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Home My WebLink About0046 MOSS PLACE - Health ,46,MOSS PLACE MARSTONS MILLS r - - A=''100 -014 Commonwealth of Massachusetts /0,9- o/N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments A 46 Moss Place Property Address Donna Atwood ' Owner Owner's Name information is -X required for every Marstons Mills ✓ MA 02648 10/5/2018 " page. Clty/Town State Zip Code Date of Inspection ,S ; Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. Inspector Information filling out forms on the computer, use only the tab Paul C. Martin key to move your Name of Inspector cursor-do not Cape Cod Septic Services Inc. use the return key. Company Name 350 Main St. 4:1 Company Address West Yarmouth MA 02673 Clty/Town State Zip Code 508-775-2825 S15016 elephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 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 10/12/2018 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is Marstons Mills required for every MA 02648 10/5/2018 page. Cltyrrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in working condition. 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): 15insp.doc•rev.7/26/201 a Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is Marstons Mills required for every MA 02648 10/5/2018 page. Cltyrrown 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 by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is Marstons Mills required for every MA 02648 10/5/2018 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 salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is required for every Marstons Mills MA 02648 10/5/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owners Name information is MarstonS Mills required for every MA 02648 10/5/2018 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 an g y y question in Section C.4 above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information.was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is Marstons Mills required for every MA 02648 10/5/2018 page. Cltyrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 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): 110x3= Description: 330gpd Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® 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 information in this report.) ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 2016=55gpd Detail: 2017=55gpd Sump pump? ❑ Yes ® No Last date of occupancy: Current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is Marstons Mills required for every MA 02648 10/5/2018 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: No Records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is every Marstons Mills required for eve MA 02648 10/5/2018 page. City/Town 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: 1989 Per BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 23"feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: +10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line was checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is Marstons Mills required for every MA 02648 10/5/2018 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"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: 1000Gal Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Oil 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? Estimated Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000Gal tank in good condition. PVC tees in place and clean. Tank at normal operating level. Inlet cover 6" below grade with outlet 12" below grade. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 110 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form «a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is Marstons Mills required for every MA 02648 10/5/2018 page. Cltyrrown 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form lis Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is Marstons Mills required for every MA 02648 10/5/2018 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 0il 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.): H-10 DB-3 with 1 line in and 1 line out in good condition. Box is clean and level with minimal solids carryover. No sign of overloading or hydraulic failure. Cover 6" below grade. 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is required for every Marstons Mills MA 02648 10/5/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-6x6 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is Marstons Mills required for every MA 02648 10/5/2018 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1-6x6 Leach pit with stone. 2'of effluent in pit during inspection. No evident staining. No sign of overloading or hydraulic failure. Cover 14" below grade. 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form y. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is Marstons Mills required for every MA 02648 10/5/2018 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Fie Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is Marstons Mills required for every . MA 02648 10/5/2018 ` 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information is. Marstons Mills required for every MA 02648 10/5/2018 page. Clty/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: +14' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 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: Auger did not encounter water at 14'. Max bottom of pit is 101 . Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Moss Place Property Address Donna Atwood Owner Owner's Name information Is Marstons Mills required for every MA 02648 10/5/2018 page. Cityrrown 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Page 1 of 2 Cif TOWN OF BARNSTABLE • LOCAZ'�ON_�'f /,�..�' l'rin.�� 'm''� SEWAGE ��''9'S`'� VILLAGE ASSESSOR'S MAP A LOT ioe7—A/ i'—+' INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY W-c!� LEACHING FACILITYitype)_ ('yas{- ��---- (size) 100b NO.OF BEDROOMS _PRIVATE WELL OR 3-YAT—Eia WATE BUILDER OR OWNER-GIZ DATE PERMIT ISSUED: DATE COZIPLI•ANCE ISSUED: if -Sr C( VARIANCE GRANTED: Yes No40 ✓ �$ 1 Qp *1 lQ - f Ay http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=100014&seq=1 9/17/2018 TOWN OF BARNSTABLE 66 1 ,�y� - LOCATION � /dal /`�`1!�_�5 r/ � SEWAGE # / VILLAGE f)'1At--S+Q,6S (OAS, ASSESSOR'S MAP LOT _ INSTALLER'S NAME & PHONE NO.g1 .'_1'3J )A SCO�' 77 I'36 SEPTIC TANK CAPACITY t LEACHING PACILITY:(type) size) NO. OF BEDROOMS. PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER G-Rff7 ,mil An i t "IL DATE PERMIT ISSUED: LATE COLIFLIANCE ISSUED- VARIANCE GRANTED: Yes No ✓�/ i 41 L + ) -` ` .............. THE COMMONWEALTH OF MASSACHUSETTS �0 O� BOAR® OF HEALTH _?O(w .._.......OF........3�Rn(� '/�/�C.� ......... ----------------------------------------------------------------- p \,� rlir il�n fear Eli-qVngttl .ark Tonstrurtinn rrntit Application is hereby made for a Permit to Construct (X or Repair ( ) an Individual Sewage Disposal System at: p , -i- vT ... I a l Moss c,�cE /'�nlsru�3 1cL.S ---•--------...