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HomeMy WebLinkAbout0118 MARINER CIRCLE - Health 18=1VIariner Circle � . � Filk 023 063 i Commonwealth of Massachusetts 'Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,.. 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information W forms on the computer,use I p 1. Inspector: only the tab key to move your Jill Cafarelli cursor-do not Name of Inspector use the return key. Civil Engineering Assocites Company Name P.O. Box 916 A10 Company Address }� South Dennis MA 02660 Cityrrown State Zip Code 413-246-9804 4405 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'maintenanca of orr site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.346 of Title 5(310 CMR 15.000). The system: ID Passes ❑ Conditionally Passes ❑ Fails c, r-r, ❑ Nee=, A the Local Approving Authority /° - Inspector's ' na a Date The sy m inspecto shall submit a copy of this inspection report to the Approving Authority (Board of He or DEP)w in 30 days of completing this inspection. If the system is a shared system or has a esign 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. 11-11, � t5ins•11/10 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form V Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 every page. Cityrrown 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: have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below); ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 or 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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: 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 Y2 day flow t5iru•11l1U Tide 5 Offusal Inspedton Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 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 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-11110 Tits 5 Official 6tspechun Fwm:Sutsivrace Sewage Dispmsaf System'Page 5 of 17 Commonwealth of Massachusetts Tale 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 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 ❑ 0 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)1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 331 t5ins-11/10 Title 5 Official fnspeetion Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Tine 5 Official Inspection Form Subsurface Sewage Disposall.System Form-Not for Voluntary Assessments 118 Mariner Circle Property Address Dan Regan Owner Owner's Name informations required for Cotuit MA 02635 2/18/2012 every page. City/Town State Zip Code Date of Inspection D. System Information Description: 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 0 No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date CommerciaUlndustrial 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•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Papa 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is reequiredquired for Cotuit MA 02635 2/18/2012 every page. ic4frown 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: 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/Altemative 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 118 Mariner Circle Property address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 every 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: 2005-Plan at Board of Health Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply welt or suction line: feet Comments(on condition of joints, venting,evidence of leakage, etc.)-- Septic Tank(locate on site plan): Depth below grade: 1 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: 8x5x5 Sludge depth: 15ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments M 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle R- Scum thickness Distance from top of scum to top of outlet tee or baffle —� "- Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? !�A.R f� Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000 gallon tank Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete Q metal Q fiberglass Q polyethylene Q 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 15ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 every page. Citylrown State Zip Corte Date of Inspection D. System Information (cost.) 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 15ins-11110 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 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 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 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): ( P ) Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: v- rrs t5ins•11/10 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 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500 Gal ❑ 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.): 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 :sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 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.): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (coot.) 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 t1 a TI C3 C � ta - o — Q6X 3H $ i n Q 66X rta ^ 97 0 �] !sc r - 38- S -- 1� ►•srr 3 31, . 