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0007 ASA MEIGS ROAD - Health
7 ASA MEIG ROAD Marstons Mills A = 031 — 012 �I TOWN OF BARNSTABLE LOCATION, ( �_, SEWAGE# _16 1'?_cj_3 VILLAGE � ,�p��lQ (`�iCL� ASSESSOR'S MAP&PARCEL OZ-1 •Did INSTALLER'S NAME&PHONE NO. Spa -7-7 1- q Zqq SEPTIC TANK CAPACITY LAC.i LEACHING FACILITY: (type) ZxleCela— (size) �' !c I�•�':3�c� NO. OF BEDROOMS Al OWNER C6 1N PERMIT DATE: COMPLIANCE DATE: 3 b Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility d-S Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) l-l4 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY P fn ® .3 '-7 -a aUf 4•i A3 .,, 35170, t 'O"� �._ Aid Fee 100, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplitation for Misposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair A Upgrade( ) Abandon( ) ❑Complete System *Individual Components Location Address or Lot No. / OOwnerr''s Name,Address,and Tel.No. �O�"e-C 5 Pit G Assessor'sMap/Parcel 31 /� a kit') 7 �cFz� . Installer's Name,Address,and Tel.No,6$- Wff- 5 goo Designer's Name,Address,and Tel.No.�-*- 31r, t 0r lo—z. �Dr+���c -u` 2k•c CjaGG.� �� %�L��I/ y-CIO C 939���/I st Type of Building: Dwelling No.of Bedrooms Lot Size J o� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures `/ Design Flow(min.required) �ao gpd Design flow provided 9�� gpd Plan Date „L & oat, Number of sheets Revision Date Titlei419-S Ste-d'dM 14 & qNgAw M I A i 9 Size of Septic Tank eXib(y' Type of S.A.S��} �d�1 S)C �a-83 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Cod to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date �7 Application Disapproved by Date for the following reasons Permit No. Date Issued O(3 } r Fee 00, THE COMMONWEALTk OF MASSACHUSETTS Entered incomppter: ✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Mis oral 6pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System endividual Components Location Address or Lot No.? s*. Alk( Owner's Name,Address,and Tel.No. 5b8-G - r`✓G Assessor's Map/Parcel ��- 8re`t'+'Coc�k I i n 7 /�Yt 14 ei S 41 3! air r1A r4 0 Installer's Name,Address,and Tel.NoJO$. Ydff- O/c.4 Designer's Name,Address,and Tel.No. .3G 2 - Y5-YI cn/�in�'er'i�,!roc �j.�fy/ai� St• D• �X r5 U>evy LL" n Q 4 D Type of Building: Dwelling No.of Bedrooms ` Lot Size cWf 5�0 0� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 31/5, gpd Plan Date('p[ay�jQ�j / IG/(, Number of sheets / Revision Date Title i i' (g 5 `)r�e_ Adn� 50./ cePS+orn ijfS j1;1/ ' � f Size of Septic Tank eXis(-j'vlq Type of S.A.S�Z_ ,,( w4m /2'83 Description of Soil G ipCr i i Nature of Repairs or Alterations(Answer when applicable) N Date last inspected: Agreement: �� /� The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage�disgosalssystem in r accordance with the provisions of Title 5 of the Environmental Code and-n t to place the systemrin operation until a Certificac to of -^ Compliance has been issued by this Board of Health. Signed Date 1 11 Application Approved by cf Ls Date j V (- Application Disapproved by Date for the following-reasons Permit No. Date Issued ------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(tO Upgraded( ) Abandoned( )by &f/e,16� (��,� rr«'}{( ,1 n L at 5Q Q q S A(r rs i(/S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No�d)-1-003 dated J/f C/11'] Installer 80rftj[r zn!G ba g Tf c� 1►�G� Designer lne r n o n r� lmr c_ #bedrooms d Approved design flown 17 gpd The issuance of this permit shall not be construed as a guarantee that the system will Mnction as designed. Date I � '1 Inspector X V 1) ', --------------------------------------------------------------------------------------------------------------------------------------- No. a U l�~ 0 -,1,- . Fee t o f') THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -isposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(k/) Upgrade( ) /Abandon( ) System located at i t✓ I L1U and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. i Provided:Constructio must be completed within three years of the date of this permit. Date