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Home My WebLink About0251 LAKE SHORE DRIVE - Health 251-,-Lake'Shore.Drive-- Mamtons Mills A = 030 003 I Z '- TOWN OF BARNSTABLE LGCATIGR'„2 12 L. .4 k C .5116Ri Pt, SEWAGE # 66-3— O /7d VII LAGE /YI.4 Td f/S A4 IL L5 ASSESSOR'S MAP & LOT .3 INSTALLER'S NAME&PHONE NO. AA C O 44 6 e SEPTIC TANK CAPACITY /, o a o o L!� LEACHING FACILITY: (type)y-/A/F/LTA Ar0P (size) f NO.OF BEDROOMS L� BUILDER OR OWNER r PERMTTDATE: 3 Q3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i t / i w 12, 9 w TOWN OF BARNSTABLE LOCATION QW1 ZAZL-�WORle M G� E'VAGE,# VILLAGE ITUS ASSESSOR'S MAP & LOT Wr0� INSTALLER'S NAME & PHONE NO. �SkCr� 6r MACOM664;e- SEPTIC TANK CAPACITY /000 ' o LEACHING FACILITY:(type)R�0 (size)4�— NO. OF BEDROOMS bl- PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No /off o o � � .o i 46`t b i Mrs. L. B. Stacks 251 :Lakeshore Drive Marstons Mills,Mass. 02648 DATE: 7/20/94 PROPERTY ADDRESS:251;Lakeshore, Drive_. .� Marstons Mi11s;-Mass, 7. _ „ _ 02648 On the above date, I inspected the septic system at the above-referenced property. Yes,. This is a title five septic system. The -system consists of 1-1000 gallon tank 1-distribution box and a leaching field . 201x12 ' .� Based on my inspection, I certify that the system is in proper working order. Yes. The septic system is in proper,- ,r�tJ� .Yi.►]g-pi'Lie.T__?_.t.- ♦♦ _ cam. SIGNATURE: NAME: J.P•Macomber Jr.. COMPANY: J•P•Macomber & Son Inc., =`}_ ADDRESS: Box 66 Centerville,Mass. 02632 PHONE: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY Please Affix Business Card and/or Letterhead. JOSEPH P. MACOMBER & SON, INC. Tan ks•Cesspools•Leachflelds Pumped & Installed Town Sewer Connectlons P.O. Box 66 Centerville, MA 02632.0066 775.3338 775.6412 P248 Rev. 1189 • r Jul 22 2019 06:57 HP Fax page 25 dab-Da3 Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments 251 Lake Shore Drive L Property Address Leslic Stacks Owner Owners Name / information is every Marston Mills ✓ required for eve MA 02648 7-18-19 page. City/Tom 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. OFuupr�� Important:When \` A. Inspector Information ( 3 q�8 filling out forms p 0 on the computer, JA M E S yR use only the tab James D.Sears _o ; key:o move your Name of Inspector — • *•. cursor-do not Ca pewideEnterp rises % -�'• c v,• key the velum Company Name 153 Commercial Street''''+mrntnstPm�``��`\ Company Address Mashpee MA 02649 City/Town State Zip Cade 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 7-18-19 I ector's signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•iev.712612018 Title 5 official Inspection Form.,Subsurface Sewage Disposal System•Page t of 18 Jul 22 2019 06:57 HP Fax page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 251 Lake Shore Drive Property Address Leslic Stacks Owner Owner's Name information is Marston Mills required for every _ MA 02648 7-18-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2,3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal. Tank D Box and four chambers 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I5insp.doc•rev.7/2612616 Title 5 Official In spection Form Subsurface Sewage Disposal System•Page 2 0116 Jul 22 2019 06:57 HP Fax page 27 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 251 Lake Shore Drive Property Address Leslic Stacks Owner Owner's Name information is Marston Mills required' forevery MA 02648 7-18-19 page. atyfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required b the Board of Health: 4 Y ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.70612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 16 Jul 22 2019 06:58 HP Fax page 28 Commonwealth of Massachusetts Title 5 Official Inspection Form vSubsurface]a} Sewage Disposal System Form -Not for Voluntary Assessments % � 251 Lake Shore Drive Property Address