5 t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 118 Mariner Circle Property Address Dan Regan Owner Owner's Name information is required for Cotuit MA 02635 2/18/2012 every page. Cityrrown 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' 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: 2005 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 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 M 118 Mariner Circle Property Address Dan Regan Owner Owners Name information is required for Cotuit MA 02635 2/18/2012 every page. C4rrown 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 .F e t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 pp pp I TOW "OF BARNSTABLE M 'LC:CATION i VNWSQ5 i_l: SEWAGE# 6 -.0-56 VILLAGE Cps„i-r ASSESSOR'S MAP&PARCEL 2 ®(03 INSTALLERS NAME&PHONE NO. JQ-ViO SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 2- CyyA"Zce—S (size) NO.OF BEDROOMS 2 OWNER PERMIT DATE: COMPLIANCE DATE: 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5 + Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY _ ���It'N sroo 25 O R 1 C, o 24 �- C. Tomsk C -,N' 32, ' 6 A N AJ st-r LANE No._CQ(QQ lD PC60 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplication for Di5po5al *pgtem Con.5truction Vermtt Application for a Permit to Construct O Repair ) Upgrade O Abandon O ❑ Complete System nldividual Components Location Address or Lot No. fie M PP-10 E2s (21QC.1-+< Owner's Name,Address,and Tel.No. 1��c�sea— Assessor's Map/Parcel Q 23 Installer's Name,Address,and Tel.No. K_Q 1f) Designer's Name,Address and Tel.No. t�C, q_N o, S Q C S 53 Type of Building: Dwelling No.of Bedrooms Lot Size Z� GOO sq. ft. Garbage Grinder ( ) Other Type of Building Aj )FQr- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �J� gpd Design flow provided �j gpd Plan Date 17- 111 2T S Number of sheets Revision Date Title `�Pm�nSQA 5?=p �C�� (�czzc,& Size of Septic Tank t Q C� Type of S.A.S. 2 r SZ;o Description of Soil Qkc -h Ocrl 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 Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H th. /�/� Date 2 " 3 —D 6 Application Approved Date c'1 re Application Disapproved by: Date for the following reasons Permit No. r�L(30�s "�5 d Date Issued `� ♦ ep +T 9 C-ar. �. �,—i No. ✓�QQ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: , PUBLIC. HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpolicatton for Migo5or *p5tem Construction Permit Application for a Permit to Construct O Repair )' Upgrade O Abandon O ❑ Complete Syste X ndividual Components Location Address or Lot No. g PP—►N EQ-S C1 ZC.1--t< Owner's Name,Address,,and Tel.No. To IT, M fT hAcc--tl�� c�Sas" Assessor's Map/Parcel Installer's Name,Address,and Tel.No. 9,� Designer's Name,Address and Tel.No. Type of Building: +. Dwelling No.of Bedrooms Lot Size F0 I CEO sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 'J gpd Design flow provided ?j( . 5O gpd tPlan Date �T 2 ► n ""j Number of sheets Revision Date Title 525f)nSRr'\ 54')A C S'-419_� �-r.60 Size of Septic Tank [ S< 1 C C Type of S.A.S. ��,G� Description of Soils t ocr Nature of Repairs or Alterations(Answer when applicable) Ro !�n C-�\pn i 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 Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. f Date ` . Application Approved Date C;?-� Application Disapproved by: ) Date for the following reasons Permit No. C00 65 d Date Issued c°� t g 7E COMMONWEALTH OF MASSACHUSETTS iBARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System,Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by �+ y` at �� yy�o . ���rS Ci�--C �)e l O,'v� has been constructed in accordance ` with the provisions of Title 5 and the for Disposal System Construction Permit No. (0 ^C) 5C) dated Installer �'mol 'r Designer <0 A- #bedrooms Approved ddpsi.gn_flo`w G-C� and The issuance of this permit shall not e c nnstrued as a guarantee that the systerwill funct` s s� ned. Date 3�g�'6 Inspector..-`� r , -------------------------------------------- No. Co� ^(0.5 0 Fee �s U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS i!5pogaf ,,.,pgtem Cougtructiou ,hermit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at ��.'r�'rQrS G � .) �� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special con/dam n Provided: Construction must Wcoplewithin three ears of the date of this e it. YDate Approved-by Town of Barnstable OF THE� Regulatory Services Thomas F. Geiler, Director • BARNSTABLE, ib;q 163 Public Health Division 9qj . `0 ArFD"A0�A Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: _Shay Environmental Services, Inc. Installer: �e�91 A Sr,\O Iles Address: P.O. Box 627 Address: Zd `!pg15, , East Falmouth, MA 02536 On l 40"©(,o ke-o- ►c l SM®\le c was issued a permit to install a (date) (installer) septic system at CQ, cp-iQN-T based on a design drawn by (address) Shay Environmental Services, Inc. dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or ri certified as-built by designer to follow. �N OF M,qS Sqc,�� o� CARMEN /"'Onstaller's Signature E. y" SHAY No. 11>31 0 ��GISTE�� 19A A I I k1l a (Designer's Signature (Affix Desi p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 