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Home My WebLink About0112 HUCKINS NECK ROAD - Health 112 HUCKINS NECK RD. , CENTERVILLE -� FA=252-032 LOT 150 No. 42101/3 ORA ESSELTE � 10% 0 0 0 0 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is Marstons Mills MA 02648 July 19 2012 required for State Zip Code Date of Inspection every page. Cityfrown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out t r forms on the computer,use 1, Inspector: L(� only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address Marstons Mills MA 02648 renen State Zip Code City/Town 508-428-1779 Li n Telephone Number License se Number u 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 ❑ Needs Further Evaluation by the Local Approving Authority July 19 2012 Job# 12-111 WInsectZire—'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. v� dl 5 icial In Form:S bsMtace e e isp�saVstem Page 1 of 17 t5ins•11/10 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is Marstons Mills MA 02648 July 19 2012 required for City/Town State Zip Code Date of Inspection every page. 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: Tank was not in need of pumping at time of inspection. Leaching pit#1 had 2' of effective leaching, it#2 was not opened. 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): IF Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of W t5ins•11110 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is Marstons Mills MA 02648 July 19 2012 required for State Zip Code Date of Inspection every page. City/Town 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of V t5ins-1111110 Commonwealth of Massachusetts r Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is Marstons Mills MA 02648 July 19 2012 required for State Zip Code Date of Inspection every page. City/Town 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 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: r 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 El ® 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_day flow l5ins•11/10 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 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is Marstons Mills MA 02648 July 19 2012 required for State Zip Code Date of Inspection every page. Cityrrown 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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 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•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is Marstons Mills MA 02648 July 19 2012 required for every page. Cityrrown 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? El ® 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): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r I Commonwealth of Massachusetts Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form Not for Voluntary Assessments 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is Marstons Mills MA 02648 July 19 2012 required for State Zip Code Date of Inspection every page. City/Town D. System Information Description: 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No N/A irrigation Water meter readings, if available (last 2 years usage (gpd)): system. Detail: Sump pump? El Yes ® No Currently Last date of occupancy: Occupied. 