Approved byC (" i 3 U r TRANS. NO,: CITY/'TOWN: Azrsf ort3 14110sz�" A-PPLICANT: i ADDRESS. DESIGN FLOW: _ � gPd REVIEWED BY: � BATE: N/A OK NO Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax.parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CNM 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 Ma 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for / upgrades]- if not, a variance is required [310 CMR 15.412(4)] i Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CNM 15.220(4)(f)] daily flow septic tank capacity(required and provided) soil absorption system(required and provided) whether system designed for garbage grinder North arrow [310'CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] l Location and log of deep observation holes (existing grade el. on / each test) [310 CMR 15220(4)(h)] Names of soil evaluator and BOH representative [310 CMR �. 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet 1 of 7 • 7 t l NSA ®K NO Location of every water supply,public and private, [310 CMR 15.220(4)(k within 400 feet of the proposed system location in the case j of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins / J located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located[310 CMR 15.220(4)(m)I (if water line cross see 310 CMR 15.211(1)[1]) l i' profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] rapproved designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Registered Land Surveyor(required if construction within 5 ft. of lot line) [310 CMR 15.220(3)] s adequate (two in each of the primary and reserve nches as permitted in 310 CMR 15.102(2) or as for an upgrade under LUA at 310 CMR 15.405(1)(k)] adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] ` Test Holes adequate to confirm adequate groundwater separation? �t j [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.000] System components not>36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] ' I I I I i i i i i Address Sheet 2 of 7 I i i i I N/A ®K NO i Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] I Note regarding installation on stable compacted base [310 CMR 15.228(1)] -- Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 i CMR 15.232(3)(f)] i Three access covers (inlet and outlet must be 20" or greater) - �✓ middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR i 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] j H-20 Where appropriate? `310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.2111 110.ul�ioxripartmen � lcs� � ,F i Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] `'� First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.2.24(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with as baffle or approved filter 310 CMR 15.224 4 g pp [ ( )] !i I i i it I j j Address Sheet 3 of 7 j i +i I N/A OK NO Y [jIL ) l`l�S ��jEI� I) OI,1k��P= Ins ? ,� .y. w. � � _ .:.$.. Located at least ten feet from any water line? [310 CNM 15.222(2)] Disposal piping at least 18"below water line(when water and sewer cross, see 310 CMR 15.21l(1)[1]) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller v than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 , CMR 15.252(2)(h)] `* Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) Mil U r - ; Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] / Riser if deeper than 9" [310 CMR 15.232(3)(0] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] 'p Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? ' —& Exceeds two units must have two pumps operating ul lead-lag mode. [310 CMR 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed? Provided? [310 CMR 15.221(8)] L Address Sheet 4 of 7 i I N/A OK NO �. fYFt�r.�2fi„YS �.:Y�''i �s4?-' T,-{'if{' Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] /n Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310,CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I'minimum-4' maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] / Width T minimum T maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] JBE� S �S, ( a�imu .