Leslic Stacks Owner Owner's Name information is required for every Marston Mills MA 02648 7-18-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a Safi marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the.SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: * This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No l ❑ ® 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 15insp.doc•rev.7P-812018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pagea of 18 i Jul 22 2019 06:58 HP Fax page 29 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 251 Lake Shore Drive Property Address Leslic Stacks Owner Owners Name information is every Marston Mills requires for ewe MA 02648 7-18-19 page. City/Tom State Zip Code Date of Inspection C. Inspection Summary (cant.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in ANORW is less than 6" below invert or available volume is less than Yz day flow , 94c1/1mC ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ IR The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5 Large Sy stems:ystems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA, Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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 15insp.doc•rev.M1612016 Title 5 Oftiat Inspection Form:Subsurfooe Sewage Disposal System-page 6 01 le it Jul 22 2019 06:59 HP Fax page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 251 lake Shore Drive Property Address Leslic Stacks Owner Owners Name in formation on is required for every Marston Mills MA 02648 7-18-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat,or answered"yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:subsurface Sewage Disposal system•Page 8 of 18 I� I Jul 22 2019 06:59 HP Fax page 31 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �55Y 251 Lake Shore Drive Property Address Leslic Stacks Owner Owner's Name information is � Marston Mills required for every MA 02648 7-18-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: 1000 Gal. Tank D Box and four chamber's. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes N No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2017-226,000Gal g ( y g (gpd)) 2018-257,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc-rev.72612018 Tine 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 7 of 18 Jul 22 2019 07:00 HP Fax page 32 Commonwealth of Massachusetts Vvip Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 251 Lake Shore Drive _ Property Address Leslic Stacks Owner Owner's Name requred fo is every Marston Mills required MA 02648 7-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont) 2. Commercialiindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: tSnsp.tloc•rev.7rAW018 Title°Ofru al Inspection Form:Subsurface Sewag e ge Disposal System•Page 8 of 18 Jul 22 2019 07:00 HP Fax page 33 Commonwealth of Massachusetts (p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v ° 251 Lake Shore Drive Property Address Leslic Stacks Owner Owner's Name required for is every Marston Mills required for eve MA 02648 7-18-19 page. CityTrown State Zip Code Date of Inspection D. System Information (cont,) 4. Type of System: ® Septic tank, distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I!A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2003 Permit #2003-070. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 37"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.): Pipeing is 4" PVC SCH-40. t5insp.doc-.rev.7n8/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-page 9 or to Jul 22 2019 07:00 HP Fax page 34 Commonwealth of Massachusetts r Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form Not for Voluntary Assessments I C 251 Lake Shore Drive Property Address Leslic Stacks Owner Owner's Name inforrnationequiredfo is Marston Mills MA 02648 7-18-19 required for every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 27"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 Sludge depth: 1 Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8, Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level.Tank at 30" below grade.W/inlet cover at 10". Inlet baffle w/outlet tee. No sign of leakage or overloading. t5insp.doc•ray.71M2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 10 Jul 22 2019 07:01 HP Fax page 35 Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments " 251 Lake Shore Drive Property Address Leslic Stacks Owner Owner's Name required information is Marston Mills MA 02648 7-18-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5lnsp.doc rev.7/2 6120 1 8 Title 5 Ofrcial Inspection Form!Subsurface Sewage Disposal System-Page 11 of 18 Jul 22 2019 07:01 HP Fax page 36 Commonwealth of Massachusetts Title 5 Official Inspection Form P Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 251 Lake Shore Drive Property Address Leslic Stacks Owner Owners Name information is required for every Marston Mills MA 02648 7-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont,) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"xl6"-20"below grade w/one line out. Box is clean and solid w/no sign of over loading or solid carry over. tainsp.doc•rev.7J.-W2018 Title 5 Official Inspection Fort:Subsurface Sewage Disposal System•Page 12 of 18 Jul 22 2019 07:01 HP Fax page 37 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 251 Lake Shore Drive Property Address Leslic Stacks Owner Owner's Name information is Marston Mills required for every MA 02648 7-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order ❑ Yes ❑ No' Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS)(locate on site plan,excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.M612019 Title 5 Offidal Inspection Form:suasurface Sewage Disposal system•Page 13 of 1a Jul 22 2019 07:02 HP Fax page 38 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 251 Lake Shore Drive Property Address Leslic Stacks Owner owner's Name required fo is Marston Mills MA required for every 02648 7-18-19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cant.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.), Leaching is four (3050) infiltrators w/4'stone. Ck 0 Box, camera out line and prob area. No sign of over loading or solid carry over. No sign of holding water. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5insp.doc-rev.7/2e/2018 Title 5 Offival Inspection Form:Subsurface Sewage Dlsposd System-Page 14 Df 18 I f Jul 22 2019 07:02 HP Fax page 39 Commonwealth of Massachusetts Title 5 official Inspection Form ' a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 251 Lake Shore Dr`ve Property Address Leslic Stacks Owner Owner's Name Information is Marston Mills required for every MA 02648 7-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cons.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15insp.doc-rev.7126(2018 Title 5 Otfidel inspection Form:Subsurtace Sewage Disposal System-Page 15 of 18 Jul 22 2019 07:02 HP Fax page 40 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 251 Lake Shore Drive Property Address Leslic Stacks Owner Owner's Name Information Is required for every Marston Mills MA 02648 7-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch In the area below ❑ drawing attached separately . i 3 v g p t5insp.doc•rev.7/26t2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 16 of 18 Jul 22 2019 07:02 HP Fax page 41 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 251 Lake Shore Drive Property Address Leslic Stacks Owner Owner's Name information is required for every Marston Mills MA 02648 7-18-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface waler ❑ Check cellar ❑ Shallow wells 0 Estimated depth tcj—high ground water: feet II Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 9-25-02 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: Bottom of chamber's at T below grade. Bottom of chamber's at 8'above T.H. Depth Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.712.612018 Title 5 Of Elal Inspection Fora:Subsurface Sewage Disposal Sysfem•Page 17 of 18 Jul 22 2019 07;02 HP Fax page 42 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 251 Lake Shore Drive Property Address Leslic Stacks Owner Owner's Name informaWn Is Marston Mills MA 02648 7-18.19 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed &Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1,2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included ORAB F om '3 C H/J A 6 E,Pr Per Gw t6insp.doc•rev.W26/2016 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Pape 18 of 18 e ' ' 3 � Fee No. Dr7p 5 0. 0 0 �' � "" THE COMMONWEALTH OF MASSACHUSETTS fEritered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Miopooar *pztern Construction Permit Application for a Permit to Construct( . )Repair(K X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot N62 51 Lakeshore Drive Owner's Name,Address and Tel.No. Iarst n� Iills,Mass. 02648 ssessor's ap arce t� Same 3D -UO3 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3—0 3 7 7 J.P.Macomber & Son Inc. JC Engineering 5 Roundhill Blvd. Box 66 Centerville.,Mass- 02632E. Wareham,Mass. 02538 Type of Building: Dwelling XX No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 5 7- 1 gallons per day. Calculated daily flow 4 X 1 1 0=4 4 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)C)m i t t i n g 1 P a c-h f i P 1 r1 I n s t a l l i n g i n 1 n 30 5c) 7c., 1-4 �e n�P 1! 3 ten. �naJC 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 thi o f alth. Signed Date 2 1 2 0 3 Application Approved by Date Application Disapprove or the following reasons Permit No. Date Issued 1 s D "No. rlr Fee 5 0. 0 C� `-- -��red in computer: THE CfOMMONIWEALTH OF MASSACHUSETTS Yes _ PUBLIC HEALTH DIVISION ,-TOWN OF BAR NSTABLE_}MASSACHUSETTS 2pprication for Miq�ogol'bpotent Conotruction Permit Application for a Permit to Construct( )Repair(KX)Upgrade( )Abandon( ) O Complete System ❑Individual Components f Location Address or Lot No?51 Lakeshore Drive Owner's Name,Address and Tel.No. MarstNartS Mills mass.02648 Assessor's apfPazcel Same b3D'-003 Installer's Name,Address,and Tel.No. 5 0 8-7 7 5-3 3 3 8 Designer's Name,Address and Tel.No.5 0 8—2 7 3—0 3 7 7 J.P.Macomber & Son Inc. JC Engineering 5.&Roundhill Blvd. Aox 66 Centerville M ss 02632 E. Wareham,Mass.02538 Type of Building: , Dwelling XX No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 457.1 gallons per day. Calculated daily flow 4 X 110=4 4 0 gallons. Plan Date Number of sheets Revision Date Title i Size of Septic Tank Type of S.A.S 61 - t Description of Soil ' 30 Nature of Repatis:or Alterations.(Answer when applicable nm i t t i n a_ 1 p-a ch f t e 1.6. T n s t a l l i ng 'a l on 14,4 �in�& ch. _h s_ 33. 5'X1 2 '9 . 2' zj 30 Sep Z".$, �i' /�-►—g +'U r 5 S v r rc�v �.�,?�er �-1 �-/ S n�Q Y 3 cr�vt '2,su!JC r� Date last inspected: L� - 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 thiySopv4d of Health. Signed/ Date 2/12/0 3 Application Approved by/ Date ? Application Disapprove or the following reasons Permit No. Z W3f 0?D Date Issued Z 3 0 3 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(KX)Upgraded( ) Abandoned( )by J.P.Macomber & Son Inc. at 251 Lakeshore Drive Marstons Mills,Mass. has been constructe4 in 4ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2.003-4D'76 dated 2 /3 1 14-3 Installer .7.P.Macomber & Son Inc. Designer7C Enaineex" -itcr. The issuance ofthis p�ermi shall not be construed as a guarantee that the system will un n a e Date �p D 3 Inspector / is ------------------------------------------ - No. 2 co 3 or7o Fee$5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ;r li5po5af *pgtem Con.5truction Permit Permission is hereby granted to Construct( )Repair(XX)Upgrade( )Abandon( ) Systemlocatedat 251 Lakeshore Drive Marstons Mills,Mass. t 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 this per Date: _ Z'l 31 G ]? Approved by t i � TOWN OF BARNSTABLE LOCATION s/ G .4 k e SHd 1e R p t, SEWAGE # -2 6 a.