05/07/2016 22:48 FAX 1a 002/002 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM c hereby certify that the engineered plan signed by me dated 2- 12-d5 , concerning the property located at BtA a"a Ccc\e t Ir meets all of the following criteria: • This failed system is connected to a residential dwelling only, There are no commercial or business uses associated with the.dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increAse in flow and/or change in use proposed • There are no variances requested or needed. • The.bottom of the proposed leaching facility will-be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) ,to B) G.W.Elevation ZO +adjustment for high G.W. _ DIFFERENCE BE EN A and B 155 SIGNFD NOTICE Based upon the above information. a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. M1W _2_q. q:ASePdC\percexwV,doc ����` • �Q T G n Q � CP � 3 G VX J , 1 � NUMBER FEE 76-2005 THE COMMONWEALTH OF MASSACHUSETTS $140.00 THE TOWN OF BARNSTABLE Board of Health This is to Certify, that the Board of Health has this day granted a Permit to Wind River Environmental 40 Carver Street, Halifax, MA TO REMOVE, TRANSPORT AND DISPOSE OF GARBAGE, OFFAL OR OTHER OFFENSIVE SUBSTANCES This permit is issued in conformity with the authority granted to the Board of Health,by Chapter III, Section 31A,of the General Laws,and amendments,and is subject to the provisions of the Laws of the Commonwealth of Massachusetts relating thereto,and upon such terms and conditions,and to the rules and regulations in regard to the carrying on of the occupation so licenced as adopted by the Board of Health, and expires December 31, 2005 unless sooner revoked. January 1, 2005 Wayne Miller, M.D., Chairman Board Sumner Kaufman, M.S.P.H of Susan Rask, R.S. Health Agent: Thomas A. McKean, R.S., CHO FFS Corporation Northeast Region APPROVED - IN Raup 11311 Approval fir-nited to Factcqy Built Portion 60'-0" 1 - I 13 11 SEE NOTE #5 I 22'-1" CEILING AND ROOF ON SITE BY BUILDER ,�----�� W.P. 7 i GF1 \ x _____________ - 1 12 ACIDCc T I SEE NOTE #5 � S 9 —----- ------ _ F--1 2 S DEN JB I r JB 4 I o n+�o I I L_— C�9 COIL 30' ® TOP 1 I L I PIKE I COIL 30' ® TOP +I} OF WALL FOR ON FAN RATED L——J — OF WALL FOR ON I SITE RECESSED BOX I I 1 SITE FAN RATED I DINING ROOM LIGHTS —I o \ L 3 i BOX — c ----------------- BATH r 10 8 6 5 200 AM 4 PANEL 1 BSMT, E TRANSFORMER TO MOUNTED NEAR SERVICE PANEL CIRCUIT AMP AWG CIRCUIT AMP AWG BASEMENT 1 15 14 2 20 12 DINING ROOM REC. GEN. LIGHT 3 15 14 2 4 15 14 GEN. LIGHT DRYER 5 30 10 6 20 12 WASHER (GFI) 7 8 20 12 WHIRLPOOL (GFI) GEN. LIGHT 9 15 14 10 . 20 12 BATH REC. GEN. LIGHT 11 15 14 2 12 1 15 14 GEN. LIGHT DEN 13 15 14 14 15 16 17 18 19 20 TOWN OF BARNSTABLE LOCATION I1e6 SEWAGE # VILLAGE 62�� T ASSESSORS MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK-CA PACrrY /" 6 C4L LEACHING-FACILITY:(type) LLB/� G ��a (size) c2- SQys NO.OFBEDROOMS a BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: 'Mkirnum 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 leashing facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet 9f teaching facility) Feet Furnished by � �✓ ' ���rcT r �c 2 A A -0- �6" -1D- 30' o E A -r-- a7' f3- - s6Irol 6 C-F a�6" 6-F- ref, D G� . Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. General Information 1. Inspector. �� Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 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 ❑ Needs Further Evaluation by the Local Approving Authority 1-19-09 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 official document•03/08� p Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 r . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every 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 is in good working order with no sign of failure. 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. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. ND Explain: ❑ 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 ❑ obstruction is removed t5insp official document•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: 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 mannerwhich 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 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. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than '/ day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp official document•03/08 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 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. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town 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)] t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions:' Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 330 Number of current residents: 0 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 Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 12-08 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp official document-03/08 Tttle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 E Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Not since new in 2006 Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No t51nsp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18"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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 Gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" 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 15 How were dimensions determined? Tape t5insp official document-OW08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town 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.):' Tank is in good condition with baffles installed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 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.): Good condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ® leaching chambers number. 2-500's ❑ 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.): Leach field is in good condition with stain line at 6" off bottom of chamber. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 f - Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t5lnsp official document•03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c�M 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch 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. Back A g c c-F 19 $-F- a+� � t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 118 Mariner Cir Property Address Fannie Mae Owner Owner's Name information is required for Cotuit MA 02635 1-19-09 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: 12' 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: Original design plans show no water at 12'. t5insp official document-03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 LOCATION ,� f''JJ JSEW GE PERM T N0. VILLAGE -,W, INSTA LL i R'S NAME i DDRESS , 0UILLDER OR ANSIM aja4 DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ,Jg d 3a o y No................7 7... Fine �r THE COMMONWEALTH OF MASSACHUSETTS e f BOAR® OF HEALTH 06 /��ll�t✓.....................OF...3 Appliration for Dinpuiial. Workti Tonstrurtinn ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: .. - - ao.n. - or Lotr eNsso. ... .. . }........................ . ........ ...._.. . OZkZ .................................. .-•-•-•-----•---------••-•----.......------•--•-------•--•------•--......•......._................� .... Installer Address U Type of Building Size Lot_._��.092....Sq. feet Dwelling19- —No. of Bedrooms...._.•.....--„---- ---------- -- -•---Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin a —Type g -. No. of persons...........f............. Showers ( ) Cafeteria ( ) Other fixture W Design Flow.............s5_137...:_.......®_.gallons per person per d4y. Total d/ai�l1'yflow.......�A-®.......................gallons. WSeptic Tank—Liquid'capacity.C° .._.gallons Length.j.-.Bi-r--.... Width.4. l!I _... Diameter________________ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. i.. i oI Seepage Pit No........ .......... Diameter......7._....... Depth below inlet...-_ .... Total leaching area... Z Other Distribution box (/ ) Dosing to ( ) Percolation Test Results Performed by-_...... . . . ........ Date.....111114A,19............. a �....... ,.a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------------------•----•--........----...--......----....:.................---•--....--•---•----•...--.•-•-- O Description of Soil..®_� ..... . . V �O-"' .. •••-------------------------- �� ---- '•... l�i��----------------------------------------------------------.........---.........-•--------•---------•-- U Nature of Repairs or Alterations—Answer when applicable.................:............................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 4 the provisions of TIT .;;:. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by he b9ard gf health. igned- . ..... .......................•...... �.. �_. ate ..... . Application Approved BY.......... el .7. ....... Date Application Disapproved for the following reasons:.........................=......... --•--------------••-••---------••-----•--•--••-----•----.....-•----•.._... ---...-----•--•------•-------------•----••---•----•------.....------------•••---•. Date Permit No.............................. ........ Issued....................................................... Date .rff C49 777 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .../j(�ff...r../ ....................OF... ,.�Cf•t'/IJS�C!C�l_�............................................ Appliration for Disposal Works Tonstrnrtinn Prrutit Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at ,r l �� O•iw . s� !7` / G2t, �`�_ C .......... ................. .......... .._.....j>. ................................L Q- : Lolt NG. �✓...I..L...[...�.•J•• ............................ kati o .ddres - '--W:3� 10 Wr ? aess7 Installer ...... . ----------- ------------------------Address -- ----------------- - � UType of Building Size Lot..... .'Q ....Sq. feet Dwelling—'No. of Bedrooms..........................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building /1 r f �%-'p p., yp g _________________________ No of persons_.__._.__.�............. Showers ( ) — Cafeteria ( ) QI Other fixtures ............................-------•-••--------------•-------- W Design Flow............. ........_._................gallons per person per day. Total daily flow........ : .......................gallons. WSeptic Tank—Liquid capacity/__.•_.:_.gallons Length./'__._L._. Width&_k...... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. r Seepage Pit No____________________ Diameter___... ...._..__. Depth below inlet.._. `..._. Total leaching area.__ -d�--44. Other Distribution box Dosing tank a Percolation Test Results Performed by-------- ",� Cam?.. ?_: ' _ ? j -------- Date_._._ , � 14 Test Pit No. 1................minutes per inch Depth -of Test Pit.................... Depth to ground water..... e.a . (Z4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0.14 .•-------- ------•-•--•••---•---•.....-•-------...--•-••--•---....•---••......--•---•-•-•-•---•-_-•••-•--••-•••-• - o Description of Soil.�.-.fie•---••-,;, c''Cr r -----------------------------------------•----- x ---•-• U Nature of Repairs or Alterations—Answer when applicable............................................................................................... • -•-•-•-----------------------•----•------------•-----••----•----------------•---------•--------.....-----------•--••••---------...•---•---•••-•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be-n issued by the board of health. igned: _-_.... _ ... . . Date Application Approved By.___....: _ °. �� Date Application Disapproved for the following:reasons-------............................. --------------•-•-------...-•----•------•-----•-••--• •--...----••..... N++e.--�&.tea-_ .......................................................................................... ......................................................................................................... Date Permit No............. «ri*' Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /!�V7�.................OF...... .: r.`.. . ................................. (9rrtifiratr ,af\,Eomplianrie f TH S IS TO C TIFYa, That the Individual Sewage=:Disposal.System,constructed ( ) or Repaired ( ) y.... . .......................................................................••........ ... •--^._ .: -•-•--............-•----....._............._.•.... •. / N ......................•: has been installed in accordance with the provisions of:� > of The State Sanitary Code as described in the application for Disposal Works Construction Permit N .__ ___..27.7.............. dated------- �7`3.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE--•---------••-•--•...................••-. •-- Inspector............................................. f --------------- - --•-•--- Ar THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF...... 'f-:� l...Mr. ........................................................... FEE.: .... ...,. .. ........... Disposal Vorhp Tnnstrnrtion rrntit Permission is hereby granted---- r �t .... L!? ...��' � :_.. /`' fir•{ ---........ to Construct ( ) or Repair ( ) an Individual Sewage Disp sal System at No... r - �.✓�s /�fG'�"�i:jirj�ar;'.1 C..K:•r.,.t„/ ` . .. ._ Sl"r� �-------;.% _, ..... as shown on the application for Disposal., Construction P No __ __.___ Dated...�.rx. �►� t f * _ o 7"DATE..--- `'s .."... oar f Health\ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS t 1 j N07f ..7 7 - D_ .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................OP..., ...................................... P `O Applir�a#ion for UhgpwiFal ,ark, C�nntitrnrtiun dmu Application is hereby made for a Permit to Construct N or Repair ( } an Individual.-Sewage Disposal Syst M at• v-''� IZAU,� " cation ddtess or Lot No. 11''�, Owner `�- �� ���� •s ' W ... ---•-•----•-•--•-•-•------•......... .......••. ...... ........................ ---••-............................... Installer Address Type of Building Size Lot..t QJP .....Sq. feet U Dwelling—No. of Bedrooms--_----.. Expansion Attic ( ) Garbage Grinder ( ).................•-• — 04 Other—Type of Building .- -_® ..... No. of persons....................... Showers ( ) Cafeteria ( ) a' Other fixtures ............................ . W Design Flow..........S.5..........................gallons per person per day. Total daily flow__..._...4:9 ......................gallons. 9 Septic Tank—Liquid capacity/®_.gallons Length.,ff /....._ Width._#..A.... Diameter________________ Depth................ W Disposal Trench—No. .................... Vidth.................... Total Length.................... Total leaching area..............;,,"sq. ft. 1 Seepage Pit No......... Diameter.._.._. ....... Depth below inlet 2�.�0_��,�Total hin area...���+.....s z Other Distribution box (�) Dosing t�� ( ) / / ~" Percolation Test Results Performed by-_...1.... ..... ... ......... ( . ................ Date.... �a,1:71..........._. aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ODescription of Soil--.D�k..... to"t... • •-••--•----•...............•-----•••-••••----------------•-•-.....---•-••--•-----•--.....-----••-•-•----------.....--•-••--•-•--- x - �., 30 --------ur�--- x ------------------------- d_-A�-------.� .n.... .................................................. = U Nature of Repairs or Alterations—Answer when applicable..........................................................................................:.... --•-------•----------•-•----------------•-•-----••-••-•-•-••---•--•-•-•••-•--•-•---••••--...--•-•••--••-.....••--•-•••---.--••-----•------••-••--•----------------------------------........_.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI1'LZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bDyjtrhe board of health. SiIg d 'OF---•-• "` �� ate Application Approved By 6 a -'� 7-1 Date Application Disapproved for the following reasons---------------------------------------------------------------•--------....--------------------------........... ...............•-----•---------------.........__....-------------•---------------------•--••----------....__.....-.....-•---------•------------------...--------•--------•----------------------....----- Date Permit No......................................................... Issued..----�"�-��- -�•--...•..... --•--- Date No.----•--•-y7L _ Fps.. ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ApplirFa#ion for R-41taii al Works Tonotrurfinn Prrutt# Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at• .�/�✓....e.fk-." ....... ...........!4...! �.....Q......----•-- --•-------•.................. _ elf yLocation Address or,Lot No. ... Ii-FLJ f.✓Y �)l fr'd(� ....r.-_'t.. t.. ?�'.-- --•- i ....... _.Q_... ..... = = r_ �'~ -----•------------•-----•---- owner f ) a jLt.•G /yL �Address� ____•___ ----• `-_:f. ........-- � Installer Address Type of Building Size Lot... __:_ ......Sq. feet U Dwelling—No. of Bedrooms.............�-________________ _____Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building r"��'G3! __._.. No. of persons._______.4 ______________ Showers ( ) — Cafeteria ( ) Otherfixtures ...................-•---___------•-------------------------------•-•-•-------------------------------_-_-_______.--------_........---....._..._------ Desi Flow-----------� _______________ lons. W Design ___.gallons per person per day. Total daily flow____.....��d_______________________gal WSeptic Tank—Liquid capacity/_. ___gallons Length_.!'? Width_A'C'_"j_ Diameter________________ Depth................ x Disposal Trench—No..................... Width......___...____.� Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.______f- __. Diameter.__._. ;= p °� ,� ....___._. Depth below Inlet 7 Tot In area ------------s Z Other Distribution box Dosing tank 4r / ~' Percolation Test Results Performed by.__._>`1!'�=x "`t::'__::''� '_^':A!_%??Ecc."�_________________ Date___�� ../.E�_!�.�f___..________.. 04 Test Pit No. 1________________minutes per Inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..................... fyi O Description of Soil...L_:�_....__./-:�'1127:�- ..... "� tl --------- ------------------------ •-------- ...... ------------------------- • ------ -------------- ...___--------------- -- ------c.. .. ....__-----1'fi r✓= = cs. t „----- - UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ -•--------••----------------•------•------•------•-•----•--•---•-•--...-------------...-•-•--•--------------...----------------------------------------._...-----••------------------------..._.....---• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT.." 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. J d_.Ai9t- !a '� - /� Date Application Approved By.... P it ' .. .. ..... 1�'r�`-"t" .. ' Date Application Disapproved for the following reasons:....... . .... ..................________________••__________---------•-----------•------•-•..._. Date PermitNo......................................................... Issued..... _ . .............................. Date .r"HE COMMONWEALTH OF MASSACHUSETTS T., BOARD, OF HEALTH $. .........................................ClC. OF..... Ct � ......................................................... (In tgfirFate of ToutpliFanrie THIS IS TO-GERTIFY, That the Individual Sewage Disposal System cgnstructed O or Repaired ( ) by..- ' �� .t /'•.ice� _ € u.------ __--•-- ---•-•--•---------- ---------------------------•-•-- -•--______________..........----•-•--•---•-------------__ _____ j - Installer,,' at.......... = 1�''`I e l: bill T ------- - ---- has-been installed in accordance with the provisions of T 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No. _ ____7.n.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS,A GUARANTEE THAT THE SYSTEM 1All,¢.L FUNCTION SATISFACTORY. ---�-- 1.............. ....... Inspector_. .. ..... .! THE COMMONWEALTH OF MASSACHUSETTS L �.�..- BOARD OF HEALTH o .......... % ✓ ..............OF._... -? ?�_. -'`� ...................... FEE. dl-•-......... �:.,. �tu�a��aal nr�� �unu#ratrrn leruti# Permission is hereby granted____ v ....... +- .C!f: _ :''!`..:.___ .....7........................................................... to Construct ) or Repair ( ) an Individual Sewage Disposal System { Cj/ /„J'/r--- ,J, {/it`-I4fi C.� t Lf`L'tii.n'r i'rCiL-SSttreet 1 as shown on the application for Disposal Works Cons/truction Pe No,. ated....,1�<.. ....�.....-��---.