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HomeMy WebLinkAbout0396 BAXTERS NECK ROAD - Health 396 Baxter's Neck Road, Marstons Mills A= ;4 i ,i r 4 1 ` TOWN OF BARNSTABLE J,,OCATION J ,�. f 1�Z( )( 2� SEWAGE# PY ILLAGE f f j ASSESSOR'S MAP&PARCEL O 7 INSTALLER'S NAME&PHONE NO. C-e ''�� SC �L SEPTIC TANK CAPACITY /S G 0 LEACHING FACILITY:(type) J Ck6g"l,,,,j' o°C.z (size) . 7 G-,(i Z_ NO.OF BEDROO S lSJ 4 OWNER` PERMIT DATE: JP COMPLIANCE DATE: I l 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 ; y ZVI IJ Vo Fee 6 �� THE COMMONWEALTH.OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS YeS ftphtation for Mispo8af *pstrm ConeftUCtion Hermit Application for a Permit to Construct(Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. +fir j ck-.+-t-C4- ftty�`, Z Owner's Name,Address,and Tel.No. Assessor's Map/Parcel el Z Installer's Name,Address,and Tel.No.16 C \, aka Designer's Name,Address,and Tel.No. C1?. �'e 5 2, i�a�t.�Cr l�o'°� l► i Y�nTa c��� —� �2 i, �- 2� r �►.r,.� Type of Building: j Dwelling No.of Bedrooms Lot Size l'' r z sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 60 gpd Design flow provided gpd Plan DateS�;�1 i� Number of sheets Revision Date Title Size of Septic Tank y'a ,. �p Type of S.A.S. �� ®� Gld%J..AA Description of Soil G Nature ofRepairs or Alterations(Answer when applicable) ��.� �C_GtiC L L t-Aj �q 4 ; lirk 14 o. �rt/t J 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. tgned Date Application Approved by _ Date Application Disapproved by Date for the following reasons Permit No. J Date Issued 5 I w ' Fee W THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: a-Fo. . , Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for MispoBal 6pstem Construction permit Application for a Permit to Construct(4'Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3MA P1-(-Vt_ t X Owner's Name,Address,and Tel.No.I%C 1 a�tg Assessor's Map/Parcel �,1 S L. t4 S 3�er r:•13 y✓ '�nx o n s; Installer's Name,Address,and Tel.No. nr, C Designer's Name,Address,and Tel.No.Ott Seyt-L- \ .1�.�j Gg �' �n _ scec,., 1.tc Gt2 .r ZOO v n. rr•'�,.,,� �:��-s f.f'n,P� e.ba 7�•�. [1-osil '7?t — 4�-n• Type of Building: r j Dwelling No.of Bedrooms Lot Size RV 1 -U�� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures rr-- Design Flow(min.required) A gpd Design flow provided gpd Plan Date p l 01 1 1f'► Number of sheets Revision Date Title Size of Septic Tank 5:t Type of S.A.S. , Ca�1�� r , Description of Soil SQ. 1$G Nature of Repairs or Alterations(Answer when applicable) I�/� 1•r e, Mn inn 6cu 1 n 0% \r IA 1 k A',11 N i�b..«n.,i�r-e�'f � �{ter�� J �•SA e��. cam �•`��. 4 ca 1`-i^e r ' 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�thisard of H Bo ealth. Sed �� Date Application Approved by r Date Application Disapproved by " Date , for the following reasons Permit No. �f f /�7 t.+ Date Issued �5 9 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 0 ��l�„e,(,t n +�[. ,4n t K,4r.46 �t at "has been consrt�ruuc d in accordance / with the proviis�ion/s of Title's d the for Disposal ystem Construction Permit Non! ��"� /co0hated Installer- Designer #bedrooms 1 _ Approved design flow gpd The,issuance of this permit shall not be construed as a guarantee that the system will onn asldesigned. Date c `1 o Inspector k / (1/ , (A,-,, ls�,_- �.w --- - _._ No. / Fee 3�� �— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposar *pstrm Construction J)Prmit Permission is hereby granted to Construct( ) Repair( ) �{ JUpgrade()(,.)/� �A/liandon( ) t System located at (� -AR CZ.k-11C r`� /V �l? 9 I 'I_ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must,be completed within three years of the date of this permit. Date ��/ �� Approved by Town of Barnstable ,lime � Regulatory Services Richard V.Scali,Interim Director KAM �� Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit# 0 f -/ O Assessor's Map\Parcel -7f 3 Z- Designer: I V l��►�M/v Installer. ` �C-e- Address: qt -e `'t-- OrV-k- Address: CO CA-5 vl,, V9 Y--\ On S-{V-/q Ad����-, was issued a permit to install a (date) (installer) ,n septic system at 3 9 G OA��"-er 5 ACAL. d�c based on a design drawn by (address) ! v Mc��6�`��' 'dated T ` (designer) /�I'certify that the se tics stem referenced above was installed substantiall accordin to P Y Y g the design, which may include minor approved changes such as lateral relocation.of the distribution'box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. 