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Home My WebLink About0063 ACADIA DRIVE - Health EOIAcad�ia Drive lls P 013006 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Acadia Dr. Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 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. Important:When filling out A. General Information forms on the computer,use 1. Inspector: . only the tab key to move your Robert Paolini cursor-do not use the return Name of Inspector key. Ca ewide Enter rises,LLC Company Name a -� t� P.O.Box 763 = + Company Address ; Centerville Ma. 0 632 ram' City/Town State Zi Code (508)428-4028 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 7/9/2007 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. 63 acadia dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 i I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M ,•''v 63 Acadia Dr. Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 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: The septic system is in proper working order at the present time.The septic tank is in need of pumping for maintenance. 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 63 acadia dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 tr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Acadia Dr. Property Address Patricia Neville r Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 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,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 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. El 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. 63 acadia dr.•08/66 Title 5 Official Inspection Form:Subsurfaca Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 63 Acadia Dr. Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 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". ' t 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 11 ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 0 ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 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. 63 acadia dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments �M 63 Acadia Dr. Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 . 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.] El ® - 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. 63 acadia dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts` REM W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 63 Acadia Dr. Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 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? 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? El ❑ 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: El ® 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)] 63 acadia dr.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 63 Acadia Dr. Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 2 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 ears usage (gpd)): 2005:268,000 9 ( Y 9 2006:126,000 Sump pump? ❑ Yes Z No Last date of occupancy: unknown 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 I , Water meter readings, if available: Last date of occupancy/use: Date Other(describe): I 63 acadia dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 63 Acadia Dr. Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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/Alternative technology.Attach a copy of the current operation and El maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No 63 acadia dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments' 63 Acadia Dr.M - Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) r Building Sewer(locate on site plan): Depth below grade: 21 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: e0+ t Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below-grade: 18"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 J Dimensions: 1 0'6"x5'1 0"x57' Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 24" 8" Scum thickness 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 12" - How were dimensions determined? Measured 63 acadia dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 63 Acadia Dr. Property Address _ Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 . every page. Cityrrown t State Zip Code Date of Inspection; f 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.): I Pump tank every 2-3 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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): 63 acadia dr.