�zeiFbe o•, ie1c1000 g1?,d� � `�� �x�� � ' minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM RI5.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] 1 A Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only [310 CMR 15.252(2)(i)] i I Address Sheet 5 of 7 ` i I 1 N/A OK NO 3 �t£ 9J ,�Js�+`,„.1'`9�: a+� i,xy�+ n.S.. Sa'1"r �iON ,Pressure Dosed�ystein ? Provided pump and piping calculations as required [310 CNIR 15.220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and UA Remedial Use Approvals] �I If used in gravelless system-make sure jet is directed as not to scour soil 'interface-[Guidance Document] _ Inspections once per year (systems<2000 gpd) or quarterly f (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] " Construction in fill -Did the plan specify that the fill shall meet I the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] G a s°9"p— e;teas Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface ' 1irc` ay e a �s'erg I/: rovcrle,5 ers Was DEP Approval Letter provided and/or have you I reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for a perpetual maintenance greement? Any alarms involved on separate circuits l Did the applicant submit an operation and maintenance manual? , Has applicant submitted a copy of a maintenance `�ar�inrace a �.�V �; Are the variances listed on the plan? [310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address Sheet 6 of 7 I N/A ®K NO �k'`1`s.. + , Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [31C CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15 216(1)] ,�'.si .r x 3." � ���-�� csd ����� Mlscel�a 1e0ILS � � �a s r'3 -a A� t „sr��a A`,�`x�.�:;�.y.� .,.5�'.'�•`v4*n:F',a. .e• Pumping to septic tank ? - 3.10 CMR 15.229] Shared System [310 CMR 15.290] i , 1 Address Sheet 7 of 7 Print Page Page 1 of 4 Print this page • Owner Information -Map/Block/Lot: 031 /012/- Use Code: 1010 Owner Map/Block/Lot GIS MAPS COUGHLIN,BRETT 031 /012/ Owner Name as of 7 ASA MEIGS ROAD Property Address 1/1/15 7 ASA MEIGS ROAD MARSTONS MILLS, MA. 02648 Co-Owner Name Village: Marstons Mills Town Sewer At Address: No GIS Zoning Value: RF • Assessed Values 2016 - Map/Block/Lot: 031 /012/- Use Code: 1010 2016 Appraised Value 2016 Assessed Value Past Comparisons Building $ 74,500 $ 74,500 Year Total Assessed Value: Value Extra $ 44,000 $ 44,000 2015 - $ 233,600 Features: 2014 - $ 233,700 2013 - $ 227,200 Outbuildings: $ 2,100 $ 2,100 2012 - $ 225,700 $ 116,500 $ 116,500 2011 - $ 223,300 Land Value: 2010 - $ 223,200 2009 - $ 271,000 2008 - $ 302,100 2016 Totals $ 237,100 237,100 2007 - $ 301,400 • Tax Information 2016 - Map/Block/Lot: 031 /012/-Use Code: 1010 Taxes C.O.M.M. FD Tax $ 376.99 (Residential) Community Preservation $ 66.22 Act Tax Town Tax (Residential) 2,207.40 Fiscal Year 2016 TAX RATES HERE I $ 2,650.61 http://www.townofbamstable.us/Assessing/print 16.asp?ap=0&searchparce1=031012 10/5/2016 1 Print Page Page 2 of 4 • Sales History - Map/Block/Lot:031 /012/- Use Code: 1010 History: Owner: Sale Date Book/Pa e: Sale g Price: COUGHLIN, BRETT 2014-07-10 28255/63 $229000 MADDEN, WALTER J TRS & CHARLES M TRS 1991-09-15 7678/186 $1 MADDEN, WALTER J& CHARLES M 1982-06-15 3499/348 $0 0 • Photos 031 /012/-Use Code: 1010 • Sketches - Map/Block/Lot: 031 /012/- Use Code: 1010 PTO y ^J 14 4" LO 1 3l 1,Z `.2 FE P 1~ GAR 22 „12r: 47 BAST; 8 BM7 14 14 :1 FK- 22 AsBuilt Card N/A • Constructions Details - Map/Block/Lot: 031 /012/- Use Code: 1010 Building Details Land fi Building value $ 74,500 Bedrooms 2 Bedrooms USE CODE 1010 Replacement Cost $100,700 Bathrooms 1 Full-0 Half Lot Size 0.66 (Acres) Model Residential Total Rooms 4 Rooms $ 116,500 http://www.townofbamstable.us/Assessing/printl 6.asp?ap=0&searchparcel=031012 10/5/2016 Print Page Page 3 of 4 Appraised Value Style Ranch Heat Fuel Gas Assessed Value $6,500 Grade Average Heat Type Hot Air Year Built 1969 AC Type None Effective 26 Interior CarpetHardwood depreciation Floors Stories 1 Story Interior Drywall Walls Living Area sq/ft 942 Exterior Wood Shingle Walls Gross Area sq/ft 2,603 Roof