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 certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was co a with the terms of the IXA approval letters(if applicable) 0 ss� 0 6 Scott A. G McGann 0 -anstaller's Signature) #1224 ti (Designers Signature) (AffiilAeq i e 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. - n•\CrntirAnP.cionrr rerfifiratinn Fnr Rvv R-IA-11 rinr Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Cynthia W. Brink Living Trust, 101 Plantation Circle, Ponpe Vedra, FI 32082 Owner Owner's Name ' information is Marstons Mills MA 02648 4/10/2015 required for 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. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not REID C. ELLIS use the return Name of Inspector key. ELLIS BROTHERS CONSTRUCTION Company Name 23 ENTERPRISE ROAD Company Address YARMOUTH PORT MA 02675 City/Town State Zip Code 508-362-6237 S 121891 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(3 CMR 15.000).The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 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. e t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Cynthia W. Brink Living Trust 101 Plantation Circle Ponpe Vedra FI 32082 Owner Owner's Name information is required for every Marstons Mills MA 02648 4/10/2015 page. Cltylrown 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 I have not foun any information which indicates that any of the failure criteria described 0 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 determi ed" (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 ey filtration or tank failure is imminent. System will pass inspection if the existing tank is replaced witt a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it s structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less th n 20 years old is available. ❑ Y ❑ N ❑ ND (Explainbelow): t5ins•3113 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 ,M 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Cynthia W. Brink Living Trust 101 Plantation Circle Ponpe Vedra FI 32082 Owner Owner's Name information is required for every Marstons Mills MA 02648 4/10/2015 page. Citylrown State 21 Code P 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 high static water level in the distribution box due to broken or obstructed pipe(s) or due to a br ken, settled or uneven distribution box. System will pass inspection if(with approval of Board of alth): ❑ 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).- El The system required pumping more than 4 tim s 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 oard of Health: ❑ Conditions exist which require further ev luation by the Board of Health in order to determine if the system is failing to protect public hea th, safety or the environment. I. System will pass unless Board of f lealth determines in accordance with 310 CMR 15.303(1)(b)that the system is not fun tioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 fe t of a surface water ❑ Cesspool or privy is within 50 fe t of a bordering vegetated wetland or a salt marsh t5ins•3,113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Owner Cynthia W. Brink Living Trust, 101 Plantation Circle Ponpe Vedra FI 32082 Owners Name information is required for every Marstons Mills MA 02648 4/10/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of ealth (and Public Water Supplier, if any) determines that the system is functions ig in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil 3bsorption system (SAS)and the SAS is within 100 feet of a surface water supply or tribut ary to a surface water supply. ❑ The system has a septic tank and SAE and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAE and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS an 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 analysi , performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the pre ence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other fi ilure 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 ❑ ,,u,( 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 t5ins-3/13 Title 5 Official Inspection 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 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Owner Cynthia W. Brink Living Trust 101 Plantation Circle Ponpe Vedra, FI 32082 