•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 63 Acadia Dr. Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 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 t 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 No. 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.): Box is level and has two outlet laterals with equal flow.No evidence of solids carry over.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): - Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 63 acadia dr.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 115 Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments 63 Acadia Dr. Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 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: 3 ❑ 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.): Sandy dry soil.No signs of hydraulic failure.No ponding or damp soil. 63 acadia dr.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 63 Acadia Dr. Property Address P Patricia Neville Owner Owner's Name information is required for Marstons Mills. Ma. 02648 7/9/2007 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.): 63 acadia dr.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 63 Acadia Dr.M Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 .7/9/2007 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. �Uz F(26A/7 61 t4wP2 1 63 acadia&•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM ,•'' 63 Acadia Dr. Property Address Patricia Neville Owner Owner's Name information is required for Marstons Mills Ma. 02648 7/9/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Bottom of leaching 44'to water. Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date' ❑ 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:, Used:Gaherty Mller Model 12/16/94 Ground water elevations.Used:USGS Observation Well Data June 1992.Used:Technical Bulletin 92-000-01 Plate#2 annual ranges of ground water elevations. 63 acadia dr.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 I TOWN OF BARNSTABLE LOCATION (rs 33 4(141)1,A De, SE AGE #-1061 VILLAGE 1AI�." ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. WIL4A SEPTIC TANK CAPACITY %5�0 Q LEACHING FACILITY: (type) 3 5DO GI L 1= C/77"size) NO.OF BEDROOMS _ r BMILDER OR OWNER PERMTTDATE: ®� D COMPLIANCE DA 6-7; Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist. on site or within 200 feet of leaching facility). Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by -; Ff2hAIT 0'r -'42 -=- , 4 -1 0 1 Yo �No. I- 2� Z Fee . /®d� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Z PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes Application for Oigpogar 6pgtem Cow5tructiou Permit Application for a Permit to Construct(: pair( )Upgrade( )Abandon( ) Lid'Complete System ❑Individual Components Location Address or Lot No.fp 3 9C"D/A] 2 1 Owner's Name,Address and Tel.No. -7-7`—`®C/L/) Assessor's Map/Parcel �� ®,3 .®®(o 15)1 Y5 /16 P— 46 A/C Installer's Name,Address,and Tel.No. z Designer's Name,Address and Tel.No. -7-7 S—Q 73 S � r !/ � �(1 Type of Building: Dwelling No.of Bedrooms Lot Size 7� d�s sq. ft. Garbage Grinder(Aha Other Type of Building U&P rA41 F—No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ® gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank f 417 124-L1 A,�5 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system i operation until a Certifi- cate of Compliance has been issued by this Bo of Hea Signed -Mvffate Application Approved by Date / Application Disapproved for the following reasons Permit No. 7i� /'Z7 2 Date Issued J---(G —U No. 6 (6 I— �� Z e ? y '�� r Fee �. + Entered in computer: THE.COMMONWEALTH OF MASSACHUSETTS Yes -.PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppYication for Di.5pon't 6p.5tem Construction Permit Application for a Permit to Construct(Wepair( )Upgrade('")Abandon( ) LtJ complete