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: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 t5ins•11/10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is Marstons Mills MA 02648 July 19, 2012 required for every page. Citylrown 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: Tank pumped 2-3 years ago. Was system pumped as part of the inspection? ❑ Yes ® No i If yes, volume pumped: gallons t - How was quantity pumped determined? r . � Reason for pumping: tY_ 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-11/10 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 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is required for Marstons Mills MA 02648 July 19, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed: 10/12/93 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 5' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): < 5' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' long x 5.8'wide- 1500 gal. 21' y Sludge depth: 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 er , t Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is Marstons Mills MA 02648 July 19, 2012 required for every page. Cityrrown 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 30" Scum thickness Trace Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 13" Measured 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.): Liquid level was found at bottom of outlet invert and tees were intact. Y 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 F t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is required for Marstons Mills MA 02648 July 19, 2012 every page. Citylrown 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.): 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 l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is required for Marstons Mills MA 02648 July 19, 2012 every page. Cityrrown 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high stains present. Liquid level was found at outlet pipes. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No f 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•11110 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 µ 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is required for Marstons Mills MA 02648 July 19, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: Two 6x6 pits. ❑ 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#1 was 2' below inlet pipe with no high stains. Pit#2 was not opened. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is required for Marstons Mills MA 02648 July 19, 2012 every page. Cityfrown 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.): 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.): l5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 474 Mistic Drive --_ Property Address -------...--------------------------- --- David Munsell Owner Owner's Name -- ----------------------------- information is Marstons Mills MA 02648 July 19, 2012 required for - ------..-----_- - every 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 \ \ \ \ \ \ \ \ \ \ \ \ \4/ /1% \ \ \ \ \ \/ / / / / ! / / / I ! / / / / / / / J\ \ \ \ \ \ \ \ \ \ \ \ \ \ N. / / / /11 Back 41 53 Outlet cover under 64 hatch in walkway 46 79 91 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is required for Marstons Mills MA 02648 July 19, 2012 every 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: 15+ 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: Low areas of adjacent properties are considerably lower than SAS. p, Before filing this Inspection Report, please see Report Completeness Checklist on next page. t t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 474 Mistic Drive Property Address David Munsell Owner Owner's Name information is required for Marstons Mills MA 02648 July 19, 2012 every page. Cityrrown 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 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I Q/ �� 4INd d]to FEE THE COMMONWEALTH OF MASSACHUSETTS 1 CEit/TEXV/LLE ,MASSACHUSEITS �ppltirattivn for Disposal Sgatent Qlnnstruction Verintit Application is hereby made for a Permit to Construct (>O or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. / Owner's Name,Address and Tel.No. LdT /SO //Z�I71/�/L/Nl /�K.� �OfiD f MSS �t'J-STEIZ C&c/r6zV/LLE� Installer's Name,Address,and Tel.No. Designer's Name;Address and Tel.No. y �94 Ci1,e/s7oP/�E� C0S7*,V r xsx c /s�rv�/ku 14- 57; �9Qd 6 115 E FRLXfo '•4" �S'S��6s/Z!K Type of Building: Dwelling No. of Bedrooms 3 Garbage Grinder( ) Other Type of Building No. per Persons 2 Showers( ) Cafeteria( ) Other Fixtures Design Flow �.$ gallons per day. Calculated daily flow 33O gallons. Plan Date �8�96 Number of sheets / Revision Date Title z 02VSE0 LU�f/�Y.C/•lll, r�S�YT/�b'F SYS;reA4 Z00-77 6.&I Description of Soil �E� S/L EUAL Uf�,7'13A2S .2E�G�7 �' &-v�S7 qwe e-- oMf 7W DdrKr 606+eM/77 . .o- 66 5- Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance ha a issued by this Board of Uealth. t �-3Q'9t Signed Date Application Approved zi Date Application Disapproved for the following reasons Permit No. OT(O Date Issued e�o NEE J j i j ' THE COMMONWEALTH OF MASSACHUSETTS, CE/ rl_.XY/LLE ,MASSACHUSETTS �ppltirattivtt for Disposal (lons#ruc#ion Permit Application is hereby made for a Permit to Construct (A or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owners Name,Address and Tel.No. LoT /So //2)/�t/c/c/n/.s /4K.e ,`oAD f MSS �STEIZ Installer's Name,Address,and"I ONO. Designer's Name;Address and Tel.No. Ci1.e/sTaP/��,�2 CosT�} S-Astoc. / ., E. �RLAi1011Ti� �YJ'•4Ss. �S/��S/Z ' )C/' sAYvue / Type of Building: Dwelling ` Nod of Bedrooms . Garbage Grinder(nd ) Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow) sS gallons per day. Calculated daily flow 33 o gallons. Plan Date 5�8�96 Number of sheets Revision Date Title REP 4LW---CG1Wa Z0CW7--1eW �escrlptlon Soil SE'E so/L E!//ALLkgZ 2.r AAG:; QT Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date of Application Approved by Date Application Disapproved for the following reasons J Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS MASSACHUSETTS Eertifirate of (compliance THIS IS TO CERTIFY that the On-site Sewage Disposal System installed (")or repaired/replaced ( )on by _ I r for at 44has been constructed in accordance with tire prov si no s of Title and he for Disposal System Constru rm ction Peit N dated Use of this system is conditioned on compliance with thf provisions set forth below: The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. This Certificate expires on DATE //� / .� lnspect r � Z_ w—L/J!_/ THE COMMONWEALTH OF MASSACHUSETTS No. , MASSACHUSETTS FEE pisposal 4VOtem 01onstructiort 1ermit Permission is hereby granted to �4, T'+ A-4 to construct ( ) or repair )an On-site Sewage System located of 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. All construction must b complet d within three years of the date below. DATE li Approved b pp Y � FORM 1255 Rev.3/95 A.M.SUL IN CO.-BOSTON.MA /�(J I �50 TOWN OF BARNSTABLE � LOCATION ify `3 &-e G K SEWAGE #2 VILLAGE (-, tP fV -e ASSESSOR'S MAP& LO i�-5�y,-a.3 z INSTALLER'S NAME&PHONE NO. (76 SEPTIC TANK CAPACITY / 0 �7 LEACHING FACILITY: (type) Lf-AC !V I PN612,0 (size) 3J� NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: e^ Qt:7CI Yd-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 facili ) Feet Furnished by 7�� 9 ; A IeL zs' . 4 " zs" TOWN OF BARNSTABLE LOCATION �V SEWAGE # &�Z,7- 131r VILLAGE i �- t ASSESSOR'S MAP & LOT_9-s-),'031 INSTALLER'S NAME&PHONE NO. /-�ll-L /. SlewcZ.v✓ 01-B9aG SEPTIC TANK CAPACITY G LEACHING FACILITY: (type) sag G L d4noliiy (size) /3X3�r s X-z ' NO. OF BEDROOMS BUILDER O WNER �% L *� PERMIT DATE: /� COMPLIANCE DATE: S -3 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S� 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 �13' 0 Ys 1 a TOWN OF BARNSTABLE LOCATION I k Aie-a.IrL SEWAGE # VILLAGE ASSESSOR'S MAP & LOT - 6 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: 16 d1-7 . DATE COMPLIANCE ISSUED- ! IT VARIANCE GRANTED: Yes No y Z- l 15 _ } �1 v�flo TOWN OF BARNSTABLE LOCATION laa C 1 UInS /t.Q.G� ��- SEWAGE # `(� a- VILLAGE CtXtr✓,4 FXM a VWr o31 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY i LEACHING FACILITY: ( pe) i1 ► t (size) O/W— NO.OF BEDROOMS BUILDER OR OWNER W PERMITDATE: 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 f cility) Feet Furnished by =A . e- Ja^ r / A B o a � dY aye SEWAGE SYSTEM PROFILE DETAILS NOTE: THIS LOT IS IN NON FLOOD HAZARD ZONE C AS PER TOP NOT TO SCALE F.E.M.A. COMMUNITY PANEL #250001 0005 C 8/19/85 FOUNDATION 79.0 THIS LOT IS NOT WITHIN 100' OF ANY FLOOD HAZARD ZONE CHANGES. F.F.= 80.0 FINISH GRADE THIS LOT IS NOT WITHIN 100' OF ANY WETLAND RESOURCE AREAS. FINISH GRADE= 78.5 FINISH GRADE FINISH GRADE 79.0 OVER TANK= ?d5 OVER "D"BOX= 78.5 CAPS 0 ENDS OF NOTE: SEE BARNSTABLE BOARD OF HEALTH PERMIT #P-8656 EACH DISTRIBUTION LINE NOTE: SEE BARNSTABLE BOARD OF APPEALS APPEAL #1996-48—VARIANCE ' } V76.5 & CONCRETE COVERS TO p .— - 2" OF FINISH GRADE 3" PEASTONE 1. INV. 4 0 1 __'_. 77.0 76.75 " 4" PERFORATED PIPE3„ 4 076_08 SLOPE @ o.o05/FT. LIQUIDDISTRIBUTION "LOT 156 LEVEL GAS76.25 BOX 76.0 3/4 TO 1-1/2 CRUSHED, BAFFLE SET LEVEL WASHED STONE _1500 GALLON SEPTIC TANK SET LEVEL BOTTOM= 74.0 113.88' _ LOT 15 3/25' LONG X 2' WIDE X 2' DEEP LEACHING TRENCHES .�4, 192 s.f. �" r :3 DESIGN CRITERIA NUMBER OF BEDROOMS 3 SOIL EVALUATOR'S LOG PERSONS PER BEDROOM 2 Depth from sail Soil soil soil other 7g DAILY FLOW PER PERSON 55 Surface ace Hor. Texture Color Mott. Relative � 'IS1iN G G LEACHING REQUIRED 445.9 SQ. FT. (Inches (USDA) (Munsel) Factors v0� LEACHING PROVIDED 450 SQ. FT. DEEP OBSERVATION_ HOLE 1 N LAR .� CALCULATIONS � � ��'/ 0"-12" A L/S 7.5YR3/3 — Friable (DEPTH+DEPTH+WIDTH)(LENGTH) 12"-30" B L/S 10YR5/6 — Friable _ 6 X 25 X 3 450 sQ. FT. �,PROP.GE 30 —90 C1 C/S 10YR6/4. — 25% Gray./Cobbles 90"-120" C2. C/S 2.5Y6/6 — 5% Gray. P�OPOS �a.75 WE G EkIS7/NO 7 8 -�-_ D 80 o D wE� .FL• LING 0� DEEP OBSERVATION HOLE #2 _ 1 v O"-12" A 1/S 7.5YR3/3 Friable 12"-30" B L/S 10YR5/6 — Friable GENERAL NOTES 30"-90" C1 C/S 1 OYR6/4- — 25% Gray./Cobbles 1. ALL ELEVATIONS SHOWN ARE 90"-120" C2 C/S 2.5Y6/6 — 5% Gray. U.S.G.S. 1.37, L=114.82' 2. ALL PIPES IN THE SYSTEM TO BE 74 R=833.24' CAST IRON OR SCHEDULE 40 P.V.C. 7� N/A 3. REMOVE ALL UNSUITABLE MATERIAL BENEATH THE INVERT ELEVATION PERCOLATION RATE = 2 MIN./INCH 72 FOR A KFILL 72 W/ CLEAN DCOARSE GRANULARIUS OF AND MATERIAL. DEPTH TO GROUNDWATER = NONE ENCOUNTERED 70 -- 4. ALL BACKFILL SHALL BE LEAN OBSERVATIONS BY: CHRISTINA KUQHINSKI LIC IVE 4O WIDr COARSE GRANULAR MATERIAL FREE DATE TESTED: 3 5 96 HUC ROA KINS FROM DEBRIS & LARGE STONES. 5. CHRISTOPHER COSTA & Assoc. MUST BE NOTIFIED WHEN THE APPLICANT: DAMES FOSTER --- SYSTEM IS INSTALLED PRIOR TO LUNG LOCATION �— BACKFILLING FOR INSPECTION. PROPOSED DWE 6. UNLESS OTHERWISE NOTED ALL PROPOSED SEWAGE SYSTEM LOCATION SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH MASSACHUSETTS TITLE V SANITARY SEWER CODE AND LOCAL RULES .LOT 150 HUCKINS NECK OAD WHICH MAY BE APPLICABLE IN A _ WORKMAN—LIKE MANNER. OF ,� OF , 9 7. THIS LOT IS NOT IN THE FLOOD PLAIN. PLAN VIEW o J. QP, ry� 8. A GARBAGE GRINDER WILL NOT BE CENTERVILLE, MASS. = 20 COBI C STA HER INSTALLED ON THE SYSTEM. SCALE: AS NOTED DATE: 8/8/96 FOST-150 SCALE: 1 c� 814 LEGEND z No. 3O5 0 9. NO CHANGES SHALL BE MADE TO THIS PLAN PROP. SPOT ELEV. = 78X5 � sA'� y ��yb� WITHOUT OS OU &PRIOR APPROVAL FROM CHRISTOPHER DRAWN BY: J.A.B. CHECKED BY: C.C. JOB NO.: EXIST. SPOT ELEV. — SUR 10. DIG—SAFE SHALL BE NOTIFIED FOR THE PROPER � �" '�'�P�L'�R COSTA & assoc. PROP. CONTOUR = ..�-+....78 LOCATION OF EXISTING UTILITIES PRIOR TO ANY EXIST. CONTOUR = •--l-,178 ASSESSORS MAP #252 SECTION # — PARCEL #32 LOT #150 HSE. #112 EXCAVATION. P.O. Box 128 / 465 Main St., East Falmouth, Ma.