information is Owner's Name required for every Marstons Mills MA 02648 4/10/2015 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. El Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ An portion of y p 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 2000 d- 10,000gpd. gp ❑ 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 cont t the Board of Health to determine what will be necessary to correct th �ilure. E) Large Systems: To be considered a ar a sy tem the system must serve a facilitywith a design flow of 10,000 gpd to 18,000 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 4 0 feet of a surface drinking water supply ❑ ❑ the system is within 2 0 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located n 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 unde 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•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - YNot for Voluntary Assessments 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Owner Cynthia W. Brink Living Trust, 101 Plantation Circle Ponpe Vedra, FI 32082 Owner's Name information is required for every Marstons Mills MA 02648 4/10/2015 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 ❑ y of the system components pumped out in the previous two weeks? `V ❑ 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 Vthis 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, p � cludmg the SAS, located on site? A,4- &,f/-71 �At� ❑ Were the septic tank mAnholes uncovered, opened, and the interior of the tan inspected for the condition of the baffles or tees, material of construction, k dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner ) provided with Information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms :ndesi `T ( g ) Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Owner Cynthia W. Brink Living Trust, 101 Plantation Circle Ponpe Vedra FI 32082 Owner's Name information is required for every Marstons Mills MA 02648 4/10/2015 page. City/Town State Zi Code P Date of Inspection D. System Information Description: Number of current residents: 14 C> Does residence have a garbage grinder? ,�/ ❑ Yes LJ No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes No Laundry system inspected? ❑ Yes No Seasonal use? I1 VYes ❑ No Water meter readings, if available (last 2 years usage(gpd)): Detail.- b e-� ,, - - '- Sump pump? f El Yes No Last date of occupancy: �� r Dat 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 Sys em? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 f - Commonwealth of Massachusetts m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Vo luntary Assessments ,M 396 Baxers Neck Road, Marstons Mills, MA 02648 Property Address Owner Cynthia W. Brink Living Trust 101 Plantation Circle Ponpe Vedra FI 32082 information is Owner's Name required for every Marstons Mills MA 02648 4/10/2015 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: /�/C �l�L�1'✓ Was system pumped as part of the inspection? Yes El If yes, volume pumped: gallons / How was quantity pumped determined'? � • Reason for pumping.- Type of S stem: Septic tank, dir -gam soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I Commonwealth of Massachusetts w Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Cynthia W. Brink Living Trust, 101 Plantation Circle Ponpe Vedra FI 32082 Owner Owner's Name information is required for every Marstons Mills MA 02648 4/10/2015 page. Cityfrown State Zip Code Daospection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes L( No Building Sewer(locate on site plan): Depth below grade: feet Material of constructioV- 40 ❑ cast iron PVC ❑other(explain): Distance from private water supply well or suction line: ���g ?b3 feet Comments (on condition of joints, venting, evidenn✓ce,�of leakage, etc. v Septic Tank(locate on site plan): /tI ) 6�lv -A Depth below grade: feet Mate'al of construction: concrete ❑ metal ❑fiberglass 9 El polyethylene ❑ other(explain) C /� tank/onfirmed isl, listage: A year "Is age by a Certificate of Compliance? (attach a copy of certificate) --' Yes ❑ o Dimensions: ✓ a � .. 