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Home My WebLink About0052 MOSS PLACE - Health 2 MOSS PLACE 00-015-001 �� MARSTONS MILLS, --r—O w,--) Commonwealth of Massachusetts lCJD U I d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 52 Moss Place M' Property Address Deyoung Owner Owner's Name information is X Marstons Mills l� Ma 10-1-18 required for every page. City/Town State Zip Code Date of Inspection K5 f%.1 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:When filling out forms A. Inspector Information Sly 3 on the computer, use only the tab Chad hathaway key to move your Name of Inspector cursor-do not HPS use the return key. Company Name P.O.Box 151 Company Address Forestdale Ma 02644 Cityrrown State Zip Code 774 274 2581 12866 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 16.000); 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 10-1-18 Inspector's Si ature Date The system inspectors I sub a copy of this inspection report to the Approving Authority (Board of Health or DEP)with ays 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 f c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Citylrown 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: septic in good working condition no failure criteria observed during inspection 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 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 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Citylrown 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 p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 � 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Cityrrown 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Cityrrown 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 '/2 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 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 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 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: E. ❑ 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 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Cityrrown 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): 330 Description: Number of current residents: 0 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 ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2 months ago Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 u Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Cityrrown 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: owner Was system pumped as part of the inspection? ❑ Yes [ No If yes, volume pumped: gallons How was'quantity pumped determined? Reason for pumping: j i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts UIV Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Citylrown 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 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.75 feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line. 26+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): no signs of leaks or poor venting 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 w 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.25 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1000 gal H10 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Sludge depth: 4 11 Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? tape and 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.): baffles in place no signs of decay or leaks. pump tank every 2 years under normal conditions t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >,.