••-••--••••-- ........................... ••-••••----•- G Location.Address ,> mayor Lot N lC(- /Y IL C Z � _ LOK'P ----I" •�•_ �( SIO C_.E NBC�1�GCC ..................................................._..._f"'_____-•---._.._._....__...._.._._... -. ------------------------------------------ 'WW Sd Address ...... - ... --•--••- Installer Address i(. 063 d Type of Building Size Lot________I...................Sq. feet Dwelling—No. of Bedrooms_____________3_.____._______._________.._Expansion Attic (Y ) Garbage Grinder (�) Other—Type of Building ____________________________ No. of persons_________________________-__ Showers ( ) — Cafeteria ( ) a' Other fixtures _________________________________ W Design Flow......................�5_._.__...._____gallons per person per day. Total daily flow-------3_-3_b...........................gallons. P4 Septic Tank—Liquid capacity_6 U 0o__gallons Length................ Width................ Diameter................ Depth______________-. Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area_-__________________sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank � ) '-' Percolation Test Results Performed by._�E"Y _..._ �".F'..G�t - Date._._°.j.... ...g aTest Pit No. 1.... _a`__•_minutes per inch Depth of Test Pit.................... Depth to ground water...IYR :........ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •-•--------•--------•--•-------------•--------/•------------•---.....-----------...•••-------•-•-----......................................................... O Description of Soil--- '`{F'�2�M.............................``'` P��I3J� c E3 x -----------------------••-•----•-------•-----•--------•-------•-•-----•---•------•••_.. U ---------•---•----•--------•-•-----•---------•--•----------------------------------------•--------•-••-----•---------------•----------------••---------•-------------•---------------------------••-•-- W U Nature of Repairs or Alterations—Answer when applicable.-_---__________________________________________________________________________________________ ..•----•-•----•-•--•-•-••-••-•••--•••--•---•------•-•-•••-••••--••••-------••---•-••-•----------•----•-•--•--•-•----------------------•---•--•-•-------•-----•-•-•-•-•••••••••••••-••••••••............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i I iE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasjeissued thle�oar-d of ealth. Si ed. "� .... .a , ''`nA lication A roved B ! ___'�(: ____ ____ � PPPP Y = - --..................................... ------•--- ---_ Date Application Disapproved for the following reasons:-•-•-------------•-•---------------••---------------------•---•-------------------•-------••••--•-------•--••- -••__._....---•-•-------•-•--•-•---•-•••-•-----------•••••-••-----•-•-•._...--••------•--....--•---•.......•••-•-•--•-••-•••••---•-•--------------•-•-•••-----------------•...-•-----------•••••--••-•--- Date PermitNo------ .:.. . --------------••-•---------___ Issued_----/-------------- --�------------------------- Date o!. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............................v .A( ? rti(� �7'dt3 C ..-----...O F.........'..`............................................•----........................... AllplirFa#inn for Bisposal Works Cnnnstrnrtion rrntit Application is hereby made for a Permit to Construct (t!) or Repair ( ) an Individual Sewage Disposal System at: ¢ y� ��. L1!+ ;} �l•`t S3 �„'1,.'i P ................................................................................................. .........._.._................................