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HomeMy WebLinkAbout0211 LAKE SHORE DRIVE - Health 211 Lake Shore Drive Marstons Mills P A = 030 002 1 fi i i li .r. TOWN OF BARNSTABLE LO(:ATION ?I, C� 54.0 - �� SEWAGE # P VILLAGE fl`1C���` `Sa ASSESSOR'S MAP & LOTS IP1S NAME&PHONE NO. 'CCo � nn � SEPTIC TANK CAPACITY 1 e LEACHING FACILITY: (type)1 �t�tt'� r� (size) NO.OF BEDROOMS BUILDER OR PERMITDATE: C&b 'E DATE: �I ,Q(p Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet f Furnished by ............. lD (9� �J z+"Q J y�O I i I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION e svev` TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A 3 CERTIFICATION Property Address: 211 Lakeshore Drive Marstons Mills MA 02648 Owner's Name: Sharon Knight Owner's Address: 1343 Falmouth Road Centerville MA 02632 co Date of Inspection: May 30,2006 Job# 06-143 , Name of Inspector: PATRICK M.O'CONNELL i Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD L _ MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a,�i(E I approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ``v�0 H 0 SV/A _X Passes p ' • ';yG T : Conditionally Passes — HI (,n.m Needs Further Evaluation by the Local Approving Authority t M. F EL c Go o • ,k Inspector's Signature:12 Date: 5/30/06 �i,�l�c RTlF1 �o?�•`�� P g 15�N SP11 E,`���� The system inspector shall submit a copy of this inspection repo to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: tank has liquid only and is not in need of pumping at this time,pump is functioning properly and floats are properly adjusted. Leaching system has no standing water and no evidence of surcharge. ""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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 211 Lakeshore Drive,Marstons Mills Owner: Sharon Knight Date of Inspection: May 30,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the".Conditional Pass"section need to be replaced or repaimd.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 ears old*or the septic tank whether metal or not is structurally P Y P ( ) Y unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and.if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 211 Lakeshore Drive,Marstons Mills Owner: Sharon Knight Date of Inspection: May 30,2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 211 Lakeshore Drive,Marstons Mills Owner: Sharon Knight Date of Inspection: May 30,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. —X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 211 Lakeshore Drive,Marstons Mills Owner: Sharon Knight Date of Inspection: May 30,2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X _ Pumping information was provided by the owner,occupant,or Board of Health _ _X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period? _X Have large volumes of water been introduced to the system recently or as part of this inspection _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on:. Yes no _X_ _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 211 Lakeshore Drive,Marstons Mills Owner: Sharon Knight Date of Inspection: May 30,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):330 Number of current residents:0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Two years total:36,000 gal.=49 gpd. Sump pump(yes or no): No Last date of occupancy: One year ago. COMMERCIALANDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped two years ago. Source of information: Owner Was system pumped as part of the inspection(yes or no): 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) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Compliance date: 5/25/9�9 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 Lakeshore Drive,Marstons Mills Owner: Sharon Knight Date of Inspection: May 30,2006 BUILDING SEWER: XX (locate on site plan) Depth below grade: under slab Materials of construction:—X—cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 2' Material of construction:_X_concrete_metal_fiberglass_polyethylene —other(explain) j If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10.5'long x 5.8'—1500 gal. Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees are intact and clear,liquid level at bottom of outlet invert.Tank has liquid only and is not in need of pumping at this time. GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 Lakeshore Drive,Marstons Mills Owner: Sharon Knight Date of Inspection: May 30,2006 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarrn present(yes or no): Alarm.level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): i DISTRIBUTION BOX: XX (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.): No solids or high stains present.Liquid level at bottom of sinele outlet pipe.A riser was installed as part of inspection to raise cover to within 6"of grade. PUMP CHAMBER: XX (locate on site plan) Pumps in working order(yes or no): Yes Alarms in working order(yes or no): Yes Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump functioning properly and floats are properly positioned. Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 Lakeshore Drive,Marstons Mills Owner: Sharon Knight Date of Inspection: May 30,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type � _leaching pits,number: _X_leaching chambers,number: Five infiltrators(10'x 33'x 2') leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: _overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Observed no standing water or evidence of surcharge. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil.signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): f • Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 Lakeshore Drive,Marstons Mills Owner: Sharon Knight Date of Inspection: May 30,2006 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. Lakeshore Drive ater Service 60 4 46 6 1 8 33 2 I Page 11 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 Lakeshore Drive,Marstons Mills Owner: Sharon Knight Date of Inspection: May 30,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 15 feet Please indicate(check)all methods used to determine the high ground water elevation: _Obtained from system design plans on record-If checked,date of design plan reviewed: _X_Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board cf Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Pond to rear of property is considerably lower than SAS. Health Complaints 25-Aug-03 Time: Date: Complaint Number: 4228 Referred To: DAVE Taken By: RITA Complaint Type: HORSE MANURE Article X Detail: Business Name: Number: 289 Street: MEIGS BACUS ROAD Village: SANDWICH Assessors Map-Parcel: Complaint Description: SHE IS ON LINE OF SANDWICH AND M.M. AND ON SEVERAL OCCASIONS HAS FOUND HORSE MANURE AT END OF HER DRIVEWAY. ANOTHER NEIGHBOR HAS THE SAME PROBLEM Actions Taken/Results: DS SPOKE WITH FRED AT SAID COMPLAINANT LOCATION (420-3530). DS INFORMED HIM THAT THEY CANNOT LEAVE HORSE MANURE ON THE GROUND. DS TOLD THEM TO CONTACT THE SANDWICH HEALTH DEPARTMENT AND LET THEM KNOW THE SITUATION, AS THE STABLES LOCATION IS IN SANDWICH. DS SAID THAT IF THEY COULD VIDEO TAPE THE HORSE GOING TO THE BATHROOM AND NOT CLEANING IT UP, THAT WE MIGHT BE ABLE TO ENFORCE IT THEN, AS WE HAVE TO OBSERVE THE VIOLATION. NO ACTION REQUIRED AT THIS TIME AS NO VIOLATIONS HAVE BEEN OBSERVED. SHOULD A VIOLATION BE OBSERVED, THE APPROPRIATE ACTION WILL TAKE PLACE. 1 Health Complaints 25-Aug-03 Investigation Date: 8/16/03 Investigation Time: 1:30:00 PM 2 e `.^• Health Complaints 25-Aug-03 Time: 1:50:00 AM Date: 8/15/2003 Complaint Number: 4230 Referred To: DAVID STANTON Taken By: DAVID STANTON Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: ILLEGAL OPERATIONS Business Name: Number: 289 Street: MEIGGS-BACKUS ROAD Village: Assessors Map-Parcel: Complainant's Name: Address: Telephone Number: Complaint Description: HORSES Actions Taken/Results: DS SPOKE WITH FRED AT SAID COMPLAINANT LOCATION (420-3530). DS INFORMED HIM THAT THEY CANNOT LEAVE HORSE MANURE ON THE GROUND. DS TOLD THEM TO CONTACT THE SANDWICH HEALTH DEPARTMENT AND LET THEM KNOW THE SITUATION, AS THE STABLES LOCATION IS IN SANDWICH. DS SAID THAT IF THEY COULD VIDEO TAPE THE HORSE GOING TO THE BATHROOM AND NOT CLEANING IT UP, THAT WE MIGHT BE ABLE TO ENFORCE IT THEN, AS WE HAVE TO OBSERVE THE VIOLATION. NO ACTION REQUIRED AT THIS TIME AS NO VIOLATIONS HAVE BEEN OBSERVED. SHOULD