coarse[] Screen: 1 GRAVEL PACK WELL Slot# Q- length from to Yes ❑ No Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slot length from to Chemical © "- Biological ❑ Depth To Bedrock PUMP TE T Drawdown _feet after pumping days hours at y GPM. How measured Cif P�.- Recovery feet after hours. LOG of FOWAAT16NS COMMENTS: (On well or water) Materials From To 0 PJ 6. ' Mel rz co DRILLER t lb Firm M 3N\.Gy'- W R k\-b�� 1\I a Address Yoo ` City O f Registration No. Aerator s ignature Please print tirm ly CUSTOMER COPY 25111•10 85-807101 i 1 d DESIGN DATA o ,w STRUCTURE iue=t..� iL�' w W E�G.. LoC_f! C 1 r....r� DESIGN '-.... FLOW--a .._`', •-., I U ­A i_ c8 L7fZObM 3 OU l '. i \14 _ SEPTIC TANK USE /ooc� G��, s .gN I / T ff' r LEACHING RATES - SIDE R 2« / r s A EA s GPD SF BOTTOM ARE A/ oGPD _SF .I., . LEACHING,FACILITY : S x 3. .L F� ,W -3 �- , 4 r j — ,, , �4�L.D Lf\"11�r`.J P~��G- a1.1-,a`I•8 8 .. W t rT-� 3 T�.:1 98 7 r { eA E INSPL1t. T i ! t T.P• Z •' r ; r a / �D L \. z9� t PLAN REFERENCE i /OG70 LAG { (-fTc £3 C. fS t� AL. , ` �d, �� I!.,!.r�T>�LLB L..• .. •-r-; ..,. .• ' \- � � :.: �... . .,1` . ..,'�.7,'r 0 0 / z t r,o i 4 i l� - ,•.. . � .� -Ll ASSESSORS LOT NO. MA--P 43 E'P�-� .. . NOTE _ { I. ALL-MATERIALS AND N A CONSTRUCTION METHODS � 4 LENVI CONFORM WITH COMM. F M 0 _ 0 ASS. TITLE � 7 , RONMENTAL CODE �.� Lup>c. l � D Lc-�r Pry �jea,Gd G70 ^q _ 1 _ ca cp t - 4 - 4 aCs oc:a �-- �2 G _ 4-6 12, F y kk T Lf- N 0 �9p tOF � H A9 o J H r , q �S g � �� DA;ID ... 1. r:. cn , FiE:Lbo Tit t ., O.2907-4 cj v No.' 976 ' c^s GMT E vQ e V L R /j <� AL LA��� o,F aST PLAN - SCALE i TEST PIT NO. 2 TEST PIT NO. SOIL OBSERVATION PITS p - 98.S" yam. 2 ELEV. g ELEV. DATE OF TEST " c>3 • ocs / C�« is OUFF LpgMy JG/650/L 9ENGINEER �'L.L.� 4 B.O.H. AGENT /d0O EXCAVATOR A L_ GAS o r" i _ ,.,. .S� y✓/Tf-/ . 'HIESYc T=u L e�il r 9 s5�c PERC RATE IN T•P• NO. 2 AT FT. _ MINJIN . 95. I W i Tom) , n tQ-f •BG>'� 'C / ,,. /• he _-— fit_ r3 to )r/. 1 T�R /o y�/.•9/o- g.� %- �� T"E/Q ELLIS & THULIN INc. LAND , SURVEYORS AND CIVIL ENGINEERS EAST SANDWICH MASS. SECTION THR U SEPTIC SYSTEM , v.. I : / = io H R i = .�' VERT.' SCALE Z.0 I J r i _• ,n Ea �� C7 F j - r i