_..............----..............................._. LocationryAddress or Lot No. ' atCrnt;xcrt•L `oF'j? 1".6; 1>c-" .510 �rr�s� 0 RvIr .... .... ----...............................•-- -------.._.......................... --------•---......A. ......•. ----•---•-----••-...........................-- Ow Address a //,, / W VI F'„ Installer Address QType of Building Size Lot...............--.•.•-.___._Sq. feet Dwelling—No. of Bedrooms.........................................Expansion Attic ('Y ) Garbage Grinder (✓``) '4 Other—T e of Building ............... No. of persons._...................._._... Showers — Cafeteria Pa Other fixtures ..--•••----•-•. --•----•--••--- . W Design Flow......................S_s.__............___gallons per person per'day. Total daily flow____•-_2..?....._...._....._.........._gallons. WSeptic Tank—Liquid capacity_: ._gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area----------.---------sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '—' Percolation Test Results Performed by. E v1 __.(1 t h"` �6 l'g.r.' W. ' ...._._._._. Date_. ' s� .. ------------------. Test Pit No. I....*'........_..minutes per inch Depth of Test Pit...........____.. Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-____•_____-_-_--_--___. . P4 -••-•------•-----------•-•--•-------•-•---•--••----••-•---•-------------------- -- O Description of Soil-• -`-"- ---------------�-n--..--.---......°.I--....�`` 3(�_�t S U •------•-•--•••--•---•••-----•------•---•----------------•-----------•---•-------•-----••---•----••-----.....-----------•--•--••------------ W --•-•-•------------------ ................................................••--------•--------••••-----•--•--•--•---•--------••----•-•--•••--------•-•---------•--•---••---••-•------•-------••..------ V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ...............................................-.....................................................................-------•-•--------•-•-----••-•---•--•-----------------------------...----•---•---. Agreement: . The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of'TTLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beep issued,.by the board of health. . Signed...= .-Y ........... t... J-------------•-....---------•------- -•--- _ D —` ee Application Approved ..................................... --•-------------------�L ------------------ -- •--•-----•----- Date Application Disapproved for the following reasons:--....___._...._________________________________________________________________•-----•----- ......--------- ------------•---••-----------•-------------•---------•-••----------------------••---......_..-----•-•--•-•----------------------------------•-- .......•--•---- ----- Permit No. .: _ ----------------------------- Issued ...... ...................... Date Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 01,A/ 751,41?d�r�12" ( r .............. ..........................OF..................................................................................... CPrrtifiratr of TontpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) o rct by....... = = --•--- Installer / at............................................................ has been instailed in accordance with the provisions of TI'LlE, j o1f�The State Sanitary Code as de 'bed in the application for Disposal Works Construction Permit No.__.1.1.:__, .................... dated----�.__�-�.