------. '7 DATE_ �,� j lam°` Board of Health s FORM 1255 HOBBS & WARREN, INC., PUBLISHERS � , L0 AVON SEWAGE PERMIT NO. 76 y 1�°L L A 6 E T- �- 6�� INS A LLER' TAME i ADDRESS ' B 1I 1 L D R R OMN ER i DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � �2 . ��► a� 3� 9 _ 394 a� •.9' ' 7, i►' k G j, b)e. '?' � ! r` �.. (,�,,T vv,° 1' 1 y rti� f" 'i' �°' ,, '„"'Vt .,. .'.. ;R w i h fi, 4`.y � I . ;. C; s.> • t .. ��'�' ;. � , v e .r. Imo.,t lam",j • 1.a. � .'� F.#L. ELEV.= r4 ---r---- FINISH GRADE " FMNtV 6RADE FINISH GRADE---- 'QP'OF FOU*D. OVER LANK = G 7+ OVER PIT ,L �) � 4„ C. • � GHtMfIEY BLOCK 4" V.C. t a►EEpED BACKFILL 3" PEASTONE r✓�.17 - '� ° b ° a 0 O o ° o WC r y \ CEL1.IiR FLIDpR !aP0 GALLON • " ,o_ q e e ! o O 0 O o o �►' r 3/4 TO i-1/2 'tLE,11t 3 w'Z'►a REINFORCED GONG. v t i o O O O o ° �_ ' CRUSHED gTOME 0 0 c 0 0 d\ o , . , • • e DIST. BOX , a ''" 0 u O ° ® o� o. - / J C O o e� (TO BE LEVEL I o 0 0 Q 0 p V � \) BOTTOM OF PIT "PTI C TAN -� a c a AND STABLE) �� ° io O c) O 0 ° 0 4 77t SYSTEM PROF/LE ( HOT TO SCALE) LEACHING PIT DESIGN CRITERIA " 77 4- NUOWR OF BFOROOlMS ----_--- _ GALLONS PER DAY _----__- ' 4--- - -e--- - -- 41_ N GARBAGE GRINDER I TOTAL DAILY FLOW LEACHW AR£,A PROVIDED - Mom e2,>Qi--,N '5506to C 540Z GAO 'L 3, N O I L S LOG o }.. � ut:' n A.#i W_ 0% ELEV. _ 0 "� r pe S. + � `b f10 r 1 'w _ coo Lbn T PROPOSED SEWAGE OF 2 i a� tN �► any, tN NAss�c DISPOSAL SYSTEM y Q �•'t' ,.' iGl�DC.fJ`JFU Tp hJRMAN &PEGT'ED f• gp. Q $Rl1LTM5 N H G ORSMA PROPOSED DWELLING z T E - � MASS. OIt r � t'27'3 e F�s Q •.o pP4 �� G•� �i�P �T�RY' >K e rr la1 SURF"° A*Gt>"TION RATE -A NIN,/INGN WNAI�� SCALE AS NOTED DATE }� s ��•►�S t9� het�►�. P+��M.A �`9(f D B Y: �iUE� Ga_�✓S:`'':�' . �c:T�-'�-`', IF Fh, �, � C,,,,iE�t 3��ri O� fli�> -T t.�ii5�.. t b? SN E.iric`'r- �• Z 24 G�EA.T P4+�.�tG� t�R.t t1�: �.-� ��g' Z.t,�+►•'��E. s Y�.I�Ni U U->t't-+} �Ib"!r"a►• ; r. :K1'"'b." ��'• "' +XG F40RAIAIV GROSSMAN P.E,, R.L.S. ` ►'r 1 �• tf. r>t0 226 HOLLY POINT ROAD CEAl rERVIL LE. MASS 4 0 • aY,v s�y F FL. ELEV.= { C -- — FINISH GRADE = a "� FINISH GRADE FINISH GRADE------ -- TOP OF FOUND. OVER TANK = b 0 i E P PIT ELEV. . �>��d t }�,�,c�� t ,,, 'M �j, WHE *-- EE D cN►«+MeY *LOCI( BACKFILL ,�PEASTONE t '--- 4�• C.I- ♦ V.C. A \ WN£RE NEEDED DW LL1N9 -- _ 4-_V.C/ O O o O b CELLAR FLOOR ELEV. Ems_ GALLON ==�— REINFORCED GONG. �� r 4 o O O o �" ; i CRUSHED STONE ' t CM ^ O O O O • . DIST. BOX o O 0 O o � r ; TO BE _EVEL 1 0 o 0 Q 0 o r � ,� �� BOTTOM OF PIT S, PT„I C. TANK -� O O V ... �----- AND STABLE) /� v ° O O • � 11 Q r�;(i/, ELEV. SYSTEM PROFILE I� , NOT 'TO SCALE) LEACHING PIT DESIGN CRITERIA NUMBER OF BE[IROOMS 1(v0.00 GALLONS PER DAY GARBAGE GRINDER TOTAL DAILY FLOW LEACHING ORE/ PROVIDED= "4l$S!Q � r fob"r''''© t.,A A..RC is V%".4'TL r1,40 :a N lV11� ZA'.On T�.NK SOILS L,.00 ,,I-Ilkao'40 ' ON IELEV. IL y o PIT .fi _�;� s� LOT 2 ' PROPOSED SEWAGE DISPOSAL SYSTEM Ajd 1R/h�'1 r � j yti� OF M, � �N OR MA.S,p, PROPOSED DWELLING °y INSPIEGTED >iq �G, �'l�4.'l7{ C� GtA�„ NORMAt� I zi N:)RMAN GRC)Sf#MAN u+ MASS. DATE „RO;SMAN PEftC,AiTI0" RATE @�siE�� '•oC�gtE �4 SCALE AS NOTED _ DATE . • VQ• �,, ,fib a ari.T`�if.; Ge,vt, SU0 CwAL OWNED ar 4L:1 O.i..1E49K1"1 it ,,. M+ NORMAN GROSSMAN FEE, R L S 226 HOLLY POINT ROAD 'j �!Ik ► + ;►c,,� .,, .� ,, C E N T ER V 1 L L E, MASS VENT PIPE (O Least 24 Inches tall) 0 min. from *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. Schedule 40 PVC w/Charcoal Odor Filter SECTION A A ALL ounFr P FROM THE ng ' �.-use Existing Foundation to septic tank PROFILE VIEW OF LEACHING SYSTEM ONION BOX SHALL BE TOP OF FOUNDATION = ELEV. 100.00 Assumed Septic 7cove r moat be tY(Assumed) tank covers moat be in. of finished SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER within 6 In. of finished grade grads `n Grade over Septic Task- 99.00 Grade over D-Box- 100.00 over SAS- ELEV- 100.00 3-6•OUTLET •a " �:�. 2 aM10 n /�•+. r it•woo"a%eeas sa.. t/r/e•- r/!•III I punts <�: KNOCKOUTS MSPECTION cover must be s.s' ' S 0.02 3 HOLE H-10 within 8 in. of finished grads r , , OUTLET 12' INLET GIST. BOX 3' mo*nwn Cover p of SAS-EIev.=96.25 f ' r +r o is, EXIST. S-0.01 or Greater S- 0.010' toot . 118 MBriret tar o O in 1,000 GAL + f EXIST. PIPE - '' � 2� r FROM EXIST. FOIINDATIQI r O O 45' o C3 C3 C3 C3 o t5 5' 4" - SCH. 40 T< r < rn rd V) 20' Effective o 0 C3 0 0 0 C3 tas' - z rn SEPTIC TANK v O t e \? A a...a. 0) a r• o C3 °°vtl' o 0 C3 0 o PANSECTION L , /1 > H-10 CONCRETE FULL FaNroA1710N-� n. � � � z Ln,rts a as• = 17• a, e 0 _ d 0) n 3. 5' F3.5' N 4' 9' 4' G..-;: Y,� , SYSTEM PROFILE _ �• 3 HOLE H-10 DISTRIBUTION BOX J~ s rn compacted stone m o 2' 6 Effect(v L th Not to Scale - c e' Effective Vldth �9 NOT TO SCALE ! c C a ®tt!WMAkpatyBCa,gmyA1 DQS IIAVTEO !r - m SDIL ABSORPTION SYSTEM (SAS) i 8 in.of 3/4'-t 1/2• 0 500 - C H-20 LEACHING UNITS / WIGGINS PRECAST GENERAL NOTES compacted stone m NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE Bottom of Test Hole 1 Elev.- BB.OD Not to Scale 1. Contractor is responsible for Digsofe notification ♦Obs. Groundwater - Test Hole 1 Elev.= NONE OBSERVED and protection of all underground utilities and pipes. 