System ❑Individual Components Location Address or Lot No. ACA D IA 2 1 V Owner's Name,Address and Tel.No. -7-7 Assessor's Map/Parcel C o 13 , 006 64 Y`S 1 1_'YE. f L46• IA.IG Installer's Name,Address,and Tel.No. _ Designer's Name,Address and Tel.No. -7'75—Q 73'5— Type of Building: Dwelling No.of Bedrooms -3 Lot Size 7 6 ad� sq. ft. Garbage Grinder(Ar[$ Other Type of Building U&P No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title 1 Size of Septic Tank /`i U`I) �, �5 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system itI operation until a Certifi- cate of Compliance has been issued by this Board of Heal�hr 1. Signed +. Z4�*A ate 6111 Application Approved by Date �? Application Disapproved for the following reasons Permit No. Date Issued - ---------------------------------------- .,7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(✓Repaired( )Upgraded( ) Abandoned( )by V,P— - /C Et/,L/E n Y at 4 3 /jC 14 n 111 7A?• n'1 • ✓j'I I LL5 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No._Z4't/ /—Z 7 Z—dated S —/O —'•d Installer Designer The issuance of this permit shall not be construed as a guarantee that the syst will function as de sig e Date c�f )T o z Inspector � �nl e p fir:'- . ————————————————————————————————————_ ——— No. f 3—d Op ..Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1wi.5pont *pttem Conotruction Permit Permission is hereby granted to Construct( /)Re air( )Upgrade( )Abandon( ) System located at 6 3 A C A� ( rq S)? 44 • M I LL 5 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. Provided:Co struction must be completed within three years of the date of this pe01 rmi Date: 1 L1 . 0 Approved by � U n TOWN OF BARNSTABLE LOCATION CADIA DR. SEWAGE #Aal VILLAGE ./ �� / I .S ASSESSOR'S MAP & LOT - INSTALLER'S NAME&PHONE NO. WI L/0-m SEPTIC TANK CAPACITY /'S�o Q LEACHING FACILITY: (type) _3! 5PO 4 CA-"size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE-. . ` D COMPLIANCE DA Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet e by o/> r � `. b Town of Barnstable P# Department of Health,Safety,and Environmental Services Public Health Division Date O� 367 Main Street,Hyannis MA 02601 RAmffrABm KAM �039. Date Scheduled Junc /3 .ao o0,. Time o A Fee Pd. `�/DO, 0-6_ - _ '.w � ,f •...*. Tl2 NOON 1 a"� Soil Suitability Assessment for Sewage Disposal Performed By: 6—tx/// ,a h �hR/` /'/%Cy ZWC .Witnessed By: 'Mko Q_AN o 1 ............._..............................-......................_....._..............._........_....................................................._..................._........_...................-.......__... ti. LiJGATtON &GENERAL INFQRMATIQN Location Address 3 n l��—�1 Owner's Name�y gh �7Q� rr f Ge.CQ c� Ca, ( J /D 10A r_e_ ' Mars�� /7?/'/fir / Address S bSfGY✓ %l Assessor'sMap/Parcel: / t^tL^4/'3—a06 Engineer's Name f f-e SJ�/�✓�h �t NEW CONSTRUCTION _X_ REPAIR ^Telephone# E5 0�- �/��— 3 3 VL/ Land Use A&S i /L7� Slopes(%), S Al Surface Stones `Distances from: Open Water Body ,moo ft Possible Wet Area &DW`r' ft Drinking Water Well �6 D11 tft `- Drainage Way qOO ft Pr'operty Line �Q 11 Other N/4- --ft> SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) -DRIVE �)5 � 1li-z Cp 1 1 Parent material(geologic) QaT-W 66 H r L /'v Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Kk Weeping from Pit Face tX AA Estimated Seasonal High Groundwater rz: L 20 t A Kea Ao' j�,C LZ)\o 6 w , I TE 1�ATtt?1�1: 'QR SEAS. NAL MGH�ATI �'TA1�Ll�'::..:':.. ...:. . Method Used: �CI�-t��C-`j N�l,C - Depth Observed standing in obs.hole: a d in. Depth to soil mottles: A 1 4- in. , Depth to weeping from side of obs.hole. = in. Groundwater Adjustment ft. Index Well fl__..._-.,.. .Reading Date:__...___ Index Well level. Arli.factor Adj.Groundwater Level ...:.:: :::..:.:::..:...::::<>: is>::<::`:.>;i:::.::':." ` 'iP.fii :CV.;t.�►�,L i\.:'1Li .. ::.::::::...A..a ..�e•'. >::'`!me; .......::: Observation Hole# — Time at 9" Depth of Perc 2 q I Time at 6" Start Pre-soak Time(a3 2 5'�A�t_n�S t� Time(9"-6") End Pre-soak 1 Z`^^ ✓� 3Q��G Rate Min./Inch z �'�"J v?