__J-�__-__--__-______--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... ............................... Inspector........ -•---................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (mo FEE....... .............. t .'(.... ? ..... ..1%�.. .. _OF. 1�T0. �... .. ---• s Disposal Works Tonstrnrtion rrutit Permission t hereby granted••... = =----•---•-----•-------------•:..•--------------•--......--...------•------------••------------------.....................•.. to Construct (v' ) or Repair,( ) an Ind••vidual Sewage Disposal System N fi l { at i O. -• . ................................................... -------------j-- ----------. --•-•--a----•--...-•- - -Street .l / / as shown on the application for Disposal Works Construction e it No��_ (-..... ated-__ - / ,..C -•------------•••--..----- Boar t Health DATE FORM 1255 HOBBS & WARREN. INC., PUBLISHERS y i as o 4. SHEET 7 OF 7 MARSTONS MILLS LOT 130 uaa s tttMt�� LOT 129 testa s LOCATION MAPS 4b I LOT 31 �� M /fit � \LO '� 4� M•O , \\ LOT 137 �� / +� �. ��. 4� ,4'. ♦ ta».s '+�' ! � ;Ii LOT 124-�' 'LOT 108 ^ LOT 126 01-4= 'its+p0 L07 123 / �i I I h • X l_ 740 �L.4 1 i 1 ' �' LOT 13 ,atrn IF e\, 11« �• LOT � \ .t 1 w ' � \ '►}°{ -potty s / ;. \`\ toew1s �OAT3 136 V�MSOO \/ _4 u . LOT 134 9+ .ed .. y �1 �� -'mil � } LOT 122 Wall Rat 3 '* ..y �1 I�, �' ��_ '�� \� �yt, LLOT 1 +\ ��LOT 107 r' LOT 148 1 I / I 1\� \ "t ^` +sue ` d� + t41ao w 1 I *.S > 1► -=TUO I i I ( 1 e10 NLOT 147;' \.tom ',`r ^ iufte r \ R LOT 119 e� '•� `\\ J <: 1 1 '� ,� .I,j.S ' 'LOT tot \ '�`� fi d�+� mariom tOT IS' 1peoo a t 20lam w LOT 117 mao 1 & Yy '1 �tMo '1f, LOTh43\\ _ -�,:\ s+r�taoes +� & lob Iof �" \ � _..,�i� ,_. � `%so tb tt� ,t•c � �` 'LO liK D, toatY �P�K 1.5" 6NEET 7A or-7 Felt` Swt. t.P&* ^4b �.� ~ l f 145 t� LOT 11S r LOT1081GT�1� �'�' .�tamo>• �.� -711RLo1•M1w•1 TEfT. R7 FVPtc _ /' +I10�H ,e t.i.�0f a.~r 7A oI7 Mlt �t.�trsND: a11ts �' '� t' �fr•0 lie LOT \ �p tS LOT I b +o \ & tomo tr too ' Ii1 o LOT it' i0.OT mt s : 4' �`LO 114 ��' 1� y ta000 +�x a n to >R, to a •a 0•1•w.o w f Wit. E tatiettwAt. \ rIr 1 t I 1 3 11 29 88 FINAL BLDG. AND SEPTIC LOCATIONS PAL 2_ ji/e/ea BUILDING LOCATION PLAN - 1 10 2 88 INITIAL IS EL If \\ NO. DATE OESCRIPTI0 BY \ ,,1 �� BUILDING LOCATION PLAN MARSTONS MILLS WOODLANDS LOT 110 `. ■ �\ L0T09 BARNSTABLE, MASS CHUSETTS �\ WOODLANDS ASSOCIATES UST,, \ \\ SCALE: I' = 50 JOB NO. 1338/tam-to ""`'�•� LM, EWMGE & TAGNO MOCUlt WG ol®e u>sae� nmm uw>falaae 889 HEST JI STRW CENrIItvnis KA 028a8 Sf(EET 7A OF 7 Itoa Ar 1.� rrr arR Aat r A� ow�P1AA •a a .rOIR MARSTONS un I e *.�tl v' ® um ® ® DESIGN C&CULATroNS: ows so 1 A 1 �01. 6 Pna •ax•rr,nt ma M rL /�Pw n. oAtsAa s1f0l�1PLOW aQ LO -aI.) il�y�AAT t AIM t1M �� 1r ma IA7 r sm•r; RtIItlta!t)M TAMI G1MaTr ��..sA� r Ina a It�rnrAlrwr�Ts 1srlrlLAAt Ili►' soawa.ARA JAG . r-r ORION MKA Loom Cw cm omsot o� seo G., ar 4rafts.0)♦tv(srt.$) Ina' scion W Aoas whatr oISTIaeNTION •� "� sox NOV : eewrwr M MAIMONS 91AU CONFORM TO eisr. M IM r r t000 OALLON StT1IC twat 1 I r mca"voYs FOR et*MUM or:osK ar ttoiac r 1 1 jhDora m sA1tTAtT inns swlu a aaiwr m trool 1r a PMOIm iIADG I Ar 1 1 AMT OrolttT uATs usm To emm 00WIt to o m SEPTIC SYSTELA Pit F owa o WOATAM 0 PEACL Aw w alit BOTTOM OF TEST NOLE ♦ ALL 00te01a is a IM tAMITARY t7r101 MAIL K wAt� 1•WWWANOW.6 LOW"01ROt 11QT Am attf 0R lof1tII m rt.0►01010 A PArq MEAL 11-a UMOMo LEAO►"PIT SMALL Iltm om OR ttM1/a rt.r M 00 !. IOoaRAL M%wrw l 0et111 L Za Lm 6�Q •ar1ol PIO.NOt0001t isECima"13,1F10 I, LOT NO. ELEVATIONS LEGEND: nwa ww olvAwoll 1� REV. 106Fo 7 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 1129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 eso W TAW o LOCA71 ! Ptnullr UMANNO PIT p r.O.FOUND. Olson 71!