A VIOLATION BE OBSERVED, THE APPROPRIATE ACTION WILL TAKE PLACE. Investigation Date: 8/16/03 Investigation Time: 1:30:00 PM 1 Health Complaints 25-Aug-03 2 flit} (+ ;,. -.7•. - - -- COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS RECEIVED DEPARTMENT OF ENVIRONMENTAL PROTECTIO ^ E SEP 10 2002 t TOWN OF BARNSTABLE HEALTH DE PT Q, VO TITLE 5 OFFICIAL INSPECTION(FORM—NOT FOR VOLUNTARY ASSESSMENTS SU9SURFACE SEWAGE DISPOSAL SYSTEM FORM PART A ' CERTIFICATION Property Address: 211 LAKESHORE DRIVE MARSTONS MILLS,MA 02648 0 ,) o o 02. Owner's Name: BARBARA PO;LLERT Owner's Address: 574 WEST END AVE#52 NEW YORK,NY 10024 Date of Inspection: 8/8/02 COP? .l1F ,l Name of Inspector: (please print) ;,.. JOHN GRACI Company Name: SE TIC INSPECTIONS AQ, Mailing Address: zPO°`BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813TAX 508=564-7270 ,,, . CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of-the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Secti n 15.34.0 of.Title.5(310 CMR 15.000). The system: a •y. . . s X Passes ' _ Conditionally asses _ Needs Furt a Evaluation by the Local Approving Authority Fails Inspector's Signature: ;�.t Y ��! Date: 8/8/02 . : The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shallisubmit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments '' 1114 SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. 1 •�. ' ****This report only describes t.onditions at the time of inspection and under the conditions of use at that time.'Phis inspection does not address how the!system will perform in the future under the same or different conditions of use. TitIF Incnrrtinn f nrm 6/1 S/,?f11 h 1 Page 2 of OFFICIAL INSPECTION'FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A f. CERTIFICATION (continued) Property Address: 211 LAKESHORE DRIVE MARSTONS MILLS,MA 02648 Owner: BARBARA POLLERT`. . Date of Inspection: 8/8/02 Inspection Summary: Check A,B,C,D or E•/ALWAYS complete all of Section D A. System Passes: ' X I have not found any information which. indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. 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,xas approved by the Board of Health,will pass. Answer yes,no or not determined`(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a 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 exfiltraton 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 yearsjold'kis available. ND explain: n/a r n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board'of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A t , CERTIFICATION(continued) Property Address: 211 LAKESHORE DRIVE MARSTONS MILLS, MA 02648 Owner: BARBARA POLLERT Date of Inspection: 8/8/02 C. Further Evaluation is Required by the Board of Health: r, _ 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. c S 1. System will pass unless Board of.Health determines in accordance w.itla 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 1 5 ;1 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 arjd'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 n/a **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be,attached to this form. t ' 3. Other: n/a ;° g 't• tO� i s � t Page 4 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 211 LAKESHORE DRIVE MARSTONS MILLS,MA 02648 Owner: BARBARA POLLERT;. Date of Inspection: 8/8/02 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No _ X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow X Required pumping more than 4.times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool,'or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool o`r+privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy,is,less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for cplifortn,bacteria and volatile organic compounds indicates that the well is free from pollution frorn,thaf facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails. [;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;sysiem must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no'to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of.a.surface drinking water supply X the system is within 