5� � y Sludge depth: -- t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Vo luntary Assessments 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Owner Cynthia W. Brink Living Trust, 101 Plantation Circle Ponpe Vedra, FI 32082 information is Owner's Name required for every Marstons Mills MA 02648 4/10/2015 page. City/Town State ZipCode Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 1� 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 v How were dimensions determined? � Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural int Ity, liquid levels asrgjaat%l ttoS vtty let invert, evidence of leakage, etc.): z� �� a Grease Trap(locate on site plan): /V A Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fibE rglass ❑ Polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or affle Distance from bottom of scum to bottom of outle tee or baffle i Date of last pumping: t5ins•3/13 Date Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Cynthia W. Brink LivingTrust, 101 Plantation Circle Pon Ownera Vedra, FI 32082 Owner's Name information is required for every Marstons Mills MA 02648 4/10/2015 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 pump d at time of inspection) (locate on site plan): Depth below grade: Material of construction.- concrete ❑ metal ❑ iber lass 9 ❑ polyethylene El 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(re quired). Is copy attached? ❑ Yes ❑ No t5ins•3/13 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 Vo luntary Assessments s 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Cynthia W. Brink Living Trust, 101 Plantation Circle, Ponpe Vedra FI 32082 Owner Owners Name information is required for every Marstons Mills MA 02648 4/10/2015 page. City/Town State ZipCode Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan)�Ox�_ 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.): 3 Pump Chamber(locate on site plan): Pumps:in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamb(r, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working ordE r, system is a conditional pass. Soil Absorption System (SAS) (locate on ite 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Cynthia W. Brink Living Trust 101 Plantation Circle Ponpe Vedra FI 32082 Owner Owner's Name information is required for every Marstons Mills MA 02648 4/10/2015 page. City/Town State Zip Code Daeof spection D. System Information (cont.) Type. /�.X�?X1 � �,��/�i �jls�—,�vli✓� ❑ leaching pits number: ❑ 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, etch}; pp �n v� 45P Cesspools (cesspool must be pumped p p part of ins p ction) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments b 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Cynthia W. Brink Living Trust 101 Plantation Circle Ponpe Vedra Fl 32082 Owner Owner's Name information is required for every Marstons Mills MA 02648 4/10/2015 page. Cityrrown 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.): di 7C2d'j? /7V jo/ `�''�yr - lam Privy(locate on site plan): - Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs o hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 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 M 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Cynthia W. Brink Living Trust, 101 Plantation Circle, Ponpe Vedra, FI 32082 Owner Owner's Name information is required for every Marstons Mills MA 02648 4/10/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at lea two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate wher public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately 0��' � L © i ijVlf V d f VA 4e.r 1 �t3 �-6 0' l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurfa ce Sewage Disposal System Form- Not for Voluntary Assessments ,-. 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Owner Cynthia W. Brink Living Trust 101 Plantation Circle Ponpe Vedra FI 32082 Owner's Name information is required for every Marstons Mills MA 02648 4/10/2015 page. Cityrrown State Zip Code -date-of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope � ❑ Surface water ❑ Check cellar ❑ Shallow wells g j� Estimated depth to high 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: ❑l Checked with local excavators, installers-(attach documentation) C✓J Accessed USGS database-explain: You must describe how you established the high`ground water elevation: r f 7-1f4� /.- 46 !`. 