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Home My WebLink About0105 MOUNTWOOD ROAD - Health L-- 015 Mountwood D„4-Marstons Mills i I i i Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - ryNot for Volunta Assessments / ill C) Property Address / , Owner Owner's Name al information is required for / " !^r1T-aHS /'//.//-C A4 Ora6y-S o?41 /V every page. City/Town State Zip Code Date of Inspe tion 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 A. General Information forms on the computer,use 1• Inspector: J only the tab key to move your p cursor- et not TO use Name of Inspector key,the return L `/v/0 TE G# Company Name /,' .� Po goy Company Addres =a.$��a w► _��i¢ O od 6�� City/Town State Zip Code . 4,9 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system�Tt thlrs add�res'sf and that the information reported below is true, accurate and complete as of the$ e o'f?ttie�in�sp4ect onl. The inspection was performed based on my training and experience in the proper�f�'Inction and ma' rranee of on site sewage disposal systems. I am a DEP approved system inspect, &Uatft t6 on�1�5.340 of Title 5 (310 CMR 15.000). The system: LBy—L23-- [IPasses ❑ Conditional) Passes Y Needs Further Evaluation by the Local Approving Authority Inspec is 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 75ins•09r08 Title 5 Official Inspection Form:Subsurface Sews e D s I S I m• ��9 Po ys a Page of 17 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposals System Form • Not for Voluntary Assessments Property Address Owner owners Name n Aa 8 information is /4// �s�-p,,�S ��//� oa � a required for State Zip Code7 Date f Ins lion every page. Ciry/Town B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ always complete all of Section D A S stem ses: Y 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: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old' or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ NO (Explain below): t5ins-09f06 k Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r e. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments (/ � /�/��M n r f,✓OocL �C Property Address �( ✓1 yvJ A Owner Owner's Name information is ,/�DI�S To✓►S /� _L'�� 6 _ a 6 required for every page. City/Town State Zip Code Date oMnspetefion B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ 'N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-og/o8 Title 5 Official Inspection Form:Subsurface sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ,/ /� i h ►M o►►7 Owner Owner's Name I information is required for AA�T.4.s / "i/�/� S9 te`4�1 C` every page. City/Town State Zip Code Date dt Inspe tion B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 5" below invert or available volume is less than '/z day flow t5ms•09108 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /D S / to a N (.✓oo J R-1 J Property Address /' f'7 1 H N'r A✓I Owner Owner's Name A� information is -"1414l /`//Ar 1� ad 4ICY 9 o�zf required for every page. City/Town State Zip Code Dat of Insp ction B. Certification (cont.) Yes No ❑ �/ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ [� Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ [[]� Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ [ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ L� Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15;000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form rd Subsurface Sewage Disposal System Form • Not for Voluntary Assessments Property Address fT l✓I v"�a✓I Owner Owner's Name information is �// /OI✓S�°n f / /� O�� U �T required for every page. City/Town State Zip Code Date of nspec n C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No �❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ [ Were any of the system components pumped out in the previous two weeks? 21-�❑ 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)j D. System Information Residential Flow Conditions: 3 Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): t5ins•OWS Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address k✓! a✓1 Owner Owner's Name information is ///�Gi/S/ "�'►f / "e��5' �'—=� K� �� required for every page. City/Town State Zip Code Date of nspection D. System Information Description: ( ' 1 CT�► ��o H �C. ., H�✓ �-17 Groh o 0/6 Number of current residents: Does residence have a garbage grinder? ❑ Yes 2'N'o Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes 2"No Laundry system inspected? ❑ Yes Gam- o Seasonal use? ❑ Yes No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes Last date of occupancy: 14i -t"'T — Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No f Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: -- (Sins•09/08 Title 5 Official Inspection Form:Subsurface Disposal sewage Dis I System Pa 7 of 17 ys •Page Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments OS1�0(1N -won Property Address /✓raj vim►a✓I Owner owner's Name ,�A information is /S �f /�� required for State Zip Code Date f Insp ction every page. City/rown D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of stem: 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): 15ins•o9m Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form 9 Subsurface Sewage Disposal System Form • Not for Voluntary Assessments UV Property Address Owner Owner's Name 1 /� information is required for every page. City/Town State Zip Code DateA inspe6tion D. System Information (cont.) Approximate age of all components, date in Iled (if known) and source of information: 4 L Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer (locate on site plan): Depth below grade: feet a( Material of constructi;'4--0 ❑ cast iron PVC ❑ other (explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: /9 p g feet Material onstruction: 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: X /'-0 Sludge depth: 15ins•09r08 Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address k, '^^ M Y—� C. Owner Owner's Name information is �� 6W bV� $zv_ d required for State Zip Code Date o nspe every page. City/Town D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Oe A!� a M �/ a -► 7-�S ✓1 Od C (00 ci r 7 /Vr? Lacks Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•0908 Title 5 Offic al Inspection form:Subsurface sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form U Subsurface Sewage Disposal System Form . Not for Voluntary Assessments DJr' /�ou ti � Deck Property Address Owner Owner's Name information is ��'Cr required for every page. City/Town State Zip Code Date of ispect' n D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): ` Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments / aS Property Address /I �I� ✓�q a(/f Owner Owner's Name information is required for every page. City/Town State Zip Code Date f Inspe tion D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): -eve tia SV Xs /Vo 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-OWN Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments / S -��0u N T1✓'ov� �C 4 Property Address Owner owner's Name information is required for every page. Cityrrown State Zip Code Date of nspecti D. System Information (cont.) Type: 6 N f l" J 7�0 ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): C4 H CQi P4 Gt'rn 0 Si c%.. /,C 74 , Ire- 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 C Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No 15ins•OV08 Title 5 official Inspection Form:Subsurface Sewage Disposal system-Page 13 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments /off' /Vo cl �z Property Address Owner owner's Name reQinformation u for red is GI/S state Zip Code Date of ns ecti every page. City/Town P P D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins'09H08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Rd Property Address 1NS w,qw Owner Owner's Name information is /� 'IrI v -' required for every page. City/Town State Zip Code Dpfte of Ins ection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where pub ' water supply enters the building. Check one of the boxes below: hand sketch in the area below ❑ drawing attached separately Q C � r r &3 15ins•09108 Title 5 Official inspection form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address I �I (/�1 Owner Owner's Name information is 4-I'lf required for r H every'page. City/Town State Zip Code Date Inspecti n D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /O d Estimated depth to high ground water: 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 ❑ bserved site (abutting property/observation hole within 150 feet of SAS) Checked with cal Board of Health - explain: ' �s 7'-ps f- Ao lv ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: S rM t Il 4� /4h 14• S s �9/ A;c� Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins,.09/048 Title 5 Official Inspection Form:subsurface Sewage Disposal system-Page 16 of 17 Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �✓4 �wbo Property Address Owner Owner's Name information is required for every page. Cityrrown State Zip Code Date of spectio E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked inspection Summary D (System Failure Criteria Applicable to All. Systems)completed [System Information— Estimated depth to high groundwater 19/Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file [Sins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 L � , f C TOWN OF BARNSTABLE TH E TOIr OFFICE OF BABa9TdBL : BOARD OF HEALTH y HAS& �0 1639* 367 MAIN STREET �craY a HYANNIS, MASS. 02601 May 4, 1999 Stephen Doyle 42 Canterbury Lane East Falmouth, MA 02536 RE: 105 Mountwood Road, Marstons Mills A=125ti-6 Dear Mr. Doyle: You are granted permission to construct an onsite sewage disposal system at 105 Mountwood Drive, Marstons Mills, Massachusetts. . This variance is granted with the following conditions: (1) No more than three (3) bedrooms are authorized. Dens, study rooms, finished attics, sleeping lofts, and similar type rooms are considered bedrooms according to the MA Department of Environmental Protection. (2) The septic system plan shall be revised to show a "locus map." This permission is granted because it is the Board's policy to grant variances for the construction of three (3) bedroom dwellings on lots of 18,000 square feet or greater. This lot is 20,030 square feet. Also, the proposed septic system meets all of the provisions of the State Environmental Code, Title V. It is the opinion of this Board that the construction of one septic system which meets all of the provisions of the State Environmental Code, should not significantly alter the quality of the groundwater in this area. Sincerely yours, Susan G. R , R.S. Chairperson Board of Health Town of Barnstable SGR/bcs doyle t FINE tp� DATE: �O �. EE: , ,BARNSTABKAM LE » CEIVy�p i6;9. p�0 AEC..aBY� o� Town of Barnstable 0 ° HED. FE: MRGT Board of Health 367 Main Street, Hyannis MA 02601 4 ti 8 Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION /� Property Address: l 0 y 1`r 1 oUur lA o 12DAX> . �-11 La4,S D t1S 4'I A Assessor's Map and Parcel Number: 1 Z s- lCs�:, Size of Lot: Z D'es 0 Wetlands Within 300 Ft. Yes Subdivision Name: �Ot��T1�pQl)�p, �U 1�► 11�51�� No Business Name: APPLICANT CONTACT PERSON _ Name: A. lT �R.�OPr+-il 0' Name: Q�� 0�1 cE Address: �l 1�t,N p ��jam- Address: gZ 7VEV--7>kAF-j � �--- F K-N AL i Phone: �p� `(`(S ^ O Z o C) Phone: 5-p Q, S40-ZS'3 A FAX: FAX: U$ VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) QJAAAJ D �G r 1.L_S Checklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variances only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only],outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VARIREQ L TOWN OF Izu, 3 -LOCATION: ) j i"'ibylU�iz»v� pj VILLAGE: LOT # : PERMIT # : INSTALLER' S NAME: INSTALLER' S PHONE # : _ 2 °� CY LEACHING FACILITY: (type) jG X � y 21 , ize) NO. OF BEDROOMS: BUILDER OR OWNER: y ' T r ` PERMIT DATE: COMPLIANCE DATE: C)� DRAW DIAGRAM ON BACK awd cut I i•,. 1 t a fb No._ / k "' Fee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Digpogal �&pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Ieomplete System ❑Individual Components Location Address or Lot No. /n&L4h t tJOX)D Ja Owner's Name,Address and Tel.No. 02-6 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. P rn3r_1`/v Designer's Name,Address and Tel.No.�� S.�T 20c.rl� 2 42 C*+ I"A&S (�.� �,Si�•3/ 3(. 4 o G• rot-j pt,�_c3 J1,, STfb— 'Z Type of Building: Dwelling No.of Bedrooms Lot Size O ®sq.ft. Garbage Grinder( ) Other Type of Building &'t g No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 0 gallons per day. Calculated daily flow gallons. Plan Date 4��2 7 Number of sheets Revision Date ! 9 Title �) Size of Septic Tank ,510® Type of S.A.S. v Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has be iss d by t is Board 0 eal Signed Date Application Approved by ' Date ZL— Application Disapproved for dwfollow,ing reasons Permit No. ZY. Date Issued No.. ! —...r Fee >` G c� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: !'3 o a-- Yes r. PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS • ny. 2pplicatiou for 3Digpool *pztem Construction Vermit Application fora Permit to Construct( )Repair,( )Upgrade( )Abandon( ) 1<Complete System ❑Individual Components Location%Address or Lot No. 09 0"—A do v p )a Owner's Name,Address and Tel.No. '7 7 02-e 0 Assessor's Map/Parcel /a t� i� '�6 2O� �G�L� J � y Installer's Name,Address,and Tel.No. J �1/JQ/�-r'•/V Designer's Name,Address and Tel.No.DGyly 5A__r 20 C-k_ fL- 42 c*,T-A d3 -c x-( Li-.,, 6A-,z AJ Si A 3I,-_ 3,62 -75 d 4 o 6;, �v ) K.Lv s. PL, `� z Type of Building: Dwelling No.of Bedrooms Lot Size J O O sq. ft. Garbage Grinder( ) '#. Other Type of Building `vt No. of Persons Showers( ) Cafeteria( ) Other Fixtures - 1. Design Flow 3 3 O gallons per day. Calculated daily flow gallons. Plan Date `71 1 `7' Number of sheets Revision Date / Title / N Size of Septic Tank Type-of-S::A.$. Description of Soil Nature of Repairs or Alterations(Answer when applicable) r Date last inspected: Agreement: The;dndersigned agrees to ensure the construction and maintenance of the afore described on-site sewageAisposal system in accordance with the provisions af-Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has b v,'n iss �by �s Board ofReal Signed Date Application Approved by Date. LO w Application Disapproved for tkhollowing reasons Permit No. y' Date Issued 016 THE COMMONWEALTH OF MASSACHUSETTS `( BARNSTABLE, MASSACHUSETTS V �%1 (Certificate of Compliance V THIS IS TO CE F5.iY)that the On-site Sewage Disposal System Constructed( Repaired ( ) Upgraded( ) Abandoned( )by \o m lit i4 M 02 /A/ _ at 10 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9V- 7,t5'/_ dated s Installer. ,_ .- ..t; -Designer 4..1 The issuance of this e �r't�shall not be construed as a guarantee that the system will function as des jned. Date XTA �fi ! Inspector �,�Y k7 v I v �Iv �/ �C�� -------- No. d— —. --- — --�----yam-- Fee In — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migogal *pgtem Congtruction Vermit Permission is hereby granted to Construct(y)Repair( )Upgrade( )Abandon( ) System located at In � uu 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. IProvided:Construction must be completed within three years of the date of this permit. Date: Approved by TOWN OF BARNSTABLE �pQ TH E TO w OFFICE OF BAUSTAM BOARD OF HEALTH KASIL °o i639, 367 MAIN STREET cMaYa HYANNIS, MASS.02601 May 4, 1999 Stephen Doyle 42 Canterbury Lane East Falmouth, MA 02536 RE: 105 Mountwood Road, Marstons Mills A=125 - 6 Dear Mr. Doyle: You are granted permission to construct an onsite sewage disposal system at 105 Mountwood Drive, Marstons Mills, Massachusetts. This variance is granted with the following conditions: (1) No more than three (3) bedrooms are authorized. Dens, study rooms, finished attics, sleeping lofts, and similar type rooms are considered bedrooms according to the MA Department of Environmental Protection. (2) The septic system plan shall be revised to show a "locus map." This permission is granted because it is the Board's policy to grant variances for the construction of three (3) bedroom dwellings on lots of 18,000 square feet or greater. This lot is 20,030 square feet. Also, the proposed septic system meets all of the provisions of the State Environmental Code, Title V. It is the opinion of this Board that the construction of one septic system which meets all of the provisions of the State Environmental Code, should not significantly alter the quality of the groundwater in this area. Sincerely yours, Susan G. R` -,YK, R.S. Chairperson Board of Health Town of Barnstable SGR/bcs doyle TOP FOUND. EL $•5� GENERAL CONSTRUCTION NOTES rj 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. - INV. EL 4S•3 3c." N1a� �.oft�rL Otr�g- S*�5,-'ttv\ �Qn,ariZ'S 2. AT LEAST ONE ACCESS PORT OVER TANK TEES SHALL BE ACCESSIBLE Flow LINEWIHITHIN SIX INCHES OF FINISH GRADE WITH ANY REMAINING ACCESS INV. EL 10" MIN. PORTS BROUGHT TO WITHIN TWELVE INCHES OF FINISH GRADE. _G4, WATER TIGHT COVER 10' MIN. q' Liam I�EP'IN 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF LEVEL WIITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' 2" MIN. - 1/8" TO 1/2" WASHED STONE OF DRIVES OR PARKING. H-20 LOADNG SHALL BE USED UNDER OR WITHIN INV. EL Z.sl Iriv »a �` t 4,-L 10' OF DRIVES OR PARKING UNLESS NOTED. 4. THE L A110 ALL THE EXCAVATOR/CONTRACTOR 5HALl:' VERIFY OC N �F MIN. 6 I SUMP ' INFILTRATOR 2 SITE U11LI11ES PRIOR TO ANY EXCA\MION. 1500 GALLON PRECAST REINFORCED CONCRETE SEPTIC TANK 3/a" - 1 1/2 WASHED STONE EFT. DEPTH 5. SEWER PIPES SHALL BE 4" SCHEDULE 40 PVC LAID AT 0.02 SLOPE. INV. EL �$. S' \0 coz -z 6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE INV. EL. co4.3 MINIMUM CONSTRUCTION MATERIALS PER'310CFMR 15.226(2) BE CONSTRUCTED OF SCHEDULE 40 PVC AND S.A.S. s 3O'LONG x t O, MORTARED IN PLACE. WIDE x Z EFF. DEPTH TEES SHALL WITH 5,A1 HIGH CAPACITY INFILTRATOR CHAMBERS SHALL EXTEND A MINIMUM OF 6" ABOVE THE FLOW LINE PRECAST REINFORCED CONCRETE 7. RINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FEET PER FOOT. OF THE SEPTIC TANK AND BE ON THE CENTERUNE OF THE DISTRIBUTION BOX W1 SEPTIC TANK LOCATED DIRECTLY UNDER THE CLEAN-OUT . r MANHOLE. THE INLET-PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR INSTALL ON A LEVEL BASE MORE THAN 3" ABOVE THE INVERT ELEVATION OF THE MINIMUM WALL THICKNESS = 2" / OUTLET PIPE MINIMUM INSIDE DIMENSION 12" SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE OUTLET INVERTS SHALL BE EQUAL TO EACH / ON A LEVEL. STABLE BASE THAT HAS BEEN MECHANICALLY OTHER AND AT 2" MINIMUM BELOW INLET INVERT. COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE � �t v HAS BEEN PLACED TO ENSURE STABILITY AND TO PREVENT THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX �r / -- SETTLING. SHALL ALL HAVE EQUAL INVERTS AS DETERMINED BY FLOODING SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9". THE DISTRIBUTION BOX TO THE HEIGHT of THE DISTRIBUTION �`? - LINE INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE. �q INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE THREE 20` MANHOLES WITH READILY REMOVABLE IMPERMEABLE AND NON-DEFORMABLE MATERIAL PERMANENTLY FASTEND TO THE �04�� 66 COVERS OF DURABLE MATERIAL SHALL BE PROVIDED MATH ACCESS LINE OR RECONSTRUCTING THE LINES UNTIL ALL INVERTS ARE OF THE CENTER AND OVER THE INLET AND EQUAL ELEVATION. PORTS BEING PLACED AT I OUTLET TEES. rr T 1 THE OUTLET TEE SHALL BE EQUIPPED WITH GAS BAFFLE L A � I -... R. Hee. /• LO T 8 20,030 sq.ft. .yo • � V 67 ' 0 JI 66- X- Lr ' ' 150' Fro �-L ">• i 56 �� ;; 67Al a m 809 Dtt �� ` _ Q ,? ch �.,, ;a4 n2 oQ �e S Propoaied. � • / �f Driv(ewayt F CB W/DH / "C10.40!a . ZsoO C,aa-Taexx ,� • FOUND IN .----- /O �� . v. •` �p0 68 CENTER STONES ° ° / x 668.13 ZONING DISTRICT: RF REFERENCE MAP: �-� O� \ SOIL OBSERVATION DATA: ' � �38Z- -,, L _, . 1 OVERLAY DISTRICT: GROUNDWATER PROTECTION \ Ile BUILDING SETBACKS: CAPE COD 0'� ' \ -------- L=31.06� WATER TABLE CONTOURS p R=25A FRONT. 30 AND �s `o � 'r'/ 's• 1 g eP SIDE & REAR 15' PUBLIC WATER SUPPLY TEST DATE 3-S- `t9 WELIJ iEAD PROTECTION AREA'S DESIGN DATA: �� FEME DATA Rsr• , S. . SEPTEMBER 1995 ' \ M „ SOIL EVALUATOR �� - STRUCTURE �v,t�.1U L� _ 67 �, L/ FLOOD ZONE C PANEL 250001 0015 C WATER RESOURCES OFFICE B.O.H. AGENT ��W.1A CAPE COD COMMISSION TYPE NO. BEDROOMS GARBAGE DISPOSAL �` (MAP REV: AUG. 19, 19'85) �2. 44 \ x'67.24 EXCAVATOR �.a�-Tv CpN t r=L,-A0,- d1Couv"Vv f��wg- DESIGN FLOW 3x \10 = 's3u 1LI=o ��i�\ 66 - - - - - - - - Mo �/? �I sa �Q° - ----- ASSESSORS DATA: 1tJ� 7 �c ,- MAP 125 PARCEL 16 PERC/RATE Z Zl��a• �r��1� 1 O X Z'b '- 3Q0 66� i� m / REFERENCE PLAN: BOOK 244 PAGE 153 �. c.4.c►� 1� SCEPTIC TANK 33� � zo0 � C-GD 1l s1 . 1S o0 �.aWL�bla `S` 1 � � 15ct. v4�`I�o � � o \o R z z , sL %QITZ -silt I, GRAPHIC SCALE Rey°�A. \\ sToi`s7_ y APPLICANT. Y EW CORP sL �� y / \"z 1Z LEACHING FACILITY o'�►� �. '30`� x Z r Dt>� F��T'rtATG\"L \� P 41 BLANTYRE AVE 20 o 10 so �' eo F ! \\ CENTERVILLE, MA 02632 �5 10.`ITC L/(. LS \O �It fo( �' y'`` / '1 s7` ��Y` `�`ti SITE FLAN OF LAND IN a�'t ( IN FEET ) \ �\\ Z.� -,/4 F1ur� K� Z 1 h/� >< Inch 20 I ' 66 `'k 66.75 MARS TO NS MILLS — BARNS TABLE, MA "� P I-,AN _N=]W BEING LOT 8, MOUNTWOOD ROAD PREPARED FOR: `ist . ss•ti� LPL SS•g, � A�'r.1.q alp #hk 6 itt r.. �. /� ``\ -��• OF B.M.: TOP HYD. WILua1,t 1f Q c: SPINDLE EL 68.84 Date: April 7, 1999 Scale: As Shown o' LIEBEF1PAA J DATUM: NGVD ' 4 N ,i /STD / y Prepared By: hen J. le and Associates 42 Canterbury Lane, EatstoFalmouth, MAssachusetts 02536 Telephone: 508/540-2534 I � � �s _yr'_S� ri-I M 1=> 1=?, C) ]ET-1 1 _VNF r-F .,, TOP FOUND. Et.. C.$•5� GENERAL CONSTRUCTION NOTES 1.. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 - AND THE TOWN OF RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SESNAGE. INV. EL. G► •3 ` 3 ....;.-,Vq\ ,.::_.C.o�lc�+2. c t t: : .SictT l+1 C.a�M 'c NTS s -----� FLOW LINE 2:. AT LEAST ONE ACCESS PORT OVER TANK TEES SHALL BE ACCESSIBLE WHITHIN SIX INCHES OF FINISH GRADE WITH ANY REMAINING ACCESS INV. EL. PORTS BROUGHT TO WITHIN TWELVE INCHES OF FINISH GRADE. WATER 'nWT COVER 10' MIN. �'UanO oEPm 1. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' LEVEL 2" MIN. — 1/8" TO 1/2" WASHED STONE OF DRIVES OR PARKING. H-20 LOADING SHALL BE USED UNDER OR WITHIN INV. EL. [.S•O Ihy, %N r.`, Gq,-Z 10 OF DRIVES OR PARKING UNLESS NOTED. 4,. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF ALL MIN. 6` SUMP INFILTRATOR 2, SITE UTILITIES PRIOR TO ANY EXCAVATION. 1500 GALLON PRECAST REINFORCED CONCRETE SEPTIC TANK 3/4" — t 1/2 WASHED STONE EFF' DEPTH 5;. SEWER iPIPES SHALL BE 4" SCHEDULE 40 PVC LAID AT 0.02 SLOPE. INV. EL. 4-4• S INV. EL. (e4 3 6» ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MINIMUM CONSTRUCTION MATERIALS PER 310CMR 15.226(2) MORTARED IN PLACE. TEES SHALL 8E CONSTRUCTED OF SCHEDULE 40 PVC AND S.A.S. SO LONG x D_WIDE x Z�EFF. DEPTH SHALL EXTEND A MINIMUM of s aeovE THE Flow LINE PRECAST REINFORCED CONCRETE WITH 5, 1 HIGH CAPACITY INFILTRATOR CHAMBERS 7. FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FEET PER FOOT. OF THE SEPTIC TANK AND BE ON THE CENTERUNE OF THE DISTRIBUTION BOX SEPTIC TANK LOCATED DIRECTLY UNDER THE CLEAN—OUT MANHOLE. ; THE INLET-PIPE ELEVATION SHALL BE No LESS THAN 2" NOR INSTALL ON A LEVEL BASE MORE THAN 3" ABOVE THE INVERT ELEVATION OF THE MINIMUM WALL THICKNESS 2" OUTLET PIPE. MINIMUM INSIDE DIMENSION = 12" SEPTIC TANK SHALL BE INSTALLED LEVEL AND TRUE TO GRADE OUTLET INVERTS SHALL BE EQUAL TO EACH ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY OTHER AND AT 2" MINIMUM BELOW INLET INVERT. COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO ENSURE STABILITY AND TO PREVENT THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX i`L.S'h•Z SETTLING. SHALL ALL HAVE EQUAL INVERTS AS DETERMINED BY FLOODING SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 THE DISTRIBUTION BOX TO THE HEIGHT OF THE DISTRIBUTION LINE INVERT AFTER ALL LINES HAVE BEEN SEALED IN PLACE. INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE THREE 20 MANHOLES WITH READILY REMOVABLE IMPERMEABLE AND NON—DEFORMABLE MATERIAL PERMANENTLY FASTEND TO THE 66 COVERS OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS LINE OR RECONSTRUCTING THE LINES UN11L ALL INVERTS ARE OF PORTS BEING PLACED AT THE CENTER AND OVER THE INLET AND EQUAL ELEVATION. OUTLET TEES. 1 THE OUTLET TEE SHALL BE EQUIPPED WITH GAS BAFFLE •O 1 � Exist. 4 Has. r Lo rr / y _ 20,030 sq.it. 617 Lr .• ,�� .From gag Ditch � ,y6 ey � ' '+' . .,` � � 67 � N, \ .QS°. '�'• t', Proposed \ , , i .4 DjrivewatK y t CB W/DH g FOUND IN f0 � z ,- /68 CENTER STONES _ _ • to ° 4 68,13 ZONING DISTRICT: RF --- REFERENCE MAP: N eP SOIL OBSERVATION DATA: oS OVERLAY DISTRICT: GROUNDWATER PROTECTION � µ ... ,.• 68,. CAPE COD p I 6 / / WATER TABLE CONTOURS �`�.M - -�, L�31� -' 6/ BUILDING SETBACKS' m� I 4 ,f- ---- -«.67.___ R=.Z5Ao'- ' FRONT: 30' AND -••= a /srnc 's• ' SIDE & REAR 15' TEST DATE PUBLIC WATER SUPPLY DESIGN DATA:3-`�- `l9 WELLHEAD PROTECTION AREAS /sl �� 6p �' � �� '� � FEME DATA: ' FLOOD ZONE "C" PANEL 250001 0015 C SEPTEMBER lass SOIL EVALUATOR _ s• �� STRUCTURE Ste•- +1�,t-1.t,-11�, � � 67 . :� +c•� B.O.H. AGENT ��t��A WA APE ix M CESaa� TYPE - NO. BEDROOMS GARBAGE DISPOSAL �' (MAP REV AUG. 19, 1986) v� 1 x 67.24 . EXCAVATOR �a�-'Cu ��1 } 1�1..1►��' yttout��r�ti- tL DESIGN FLOW lox, 1\O " 's3C7 .� LA3 — — — — b ? -------- � } t 66 — — �' ' ��,,' AQ° ASSESSORS 12 DPARCEL 16 PERC/RATE LtiN C►a�l� toxa = `moo O �. O;1A'4 b 4F'b � S\(�W,1~> \66 \g '� REFERENCE PLAN: BOOK 244 PAGE 153 V6•�� of SEPTIC TANK 330 "j. Zo IJ/. ._ L 40 lase ;vQ _ �,.�., S Aj 1 { + APPLICANT: s�. A�E �oyR 3/2 ,+ sL /� �oytc 'zfZ a GRAPHIC SCALI_'', y0. �� &7:�1�67 , ; BAY VIEW CORP •� 12 LEACHING FACILITY �t Zo ''� �� ' ea 41 BLANTYRE AVE A H 1� IM \O \� x 30 \ x �.S.�Fi �s 20 0 10 20 40 BO F i Io.yyt ��4 Le, `{tt b L �.�,,� ` �� clze�\ tR_S d CENTERVILLE, MA 02632 , �,� a ,t 3� ' 67 '`,0 I T E PLAN C) F LAN I� iur= x� z 51 h/4 i incsh = zo tt. '66 �'lx 66.75 MARS TQ NS MILLS — B ARNS TA BLE, MA P LAN VIEW BEING LOT 8, MOUNTWOOD ROAD PREPARED FOR: tH of`"��s 1A OF IE3 A-"Y— V 3C = -N/\T <=> T�. T=�' .. � s,�c o� ��.GISTFR fi7 OyG o� tiG STEJFIEN B.M.: TOP HYD. WILLIAM �� 130YL>~ SPINDLE EL. 68,84 Date: April 7, 1999 Scale: As Shown p LIEBERMAN y, DATUM: NGVD tau. zs9i No.37559 STEP�'4``�"� SSti��4Q �'�� Su�� y Prepared By: A/1 Stephen J. Doyle and Associates 42 Canterbury Lane, East Falmouth, MAssachusette 02636 Telephone: 508/540—2534 a. _