Structure Structure Roof Cover Asph/F GIs/Crop • Outbuildings & Extra Features - Map/Block/Lot: 031 /012/- Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value GAR Attached Garage 308 $ 8,200 $ 8,200 BFA Bsmt Fin-Avg 348 $ 4,400 $ 4,400 FPL1 Fireplace 1 story 1 $ 3,300 $ 3,300 FEP Enclosed porch- 144 $ 7,100 $ 7,100 roof,ceiling BMT Basement- 942 $ 19,900 $ 19,900 Unfinished PAT2 Patio-Good 240 $ 2,100 $ 2,100 FOPC Open Prch-roof, 27 $ 1,100 $ 1,100 ceiling • Sketch Legend Property Sketch Legend B2N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area SOL Solarium (Finished) BMT Basement Area FUS Second Story Living Area SPE Pool Enclosure (Unfinished) (Finished) BRN Barn GAR Garage TQS Three Quarters Story (Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLIP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area (Finished) GXT Garage Extension Front UST Utility Area (Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) http://www.townofbamstable.us/Assessing/printl 6.asp?ap=0&searchparcel=031012 10/5/2016 Print Page Page 4 of 4 FEP Enclosed Porch Wil Mezzanine, Unfinished UUA Unfinished Utility Attic FHS Half Story(Finished) PIRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in PRT Portico WDK Wood Deck Porch PTO Patio Microsoft VBScript runtime error'800a01a8' Object required: " /Assessing/print16.asp, line 151 i http://www.townofbamstable.us/Assessing/print l 6.asp?ap=0&searchparcel=031012 10/5/2016 Town of Barnstable Regulatory Services Thomas F. Geiler,Director 26 Public Health Division o> � Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Desi ner Certification Form nstall ti g r Date: 116 �7 Sewage Permit# Assessor's MaplParcel I �" Designer: J ,q Li& Installer: �d/ /� D I Address: l Nov 1, V Address: On was a issued permit to install a ( ate) (installer) septic system at 7 f'a, /'I el .f based on a design drawn by (addresif Q v1,I C a �a.. dated 1 a � l (de gner) V 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 tl1an 10 lateral relocation of the SAS or any ve rtical relocation of any compo nent of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. ('A f 1.1i (Tn Signature) ll r:�vPI s r s (Designer's Signature) (Affix Designer's Stamp Here) pLEASE gFTUgN TO BARNSTABL,E PUBLIC IICALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOS' BE ISSUED 'UNTIL BOTH THIS FQRN AND A& UIUT CARD ARE RECEIVED BX T l3A"STABLE PUBLIC WAT.,TD DMSION THANK YOU. Q:Healtb/Septie/Dosigner Certification Form 3-26-04.doc 7 7 13 I - TO WN OF BARNSTABLE i � SEWAGE# i LOCATIONa--? � l VILLAGE F1 �z �� ' r ASSESSOR'S MAP&PARCEb INSTALLER'S NAME& HONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 1 (size) Cul NO.OF BEDROOMS c — OWNER -f-1- COMPLIANCE DATE: PERMIT DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ' Private Water Supply Well and Leaching Facility(If any wells exist on Feet site or within 200 feet of leaching facility) _ Edge of Wetland and Leaching Facility(If any wetlands exist within 14 Feet 300 feet of leaching facility) FURNISHED BY Town of Barnstable -n h tD�p;�ar�tment.of Health,`S�afe�ty�,� TEn�� �tal*Se�;vr�cesµ ,t,� a%• Public:0Hpealth Dimis;ydn Date, l� -:'<•6 `367 Mam"Street,Hyaanis MWd 6 ll S awaxare13M - Z MA8.9. °i16 A Date Scheduled �- (/� Time_LL,&-✓yl Fee Pd. l _. . .. l Soil �` 'itaib•ilit' AssessM` ent for �S"e qge Disp:o al Performed By: Witnessed By: !�1• n FJ, W I- .;s .. . 00 .....�....._..._..-...........,,_. `vijijj;•ij?};:i:iiiil$}iiii i:•ii'riii iii'r'rii:v4iiij:•:•iii:4:•::Nri�!Chi::•:iii:•lii:iii::::wi::::::::::::::r::::::n::.............................. Location Address �Q f� �l/�e �� Owner's Name I / Assessor's Map/Parcel: 3 /oZ Engineer's Name JJOw�— � _ NEW CONSTRU61ON REPAIR Telephone# 65S v) Land Use Slopes C/o) y Surface-Stones /VOA Drinking Water Well? 60 ft Distances from: Open Water Body >/L �O R Possible Wet Area �(�G ftr Drainage Way >c O a tt Property Line �3C) ft Other ft SKETCH:(Street name,dimensions of tot,exact locations of lest holes&perc tests,locate wetlands in proximity to holes) ASo, /4e►Gj5 (o1�yG A - © _ Q o y r. 33 .i THZ �A �•,� to�. �:u Wash Depth,to Bedrock Parent material(geologic)' t �'t �' A/ Depth to Groundwater: Standing Water in Hole: /" Weeping-from'Pit Face Estimated Seasonal High Groundwater._�l �Niethod Used:':::::.