200,feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen.,sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply.well, ,'yes"to any jquestion in Section E the system is considered a significant threat,or answered If you have answere� "yes" in Scctiun D ubuve(lie Iur e,systrnt Bits failed.The owner ur upernlor of nny Inr ican ge system considered a Signift threat under Section E or failed under, ection D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of .r, OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART B CHECKLIST Property Address: 211 LAKESHORE DRIVE MARSTONS MILLS, MA 02648 Owner: BARBARA POLLERT Date of Inspection: 8/8/02 Check if the following have been done',You m.gst indicate"yes"or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components,pumped out in the previous two weeks X Has the system rece;ived normal flows in the previous two week period? _ X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwellidg..inspected for signs of sewage back up X _ Was the site inspected for signs of break out`? X _ Were all system components,excluding the SAS, located on site'? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems',? rl The.size and location of the Soil'Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information' FoFexample'a-plan at the Board of Health. X _ Determined in the field(if any,of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] ark. .. ` 5 Page 6 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C : SYSTEM INFORMATION Property Address: 211 LAKESHORE DROVE MARSTONS MILLS,MA 02648 Owner: BARBARA POLLERT Date of Inspection: 8/8/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):,3 Number:of bedrooms(actual): 3 DESIGN flow based on 310 CM'R:15.203(for example: 110 gpd x#of bedrooms):330 Number of current residents: n/a Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or.no)-.ENO Seasonal use: (yes or no): NO ; , Water meter readings, if available(last-2,years usage(gpd)): Ww i)O -z_zj0 Sump pump(yes or no): NO ® (- Z�e� Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL , Type of establishment: n/a Design flow(based on 310 CMR 15.203):,n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date cf occupancy/use: OTHER(describe): n/a .GENERAL INFORMATION ,yy Pumping Records Source of information: n/a Was system pumped as part otthe inspection(yes or no): NO If yes,volume pumped: n/agallons 4- How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil`absorption'system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,-Attach previous inspection records, if any) _Innovative/Alternative technology. Attach a eopy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1969,SYSTEM 1999 RY.OWNE,R Were sewage odors detected when arriving at the site(yes or no): NO • o Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 LAKESHORE DRIVE MARSTONS MILLS,MA 02648 Owner: BARBARA POLLERT Date of Inspection: 8/8/02 BUILDING SEWER(locate on site plan) " Depth below grade:9" Materials of construction:_cast iron X40'PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints, venting,.;evidence of leakage,etc.): TOWN WATER 4 ' SEPTIC TANK: X(locate on site plan) Depth below grade: 3" Material of construction: Xconcr'ete metal fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a: Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6" `5'.8111' Sludge depth: 1" " Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to4`bottom of outlet tee or baffle: 17" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY'.TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) , i` Depth below grade: n/a Material of construction:_concr'ete_metal=fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum t6top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,.- inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage.,etc:,):, };k n/a � ,.rep 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 LAKESHORE DRIVE MARSTONS MILLS,MA 02648 Owner: BARBARA POLLERT Date of Inspection: 8/8/02 TIGHT or HOLDING TANK:* (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction: concrete• metal fiberglass polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons { ` Design Flow: n/a gallons/day' Alarm present(yes or no): N/A' ' Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and Ifloat"switcNes,etc.): n/a DISTRIBUTION BOX:X(if present must be.opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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 STRUCTURALLY�SOUND:RECOMMEND RAISING COVER. PUMP CHAMBER: X(locate on site plan) Pumps in working order(yes or'no): YES Alarms in working order(yes or no):YES Comments(note condition of pump chamber,-condition of pumps and appurtenances,etc.): PUMP CHAMBER IS STRUCYURALLY SOUND. 6 e r•� t. . 17 St 4 y R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 LAKESHORE DRIVE MARSTONS MILLS, MA 02648 Owner: BARBARA POLLERT Date of Inspection: 8/8/02 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a INFULTRATORS leaching chambers, number: 5 n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a S„ s .:innovative/alternative system f ,Type/name of technology: n/a Comments (note condition of soil,signs'of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): INFULTRATORS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE. RECOMMEND RAISING INSPECTION PORT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no):zNO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a ,t PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs'of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a , VA FN. 4 Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 LAKESHORE DRIVE MARSTONS MILLS, MA 02648 Owner: BARBARA POLLERT Date of Inspection: 8/8/02 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. t S A C t.� E, 5 a PIS A �q { in f Page 1 1 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 211 LAKESHOR{E DRIVE MARSTONS MILLS, MA 02648 Owner: BARBARA POLLERT Date of Inspection: 8/8/02 SITE EXAM _Slope _Surface water _Check cellar _Shallow wells Estimated depth to ground water 15+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 15+FT. • .I II a If 6 CONSTRUCTION NOTES: MARSTON MILLS a 0 1 a �(�/ (� plp MA; ' .)LIMIT OF WORK 5HALL BE A 5TAKED FABRIC SILT BARRIER,BOTTOM:TO BE Y g DUG INTO THE GROUND G'QR AS REMIKED BY BARNSTABLE CQN_SERVATIQN. �, Ip 9 i 2.)BUILDER TO CONFIRM GARAGE SLAB ELEVATION ON 51TE,PRIER TO CONSTRUCTING FOUND ATION AND/(XL COV CRETE GARAGE 9lAB. SIC _ h� H,�DGRE>t E' 3)E%I.STING COVERERED ENTRY SHALL BE RE-CQSTRUCTED IN THE SAME LOr,ATICN. ' O 2)PROPOSED 4 x 2 DRYWELL.S,TWO FOR ROOF RUN OFF(GARAGE)AND TWO FOR ((�CO Cry DRAT N5 PROPOSED FOR GARAGE QOOR OPENING.`"+.DRW�ELLS TO BE CONSTRUCTED - 53,7 0 O CON STRUCTEp OF 3/4- /21NEH STOVETOPPED W1Try FILTER FABRIC. n p-¢ LOCUS NOT'T05CAL L9 UTILIP'POLE �^ W/OVERHEAD UTIUTIEs PLAN BOOK 20G PAGE 135 p`�e1 DEED BOOK.25900 PAGE 234, A55E55OR5'MAP 30 PARCEL 002 p® \ o PROPOSED LIMIT OF 100'WETLAND \�I9'0 ` ` <�' LEGEND WORK SEE NOTE I SETBACK PROPOSED NEW PAVED �i�— EX15TING CONTOUR DRIVEWAY - 32 PROPOSED CONTOUR E—tirq Carport 22'x 22' x a-'• rXI5TING SPOT GRADE 24.5 PROP05ED 5POT GRADE —W— WATER5ERVICI!UNE , (/ pR PROPOSED GARAGE 24'x 24' —O— OVERHEAD UTILITY SERVICE —u—5±S EL 43 TOS UNDERGROUND UTILITY SERVICE \ . - . EE E 2 _ NOT C— GAS SERVICE LINE ' 5d WETLAND c �o QJ 8 TEST HOLE/BORING LOCATION .SETBACK \ .� gag - eT 5EPTIC TANK / d PROPOSED 4 x Z DRYWELL De DISTRIBUTION BOX 5EE NOTE 4 sAs 501L ABSORPTION SY5TEM Op R«<iv< RESERVED FOR FUTURE PK 3 6 w' •o., -.UTILITY POLE ® CATCH 5A51N v FIRE HYDRANT - \ 0 WELL ".3 \ �ly�° k•L \ - - 3 I so .. O DRAINAGEMANHOLE r 02F '� Is\ 0 CONCRETE BOUND,FOUND TOP OF BANK \ TBm yllyll .� w QS�r F3 }1}}I ILs 11 / 13) D��W 19.E •—• LIMIT OF WORK 1 EFEDGE NCE. OF CLEARING 7..\ AO 4, BENCHMARK ZONING TABLE r,or Co,er< BUILDING ZONE RF - 1 BUILDING SETBACKS .REQUIRED EXISTING PROPOSED - I(43 y p 63 / a a4 J. 1 / �gp FRONT', 30' 25:3' 22.I' ;\\ {).6 SIDE / \ X REAR I5'.' / - 33 \ \ \ GARAGE HEIGHT REQUIRED U15TING C.P. PROPOSE)GAR. '1 LOT S7 1 ` BUILDING COVERAGE REQUIRED. EXISTING PROPOSE)Area=28,5005�±(PER SUBDIVISION PLAN) ♦, \y^v, �Qe� x,b,, Area=25,522 SF±(PER SURVEY) Upland Area=23,609 5F±(FER 5URVEY) \y0�. - E.4% 9.0% Wetland Area=2,01 6 5F±(PER 5URV -EY) _ BUILDINGCOVERAGE BASED UPLANDAREA(23,0E935F),1,990 5F EXISTING' STRUCTURES AND 2.132 t5F PRCW05ED STRVCTUREt, P+ SCALE - p Stetson Re5ldence JEFF,JONE5,40 