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 Massac l husetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 396 Baxters Neck Road, Marstons Mills, MA 02648 Property Address Cynthia W. Brink Living Trust 101 Plantation Circle, Ponpe Vedra, FI 32082 Owner Owner's Name information is required for every Marstons Mills MA 02648 4/10/2015 page. Cityfrown state Zip Code Date of Inspection E. 7port 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 U 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 T �0WIv OF BARNSTA3LE CATION LOT 3 R4K1r(L. V4 SEWACE # VILLAGE mw S-roO�, , 1. S. — ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.t}VC ki-Lr e4a NS 1 -)')I ASEPTIC TANK CAPACITY LEACHING FACILITY:(type) 4 �O. OF BEDROOMS PRIVATE WELL R�PUBLICWA�TER BUILDER OR OWNERS 1L� l��Yk 1�►�I DATE PERMIT ISSUED: ' DATE COLIPLIANC.E ISSUED: - VARIANCE GRANTED: Yes No®s �ov i X 7 - �.: No.......'- $....y.l Fmc........ ...i�J........ . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -..-1© .--------------------OF... � --•-•------------•---- Appliration for UiovooFal Works Tonitrnrtion V.rrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal S tem at ....PzAD..Mhc5miu&.H..ILL&....................... .. Loc t''pn.Address X�1tQ l�lls _ _ �ll�t[°aY1.�l �5.- i�l -._ i`A�.s '�f t�_ Owner Address W Installer Address 1 /� _T� Type of Building Size Lot---`.--��.__" - t U Dwelling—No. of Bedrooms............................... .Expansion Attic Garbage Grinder �c Other—Type T e of Building No. of persons............................ Showers — 64 YP g --------•------•-----------• P ( ) Cafeteria ( ) Other fixtures e_________________________ --------------••....................................................� �•� W Design Flow. ' .___ X..._._._..gallons per person pFr day. Total daily flow....Cc�lal,.�l.........................gallons. R: Septic Tank—Liquid capacity.lS allons Length.l�• __. Width-,5.-_�... Diameter---...—. De th.j_..= . W Disposal' Ks No. ._13.............. Width__._-8.......... Total Length..._........ Total leaching area._�40.....sq. ft. x Seepage Pit No................ Diameter.---.---.---.------- Dep h below inlet.................... Total leaching area..................sq. ft. Z Other Distribution- istribution box Vii Dosi}}j�tank N 1 ( ; Percolation Test Results Performed by.D ._ . E.4...K'f.G..tw ................. Date_- _�.. r -----------.. Test Pit No. l...L-g---minutes per inch Depth of Test Pit....1_Z........... Depth to ground water....o_!-7�----.---. fi, Test Pit No. 2................minutes per inch Depth of Test Pit.-.-----..__-------. Depth to ground water------..........--.----. 9 "A� ( •--'• -------------------••--_._. _..._.............._.............._.....Y._.. s .._•__._.__..____....__.._--•--•_.___ Description of S oil......Q_:".Z--. .........=�...G.Aut>----------------------------•--------- x U ---•-•••-----------•----•----------------------•--.....----------•-------------....---------.....--•--.....-----••----------•--•-----•----------•--•-...-•----•--------•-•---------•--................. W ----••••---------------------------•-------•----••-----------•...--•--•-•••••---•---•----------..... -----••-•--------------------•---••----•----•••------------------------------•......------------... 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'TT LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complianc Lsued of health. Signed.------. _. ------------- -------------•-------------------------- -•--------------.--------------- Date Application Approved By---••------•.... .--- -- 3 --------- " Date Application Disapproved for the following reasons:----•---------••----•--•----•--•-----------------------------------------------•---------------------.....------ --------------------------------•----•--...-----••-•-•----------------------------...........-•-----•.--- Date Permit No 20=..�(.7)-----------------------• Issued............. fi No....... .......7,;L Fss..........THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH S Appliratiou for Uiiposal Warke Tomitrurtiou Prrutit Application is hereby made for a Permit to Construct (Y\) or Repair ( ) an Individual Sewage Disposal System at: r /a 3c i r `�.. t`C: T <•t?-M {4- 4�7......... ). 11 Lt�•.....__..... --` ..---- Location Address .�� \ _ or Lot No� I AA( L �, A IVII�?sAa' 1tA fb. \�!�(4�itt_l� � l�� ..................................s1 r. ---- ---•--------. ----------------- :.. Owner Address W Installer Address Q Type of Building Size Lot___ __-k-.LA!..sv.--feet U Dwelling—No. of Bedrooms.........: ......................... _Expansion Attic ( �), Garbage Grinder e(/=) �+ '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures,.....