�:.�...:••;::::. ...::::::::::::::::::............................ . Depth Observeding in obs.hole: in. Depth to�sOwmottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well#___,_._ •Reading Date:_.___ Index Well level,,,_' Ad0factor " Adj..Groundwater Level >liirt..... OiW Observation l „ Hole#' t Time.at 9 . : - Depth of Perc -- -- / Time at'6` Start Pre-soak Time® Ti=07-61 :S End Pee-soak Rate Min./Inch Site 'Suitabiliry Assessment: Site'Passed.• *+' Site Eaileil: .. QddlttonaltTesting.Needed,(Y/_, Original: Public Health Division Observation Dole Data To Be O: m"letdd'0n•13aa k Copy: Applicant - 1 } ::::::::::.::.;:•;:;.;:•;::.;;::;.;:;»>:::<:<:::»:z:s>::.'zons»» :>::»:<:»;:•>::•>;>:.:;; r'::.::;;:::::.:::.::::: .:..;•.........:r:.......... Other 5:::::..:................ Depth from •• Soil Horizon Soil�Texture't� ? �)#Soil1.lColor x„`q; Soi u face(inJ (USDA). (Munsell) . Mottling (Structure,Stones,Boulderes. ° . .,. •<: ::: ;r^iiiii`iiiiii'iiiiiiii:ii2ii;iii! iiiiiiii''S.......»,:;::.i:.'....,:::::._.:....; `i.�:.:::.>,,:::'.::'�.;!:::: 2 i::::}•::}I�rvv.i2iii iiiiy i2: ?i?ii is ii i::._::;;t:iy:.. :... .........................:.................. Depth from ' Soil Horizon Soil.Texture Soil Color Soil µ Other °Surface(in.) '" ,Fa `r (USDA) (Munsell) , Mottling (Structure,Stones,Boulderes. o n °°Grave O - V (V -'�Z LS 10 g 12 � 5yEV :::.::.:::.::.:.:::.::::..:: :::.: ::.::::.... ......... .................. Depth from• • Soil Horizon Soil Texture Soil Color Soil Ot ter Surface(in.) (USDA) (Munsell) Mottling (structure;Stones..Boulderes. el : `a::.:::::::.::::.:..:::................... lad 10 Depth from Soil Horizon Soil Texture Soil Color Soil Otter Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. ons een ili an id Above 500 year flood boundary,-No_ Yes V/ -Within-,500,year.boundary Nov Yes r �"" wttfiiiilOOyeaiflood�6'oundary NoQ,�/ `;:`"�Yes4�- 0-6pth of Naturally Qccurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absor Lionsystem? ]Snot,what is the depth of naturally occurring pervious material? Gertificati®n bcertify that on 5 Z (date)I liave passed the soil evaluator examination approved by the Departmeng'dfEnvironmental'PFotection_and,that,the above analysis was performed by'me consistent with ,the required training,,expertise and,experiencekdescribed in 310 CMR 15.017. Date Signature � '"`-�''•.f �s��� 01 Commonwealth of Massachusetts ,s _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 7 Asa Meigks Rd Property Address - - Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 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. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information - on the computer, use only the tab . U 1 1. Inspector: key to move your cursor-do not Matthew F. Gilfoy use the return key. Name of Inspector B&B Excavation fey Company Name 14 Teaberry LaneAlf - Company Address Sandwich Ma: 02644 City/Town State Zip Code (508)477-0653 S131640 Telephone Number License.Number B. Certification 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 15000). The system: ® Passes ❑ Conditionally Passes ❑ _Fails El Needs Further Evaluation by the Local Approving Authority 5-1-14 Inspector's Sijrkure- .. - - Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving:authority. ****This report only describes conditions at the time.of inspection and under the conditions of use at that time. This inspection does not address how.the system.will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspec F Subsurface Sewage:Disposal System-,Page 1 of 17 r Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 7 Asa Meiggs Rd Property Address Walter& Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has 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 Y day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 r Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 r Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 7 Asa Meiggs Rd Property Address. ....... Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 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 El K. 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 thesystem 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?. p. ... ® ❑ 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 El ® 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. ® El Determined in the field(if any of the failure criteria related to.Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential_Flow Conditions: -Number of bedrooms (design): no design Number of bedrooms(actual): 2 .._ plans DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): na l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage n/a 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6 months priorDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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): Tank, leach pit t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 Asa Meiggs Rd Property Address Walter&Charles Madcen Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade 20": feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order no sign of leakage. Septic Tank(locate on site plan): Depth below grade: 14"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: 2" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 0" Distance from bottom of scum to bottom of outlet tee or baffle 0" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order,Tees present no sign of back- up.Liquid level equal with outlet invert. Pipe from tank to pit orangeburg and in poor condition but still working. may need replacement in future. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 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.): 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.): I "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 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): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 6'X6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to in working order no sign of hydraulic failure.Pit dry at time of inspection. 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 L a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disp osal- g p System Form Not for Voluntary Assessments i ;M 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal'System form -Not for Voluntary Assessments 7 Asa-Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills. Ma. 02648 5-1-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketeh 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 9f 0-Y o f I�nuSe ► 13 Ai CO 2n' t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 h Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >10' 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: USGS top maps You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 °M 7 Asa Meiggs Rd Property Address Walter&Charles Madden Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-1-14 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 LL SYSTEM PROFILE MARKED WITHC MAGNETIC TTAPEAOR BE NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD �P 0 P' ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE SP�O���eao``, 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING TOP FOUND. EL. 105.2 FILTER FABRIC OVER STONE \ lO4.O MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM EEO 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. I �Q oOs PRECAST H-10 WATERTEST"D'BOX FOR LEVELNESS BLOCKS OR ( 4. DESIGN LOADING FOR ALL PROPOSED PRECAST RISERS H-1 MIN. 2 WALL THICKNESS PRECAST RISERS � UNITS TO BE AASHO H-M � 4"OSCH40 PVC MORTAR ALL 103.2 PIPES LEVEL 1ST 2' COMPONENTS INVERT IN 101.17' O 4' (Np) 4' 5. PIPE JOINTS TO BE MADE WATERTIGHT. ENDS SIDES 102.0• Z EXISTING y;e�;e o 0 0 0 ° ° ° 10" 14„ °° °°° ° ®®®� ®®®® ®®®®- ®®® 'o°o°o°o° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE y TEE SEPTIC TANK** TEE �* o o.