CAR5ON5 PATH,BREW5TER,MA \ SITE FLAN u 2 1 1 LAKE SHORE DRIVE,MARSTON MILLS,MA J.1'rY. OIREIUY&ASSOCIATES,INC. `�'�x N.9 Aoteeeloael.8nalaam3nd$Lnd.9utveyluu,t 90avWes 1373 N.J.3tm t-P—U CA 0 20 40 60 s773 o3�ce-deoI omae sLarr t ILA 03331 i ( (3oe)aee-aa33 r� .SCALE I"=2d - DATe: scAiE: 5n cnecK: ,IpE NUMBER: I/10/12 As Noted GMB/ JMO JMO-G531 G:,AAlubaIIONESIIOVE.SS531,DW F53151TEPIAN.DWG MTP RONALD J. CADILLAC, PLS, RS Professional Land Surveyor & Registered Sanitarian P.O. Box 258, West Yarmouth, MA 02673 (508) 775-9700 (800) 520-5591 Date: 9 To: The Board of Health I inspected the septic system installed at Z 1 L ,� � � gr and found it to be: V/In substantial compliance with Title 5 Not in compliance with Title 5 Comments: R)ions r)1 t U�Q Rn k a lu C12' j R�—)- -D i FIL3 T - Fj c��-x, 1 "U S US B LT SKE CHI �,Q acD 1 Es t= 52' �A-YI cc� 4 Wei is � a �3 H &��A Ronald J. Cadillac, Ws,Rs .op rkmo '5 W Eat O 657, 5 ;, tl E >> 6SR7 TOWN OF BARNSTABLE LOCATION 2`� �akeS41PIe AAJ; SEWAGE # �P—/'5PS" VILLAGE /yW51-0e5 //fS/- ASSESSOR'S MAP & LOT r �- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY IS'r0 6-C` WWlk LEACHING FACILITY: (type) 0,zfc �5-) (size) /L',,Z 33� 7 ' NO.OF BEDROOMS -i BUILDER 01 1 WNE �e PERMITDATE: T l�?—�9 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /S,� Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 4114 Feet Edge of Wetland and Leaching Facility(If any wetlands exist f within 300 feet of leaching facility) ��'� - Feet r Furnished by t,) Q O61 II dud v �4 No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for 30i4po0al *pgtem Construction Permit Application for a Permit to Construct( )Repair(Upgrade(/SAbandon(XXomplete System El Individual Components Location Address or Lot No. Z Owner's Name,Address and Tel.No..li Lary S1.oPe D� C3ru,,jn H--r�unu C�Am6lC 3 STunsS Ivttlls Z�_So7`Z Assessor's Map/Parcel °71 i L ��P b►- Installer's Nan3p,Address,and Tel.No. Designer's Name,Address and Tel.No. ?�'6 7 75-cf 7c� 7 �/` W H+rmoJ►a4 MA 0267 Type of Building: 1SC.0A,As67cT' Dwelling No.of Bedrooms _3 Lot Size sq.ft. Garbage Grinder 1,fiQ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ��v gallons per day. Calculated daily flow31k gallons. Plan Date 1 12-11 gi Number of sheets t Revision Date Title S 1 T'G (At, f rU A A- G L-Ok 67, 2-11 LA4ce w s_Dr.f M 4V`P'A.sj Pi►G A Size of Septic Tanker ��� pe of S.A.S. ��c�� r" nGr'Ic,, I w�+��' '� Description of Soil C04,01a ,Gt,%a w 1O`Z 4r+ud !/ .To 137 Nature of Repairs or Alterations(Answer when applicable) ViSC.opxiccl EXtS h/jc, 6,64. Date last inspected: DESIGNING ENGINEER MUST SUPERVISE INSTALLATION AND CERTIFY IN WRITING Agreement: THE SYSTEM WAS INSTALLED IN STRICT The undersigned agrees to ensure the construction and mainte a1, bgffM9eTd9sPchft9h on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this laoaropf Health. IfZ Signed Date Application Approved b Date 4e ��,l Application Disapproved'for the following reasons Permit No. `r' Date Issued -°' - - - - ------- -- -------- - •n No. s�,.1/ LLUII - -�" wee a rs_w THECOMMONWEALTH OFWASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 2pprication for Mtgpogar *pgtem Congtruction Permit Application for a Permit to Construct( N)Repair Upgrade(/Abandon(X,/Complete System ❑Individual Components Location Address or Lot No. ��; Sl< Owner's Name,Address and Tel.No. ti LA ��rc D� rv�,gv s7-uN S Ivt�I I Q r d�)NA Assessor's Map/Parcel S 21 t' Q^7 2- 'MA.Sjz�vS wl,r! C t/) `�Zg Installer's Name,Address,and Tel.No. y— Designer's Name,Address and Tel.No. eox 25-8 -� 7 W'I Y flrvnOJlt-{ rn 0-4673 7 7t--i '700 Type of Building: r Q I5 N NEST Dwelling No.of Bedrooms �� Lot Size sq.\ft. Garbage Grinder(W- Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ' , gallons per day. Calculated daily flow 3 gallons. Plan'Date 1 2? l q� Number of sheets Revision Date Title ifC %!A, V)ru .)A ()A-n, Lm (:�)7, 2 It 1. Dr, ft�PAv;I'�^�� 0?fti A Size of Septic Tank f Sov 6AI � — +' i?y�Q �pe of S.A.S. `� �i,,�k r t'Ai �r� t"+�I ��aev� Description of Soil ,fr A-A,� A,,.J w Ct i e)°Y,. r4,t e f 66 Td 137 Er / i Nature of Repairs or Alterations(Answer when applicable) t1i5coPX,cc 1 CX1 S?) �>AvlA" o �lirl Pr` Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board f Health. /� Signed �T Date 1411,1�y Application Approved by l Date 11P/ Application Disapproved for the following reasons Permit No. 4r Date Issued'' 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. �O�' �"d��% Gi%�S�,i`u�j`�/d`J at Z!I 1.Arp n r p Dr'• W A`r S_P,iu C M r lk has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.q�-� / :$ dated 7 . Installer Designer S .�. CA Q t t A_A-c The:issuance of this permit shall not be construed as a guarantee that the sygeail ill function as designed. V c Date f''I n r_:f 0 Q Inspector ✓T�1I1-A ,,-I Ifil / 1� �� t No. � %`-' ` --------------------------- �� Fee THE COMMONWEALTH OF MASSACHUSETTS _ PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS _ ~ _ Mtgoga[ *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(Abandon V 1 System located at 2-E( L A!e,- Sh nr F b r YV1/r✓Si a 3S 01 r I c S and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. . Provided: Construction must be completed within three years of the date of tth r�niit. Date: r`/ Approved b Y4, z"ram TOWN OF BARNSTABLE to ATION `� u/i G.`7�l11{�Z� �/% SEWAGE # VILLAGE NY�103 `*'�I/��.5 ASSESSOR'S MAP & LOT 3U� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY/S`aO (a C f�,0lc "04 4 1` Re»19 CIW Zh,a- LEACHING FACILITY:'(type)_1y,,t,'/ x/aK IS) (size) /©�e 35�e,7 NO.OF BEDROOMS 3 ' BUILDER O)��. Aahle PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /10,00 — Feet i Furnished by Qrra� Cr f� L«"er POOP �I:3 TOWN OF BARNSTABLE LOCATION �21I �� SG.o+� Qr— SEWAGE #�tsP -VILLAGE Mqk n"`5 M311S ASSESSOR'S MAP & LOT CIL 00i,7- I?t35khi:6R.4 NAME&PHONE NO. � (®sCo�► '( SEPTIC TANK CAPACITY c LEACHING FACILITY: (type) ' (size) NO.OF BEDROOMS BUILDER OR�n� �� �°` �►�`��fi PERMITDATE: DATE: ,S IQP Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �� ., V'_ � • F � ^_ j� l0 t9� ,.�,., �, ��Q y�O t r LOCUS WATER METER X 85.8 o \\ OT S PSP ME1G5 RO---- N/F BERLAND (VACANT LOT) 86'0 \ 1. LOCUS I5 A.M. 30, PARCEL 2. co 0 8 \ 2. ELEVATIONS SHOWN ARE ASSIGNED. < 3. LOCUS IS IN FLOOD ZONES B & C ON FIRM DATED 8/19/85. CONSTRUCTION NOTES: WATER SERVICE ENTERS \\ 4. ALL PIPES TO BE 4" SCH 40, AND PITCHED AT 1/4' PER FOOT. (UNLESS NOTED) o Q�O�OPO SCOALEO N / 5. MUNICIPAL WATER IS AVAILABLE. LOTS WITHIN 100' ARE ON TOWN WATER. N HOUSE HERE 85.6 �'' '\ \ 6. COMPONENTS TO BE AA5HT0 H-10, UNLESS NOTED. � 1. SEWER PIPES DISAPPEAR BELOW SLAB AT POINTS f / \ \ 7. INLET TEE TO PROJECT DOWN 13", OUTLET TEE DOWN 14". 3 83.3 3 A AND B. 3 CESSPOOLS INSTALLED IN 1969. NO . 6•'� 8. IF TWO OR MORE LINES, WATER TEST D-BOX FOR EQUAL FLOW QR' D-BOX EXIT PIPES TO BE LEVEL FOR FIRST TWO FEET. pFz ASBUILT FOUND. AT LEAST 2 CESSPOOLS BELIEVED / \ \ 9. DEPTH OF COMPONENTS NOT TO EXCEED 3', OR VENTING MUST BE PROVIDED. TO BE BETWEEN PROPOSED SEPTIC TANK AND / \ \ BUILD UP COVERS TO WITHIN 1' OF GRADE. MORTOR CHIMNEYS IN PLACE. LEACHING. PRIOR TO SETTING SEPTIC TANK X 81. \ \ ONE COVER OF TANK TO BE WITHIN 6" OF GRADE. LOCATION MAP LOCATE SEWER PIPES BY EXCAVATION AND OR , 3 3 \ \ 10. STONE TO BE DOUBLE WASHED 3/4 TO 1 1/2" WITH 2" MIN. 1/8 TO 1/2" PEASTONE ON TOP. FLUSH TESTING. SEPTIC TANK MAY BE G 11. IF UNSUITABLE SOILS, OR SOILS DIFFERING FROM THE SOIL LOG ARE FOUND, LOWERED IF NECESSARY PROVIDED NO MORE do /� ' \ CONTACT THE BOARD OF HEALTH, OR R.J. CADILLAC. �( 0 1 12. IF AN OVERDIG IS CALLED FOR BELOW, FILL MATERIAL FOR 5' AROUND AND UNDER LEACHING HAND BORING 1 THAN 30" OF FILL IS PLACED OVER POLY TANK. > '`� BENCH MARK--TOP S.E. CORNER IS TO BE CLEAN GRANDULAR SAND MEETING SPECIFICATIONS OF 310CMR 15.255(3). 2. A 1500 GALLON NORWESCO POLY CONC. STOOP 71.62 ASSIGNED 13. PUMP AND FILL ANY EXISTING CESSPOOLS. REMOVE ANY CLOGGED SOIL, BLOCK, AND STONE IN SEPTIC TANK IS PROPOSED. FOLLOW �6 x 8 8 LEACH AREA, AND DISPOSE OF AS DIRECTED BY HEALTH AGENT. DEPTH (inches) ELEV.(feet) MANUFACTURERS INSTALLATION x 2 8 \ ' ! X 5.3 \ ( � \ 0 14. ALL7IOSTRUCTION TO MEET TITLE 5 AND LOCAL REGULATIONS. 0 A Foyer 7.5y 3/1 62.8 1 INSTRUCTIONS. A STANDARD CONCRETE 84.4; ( \ G TEST HOLE DATE: December 17, 1998 2„ sandy loam TANK MAY BE USED IF YOU THINK x 7 .5 8 \ may✓'" \ Top Found.