2. The septic tank and distribution box shall be set level on 6" of 3/4"-1 1/2 stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. LOT #1 10 5. The contractor shall install this system in accordance PERCOLATION TEST with Title V of the Massachusetts state code, the approved plan LOT #111 LOT #112 and Local Regulations. Date of Percolation Test: DECEMBER 22, 2005 6. If, during installation the contractor encounters any Test Performed By. CARMEN E. SHAY, R.S., C.S.E. soil conditions or site conditions that are different Results Witnessed By. WAIVER (BARNSTABLE B.O.H.) from those shown on the soil log or in our design SHAY ENVIRONMENTAL SERVICES, INC. installation must halt & immediate notification be Percolation Rate: Less Than 2MPI 0 36" 125.00' made to Carmen E. Shay - Environmental Services, Inc. TEST HOLE #1 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. 22 25'ELEV.= 100.05 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. ' ---------- 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. Test Hole 10. All solid piping. tees & fittings shall be 4" diameter T H2 No. 1 No. le I RESERVE AREA i SHED Schedule 40 NSF PVC pipes with water tight joints. DEPTH SOILS ELEV I PIP 9 j 0 100.0 DEPTH SOILS 0LEV. 100___ ------- 1 11. Municipal Water is Connected to The Residence and Abutting L�rrl TEST HOLE #2 Properties Within 150 Feet. Loam O 100.0 I�•--s^ '-;T cam' Sand Y F CHIN O•. ' 65.45' Sand ELEV.= 100.00 10 Y 3/2 r THE PROPERTY LINES ARE APPROXIMATE AND 0"-9• A 99 30 t0 Y 3/2 - _ __ _<-'j COMPILED FROM THE SURVEY PLAN GENERATED BY "� ` f, f MORMAN GROSSMAN, RLS, of CENTERVILLE, MA, ENTITLED D'-9' A 99.25 te'__L _ �' Sad Loamy O Vent D-Box --_,`\ "CERTIFIED PLOT PLAN OF LOT 121 MARINER CIRCLE, COTUIT, MA" s DATED DECEMBER 29, 1973, 10 YR 5/6 10 YR s/8 Be Q � & THE DEED DESCRIPTION ( BOOK 18256 PAGE 271) 9"- 36" 97.05 Be CQ � Med. 9-- 32" 97.33 25• IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Sand M . Failed �� THE SEPTIC SYSTEM INSTALLATION. 25 Y 7/4 a Sand 4 Leach Plt �� 36"-144" C, 88.05 ` EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE 3s"-14a' C, 88.00 4 39.02 REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION O ' �� CD NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE LOT #120 \��� LOT IF 122 FROM THE__EXISTING__CESSPOOLS TO BE DISPOSED OF AS PER BOARD OF HEALTH SPECIFICATIONS. NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY PROPOSE -12.T Q Septic Tank00 gal. I PROJECT BENCH MARK ASSESSORS MAP 023 PARCEL 063 ADDITION. i TOP OF FOUNDATION 14' x 60 ° ELEV. = 100.00 (Assumed) LEGEND Perc #1 Depth to Perc: 36" to 54" 8 I DENOTES PROPOSED Perc Rate= Less Than 2MPI 104X1 Groundwater Not Observed SPOT GRADE� No Observed ESHWT _ - ADJUSTED H2O Elev. = None EXISTING �`. X 104.46 DENOTES EXISTING Q BEDROOM SPOT GRADE R"CH `/00 PL#f f8 PROPERTY LINE NOTE: Existing GARAGE to be Or PROPOSED CONTOUR Razed and Replaced with i New 14' x 60' Foundation as Shown. - - - -- -97 EXISTING CONTOUR 1 1 I I . 2-18• DIAM. ACCESS MANHOLES I 1 DEEP TEST HOLE & ► I e LOT #121 ►i i PERCOLATION TEST LOCATION 20,000 Square Feet t I I i s4.17o i 3 6 FOOT STOCKADE FENCE I ASPHALT I INLET / 1 THE ASS COBS FOR THE NK SEPTIC TA . I I DISTRIBUTKIN BOX AND LEACHING COMPONENT ���` I DRIVEWAY I. OUT SET DEEPER THAN 6 INCHES BELOW FINISHED 1 1 - �- GRADE SHALL BE RAISED TO VATHIN 6• of r` FINISHED GRADE ____-�_--_.-_1---_ I� 125.00' INSTALL TUF-TITE GAS BAFFLES OR EQUALS I ---, ____ _ P LOT PLAN �-• '_.•. -".':. '?:'=assi.._• I 1 -----__----- OF PROPOSED SEPTIC SYSTEM UPGRADE STEEL REINFORCED PRECAST CONCRETE � �� `� PLAN VIEW ----------------------- ----------' �,----------------------------- ---------- ► PREPARED FOR 3-24•REYOYI BLE COVERS MA-"INER CIR CL E � �'°�" , MS. H EAT H E R H U Y S E R Gum AT •min. :i 4• r.; (40 FOOT RIGHT OF WAY) T. 3• min.rnearance ,r "' 1 18 MARINER CIRCLE ns�r B• mT 2•min. Mlet to ouHet e.,,,r, 0 20 40 50 ti urauia lewi OUTS to'ran ,�. 5' _7• 'S' _,-E� COTUIT, MA - 4'-W min. Design Calculations 3 ca ow srs. Liquid depth 9 SAC 1 GF 1 "•.s PREPARED BY: Number of Bedrooms: 2 Equivalent to 220 Gal./Day (330 Gal./Day Min, per Title V) SCALE: 1 n=20. _ Garbage Grinder. No ?� CAR�L�'N E. ,SH�1 Y 4' -t0" ' Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) PROPOSED LOT COVERAGE = 11 PERCENT o`er E �, "r Septic Tank - 2 x 330 Gal./Doy = 660 USE EXIST. 1,000 GAL. Septc Tank.CROSS SECTION END-SECTION SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch 0. ENVIRONMENTAL SERVICES, INC. ]Bottom Area: 0.74 gal/sq. ft. x 300sq. ft. = 222.00 gallons o P.O. BOX 627 Sidewall Area: 0.74 gal./sq. ft. x 148 sq. ft. = 109.50 gallons EXISTING HOUSE = 832 S.F. USE EXISTING 1000 GALLON H- 10 SEPTIC TANK Providing: = 331.50 gallons. EXISTING SHED = 120 S.F. SANISTF TAR"i EAST FALMOUTH, MA 02536aN NOT TO SCALE Use: (2) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, PROPOSED ADDITION = 840 S.F. TEL/FAX : 508-539-7966 TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND SCALE: 1"=20' DRAWN BY: CES DATE: DEC. 12, 2005 4' OF WASHED STONE ON THE ENDS. TOTAL = 1,792 S.F. PROJECT#SD850 FILENAME: SD850PP.DWG SHEET 1 OF 1