(7e 11'l7C K Site Suitability Assessment: Site Passed _ Site Failed: K�D Additional Testing Needed(Y/N) 6 Original: Public Health Division Observation Hole Data To Be Completed on Back—� Copy: Applicant ........... EEP OBSERVATION HOLE LtC dole# ! Depth from I.I.S. oil Horizon Soil Texture S 1.oil Colo 1.r Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. AA o C) -10 b2.6A&.il Yeti-1 Le)r.Aw q A 10�1(Z 5/d la-3s' s C, �Os Q,�E '� SY2Sfg ..............I.............................................................................. ...... :DEEP OBSERVATIOII HOLE LO....... B Hole# 2 . . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % O -WAT 20-36// Ls M� toM 36- �p >3 SP,n�0 �oV u2Slg Q C DEEI'OBSERVAT'.I:O*V O:.E LOO Hate# . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.o DEEP OBSERVATOONHCILE LOG Hole# ; Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency," Flood Insurance Rate Map; Above 500 year flood boundary No— Yes X Within 500 year boundary No X Yes Within 100 year flood boundary No y. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? `�CS If not,what is the depth of naturally occurring pervious material? 'A Certification I certify that on 4!9S (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature yz Date (W 14 ZOOD LU Public Town of Bar: 4.4 PO Box 534 �� U � •• . Fax Massachusetts 02601 r . ' ax(508)775-3344 Phone(508)790-6265 _'Ir ly Cli LA Ln L 1 I -- 6dI.LC y r �-"'.i y '-�_S ram_�-c --I —�o+-_C�T��.) .`G::. I (:o'-,.•C r_.�r� � —__—__— —0 I '->'•-tee.-�--.� - - .. 1 ' I -, --� .• ` tl I I I - -: T �'� ' � Y'.T nC�"•-r.i -S' . -y ' -t '- � ' 1✓'-Lt �1�11 D-'� O�:ot Z'-6' �_ ' �h1 BI_yl � _ ; 0 i ! ! i i (�.�.-•TLC 1 l�� 'I—,- I L1� T I a____� -I � � � - - • I I I I _ s � _ �•� �. I I I I I_ - � � _ � � , v }+T•-' �� ^..00.c(�oo= (.—.•..c./U..o-ir) � z ` _N 1 t �`6 I — tl I� y. "TI: I '';,��j •o� _- -. I _J' I `r', ;i`?- 112 I 7I I Is -0 13 �. e L •IIf I •, I I t t � � Z (( ]R I — pry: -cow-•/. Mee o � � Lvcus) TEST HOLE LOG DATE: JUNE 13, 2000 P-9764 n/ /�-: � / A - SOIL EVALUATOR: P. SULLIVAN, PE '01 --1 WITNESS: D. MIORANDI, BOH PERC RATE: < 2 MIN/IN -#'/ -*Z. IO \ S✓ 60.0 O" 60.0 0" OORGANICORGANIC / /O Q 58.5 18" 58.3 20" \� \ A=LOAMY SAND A=IAAMY SAND yy 10YR5/4 10YR5/4 57.1 35" 57.0 36" H=SAND B=SAND �Z 10YR5/8 10YR5/8 54.3 68" 54.5 66" C-COARSE SAND C-COARSE SAND 7.5YR5/8 7.5YR5/8 ezT \ '�JT�1ec) 49.7 124" 49.8 122" P14eR� �� _ NO WATER ENCOUNTERED o E DESIGN DATA DAILY FLOW: (4) BDRMS. x 110 GPD = 440 GPD Gb SZ� SEPTIC TANK: 440 GPD x 200% = 880 GPD \ USE: 1500 GALLON PRECAST SEPTIC TANK LEACHING FACILITY: USE: (3) 500 GAL. PRECASR DRYWELLS (5' x 8.51 ) LINED w/4' OF DOUBLE WASHED STONE Z z5-S-t �N CAPACITY: �'- `•.. 'N SIDEWALL: 93 x 2 x 0.74 = 137.6 `'..� Nj BOTTOM: 13 x 33.5 x 0.74 = 322.3 ``.. TOTAL: 459.9 GPD MINIMUM BUILDING SETBACKS p6y FRONT: 30' SIDE: 15' -� \ .� REAR: 15' 1N OF A/,4 off` DANIEL[. �yo BRAMAN N C o CIVIL G V No.32686C ~ 3 Ss�ONAI V. 8 � - C? _ O 1 S-lo-a 1 NOTES: 1. ALL PIPE TO BE 4" DIA. SCH 40 PVC. 2. PIPE TO BE LAID LEVEL FOR 2' OUT OF DISTRIBUTION BOX. /Y 3. RAISE ALL APPLICABLE MANHOLE COVERS TO WITHIN 6" OF FINISH GRADE. 4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A - ,COJ'Z ''4 S �A�/uS �2o`u�.0 7.i�E Sign-- - GARBAGE DISPOSAL. Xd --4« W ITN CL�I�i/�.J/Q/✓�� ij 5. SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED �j ON A 6" LAYER OF STONE. 6. INSTALL GAS BAFFLE IN OUTLET TEE. � 2" LAYER 08 3/8" PEASTONE OVER - - DOUBLE c�►sxED STONE -------'; ALL AROUND TOP OF FOUND. 3 ----_------8`---- S�7a Go.Za s1sZ sy3s �7oa Syg� . 4z s' SEPTIC SYSTEM PROFILE SZ•o 0 SITE SEWAGE PLAN GENERAL NOTES FOR 63 ACADIA DR. , MARSTONS MILLS, MA 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION ASSESSORS MAP 58 PARCEL 13-6 OF ALL UTILITIES, ABOVE AND UNDERGROUND, PRIOR TO ANY EXCAVATION OR CONSTRUCTION. PREPARED FOR 2. SEPTIC SYSTEM TO BE INSTALLED IN COMPLIANCE WITH 310 CMR 15. 00: TITLE V. BAYSIDE BUILDING CO . 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE DETERMINATION. DATE : MAY 7 , 2001 SCALE : 1" = 40' 4. ALL DISTURBED AREAS TO LOAMBD AND SEEDED. 5. CONTRACTOR TO PROVIDE 24 HOUR NOTICE FOR ANY REQUIRED INSPECTIONS. WELLER & ASSOCIATES 1645 FALMOUTH RD. - SUITE 4C P.O. BOX 417 CENTERVILLE, MA 02632 TEL: (508) 775-0735 FAX: (508) 775-0754 APPROVED BY: