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0277 MARSTONS LANE - Health
277 Marstons Lane , Barnstable A = 349 - 077 l P No. 4210 1/3 BLU ESS E LTE 10®/0 O ® 0 0 �,��) a�� ��� ���� � � � 3C�� kJ�P�P4Q C� ✓/w- o Y�r9� TOWN OF BARNSTABLE JF,OCATION�'j7 ,, � � La SEWAGE# / VILLAGE C�a,�,4, 4A ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1�,n � / P P• LEACHING FACILITY:(type) (size) �� f� • �NO.OF BEDROOMS OWNER PERMIT DATE: Z—ii-lC-, COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ; Feet FURNISHED BY Z6-4 rlt 3s' 77 G No. / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for Disposal 6pstrm Construction 3pPrmit Application for a Permit to Construct( ) Repair(k� Upgrade( ) Abandon( ) complete System ❑Individual Components Location Address or Lot No.vZ7 {-�cr'S aS Can Lner's Name,Address,and Tel.No. ` /7 ' Scl� Co r) 0 a 7�"Mar-slbn 5 44Assessor's Map/Parcel 3U9 �7 fY1'1 4 U4 0243,) Installer's Name,Address,and Tel.No. ,bD - �a� Designer's Name,Address,and Tel.No. v�' S� c 1 e 00 S�-(t� �18�rt� �� b, i• Type of Building: ? DwellingNo.of Bedrooms ✓ Lot Size 36�g� �— sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 U gpd Design flow provided 3 51Y gpd Plan Date �a�la)!t_a/ , ���/tom Number of sheets ' a Revision Date Title ?� � �'�'>K-O CCdt �1- 2 97 es L )S LfJ C0_9=X-!6L< Size of Septic Tank 46-001al Type of S.A.S. jI) Description of Soil�� fa7 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and mainten of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmenta ode a not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. i ed Date _ 11111o, Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued -•, Fee NO.l (0 I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Vsposal 6pstem ConitrUction Permit Application for a Permit to Construct( ) Repair(k) Upgrade( )?Abandon( ) Complete System ❑Individual Components Location Address or Lot No.oZ 7 7 NA1-6�IsCeR n Wner,sName,' Address,and Tel.No.�r, .('c- on or a ), rNa rsFons e i Assessor's Map/Parcel 34q A77 CvmmQ GCGdV14 OA439 Installer's Name,Address,and el.No. $ a4'' Designer's Name,Address,and Tel.No. 1(�040(otti C?o S{ rcz -(���ne" ,c�cLv� �n i�t�r:oj, nC ?3g';06P' Ys:�J" nl a"s »S i is M4 0, A off, Type of Building: I/ Dwelling No.of Bedrooms 3 Lot Size 36199 G sq.ft. Garbage Grinder( ) Other Type'of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .3 3 U gpd Design flow provided 3 7/ gpd Plan Date �t. e?l , �Q/�o Number of sheets // Revision Date n Title!- #6 Size of Septic Tank /5A©iQ Q /.]►U / Type of S.A.S. o! f/ojan5 11� aS�X /')l�,3y Description of Soil� C 5o e_1 Wes? J b 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 of Title 5 of the Environments)-Cod's e and not to place the system;in operation until a Certificate of Compliance has been issued by this Board of Health, Signed , .- w, - ",-" �_ Date Application Approved by /�f/9 /I ( 1 / --L' Date Application Disapproved by p Date for the following reasons ' ! . �k Permit No. /: Date Issued / - �! l i THE COMMONWEALTH'OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Se sal system Constructed( ) Repaired(�C) Upgraded( ) Abandoned( )by`` r i C� " a n s'T7Z�G-1'yd1'� --Z e.. at 7 7 Q e"5-6 S L• Ct has been cons cted in act r ' c with the provisions of Title 5 and the for Dis osal System Construction Permit No. / ted -7/' /V ' - Installer or Ij�JS?Y(x /6h� yj G j Designer , ! Cam►'/l�l C #bedrooms Approved design flo gpd The issuance of is permit shall not be construed as a guarantee that the system wil func ibrl as des i ed. Date a Inspector , ----------�V I Y-- lG - - ��; No. i Fee 702 `� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction i3ermit Permission is hereby granted to Construct ) /Repair( ) Upgrade( ) Abandon( �System located at /,7 All e Q � and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons f'&njust be completed within three years of the date of this permit. Date , Approved by AUG-31-2016 23:38 From: To:15087906304 Paee:1,'1 FROM : FAN 1.10 ; ALL.s. 31 '30z6 10:.31AM P1 Se ' T ilQomm F.G'cd.4d=,DillMiDT ��br:a�i '�'�oa?>i'm�n 1p"1'��G.n:a.�,l�iu;�c�d�P• ' �p��n�5'�t•r.�N R����i�,I�ilf�n.i1:G�0�. ; C};�ir..r.: SQL••=62-��4 . ' i�gu: 1�R••7a0-G30� I it r�Rs. ate.bS mays, a� �ifia b 7£' Deco V-5 � Sewage I Plr iw 1d 6!/, J)sogner. c_IJC� K.�to e t[ln as id.a pF, zt to;aspt��a (date) /� Cc►w,r►��ba:sod�s.d,esi.�dza�a.b�` / T,Cf `f �„t th?x�'p .c sy+ ri�l aefiFJcnA ra rrcr. cbz�.• s b t n d�sli, wio�l.m. 3nrl,�d;,r1#sioi a3g�. ,c -�. ,,lafe;�lrolac�tso .a � l� diffh bWi.on box s)1410r s tip G Y re tifp flzdt tlics se t syst��r�.rafc enre� ;�buVF f1L 11,aa With)^aajax ahax),�AS i Q' �,r,al.r.Plocatio.�s.�-tli rh5 nr @n V'L-,Lh.c6l1.rf�OCutii:n CtiT ns]y C�iL� ;c13t�fiT • gzr:.:�d;'t�:c�1. - �'tsai;e �4��oc�i,T.t��ul��.nn.^:. I�it�).r.rr1g1rr-l.Or . : . pf'(]fin Se�6,C;7Ys'tt✓nq��fr}t 71'1,flt;r:8]'Cl,'3UCe*NS:f+�.�:+ • � , r 4zt,ie t-b`ta71t u icllar- ; ' .. r• �NC.�FMgS,c DANIELA. df Q.IALA i �Cfts 9 ��afi, �) " CIVILo Mr„-485U2 k L IONA L _ - �`,',, :€3�''§' h. 7'(� � �� ',�-- t 1'+l�f �,.Cds! .,3.7`•„4��. C� cup . • 6'�3:1�$1iti� •,��.� ��- _"— gG]Fd. '�}_ Cif 1, o✓ Ash - _ -.. _� _.. e .�; ...i,. �"; 9 — �/� `"� b�° � v l � _+ f TOWN OF BARNSTABLE LOCATION �""s ''.5 �" SEWAGE VILLAGE ���'^�"^ _- ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) / (size) x6 NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ,� o Feet Furnished by �'�i�,0, s (� `" ! L L 9 �h Lt �± 4 91 o� Town of Barnstable P# (�W, sDLepartment�of Hea'Ith,Safety,�an'diEnvirontnen,ta'1'Serveces+;`,,, a r i'�Ek i aF l tw F'# ,s?t.I PublicM,16hith Diiis><"o,n Date 367 Main Street,Hyannis MA#02601r a►nxarearE d clad, rE03 Date Scheduled ` Time tl t^'' Fee Pod. . Fail Suitability Assess�raent,f®r ,Seiva le DIs vsat -7 Performed By: Ca of Witnessed By:, t4 _ ✓ , ( 'X. :. .:.:.,:.{,:....,:;: v,;',;:.:::::.,,;,:;•:..�..,..i�'.' �.:.y<:`..`•>}a......'ii i i ?2''' i i ii`fi?` 2%?! ::..............::.::.:_:::::::::........ ......::::::... Location Address c�77 Owner's Name E Addressl f�r. rr i G' Assessor's Map/Parcel: 3 t f 9 r'f. t �+ Enguieer Fs;Name NEW CONSTRUCTION REPAIR Telephone 961 e 36,( 4-YY F' Land Use Slopes(°/.)" �'� �G Surface-Stones , Y. w,!f, ��`t , Distances from: Open Water Body�ft Possible Wet Areat�L..1 ft Drinking Water Well Drainage Way t G� ft Property Line ft Other ft SKETCH:(Street name,di' ensions t;exact locations of test holes&perc tests,locate wetlands in proximity to holes) + s � V .:,���.p i Parent material(geologic) a v. Depth,to Bedrock Mr_.a � Depth to Groundwater: Standing Water in Hole: W.eeping.from Pit Face t Estimated Seasonal Higkfjroundwater .....................::::::. :. :.'; .. .. ;. . .: .;.': ;i <.. - :: .V. : :'. :`i::ici::.: . ., ..,:..•`.l'•I:��, '•`. `< >:.iiii`iiii �i%'%% •Method•tJsed:"'.. . t���......................... Depth.Observed standing in obs.hole: in. Depth.to`:soillnibttles: ' Depth to weeping from side of obs.hole: in. Groundwater Adjustment • Index Well# _,_ •Reading Dace:_•___ Index Well level,••_' Adie'factorxx "'M'` "Adj Groundwater Level_ Trbd .:::.::;.:.............. Observation Hole:#' , ,r Time,at,9'ur �__ Time at 6 Depth of Perc • Start Pre-soak Time® 101101 End Pre-soak �f�a�fa Wit{• it Rate Min./Inch G � --- . ->`. _ 3i. • Site'StiitabilityAssessment: `Site'Passed••• +� r{+ �Site;F^ailed:sRsta,;.;, -,;.+-AdditionaIrTesting•Needed,(Y/N) -+ 4. Original: Public Health Division ' Observation Hole Data To Be-Oompleted on`Back Copy: Applicant •o ;tI S::i•:;::<P•:::d;:i:i::i': i..... '^;:::::::i:::..`<i,•'::; Depth from Soil Horizon Soil�Tewturet~ 1 3*i,Soil;Color;!, t," Soil Other Surface(in.) (USDA), ,, (Munsell) Mottling (Structure,Stones,Boulderes. u ►, • !�.,i� �'++;4 *�,i�Zr..`�'$ !'4, `;.a ( �ii'�r�t�,'��.:?`;f J 4a1�'1�y4�. � jc i i i ti54,.,`.3_ Depth from Soil Horizon Soil Texture Soil Color Soil Other "Surface(in.) (USDA)' (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel) s j F---------------- ;,t'{;j:';:::' >:';':<:'::;::i�::t::;:: j:.. <:::`": '> :i2;::•':i::2:5:::::i::::::i'r'�i:i::i:'':i{ii:::::`i:i::i:::2:3: Depth from Soil Horizon Soil Texture Soil Color I Soil Other Suliface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistcnpy.% el -EM .A:TxO .. ..... ,Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistencv.% ravel) io°odd'nsu�aeec'e Ra`E'e 1VIan^ t ;z , # i P& Above 500 year tlood2boundary,r No_ Yes Within;500 year:boundary No X Yes d withinl0'Oyea""flodbriall000 Da nth of Naturally Occurring Pervious Material Roes at least four feet-of naturally occurring pervious aterial exist in all areas observed throughout the area proposed for the soil absorption system? Itnot,what is the depth of naturally occurring pervious material? Certification I reify that.on (il'ate)I have passed the soil evaluator examination approved by the ° bpartmenY ofEirvironinental,-�Protection_and.that the-above analysis was.performed byame consistent.with the required training,expertise and experience-described in 310 CMR 15.017. Signature Date jz� � 1 oFZME Tic,, Town of Barnstable Barnstable ti Regulatory Services Department AHmerccaC j BARNSTABM MAS& g i639. ,m Public Health Division. FDs 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1520 0000 1968 9651 June 21, 2016 Patricia Connor P.O. Box 15 Cummaquid, MA 02637 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 277 Marstons Lane Barnstable,MA was inspected on 05/25/2016 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below inlet (per Town Code 360-9.1). You are ordered to repair or replace the septic system within Two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH T Oz Coe an,R.S., CHO Agent of the Board of Health - Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\277 Marstons Lane Bamstable.doc ; Town of Barnstable snxivsr�er,e. Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO S i a Feb 6,2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to,clogged or obstructed pipe ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS,cesspool, or privy below High groundwater elevation - ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no " acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) r Leaching pit or cesspool with high liquidlevel, <12" below inlet(per Town Code §360-0.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town • Code §360-20 h) OTHER . Repair deadline: 0:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Parcel Detail Page 1 of 3 a Logged In As: Parcel Detail Monday,June 20 2016 Parcel Lookup Parcel Info Parcel ID 349-077 I oevelopot LOT 167 I Location 1277 MARSTONS LANE I Pri Frontage 1154 f Sec Road IWINGFOOT DRIVE I Sec Frontage 215 I Village Barnstable Fire District BARNSTABLE Town sewer exists at this address NO .�_M.rl Road Index 10989 I Asbuilt Septic Scan: si Interactive t xti w 349077_1f ? I Map 349077 2 "it . Owner Info Owner ICONNOR, PATRICIA M I co-owner Streetl IP O BOX 15,277 MARSTONS LN I Streetz II city rCUMMAQUID state PA zip 102637 country Land Info Acres 0.85 use'Single Fam MDL-01 Zoning{RF-1 I Nghbd 10108� Topography Level Road jPaved Utilities IPublic Water,Gas,Septic Location I Construction Info Building 1 of 1 Year 1972 I Roof Gable/Hip I Ezt Wood Shingle Built Struct Wall Living Roof AC ....� Area 1732 I Cover Wood Shingle Type Central t0 FHS, - Style Cape Cod ( wall Plastered Rooms Bed Bedrooms 9 °K z Model Residential I Floor Hardwood I R oms 22 FUII-0 Half I Z" z+ Total GAR 1 6 @ T BA5 Grade Average Plus Type Heat Hot Air I Rooms 7 Rooms uar w Zt 3 F v 26 Stories 1 1/2 Fuel$tories L Heat Gas -"""'"'I Found {pOUred COI1C. I :2761 ation�` Gross Area 5448_� ' - Permit Histo " Issue Date Purpose Permit# Amount [63 p Date Comments 12/2/2010 New Roof 201006543 112,000 0/2011 12:00:00 AM REROOF STRIPPING OLD 4ttp:Hissgl2/intrariet/propdata/ParcelDetail.aspx?ID=28708 6/20/2016 Parcel Detail Page 2 of 3 II 12/4/1998 I Remodel 135193 I$20,000 18/1/2000 12:00:00 AM I II Visit History Date Who Purpose 3/19/2015 12:00:00 AM Susan Ricci Cycl Insp Comp 12/22/2014 12:00:00 AM Anne Leonelli In Office Review 12/13/2013 12:00:00 AM Jeff Rudziak Sale Review 7/11/2013 12:00:00 AM Denise Radley In Office Review 3/27/2012 12:00:00 AM Denise Radley In Office Review 11/13/2000 12:00:00 AM Paul Talbot Meas/Listed-Interior Access 8/1 511993 12:00:00 AM ME I Meas/Est Sales History Line Sale Date Owner Book/Page Sale Price 1 11/24/1997 CONNOR,PATRICIA M 11077/200 $164,500 2 11/24/1997 CLANCY,FRANK W ESTATE OF 1 1 077/1 98 $0 3 11/24/1997 CLANCY,FRANK W 11077/197 $0 4 5/19/1971 CLANCY,FRANK W&MARION G 1511/48 $0 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2016 $158,700 $52,500 $3,800 $224,300 $439,300 2 2015 $156,900 $51,600 $4,800 $226,000 $439,300 3 2014 $159,100 $51,600 $5,500 $189,300 $405,500 4 2013 $159,100 $51,600 $5,700 $199,100 $415,500 5 2012 $162,600 $50,200 $4,400 $189,300 $406,500 6 2011 $200,900 $7,100 $0 $189,300 $397,300 7 2010 $200,500 $7,100 $0 $183,200 $390,800 8 2009 $249,500 $5,200 $0 $193,300 $448,000 9 2008 $271,800 $5,200 $0 $206,900 $483,900 11 2007 $292,000 $5,200 $0 $206,900 $504,100 12 2006 $293,200 $5,200 $0 $226,200 $524,600 13 2005 $264,800 $5,100 $0 $208,100 $478,000 14 2004 $216,500 $5,100 $0 $226,200 $447,800 15 2003 $206,800 $5,100 $0 $111,000 $322,900 16 2002 $206,800 $5,100 $0 $111,000 $322,900 17 2001 $212,900 $5,400 $0 $111,000 $329,300 18 2000 $139,400 $2,500 $0 $90,800 $232,700 19 1999 $139,400 $2,500 $0 $90,800 $232,700 20 1998 $139,400 $2,500 $0 $90,800 $232,700 21 1997 $138,900 $0 $0 $62,500 $201,400 22 1996 $138,900 $0 $0 $62,500 $201,400 23 1995 $138,900 $0 $0 $62,500 $201,400 24 1994 $116,400 $0 $0 $105,100 $221,500 25 1993 $116,400 $0 $0 $105,100 $221,500 26 1992 $140,500 $0 $0 $125,100 $265,600 27 1991 $155,100 $0 $0 $139,000 $294,100 28 1990 $155,100 $0 $0 $139,000 $294,100 29 1989 $198,000 $0 $0 $139,000 $337,000 30 1988 $110,600 $0 $0 $51,600 $162,200 31 1987 $110,600 $0 $0 $51,600 $162,200 32 1986 $110,600 $0 $0 $51,600 $162,200 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=28708 6/20/2016 Commonwealth of Massachusetts W Title 5 Official Inspection , Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 277 Marstons In C 1M . Property Address L CONNOR, PATRICIA M _ Owner Owner's Name information is required for every Cummaquid ✓ Ma 02637 5/25/16 s page. City/Town State Zip Code Date of lnspecbbi .ly Inspection results must be submitted on this form. Inspection forms may not be a~red in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information �# //�� , on the computer, !/ ((/ use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain ,y Company Name 8 Johns path Company Address S Yarmouth Ma 02664 City/Town State Zip Code 508-364-9587 S103522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails El Needs Further Evaluation b #e Local Approving Authority 5/30/16 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 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 . �� Vs Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -277 Marstons In Property Address .CONNOR, PATRICIA M Owner 'Owner's Name information is required for every Cummaquid Ma 02637 5/25/16 page. `City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) 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: System fails by state requirments of 12" seperation in pit. Baffle on outlet side of tank has rotted off. Liquid level is within 6" of invert pipe 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 ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 277 Marstons In Property Address CONNOR, PATRICIA M Owner Owner's Name information is Cumma uid Ma 02637 5/25/16 required for every q _ page. City/Town State Zip Code Date of Inspection B. Certification (cone.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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: y ❑ 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•3/13 - - 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 277 Marstons In a Property Address CONNOR, PATRICIA M Owner Owner's Name information is required for every Cummaquid Ma 02637 5/25/16 page. City/Town State Zip Code Date of Inspection 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 aseptic 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. 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 6" below invert or available volume is less than 'h day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 277 Marstons In Property Address CONNOR, PATRICIA M Owner Owner's Name information is Cumma uid Ma 02637 5/25/16 required for every q page. Cityrrown State Zip Code Date of Inspection 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. ❑ ® 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 2000gpd7 10,000gpd. ® ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Marstons In 1M Property Address CONNOR, PATRICIA M Owner Owner's Name information is required for every Cummaquid- Ma 02637 5/25/16 page. CitylTown State Zip Code Date of Inspection 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? ® ❑ 