��, 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Cityrrown 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Cityrrown 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.): in good condition no carry overs t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working orders stem is a conditional ass. P P 9 � Y p 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 6x6' precast ❑ 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 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. City/Town 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.): Pit is dry at time of inspection. stain line 18" below invert pipe 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Cityrrown 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Citylrown 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 A 0 D a I 3 Z) aq 3) 3V ', r �2y / 3� , t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 c Commonwealth of Massachusetts - Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Cityrrown 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: 30'+ 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: town GIS You must describe how you established the high ground water elevation: town mapping in lot el. 76 low in area 40 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '•v 52 Moss Place Property Address Deyoung Owner Owner's Name information is required for every Marstons Mills Ma 10-1-18 page. Cityfrown 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 TOWN OF BARNSTABLE LOCATION e- SEWAGE #�-.5 VILLAGE 9Y e� ✓ fC.� ASSESSOR'S MAP,& LOT INSTALLER'S NAME & PHONE NO. r c� SEPTIC TANK CAPACITY AOd't0 f6 LEACIIING FACILITY:(type)_ (size)� 0,0 ENO. OF BEDROOMS CZ _PRIVATh WELL OR UBLIC WATER BUILDER OR OWNER �, �C1✓�v�e�� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: � ® � O • � cJ VARIANCE GRANTED: Ye4 No t� r f a� �y .3,. -3� t� � `�Y No.... ( .- `_ij FES.......7� ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH --- - - ---........................................ Appliratiun for R-4putittl Works Tunitrurt"tun thrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at ,Co% Iay L,/p5S � J'�f/�rKsraN`F rccj ............................ --- --•--Y-•------"""---•---•------ --•------- --------'-----.......------•-------.....----------------...................------ Location- ress r Lot No. (rtzc-(A/�3Iri 61C &b�d�• 1�•d, 1?dr 5 6 CFn/r ✓Ic CE .............................................................. Owneb n/ .-.............................. .................. f............ Address------------......-'................-'•---. •-----•---_.=/-___./��3SCOCCL..._-�-+-staller--------•-•--._...---•-----'---•-.-.....- --•----.._..---•-----•-••-•---•-•'------'---Address---------------------------"--'-•--------- Type of Building Size Lot----- `�� .......Sq. feet Dwelling—No. of Bedrooms.......... ..............................' Expansion Attic ('/) Garbage Grinder (/✓) PL4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------•-•---------•-----------•--•-•••-•--•-•••--------•••••------•.....--••-•----•••--•-•-•-•-•......-----------------•••-• W Design Flow.............................................gallons per person per day. Total daily flow............»3.AQ.....................gallons. A4 Septic Tank—Liquid'capacity_!_O .gallons Length................ Width_____..--__•__-- Diameter_--__________-__ Depth_-_____-____---. Disposal Trench—:�?o..................... 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._..�_6.v. ..._.. .c ij iz C'..�`. g G,,n�...c�. `-4 Date r �39 �� aTest Pit No. 1....e_. ...._.minutes per inch Depth of Test Pit...!i�............ Depth to ground water_._N_B�rF (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------------------••...............................................--------'--'--••---••----•--•..............._"--------- O Description of Soil..... t-tSL�.JuM•----......S w�� w� P��Rt ------•------------------------------------------------------------------- - V ----•-••--------•-•••-••-•----•-••---•------••--•-•---•-----•-•----------------•-----••---------••--------------•-•-•-----•••-••------•-•----•-•----•-••------•--••--------•-----•--•--•••-•••----••-•-- W x ---•--•--•-•--------------------•------•---•----•--••----•--......•--••-••-••-•••••••••...........-•---••--••••... •--...-••---••••--•--••--•--•--------•-•-----••-•---------------•-......---•------•-. V Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the rovisions of T.71 T E p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued D� th�oa rd,of i alth. S d f ...............................!aat roved B A D Application A Date ry Application Disapproved for the following reasons-----------------------------------------------------------•------------------------------------•......----'----- ...........................-............................................................................................................................................................................. Date PermitNo.-----..0 `4 ............................... Issued........ 0........................................ ' --- Date lv f/ 3 No..--°�•.............. Fps.......f�...�.................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ... .. . .......................................... ApplirFation for Disposal Works Tonstrurtinn rumi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ................... - .... Location- ress r Lot No.. ......................�tfg.. . ;.. .... .t, ....................................7 € CAs' nt 't ..v. i . t Ownei�;,.J Address Installer Address Q Type of Building Size Lot.... .`.� - ------- feet Dwelling—No.,of Bedrooms........... .............................Expansion Attic (V) Garbage Grinder (,#V) `4a Other—Type of Building --------------------•------- No. of persons............................ Showers Cafeteria Otherfixtures ------------------------------------•------------------•••---•-•----------••--------•--------•------••--•---•-----.-- -(-----)- W Design Flow.................5._ .....................gallons per person per day. Total daily flow............ ..3. _._.......- _ ....... WSeptic Tank—Liquid capacity_!_ G6.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—NTo. .................... 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 W Percolation Test Results Performed by.. d....... y ----•-----•--------- Date / d Test Pit No. 1................____minutes per inch Depth of Test Pit... ............ Depth to ground water------------------------ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--_______-___-_-----_--. ----•-•-•--.........................................S /...----•------......-------........................................................................... it Gas c .. I €D Description of Soil----- . ..................... ......-- U ---.....•----------------------•-••--••---••-------••--•-•---------------•----•--••----------------•---••-•-----------------•••----•--•-•--------•-•---•••--........................................... W UNature 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 TTTx ; p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b4pen issued, th6'board of iealth.l .st } fr � Al Si d = � �t- - Application Approved By................................ --------------- --------f---------- Application Disapproved for the following reasons:__......................................................................................... Date . •----- -•-•---•------------•...................•••--•-------•-•----------•••-•••••-•--------•.......------•.....--•-••-•-----••-------------------------•--•-•------------------•----•-----••--••-••--•---•---- G Date PermitNo.---....0.l(_.�/ ..:..................•----•--- Issued--------- ............................................. to Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .............OF.......t a�?.i ;;,�J(;< Tntif iratr of ToutpliFanrr THIS IS TO CERTIFY That t�e Individual Sewage Disposal System constructed (V�or Repaired ( ) lZ by.......... d.........•-- ---•-•-•-•--------..... ••-- -•----..... v / + /°` S 5 r t" y Installer I at x I n ------•-•------------------• -------------&---•--- -- has been installed in accordance with the provisions of TILT.'; " of The State Sanitary Code as des -ed in the application for Disposal Works Construction Permit No._ � �G y:..�3--••-•......-•-•••.. dated-------------------------•�-----------.----- THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................ _.�._�.B_ . _`3....... Inspector........---- . ................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r �3 FEE---�................ MsVos a1 nrk dun rnr uan anti Permission hereby granted....:L - �i" ' t c•e c ----- -•................. ......•---• - to Construct ( ) or Repair. ( ) an Individual Sewage Disposal System at No......... ..... ,................ . � ter. Or ...(,r... �raA .. .... Street r� as shown on the application for Disposal Works Construction it No.�s.�.:.J�.___ ted..._._� -�� •--- •........_. U ` / 0. Board ealth DATE................. - ` -- �-------------•-----...---- FORM 1255 HOSES & WARREN. INC., PUBLISHERS F tMARSTMONS SHEET 7 OF 7 LOT 130 usa= LOT 129 � ultra OF LOCATION MAP df / \\ fop �o►p // ^ >➢.c ;� a LOT tz� .s OT YS2 KV4=w �y�► --taus= +s I s �y LOT 31 � t tLOT 137 'h•�4 �'„ ! �i LOT 124��%' 4 j(" ; ICI �• i. a �°` � � 'LOT 108 LOT 123` r-1 P V r- liirr toed 1Y II `\�� LOT 128 -'L01V23 '� 1 aI j ,ri I M .' /t.��. C yH �l)L_ 74° ( �4.b i I �' LOT 13 f. td -\ia4o LOT 149 LOT 138 �d ( LOT 122 `�1 i� t°Jv�= �. J �'� '�4 �� A} LOT 1 lam I 21 �06�>3 I COT 107 rY /l 1 1 1 1 * - -4 G ax I i�aa s a �NO' I soy �� o - 3i.°°' .%6T 147 ', y �•� �-t 14ao�r LOT 119 'LOT 141 1 �� ,.S 1n• lei * •� ,a>m �, 1 Y t' r e V�`I tOT fill ta`F orti e• 1}foo= �°� �' LOT 120 '• LOT 117 .\ ►a se t°so s 'k•LOT�43t ��-'. rasa= ,t , 4 � 1 � • ; �y � ��; K v14A ��''�� it►nli 1 ' :pt,3 �.� K •g � t i I ''PRK V- NOns I.bit 6OMT 7A oF'► WIC see(- lib! A.4P SL LOT R ~ L 1145 t� y LOT 113 >N ,. a �__ -70CLot.ATt4Yd TLST. JCLs.1t�a:. t.ses s,~T 7A Or7 FVAL 'LtmariWp•• LOT 146 ,slim= I � �/' = \� LOT116 ft LOT 11i t� 8 toss OF lei S,, Iri Jp0 y '� LOT 11� i4mtls K 4' LO 114 Y �ats>K t�} a I °i to =. 11 a •6 •o•rw.te e.1 Rpko E a.edima•►s. ' r yP .. r 1 3 11 29 88 FINAL BLDG. AND SEPTIC LOCATIONS PAL I \ �^ 9 ^ �� I Il•v 1�� I�r 1 BUILDING TION I oaf 1 10 2 88 INITIAL ISSUEELK y� A N0. DATE I DESCRIPTIO14BY ,oI BUILDING LOCATION PLAN MARSTONS MILLS WOODLANDS LOT 110 tta LOT 109 BARNSTABLE, MASS CHUSETTS �\ ^' WOODLANDS ASSOCIATES US \� SCALE: 1' = 50' JOB NO. 1338 4335-10 ✓'"_` � LEVY, MMEOGE do TAGNER JMOCUtt WC olol® ulsrat am= nam alto xmw ,3—, NO HEST MAIM STRUT CZNTERVWA it-OP832 -------------- tUAR;:S SHEET 7A OF 7 /wBw eMMIQ�As pm e 7*� *. ® ® ® DESIGN CammanALCULA11011s: 1 1 A I mmamm 1OG11U1 YAP �1� on >/�A R _ IOTK O1Wamwm�� 3p _.� 11001 R 111�OALALAAY; 7 w.) ,y3y.��SA�AAY r IA1.v ACNX K o E01n vmNOMM 1> ILK L r Zwv ,U w Awww •atY001 w� feo e., Ta1w.0)♦S7(Od1L0) wm r MR. 012011[IfAOSIS CMgR• 000 NA OISTIBl1111pN a 6pTe w•,'� Box NOTES: ® I. ALL°008mov me IMTgAIs!WL 001°Owl 10 LULLim S AM 0=no"weAAreneu me 1000 GALLON SCIM TANK ttO1LA%O IOS IM O=JAZ 0MWK or>OM l r-I r I + I t .ALL alou To rMnAMY IeOls s1ALL BE 01011OIR 10 uses tr w loeslm w AL SEPTIC SYSTELA PROM F r I i ANY mmmy OMns USED To Slww 0e0430 A am" swL BE 11of vwm s wAQ Mr Is awl COTTON OF TEST HOLE a ALL eore1lMMif w•Q Sam"Smw SMALL a CAPIwf a w 0001110 01-10 Lefti M,U =M[Y NO umm w I EGIN to R.0r OwIO IN AI ft ARAtt M-20 Lamm LEACHING PIT swL Oat wm iww w vsr ro rt w Owlo w L I�O1TK Am MICK m1w Ot R.S Lm flO�R ` b MO Am W m=#ALAMw PLAN 1330-10 t LOT NO. ELEVATIONS �{D, + tO1K ow[LtYN11011 m ELEV. 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 �128��29 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 Z tail tox ' C=LOCATI O.FOUND. f I Im PPiT 0 A 70.9 7t.9 71.0 ko lbo 110 16•e 7/.s 7Mf 1f•9 x.A 71.0 7s.9 se.e 9Ms b s 6L° sto �LI vo• - Dl.o. 01,0 Alo 0wlonAwwt 1aT (el 704 11.0 74.5 70.4 7f4e 74.• 714i 74,T 7640 7ro 71.0 7s.o 7i•3 s 7s4o A 4900m LEAoww PIT , 11 •7.40 71A 7040 11.3 79. A/w tm owww/wM Mwt B 7e•9 6H49 w•0 b4J 4b•I 06.0 611 nes Tc.o 7}e 78a 74 7�•0 7bi 3 TIS 1�d ts.l 7►� 711.E _ 7►.I I i 1 77. 17s°w �",i f W.1 71.4 7Ls 1s.9 Its 7f.f 1F1 1f.6 749 7;A 7f.9 77A 7b4 jp4AI K/S bf s N•o 76o B C 70-4 •s bF.l 6f.6 6A b$7 Nti 'At 7L1 7t.1 1t.1 74-L 7l.7 tb.s 17 17.s 7#.s 77•* 1R00 1b.t - 77.7E 77471 7f4i 71 'tL3 124 71•; 1e.t Tint 7G7 7>s 7;b 7ft146 7AF, n4p 7S.1 i7m I114 i6 Ilfs 64r7 7i.7 C D 710•0 H+ bf'! 644 6046 11.fr 6%0 7L• 11.0 7t.f 7L.S 74•o 7f.9 140 •e WO *.e "to 77 I J 77•s 77tf,7 ,o 0 71•I fi.1 741 71ro t0.o 714E 1 79-o n•4 7f,0 74.4 754 1 1t.1 71.1 10. N1 6•b••0 boo 4s.f 70,5. D E b1•► 6s.s jmo bt.4 69A 011 t*% by 71.3 ns 7t.3 76.9 7f•3 7f•0 -MS 7b.e 7ti 771S TS3 7f.o - 7Ej; 77- 1 Ii7 73. 7rA 7t•1• 'M.1 &fs 6*0 71.4 -t.$ 71. 14.1 74,3 714b 7t•S 7as • 6s.•6f.b 64.6 64-) 14; E 11 I � F 61•b Ioi bs.l 14.s bf.i bst 64•6 7e.6 71.1 76.1 70.6 70-1 1f•6 *,{, 74.6' 711 7741 77.1 71b6 - 77.1 I1Ii741; Li- 79•i1 I%.'1 7z.1 10.1 b4.6 H•6 71.L 7t.b 73.1 74.7 744 Yhb 7e.0 KL 64b 6s.1 S4 F G ('1•5 615 6f.0 bt•O bf4s Lae 4I•'3 W-9 7Lo 71.0 71.0 7111•5 79.0 0.9 7e.s 76.J 725 77.0 7Le 7f,y - 7Z0.�y1.0 I - 14f 7s.f -rwi 7t4o 7of bi•S b4.S I.o 40 7<s 74e 7)e ts.o 11.E rws bsS 69. i 1 77•i 643 bs.o b,o G H bff b19 01•6 f1,0 91•I 61.9 bt•f bAf bsp ii.o its 0-$ 610 $4.9 1r.f 70. 71.9 'R•° 71.0 4,1.5 - 71.0�I7t.0 09.9 1a•0 64•0 16.0 61e 6S.6 Ills bs,e 61.5 6so bs•f 6s•o 7.0 1 c-ko j6f.f 04.5 (Pi.s 6440 db.f bt.o 640 H APPROVED: BOARD HEALTH J St Mefs•o sso Q6o �7•o ps Ms bW 41.e MeL.IAS bs,e bf.9 6s.e 6b•s 67.5 67a ble b4.9 - 47ew bs•51bhs 434E 66.0 69.0 6e45 I Off 04•9 61.0 bt.f 410e 64f 64.0 6S4e Ilt.o W.f bs.f jfbj 14qs I.° .o 60.0 J K 72.6 Ids 704o b1• 4a• 1e.o 11•0 7D•3 74-0 7A0 7!•t 14.0 10 71.e 74.5 X, M•e a 00.0 74•5 - 540,,, gas,I •�_ Awn f 1s.3 7ss 74•s 744r 7!0 1►) 7>SO 70,e 1b 70's 7>0 7s 16 74; JM3 7b 1. 61•0 70•0 7t.e 7w o K L 7f.4 7J.5 w0 ire bs) H•s 70.1 1a1 lac fLf Ito 70•9 77.0 A.t x•• 74•e 740 7*6 74.6 19.0 - 71•d 71•S�;7Le �„e 7f! 74,E 7M 7$4 73.0 7gs 74,7 0 70•0 118.6 7f.5 149 1740 !live 71.0 10.0 7Lf Iftf L M Tt.o 61 bf.f bso 61s Mo 71.9 71.0 �,� twb 70.0 7b•S 77.5 �• 7se 71.4 s1.b 71.9 11• - 764 17.)J,&ao 71b.0 714t .o 7N5 19.6 72.6 78.0 )145 i 7.rx 7710 7sS 7s4 74.4 Ito 1s. M N tt.o17�v 6�•f Ito 11.5 b7e if 6 7070.0 7e0 Its Ise 7b! 7As 7f.e 718 7)5 its 7&0, 7b4 114 b.s '►f0 - 7s.[ 77.0� ►4•° �.0 7f.o 74.5 71.E 7}O 7f•t 74.E 1f.0 A.f f 7!••l 143 7i.o 7).O 71M6 641.0 64.0 1645 sf.s N 1 12 INITIAL ISSUE IWICT N0.I TE I DESCRIPTION I BY PERC TEST 1 PERC TEST 2 PERC TEST 3 PUtC TEST 4 PERC TEST 5 SEPTIC SYSTEM DESIGN LOT 118 LOT 125 LOT 131 LOT 149 LOT 146 MARSTONS MILLS WOODLANDS Lilt i an..�t- �-L11 sAA1 u11 yO AND�IOAw.MA" r swa t•w sSwL wr wwna �•�' tr r aSlt ~ 00811119 Ile.lyeal lwrw e�sL we BARNSTABI.E, MASSACHUSETTS � `� ,�wsWOODLANDS ASSOCIATES REALTY TRUST r110•A�w am IF.-Om r w•o1eL A �� w°Aw►ee°trwtem 9eu wr wR e11e=e1e Mrw ^�w �� SCALE 1- >• 40 JOB N0. 1338/sfe w _ V •IAw IUe mO mum -r a�•Auc DAN OF SOL=Tn" eAR or SOL RfT-"Md" OA1t Q SM MTBY � SAE S fOL Twill QI bAlt I v• - /wOQA11wIFTINIZED�RAli�_IwLA1011 Pum=Amm RAit WIN=D BY �1wLA101 - MwonAIM MAIX 3L�Aa1 0mCOLAIM"101frMCCED BY 1-SJ 1wL/w01 •w�AwoM i■iwaAloM -b .•epf PERCOLATION SOIL TESTS Lm nmam g ium Aper, INC• • r , � '.. . � s®e try r�s 71�! uli alnte '