- O b VILLAGE /YlQ',STd,(/S /lit /L LS ASSESSOR'S MAP & LOTO-b-0.3 INSTALLER'S NAME&PHONE NO. .T. P /J9 A C O At 13 e R -1- S o Al SEPTIC TANK CAPACITY /, o b o o L!� LEACHING FACILITY: /Z T,( AT DP. (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: -3 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 j on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist a, - within 300 feet of leaching facility) Feet Furnished by q ! � a I I 5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS = 16.00' - 17.20' TOP OF BASEMENT SLAB = 17.00GENERAL NOTES REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM 4" SCHEDULE 40 PVC MIN SLOPE 1% I FINISH GRADE OVER D-BOX= 16.00 3/4" TO 1-112 DOUBLE WASHED STONE TO CROWN OF PIPE FINISH GRADE @ FND. EL.= 15.90' FINISH GRADE OVER TANK EL.= 15.85' 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION 2" OF 1/8"TO 1/2" DOUBLE WASHED STONE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN. ACCESS COVER (TYPICAL FOR 3) 36"MAX. 9"MIN. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD BASEMENT SLAB EXISTING 4" 13.70' 36"MAX. BREAKOUT EL = 14.20' OF HEALTH AND THE DESIGN ENGINEER. PVC PIPE 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL -' 6" 3" 2" DROP MIN. PROVIDE WATERTIGHT- 3" DROP MAX. 3" 9' JOINTS (TYP.) o BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. o 0 0 III-III-III o 4" PVC IN FROM oo O 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN 14,17 SEPTIC TANK 4 PVC OUT- o0 0 - o ELEVATION = 14.20' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS -III- I-III 14.33, 14 (CONTRACTOR LEACHING FACILITY 2' oo moo 0o A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE SHALL VERIFY) oo o o FEET FROM S.A.S.AND THE TOP OF (CONTRACTOR o 0 0 o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 12' } 0 104111 0 0 SHALL VERIFY) OUTLET TEE 14.05' Mw 13.88' o o o 0 0 5, SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. CONTRACTOR TO VERIFY 48 3' EXISTING SIZE OF TANK AND 6" CRUSHED STONE 7.1' (TYP. FOR 1) 3 4 4' 6, THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 4.3' 22"ZABEL FILTER (APPROX.) EXISTING TEES MODEL#F 18 1 HIP COOMPACTED BASE VER LLY � 5.2' (GAS BAFFLE , GROUND - 5.75' (TYP.) 7• LOCAL BOARD OF HEALTH TO BE NOTIFIED BOTTOM) 5 11 .70 D WATER ELEV.- 12,2' PRIOR TO BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND j OUTLET DISTRIBUTION BOX READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED TO BE INSTALLED ON A LEVEL STABLE 5' MIN. WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH. EXISTING 1000 GALLON CONCRETE SEPTIC TANK BASE. FIRST TWO FEET OF OUTLET PIPES TO BE LAID LEVEL. 4 - INFILTRATOR 3050 CHAMBERS LENGTH 8'6" WIDTH 4'1 " DEPTH 5-71 8. ELEVATIONS BASED ON ASSUMED DATUM OF 46.25'MSL OBTAINED ' CROSS 'SECTION VIEW FROM CATCH BASIN GRATE AS SHOWN ON PLAN. SEPTIC TYPICAL CHAMBER PROFILE I L CHAMBER END VIE TANK PROFILE DISTRIBUTIONL 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION NOT TO SCALE NOT TO SCALE NOT TO SCALE THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY T EST T DISCREPANCIES TO THE DESIGN ENGINEER. € DATA �xx•. 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE WATERTIGHT. INSPECTOR: �j ,K " A SOIL EVALUATOR: Samuel Phi Jensen 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED YET rt B.M. `` DEEDED OR H z DATE: September 25 2002 ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN Catch Basin Rimy' �� , �� , j " _ N. y SUCH Elev. 46.25 Assumed R� ,�" DETERMINATION FROM APPROPRIATE AUTHORITY. TEST PIT#: 1 }3 "� z _ 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS 40 5 " T LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH ELEV TOP - y s „ . 15.75' �O ry f z 4 � M _ ELEV WATER= 5.75' CASE THEY SHALL WITHSTAND H-20 LOADING. F' PERC RATE _ < 2 Min/In(Assumed) 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND �t w �� a FINES. I W. E. d ti" 4 r 9 . i 1 SM g s 4A: � � DEPTH OF PERC= N.A. l, a� j `� a �` 14. WHERE REQUIRED CONTRACTOR MAP 30 t' . Y TOR SHALL REMOVE ALL LOAM, SUBSOIL AND mamtry TEXTURAL CLASS: 1 UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES LOT 3 ... •vf r r ,:,,a ° '. 7 ' l'"` ti LEAN OF LEACHING FACILITY REPLACE ALL UNSUITABLE MATERIAL WITH C COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN ' `2g c y ACCORDANCE WITH 310 C 60 242 SF± 0 MR 15.255 3 N � ; . A Sandy Loam 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER N 4"� yy,. � �' „a�`'"veFv': L � j � '"m.. Y 10YR 3/2 FOUND I N SITE CONDITIONS' OF ANY DISCREPANCIES 4 � " 4,� „ FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. I 4 15.42' 16. PROPOSED PROJECT IS LOCATED WITHIN: B Sandy Loam ASSESSORS MAP 30 S. L-1 N 10YR 5/6 PARCEL 3 14" 14.58', 1 fI ` � (A .` i r C1 -C Sand & 17. OWNER OF RECORD: LESLIE STACKS M i f 7�, Gravel 2.5Y 5/4 ADDRESS: 6 ELLIS ROAD t € ',?�,�,, �,,,- 1 �� . tNk �� ,�,. WEST NEWTON, MA 02165 fi ��': ' M-C Sand k r" s ,, 2.5Y 5/4 C2 18. PLAN REFERENCE. BOOK 222 P ... ,,.... .:1 S , r++ t4,. ;_ . w«y� ap r� '.r,a:': r EXI ;I•,i; �. t4 s120" Mottling µ � 5.75 F AGE 157 � �� , 7.5 R 56 19. ALL DI�T�IRSE�J AREAS SHALL BE RESTORED TO ORIGINAL CONDITION a I 132 Groundwater 75 r _ oundwater 4. � Observed 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY LOCUS PLAN R�- , "'" `�"�'��-. , 1 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY EXISTING LEACHING FIELD TO BE ABANDONED FORH PLAN ITS INTENDED j NG FIE ABA , 38"' 4 25 USES OF IS OTHER THAN ENDED PURPOSE. _ - SCALE 1000' DESIGN30 T z LEGEND h _ x ,......... ..., r ; EXISTING SPOT GRADES 28 a, I w o ... 26 -.,-- --..... EXISTING CONTOUR 24- Fn, 22 OA NUMBER OF BEDROOMS 4 50 PROPOSED SPOT GRADES r #251 _ 20 .,.......... NUMBER OF PERSONS 4 0 EXISTING 4 -� - ,_._..._-- EXISTING 1000 GALLON SEPTIC TANK BEDROOM 1'8 DESIGN FLOW 110 GAUDAY/BEDROOM , . PROPOSED CONTOUR EX. DWELLING e 5 4 TOTAL DESIGN FLOW 440 GAUDAY _ E �. /C EXISTING ELECTRICAL UTILITIES HOT TUB FF = 25.5' DESIGN FLOW X 200 % = 880 GAL/DAY 12.5' _ GAS EXISTING GAS LINE +->,., N USE EXISTING 1000-GALLON SEPTIC TANK BUFFER LAND 1' r, PINE `v� �M.� EXISTING WATER LINE ISTINDECK G `L{ 4" OAK'..,..,, ; ,.Wi NSTALL FOUR INFILTRATOR 3050'S TEST PIT LOCATION �I 15" OAKS,.,.., INSTALL 4 - INFILTRATOR 3050 CHAMBERS � Q C7 EXISTING SEPTIC TANK SURROUNDED BY STONE (SEE I7E.TAIL) i, .. . __...,..._.�� 12" OAK "". . DISTRIBUTION BOX SIDEWALL CAPACITY I h xi 8" OAK 4"SOLID SCHEDULE 40 PVC PIPE (LENGTH +WIDTH) (2) (2' HIGH) (.74 GPD/S.F.) = GAUDAY .......,, j __M ry (31�y+12.2') (2) (2') (0.74 GPD/S.F.) _ /3`J,'`l GAL/DAY E3 DISTRIBUTION BOX INFILTRATOR 3050 CHAMBERS BOTTOM CAPACITY I (LENGTH x WIDTH) (.74 GPD/S.F.) = GAUDAY 1 5/29103 JLC INFILTRATOR 3050 (3a/,V x 12,2') (.74 GPD/S.F.) _ l�(�, GAUDAY REV. DATE BY APP'D. DESCRIPTION _.. ._..,.,.... .. _..._m..., PROPOSED SEPTIC SYSTEM UPGRADE of of �3oRDIRI TOTALS: VEGETATED I✓TATED WETLAND PREPARED FOR: LESLIE STACKS " + TOTAL NUMBER OF CHAMBERS: 4 TOTAL LEACHING AREA: ,/ SQ.FT. LOCATED AT l ' - TOTAL'LEACHING CAPACITY: GAL-/DAY S 1 53'S0„� 251 LAKE SHORE DRIVE .0 MAR o STONS MILL M S A 02648 �cx�E OF wA { (ELEV 3.56'p �/ SCALE: 1 INCH = 30 FT. DATE: SEPTEMBER 30, 2002 LONG ; �OF 0 15 30 60 120 FEET JOHN L. y`�� PREPARED BY: - I CHURCHILL CIVIL JC ENGINEERING, INC. No „«�7 5 ROUNDHILL BLVD. EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 SCALE: 1°= 30' Drawn By: JLC Designed By: JLC Checked By: JLC JOB No.298 r l _ _ - - - -