•5 11,s 71.0 7b.o p-o 110 #•1 74.0 74�f Ids 30 77.0 'Iss s0.o fo.s a7 #to slo 1IIA p• - 01.o 61.0� 7�l�7Ji- 7415 7f.6 7fo 74.o 00 PENCRAIMMIa (!I 74.i 7t1,T 7o a 7f a 7q.0 7s.o 76.s 7! A M ow comer Alm a�Pit tall 7f16.f 71s.o 74o Ts.o 70.0 1115 7l1. B 1b.6 41A 6" 64J 46.1 00.0 61J 70 7t.o 7b.9 73.0 741s 76'.0 7r.i 71.5 77.5 mi 7s.1 7S4 761E - 71.0 7p� G .• JAs i 71 714 �s104 . B t1 ►! Ira i,s 7f.5741 7M 7t A W-47b4H4 4i.3 0.0 &" -xv C . . .7117ft 1. W471• 70,% -11L1 l 1 Ifs 746 7Ai Imip 7s.1 7f.1 w•l #*.1.,ost 6.0.9 10.7 C D 7b.0 N+ real su bo.i b7.9 ite 7Lo 11s 7td 711.5 7,p 7s4 760 '7Ze 77.0 7♦►.e Ttb 77{, 'x0 - 77.5 77f 17 .o 1 1.60 1 11.1 •ft-4 '311 70.0 7e.o 71 f 73 a 75.4 71so 74•4 1754111.4 71.1 1p. 6,9.1 IP6•° 0.0 66.s IA5 D E btt► (,e.e 6,15 bs14 6sA bx3 &LO bs 71.3 ns 7s.3 7#t 71.3 7f.t TA.t R.e 711 7Y.9 7%5 Tr.# - 7J�j T/3 (7 +�. bA Its• 70.1 N.s yl,i 7L4 7t1• 71. r4A 74.*r I no 7t•S Tt•E I}.♦ 6t►.9 bf.b 64.4 64•3 14i E F oto 60 �,,1 61.t 6s.t bss 6s.6 70.6 71•I 7e.1 7s.1, 7l.I 7f•I., 7s,1. 76.r 7S1 77.1 77.1 70 6 - 77.1 721 � 74 L 7mr 7s.7 7 . W.1 64.i 4" 71•L 1s.b 7r�4 74.1 744 7s.1 bb 7yap Ko b46 cs.l 7ba F G N•s ii.f 65.0 66e bl.e 61S ir•d 70-5 7Lo 770 ,P.o 7%5 1i.0 7s.5 7o, n.9 775 77.0 77.o X.9 - 77.b 77,0 74 t.f 7ws 71.0 7o.S i1•S N.S 71.0 7s,, .0 745 740 TAo 7t.o 1I•f 1e•i 6&5 b6. i44 •t.0 7o.0 G H 6#f iL5 01•6 57.0 51.0 ►1.@ ♦t•d 64.9 660 N..o Uo 1.7.5 61-0 M3 7r.f 70. 71.E 71•D 7J.0 N•6 - 7110 71.0I1 ots�,w.i &4.f I•b.o t.40 6Tr•s o;s I,i,o rs.b 6io Gs.f Na L.F. w.o bs.i o4.5 bs.f 6411 JiJi 64.0 4.40 H APPROVED: BOARD OF HEALTH J 049 iso 6o s>o i o f 073 6p 6o 41 - II ir.f st.• •S 91•! 6s l•v DW st•o &Lo 6%5 hs.o Ifs ts. bUo 644 64.0 6vo ot.o 61.E brls Jtl4 413 I.0 .o Eom J 60 $to . 11.0 73.3 7t.o . 71. 71.9 .• W see 71.5 - bRo " s; u •� 4.0 75.0 #)K 79 i 7 E 71.0 I . I7613 s 74 a>< Ar 7i•b 7!s•o 7i 1%,s 77.o 7f 1S 74% 7M3 ; 1, b1.o 7b.s ts•o 7A.o K L 70.5 71.5 We 69•e 1,&J 0.0 Te.7 7te 7 r, 7t.0 79.f 770 .i7 •0 ".0 746, 1s 7 .► 74.0 1.5T71-91 s t4, ,,7te -we Tl.f 7 1 1Nt We 71.0 The 7e.0 7Ls 7#S L M Is 71.o i'Ls bf.s N.e 04d 740 71•s 7s.0 3 74t, 70.0 76p 77.s 7#0 710 71.1. 71•6 71.1 720 - 7Rf 77.0 J 16.0 1 7s2. o 'MJ Tr.f 721f 77.0 7ys is. 1 o t 7i,4 71.4 7f•o 7b. L'b'vb'T•f 1 710 1s.5 M N 1l.0 71.o i2o 60.0 &6.o 76,e 70.0 7s.a To. 7413 7A� 7s.e I 76.0 775 lip 7b0 714 744 �,, 7T.9 - 7/.! 7bo �4•0� 76,0 -M.0 It-gi Iss 7;0 72•f T4.f 76.0 A.s Is' Ts.! 143 1io 73.0 1Ab 6sA61,0 76.s Tt.s N 1 12 INITIAL ISSUE WCT NO. DATE DESCRIPTION By PERC TEST i PERC TEST 2 PERC TEST 3 PERC TEST 4 PERC TEST S SEPTIC SYSTEM DESIGN LOT 116 LOT tzs LOT 131 LOT 119 LOT 116 MARSTONS MILLS WOODLANDS .aa�.... ..,�.,.. u. oaw,��o _ oa .. �4n .. �. = ..�` �` BARNSTABLE, MASSACHUSETTS r.ArR r rrrsl0t rAr va owi Aral M tltR •. r WOODLANDS ASSOCIATES REALTY TRUST Now OA�s r F r ywt WRAC r WOatfaxAm_r .vOI sw r oAa.Pie ��r am AreAa r SCALE 1 s 40 JOB NO. 133E a0 ar •aO •O raa ot�t PAY a 0 a a i R CAN ar sot TM^1i1a 0AII r tea MR-M IP MII r al 1QT ■e®0T+irt»_ s171®0y a�g R110 BY LAuMc MR Ol filL.TOTJIIA� MR r!M 10T � I rr f°ttt01 0Y .��e �11R0)tto rr a�� PaonAllsr MII sLON.A11eI Pa104A110N YII SLMARM Paenllwao YII SL1/L/Oel PUImtiAtmtt MII�J�L/rtOII PEI100IA11011 MII 3L�r6/elol •^ •♦0~{ PERCOLATION SOIL TESTS IB�G p,DggpGg k TAM AMOMtS INC. s ssm mm m am 089 W= YAW STRIP cZNfZKV= YA a2m