(E.,W., & S. Walls) PERFORMED BY: Ron Cadillac, Soil Evaluator B layer 7.5y 5/8 WITNESSED BY: Glen Harrington, IRS loamy sand YOU CAN GET IT DOWN THERE. X 6 .1 � ( x 82.4 � \ \ 9 15' do O 63.0t PERC RATE: <2 -00"/inch (C3 & C4 layers) C1 layer 2.5 6 4 3. THE ROUND PUMP CHAMBER MUST F. 1 / \ \ v� \ � \ TOP SLAB SOIL SURVEY(1993): Carver coarse sand 45„ coarse sand / HAVE A 5' INSIDE DIAMETER. O ��0 7 8 6.5 \ �, \ GEOLOGIC MAP(1986): Mashpee pitted plain deposits C2 layer 2.5y 5/6 p� Q �J \ \ Invert 61.0f sandy loom 53" 58.4 Estimated Invert 58.65 C3 layer 2.5y 5/6 Dc X, x 6 8 78, Use Gas Baffle loamy coarse sand � tp QF, \ . Invert 65.50 5 HIGH CAPACITY a 66" (30% ravel) 57.3 /4.3 / BENCH MARK--TOP P.K. NAIL „ INFILTRATORS 66' C4 layer 2.5y 6/4 6 1 / IN DRIVEWAY = 80.39 ASSIGNED „ 30 maximum see detail Proposed \ S=1/4 /ft Cover 66.0 coarse sand CP / �76.2 Poly TOP PEA STONE (10% grovel) \ <,,/75•3 77. 8 .5 \ Invert 58.9 1500 Gal. ® \ 6 7 'O \ \ Septic Tank P 5 8 F 9V 10 I Proposed P _ _ - _ i_ 137" 51.4 \ �O /S� F p �, 83.0 TeeSan 241) 1 x 1.2 / � I Bottom 54.15 �.ti`' ,• -:"�*�'.: �� 2 ti0 4.0 76. F 81.9- Proposed Invert 65.50 T \ / Invert 65.67 15 3 NSF78' I Use 6 Stone under Proposed Proposed 63.5 ALARM & PUMP NOTES s/ p 080.5 A=45' 1 , I I I 1 ( Bottom \ cs \ X 2. °6� A: �1- 7 I �-13 24 0 j 1. ALARM TO BE WIRED BY ELECTRICIAN ON Nx 52.7 107, 6�O �6,, B=100' 1 I I 1 2.8' USGS Adjustment SEPARATE CIRCIUT FROM PUMP. 1.9 Using SAND253-Zone B 2. ELECTRICAL WORK TO BE INSPECTED BY 82.2 DESIGN DATA Dec 98=48.6 WIRING INSPECTOR. 3. ALARM TO BE LOCATED IN HOUSE. \ ::. 5� •, :;; :::` ::::? ':.; S \ POND WATER ELEV.=45.4 ' FA \ 4. PUMP TO BE CAPABLE OF PASSING -1 a' X• 47,19 �;•'��� 28 � �:.;::`.:�.> � � \ BEDROOMS: 3 LEACH AREA 1-1/4" SOLIDS AND INSTALLED IN STRICT X 5 X 49.7 . x \ \ OO \ :':'::" `. \ GARBAGE-GRINDER: -- - -No CONFORMANCE WITH MANUFACTURER'S \ \ USE 5 HIGH CAPACITY INFILTRATORS SPECIFICATIONS. O 1.3 \ Cyr �:•.:: / REQUIRED CAPACITY: 330 GPD WITH 3 1/2 OF STONE ON SIDES 5. USE MEYER MW50, 1/2 HP PUMP, OR \ ;::;:>,, 6 .:f . .. \ \ SEPTIC TANK: 1 GAL. AND 1' STONE ON ENDS AND 14" OF EQUIVALENT. ON \ X 3 5 �. p \ \ \ BOTTOM LEACHING AREA: 330 SF STONE UNDER, FOR A 10' X 33' X 2' 47.5 tv \ x ;9 �3\0.9 [(33' x 10')] LEACH AREA. 5' REMOVAL Z n 56 0 x 6 6, , "]� 05D.6 66 \ \ SIDE LEACHING AREA: 172 SF r 1• 6\ [2(10'+ 33') X 2' DEEP)] DIG 5' ALL AROUND AND UNDER DOWN 5'f TO COARSE SAND.cA n `> `� x 68,.7 \ \ DESIGN CAPACITY: 371 GPD LINE EDGE OF DIG WITH VINYL BARRIER, WHERE SHOWN. v \ , r LOT 67 1 x [(330 SF + 172 SF) X .74 GPD/SF] �'3 SHOREY 5 INSIDE DIAMETER PUMP CHAMBER 48.0 � '- CO �O, / X 707 1 0� PUMP CHAMBER STORAGE CAPACITY: 342 GAL 1 / DRILL 3/8" WEEP/VENT HOLE X 3.6 DOSES PER DAY: > 4 I x � 5.5 X .7 50.5 X 56.2 .11 - �-"< \1' -----4_ „ Line x 53.2 I X/ / X 73.5 ��P� (Q j79.5 2 X 49. X 56.3 Invert 58.39 ALARM 25"' CHECK VALVE ON 22" 48.0 F` x OFF45.4 58. (63.6 3' DEEP IM IMPERVIOUS L.F. 40 MIL AFCO VINYL Bottom 53.39 6„ STONE UNDER x 4:8. 56.1 i �FZ¢ FLASHING, OR EQUAL. / ox, o / i P� TOP FLASHING=TOP `O/i� \ 50.4 i �� PEASTONE=66.0. n �T< X 0.6 62i� �'� NO SLOPES STEEPER DESIGNING ENGINEER MUST SUPERViSE v �/�� V, �j Q5 THAN 3:1 DOWNSLOPE INSTALLATION AND CERTIFY IN WIRIT➢N8 SQ I �p LOT 68 OF BARRIER. GRADE SITE PLAN THE SYSTEM WAS INSTALLED IN STR°CT 0� 0 / i� P`' ABOVE LEACH=69.0 pCCORDANCETOPLAN. � FOR THIS PLAN IS A VALID COPY ONLY IF IT BEARS AN 0 11ED STA NATURE. BRUNA GAMBLE ' �OF l FP�� ASSge ` 1� END PIPE LOCATED � ROINALD o= RONALD y� JANES j� ; JAMES P LOT 67, 211 LAKE SHORE DRIVE LEGEND CADILLAC ADI AC MARSTONS WILLS (BARNSTABLE), MA #3 -7:9 HB 1 HAND BORING LOCATION, NUMBER F�Ot � s�NiTAA�Pa » ---OE OVERHEAD ELECTRIC WIRES (IF SHOWN) a JANUARY 27, 1999 SCALE. 1 =20 x 9.5 x 11.0 EXISTING & PROPOSED ELEVATIONS ('X' MARKS POINT) �-6 EXISTING CONTOUR ? ( RONALD J. CADILLAC, PLS, RS 8---- PROPOSED CONTOUR 1 UTILITY POLE (IF SHOWN) PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN --0U- OVERHEAD UTILITIES (IF SHOWN) P.O. BOX 258 i ' • TREE (IF SHOWN, NOT ALL SHOWN) WEST YARMOUTH, MA 02673 ❑ EXISTING DRAINAGE CATCHBASIN (5O8) 775-9700 HEALTH AGENT G APPROVAL DATE PAGE 1 OF 1 - 1999 BY R.J. CADILLAC