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)] D. System Information 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ec°,M 277 Marstons In Property Address CONNOR, PATRICIA M ' Owner Owner's Name information is Cumma uid _ Ma 02637 5/25/16 required for every 4 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: System contains a 1,000 gl septic tank and a 6x6 Leach pit. Level of liquid in leach pit is within 6 inches of invert pipe,and does not meet the minimum state requirement of 12 inches se eration. Number of current residents' 2 Does residence have a garbage grinder? [I Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d 213 Gpd g ( Y 9 (gp ))� Detail System fails laundry not inspected Sump pump? ❑ Yes ® No Last date of occupancy: OccupiedDate 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 Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3I1?. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M a' 277 Marstons In Property Address CONNOR, PATRICIA M Owner Owner's Name information isequired for every Cumma uld Ma 02637 5/25/16 page. City/Town State Zip Code Date of inspection- D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: None provided 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 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): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ^M 277 Marstons In Property Address CONNOR, PATRICIA M Owner Owner's Name information is Cumma uid Ma 02637 5/25/16 required for every q page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 30 + Years Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): 2 Depth below grade: feet Material of construction: 0 cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented throught the roof Septic Tank (locate on site plan): 15 ' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑,fiberglass ❑ polyethylene ❑ other(explain) 1000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 277 Marstons In Property Address CONNOR, PATRICIA M Owner Owner's Name information is required for every Cummaquid Ma 02637 5/25/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 24 Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of leakin ,outlet baffle is missing 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 277 Marstons In Property Address CONNOR, PATRICIA M Owner Owner's Name information is Cumma uid Ma 02637 5/25/16 required for every q page. Cityfrown State, Zip Code Date of Inspection 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.): Outlet baffle has rotted off. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Marstons In Property Address CONNOR, PATRICIA M Owner Owner's Name information is Cumma uid Ma 02637 5/25/16 required for every q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Na 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.): 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. Soil Absorption System (SAS) (locate on site plan, excavation not required).- If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Marstons.ln M Property Address CONNOR, PATRICIA M Owner Owner's Name information is Cumma uid Ma 02637 5/25/16 required for every q page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): Liquid level in pit is within 6 inches of invert pipe 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts 5 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Marstons In Property Address CONNOR, PATRICIA M Owner Owner's Name information is required for every Cummaguid Ma 02637 5/25/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): No ponding no break out as of yet 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.)-. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 6/9/2016 Assessing As-Built Cards TOWN OF/BARNSTABLE �' 0 LOCATION �` � L rS TD1 5 (.�. SEWAGE VILLAGE �J t^-✓+^.z- 9 d• ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC'TANK CAPACITY LEACHING FACILITY:(type) t (size) NC.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ` C� 77 Feet Furnished by ✓.