° g°000°g° ®®®®�®®��®® ��®®®®®®®®® >0000gaoo WITH 310 CMR 15.000 (TITLE 5.) As Mei s 101.8f o°°°°°°°°°°° >°°°°°o°o ®®®®®®��®®® ®®®®®�®®®®® Sc ooI OOP°OOOO^°° ®®®®®®®®®®® ° ° °°° °°°°°° ° AS BAFFLE.., ° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND ° ° ° ° 101.44' 101.27' >°o °0 99.17' NOT TO BE USED FOR LOT LINE STAKING OR ANY Locus } OTHER PURPOSE. 3 • = H-20 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL. 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ALL AROUND PRECAST STRUCTURES a _ 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' 9. COMPONENTS NOT TO BE BACKFILLED OR ` COMPACTION. (15.221 [2]) CONCEALED WITHOUT INSPECTION BY BOARD OF 2 % SLOPE 1 LO HEALTH AND PERMISSION OBTAINED FROM BOARD �o� �i'ntd ( ) ( % ) SLOPE OF HEALTH. FOUNDATION EXIST. SEPTIC TANK 18' D' BOX 12' LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FACILITY CALLING DIGSAFE (1-888-344-7233) AND *THE INSTALLER SHALL VERIFY THE **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP 93.5' rOTTOM TH-2 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF LOCATIONS OF ALL UTILITIES AND ALL SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR NO GROUNDWATER FOUND WORK. NOT TO SCALE BUILDING SEWER OUTLETS AND RE-USE. REPLACE WITH 1500 GALLON SEPTIC TANK / ELEVATIONS PRIOR TO INSTALLING ANY APPROPRIATE TO SITE CONDITIONS IF NOT SUITABLE /11. ANY UNSUITABLE MATERIAL ENCOUNTERED PORTION OF SEPTIC SYSTEM � v v ���/// PROPOSED ALL BE REMOVED LEACHING FACILITYm, AND AROUND THE ASSESSORS MAP 31 PARCEL 12 SITE 'IS LOCATED WITHIN A ZONE II LEGEND 12. EXISTING LEACHING FACILITY SHALL BE PUMPED 2 BEDROOM DEED RESTRICTION REQUIRED o �/ AND REMOVED OR PUMPED AND FILLED WITH CLEAN AS A 1VI G s ROAD VARIANCE REQUESTED: 99- EXISTING CONTOUR (3): SEPARATION FROM SAS TO PRIVATE WELL X 99.1 EXIST. SPOT ELEV. , TO BE LESS THAN 150' BUT GREATER THAN 100' -[99]- PROPOSED CONTOUR ¢ o (120.6' PROPOSED) 198.41 PROPOSED SPOT EL. SYSTEM DESIGN. TH1 �0 103 TEST HOLE o I "o� ,00 GARBAGE DISPOSER IS NOT ALLOWED 2� SLOPE OF GROUND EXISTING 2 BEDROOM DWELLING UTILITY POLE I DESIGN FLOW: 2 BEDROOMS @ 110 GPD = 220 GPD PAVED r� USE A 220 GPD DESIGN FLOW FIRE HYDRANT / DRIVE o � > Oj NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING l/ / , [� SEPTIC TANK: 220 GPD (2) = 440 **RE-USE EXISTING 1000 GAL. SEPTIC TANK o � LEACHING: TEST HOLE LOGS SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD 105 237 GPD DANIEL E. GONSALVES, SE #13587 o BOTTOM 25 x 12.83 (.74) = ENGINEER: ` TOTAL: 472 S.F. 349 GPD WITNESS: DAVID STANTON, RS �06 � DATE: 12/5/16 � USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) _ < 2 MIN/INCH ✓ o WITH 4' STONE ALL AROUND PERC. RATE CLASS I SOILS P# 15220 J I ELEV. ELEV. of$ 4 104.5' 0„ 104.0' EXISTING MA " APPROVED DATE BOARD OF HEALTH A A DWELLING T&E T E LS LS PATIO TOF = 105.2 TITLE 5 SITE PLAN 10YR 4/2 10YR 4/2 � 4„ 6„ / OF 23• B B ,- ' �.''�l, � LOT 81 a 7 ASA MEIGS ROAD LS LS 1, \ < _ 28,562± S.F.1o3 �, MARSTONS MILLS MA 18" 103.0 22 10YR 4/4 ' �� 1022 10YR 4/4 ' 10� �' \ � r, , \ i BENCHMARK 10 0 W \ o� COR STONE STEP PREPARED FOR i C, \ T ; EL. = 104.9' BORTOLOTTI CONSTRUCTION �S L \ j TH 1 5' REMOVAL OF UNSUITAB E SOIL RE UI I CILI 2.5Y 7 4 „ 2.5Y 7/4 \ TH2 AROUND PERIMETER SUITABLE E 0 LEAYER.GRF LAC ° H 54" / 100.0 58 99.2 DOWN LE SUMS COUGHLIN WITH CLEAN MED. SAN TO MEET S IFICATIONS OF 31 CMR 15. 5(3) ./ �p L'ZrL_ 6 DATE: DECEMBER 6, 2016 2 2 W 14 100' OFFSET ABUTTINqS o�f -362-4541PERC or M M/CS M/CS sq Y`:i I A j ,, p, s fax 508-362-9880 o A�,NIELA >>^Iv Iml A��� �� 2.5Y 6/4 2.5Y 6/4 0 o IU downcape.com O 7 I� OJALA ` 01�� F, �ati�� Q, > .. � - UNSUITABLE 143. 4 � CIVIL '� r� 1 €� I; ;` N �U�i8'� If q d'own cape engineering, inc SOIL No.46502 x1 a n , " , .n'Q�G FL�O � � [;, tJ 4 � �� r c- `^O�. /,%�.. civil engineers .. 126 94.0 126 93.5 Scale: 1 = 20 F �sr� �a F' H land surveyors " b�S/ ti ��V ,a,5j0\, E�Ni�c 1 n tU 'JEy o°K' G �UaVE NO GROUNDWATER ENCOUNTERED � - 939 Main Street ( Rte 6A) 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 LICE # > 6-395 16-395 BORTO-COUGHLIN.DWG