�h,, , U /— 1 In http://www.townofbarnstabl e.us/Assessi ng/H M display.asp?mappar=349077&seq=2 1/2 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Marstons In M Property Address CONNOR, PATRICIA M Owner Owner's Name information is Cumma uid Ma 02637 5/25/16 required for every 4 page. City/Town State Zip Code Date of Inspection 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 public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t51ns•3/13 Title 5'Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts ' W Title 5 Official Inspection Form fSubsurface Sewage Disposal System Form - Not for Voluntary Assessments M a 277 Marstons In Property Address CONNOR, PATRICIA M Owner Owner's Name required for is every Cumma uid required for eve 4 Ma 02637 5/25/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft 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: To be determined at time of perk test. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 277 Marstons In Property Address CONNOR, PATRICIA M Owner Owner's Name information is required for every Cummaguid Ma 02637 5/25/16 page. Citylrown State Zip Code Date of Inspection 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 ❑ Sketch of Sewage Disposal System.either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 P� - .::_l, Y WILLIAMS9 SEP"TIC INSPECTIONS „w Certified by MA Department of Environmental Protection ✓(/N (505) 5-1500 19 Hummel Drive 'owti, 0 199 South Dennis, MA 02660 � pNSTAB , N ,per fipj (E \ COMMONWEALTH OF MASSACHUSETTS D EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA E p� DEPARTMENT OF ENVIRONMENTAL PROTECTIOi\ , ONE HINTER STREET. BOSTON, MA 02108 617-292-5500 WILLIAM F.VELD TRUDY CORE Govemor Secrctary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A �,/ CERTIFICATION 1 /te a aL s-S '�L1 S L N. W/lrA.— 5 u- to �K v r r�^,^ G C Property Address: 7 Address of Owner: ES l k r - Date of Inspection: 6 (If different) �o tq�+r'�, ,, C-o 1,n Q v Troy Williams 5 Name of Inspector:. y a o o i�r-o a 4— I am a DEP approved sj ern inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: Troy Wi I I iams Septic InsDectio.ns Ste'+� Zy3 Mailing Address: 19 Hummel Drive_, South npnniS, MA 02660 S A , LT Telephone Number: (5II8) 3.8 5=1-3.0-0 66 5,o f CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection: The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: V Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails '^ / q Inspector's Signature: J Date: b /y // 7 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty 30 days of completing this Y Pe PP 8 tY rh'( ) Ys 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: e] SYSTEM CONDITIONALLY PASSES: IV/1 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. Indicate yes,no,or not determined (Y, N,or ND). Describe basis of determination in all instances. If'not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector wiffi a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the Wortd Wide Web: hUpJtW*W.m&gnet.state.ma.us/dep SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ,/� CERTIFICATION (continued) Property Address: .?7 7 /4(Gr S _&11 S (" . Owner: , C I0�a L y Date of Inspection: - /7 /9 A/ BJ SYSTEM CONDITIONALLY PASSES (continued) /Y /, Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: /V/11 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ,A1 CERTIFICATION (continued) Property Address: �7 P 4 Owner: G t a h y Date of Inspection: (" /y D] SYSTEM FAILS: IVIIJ You must indicate ei;!.er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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 6" below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspooF 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 I of a public 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (ravisad 04/25/97) Pag• 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: '? 7 7 �"'� `` L h ' Owner: c- h C y Date of Inspection: 6 /y / /-2 Check if the following have been done: You must indicate cate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates. during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. A'/I As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. _V/ _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material•of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _✓ _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of / Sub-Surface Disposal System. 1/ Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)j i (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7 7 Al a e-S )-b`` s L-�^ Owner: C, t G,d— L y Date of Inspection: ' FLOW CONDITIONS RESIDENTIAL: Design flow: 2 o g.p.d./bedroom for S.A.S. Number of bedrooms: Q Number of current residents: Garbage grinder (yes or no):__Y'6S Laundry connected to system (yes or no): y�S Seasonal use (yes or no): 7 if 5 Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no): Last date of occupancy: `c k 4.t"Cf s COMMERCIAUINDUSTRIAL• 019 Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if.available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) A10 If yes, volume pumped: rtallons Reason for pumping: TYPE QF SYSTEM • Septic tan k/dist+"4e"-6sK/soiI absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other PPROXIMATE AGE of all components, date installed (if known) and source of information: y'� ' y ' H w -'-a 4 O �„L Sewage odors detected when arriving at the site: (yes or no)N" (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: '9 7 /14 C�' Owner: C t h Date of Inspection: /y 7 BUILDING SEWER: N/'� (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) �r Depth below grade: lD / Material of construction: ifconcrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: S �X Sludge depth: o " Distance from top of sludge to bottom of outlet tee or baffle: v2 Scum thickness: Distance from top of scum to top of outlet tee or baffle: AN Distance from bottom of scum to bottom of o tlet tee or baffle:°s c-"°�`� How dimensions were determined: ru e Comments: (recommendation for pumping, condition of inlet and oufi let tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) y //P � -{ r ; / J._ c ` r e- t o f e-,JL t.J< r L Ta✓ c� ��. o � o r EA' /o S S o ,C �t ct A c. � ire S c &-4 cf- � fct ! S GrK c lc t ck S t 6 f WQ$S 7�y✓ cif/ri c �f 4 S U /v. .� ri �- y ✓tit u/� S A; c` GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: _ (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2 r/�" ' Owner: C Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order_ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:14 /4 (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:/v///1 (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised O4/25/97) Peg* 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C LL SYSTEM INFORMATION (continued) Property Address: Owner: v c y Date of Inspection: 6 /9 /y -2 / SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. bhc l� X e :�c /,. 7' leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note,condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 4W b j. f c.. ✓�wN ✓^-� 1 L -i 4/ r'L O e� G �a �•� La^t S t rn i U- .S ! ✓L /✓�. S t O I.Jw��✓ <-ti__7- G �.,•. 5 �, b.r ct + < k- CESSPOOLS: _)V14 (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: A /_9 (locate on site plan) Materials of construction: Depth of solids: Dimensions: _ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �w SYSTEM INFORMATION (continued) Property Address: 02 -2 144 "r S.1 L"° 5 L h Owner: `7' Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 13 D5 1° I 1 6� p5 I ' v,,•,f-L, � � 5-fa tot , . (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ``SYSTEM INFORMATION (continued) Property Address: Owner: C ru h L y Date of Inspection: Depth to Groundwater — Feet r adjusted high groundwater level Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) 1v vu. /V C c)-7- c C/ o.% 1-�-.-7/ /I w i f`�/ /r'f h i wf� a kit, d p vL.U(` Dt/p L...., -t V � _. ; s w w 4 (revised 04/25/91) Page 10 of 10 SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES Rt 6A MARKED WITH MAGNETIC TAPE OR (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MEN. 20" DIAM. WATERTIGHT 1. DATUM IS NAVD '88 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE \ �TOP FOUND. EL. 51.0' FILTER FABRIC OVER STONE 2. MUNICIPAL WATER IS EXISTING �J� o 50.0' 2� SLOPE REQUIRED OVER SYSTE 49.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Locus PRECAST H-10 THICKNESS REQUIRED BLOCKS OR UNITS TO BE AASHO H-LQ RISERS (TYP.) PRECAST RISERS s . 2'0 4"�SCH40 PVC MORTAR ALL H-10 ,.: PROP. TEE PIPES LEVEL 1ST 2' I 4, COMPONENTS INV'S FL. 7 4, 5. PIPE JOINTS TO BE MADE WATERTIGHT. oro ENDS 1p�� 1500 GAL H-10 14" SIDES 46.b' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE Poo�oo� ° ;;. f °° °° o ° WITH 310 CMR 15.000 (TITLE 5.) `Y TEE SEPTIC TANK TEE ° ° ° ° ®0�� ®®®® ®®®® -�D�Q� >o�o�o�o� (EXIST) 47.25 47.0 "' ° ° o ° o 0 0 0 0 0 ° ° 7, THIS PLAN IS FOR PROPOSED WORK ONLY AND ° ° ° ° ° ° 6" MIN SUMP a°o°000° ®®®L7®lam®®®�� 00®0®®®®®®® >o,o�o�o� °00000°000°O O ,°o°o°o°o p O O O O O O O O ,o°o°o°o° GAS BAFFLE::: °°°°°o°°°°�, 12° MIN INT. DIM. o°o°o°°° ®®®®ooa®®®a 0®®®®®I���(�0 °°o°°°o° N ;oa000000 ®®�0®®®®®®� 0�00®®®®®®� °oog°o NOT TO BE USED FOR LOT LINE STAKING OR ANY 45.52' 45.35' ° ° ° ° ° ° ° ° 4' LIQ. LEVEL (ACME OR EQUAL) :'; ,o°�°�°�° o°o°o°o° 43.17' OTHER PURPOSE. xit 4' ,go°000°oo°°o°°o°o°o°o°000000000°o°°°°o°°°8;� 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. w DEPTH OF FLOW = °°o°o°oo°°°°°°°°°°°°°°°°°°°°°°°°°°o°o°o°o°ooe n,o,,° o_°_°_�_q.q ° ° o o n e.°_°_°_�_°.° ° 3/4 1-1/2" DOUBLE WASHED STONE 4' MIN.LH-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. Yarmouth m J TEE SIZES: ALL AROUND PRECAST STRUCTURES (7) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR Compground o INLET DEPTH = 10„ 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12,83, CONCEALED WITHOUT INSPECTION BY BOARD OF = 14" COMPACTION. (15.221 [21) HEALTH AND PERMISSION OBTAINED FROM BOARD OUTLET DEPTH ( 2+ % SLOPE) (12+% SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP ( 1 9� SLOPE) CALLING DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & 37.0' BOTTOM TH-2 NOT TO SCALE LEACHING NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF FOUNDATION--- 12' SEPTIC TANK 12' D' BOX 8' WORK. FACILITY *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 349 PARCEL 77 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS SHALL BE REMOVED 5' BENEATH AND AROUND THE PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM ' PROPOSED LEACHING FACILITY. NOTE: PLUMBING IS To BE RE-ROUTED TO EXIT FRONT OF DWELLING AS SHOWN, AT APPROX. INVERT ELEVATION OF 12. EXISTING LEACHING FACILITY SHALL BE PUMPED 48.0't AND REMOVED OR PUMPED AND FILLED WITH CLEAN 00, SAND. LEGEND 99- EXISTING CONTOUR AS X 991 EXIST. SPOT ELEV. 99 PROPOSED CONTOUR 46 N I 198.41 PROPOSED SPOT EL. � T"' �� I TEST HOLE ,, SYSTEM DESIGN: 48 I 2 SLOPE OF GROUND I UTILITY POLE 4"' GARBAGE DISPOSER IS NOT ALLOWED w �_ o c.��ciyF` RHODYS / i DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD FIRE HYDRANT - / _ NOTE USE A 330 GPD DESIGN FLOW : NOT ALL SYMBOLS MAY APPEAR IN DMMNG P EXI G 000 GAL. TANK EXISTING ac TH AN SAND co DWELLING o SHEL DRIVE 6 SEPTIC TANK: 330 GPD (2) = 660 OTE: H A SS - -I - TEST HOLE LOGS TOP FNDN. EL. 51.0' _ --- 2 USE A 1500 GAL. SEPTIC TANK TRI 4" AK 10 2 .5 ENGINEER: CRAIG FERRARI, SE #13871 C), _ RE-ROUTE 2 P 3 LEACHING: N t LUMBING WITNESS: DAVID STANTON, IRSI T 1 I '� SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD 16 20 6 P DATE: / / 000 = --� BOTTOM 25 x 12.83 (.74) = 237 GPD PROP. EXIT v I "'1 PERC. RATE < 2 MIN/INCH _ - - INVERT EL. 2i O TOTAL: 472 S.F. 349 GPD _ I DECK 48.0'f a. CLASS i SOILS P# 15078 s oA 1.2' USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) ELEV. ELEV. R A WITH 4' STONE ALL AROUND 0" 48.5' 0" 48.0' UNDERGROU EGTRIC LINE A GARAGE i ___ ROX. LOCA�ON) s A Asp i MA LS LS Se; ss �, DRIVE' � APPROVED DATE BOARD OF HEALTH 9„ 10YR 5/3 10YR 5/3 12" B B S RHO D S �\ , TITLE 5 SITE PLAN LS LS BENCHMARK: USE CORNER OF a Sg \ CONCRETE APRON, EL. 51.9' \ �� OF 32„ 10YR 6/6 45 8' 36„ 10YR 6/6 45.0' 61 60 `Roc I 51 277 MARSTONS LANE 62 RHODYS I CUMMAQUID 63 cn 6 s NI C C 6sA ss PREPARED FOR PERC 66 S6 LOT r 6 MS MS PATRICIA CONNOR 68 s ', � l 69 , sa �, � �0 5g O (� JUNE 21, 2016 10YR 7/6 10YR 7/6 �� 60 a�4N c1t Mgss9� of M ZN OF MgS�gC �p��N CF MySsgc off 508-362-4541 �� ti fax 508-362-9880 DANIELA.�cyG� ��� D�ANIEI_ iy�m �o DANIF1 GJm OJ downcape.com A_ J L No iVIL A oJALA q OJAIA U, wn cape engineering i/!c. 0.46502 No.40�&{J Ne.40380 132" 37.5' 132" 37.0' 15 2 • 8 1 ' �f. o �p �� �o �;/ �s o ���. �F��, T������ �q� s �NFFS�� ��� civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1 '= 20 WN _ s,o�A� e� .�� �suRv� land surveyors GFQ41-pR�V,,� / 939 Main Street ( Rte 6A) 6- > 88 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA P.E., P.L.S. YARMOUTHPORT MA 02675