---•-•---•----•-•----•-••. . - w Design Flow_`'D-4"........ ..........gallons per person per day. Total daily flow.... _ (. ........................gallons. 14 Septic Tank—,Liquid capacity.).:':.. gallons Length.2.`I`-... Width...-::Y�__- Diameter Depth�.�~. . Disposal T-reiick No. .. _-?.............. Width.....__ ...__._... Total Length__..:. k........ Total leaching area. ~ . sq. ft. Seepage Pit No_____________ ______ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( E): Dosing tank `-' Percolation Test Results Performed by.:'AKA__-,i :�: ... ►` :._'_?�-t . _ Date__�,_:. __.F�----__-__---_-- a Test Pit No. I...�-=-....minutes per inch Depth of Test Pit 1_7........... Depth to ground water_._!)._.`----_-_ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-__-_________-----___. 04 O Description of Soil...... -?, -t- Cj A. . _3 i1 e` .1..�:-' = -� 7_` A-�` x w UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 1 1 Y the provisions of li 1:.1 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Complianc ssued ..... of health. Signed-------- ------ ......... ---- ------D-a-t-e.. ....--------- ' V � ...............•-----•-Application Approved By (J� '�---- = = Date Application Disapproved for the following reasons----------------•---••-•----••-------•------------------•---•----------------•--•----------------------•----•---- ---•--•.....----•---...------•---•-•-••-......--•----•-----------------------•••-•------------......------------•---•--•--••••-•--•-•-•......•--••---------•-••-------•---------••--•.................. Date C Permit No....... -�--•---�..7- .................. Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... .............OF.........��+.r .. <<. ..C�......................_.............. �rrtif iratr of TI-Imphattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -� ,Installer at k has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.........e'19.._...V.. dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... ..'.$ .................................. Inspector.................... A ............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� L/ 1,(::c. OF............. r:..l.E.«.J.l�?. ��.............................. -- No................... FEE....... ........::. %youttl Workii T.1ottotrurtiou rrutit Permissionis hereby granted.............................................................................................................................................. to Construct 0-1-1 or Repair ( ) an Individual Sew�ge Dis o System atNo.. -=r' j �f_ e=� `�-�- AI......M............................................................. Street as shown on the application for Disposal Works Construction Permit No. 3_ __ Dated.......................................... .......................... ............................................... ............................... Board of Health DATE..................... - � FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - y 1 l 1 Li''JJ Vil1 y 1'1 1 .J1 rA 1 J , (1 1 j ♦\ 1I LOCATION LoT 3 51LVz r+L- (ZD NO. /055 VILLAGE M AAC,70J> M►UE-S _ DATE APPLICANT �b�tt�l P AiWTj FEE '2 ADDRESS %J 'PL _sA,-r, ST JI/I��es�1���n TELEPHONE NO. (Non-refundable ) ENGINEER t*)LTW_+ 11(s A • A&JeK PLC TELEPHONE NO._4'Z8-`t1SJ DATE SCHEDULED Qpft►L_ 6, 1%-L (Applicant' s signature) • • • • • • • 0 0 0 0 0 0 • 0 • 0 0 0 0 0 • • • • • • • • 0 0 • 0 • • • • • • • • o • • • • • • • • • • • • o-• • • • • • • • • • o • • • • • o • • o • • • • • . SOIL LOG SUB-DIVISION NAME DATE 4-5- 82 TIME IOsoa EXPANSION AREA: YES ' NO _ '�g .} &JaS Pb ENGINEER TOWN WATER �7PRIVATE WELL VO4 6-1rr-o2c, BOARD OF HEALTH p V Uu-�i1Z_ EXCAVATOR SKETCH: (Street name, etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES : zo � 241.3t r I � 2 4 4o EL=1 f T714- M� Covr- PERCOLATION RATE: TEST HOLE NO: / ELEVATION: 1/ � TEST HOLE NO: ELEVATION: 2 Cam? 2 --- 3 .5� 3 - 4 4 - 5 7 5 6 7 _ 8 �lr�J/� 8 9 9 ---- 10 10 GL=O�y .11 11 _ 12 12 13 13 14 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE : LEACHING FIELD L ACHING PITS LEACHING TRENCHES . UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS; NOTE : ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON P TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . E . AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT Route 28 Morstons Mills, MA I J a 0 v o � o` 1 Map 75 W J / f lir Parcel 33 I WoterfOrd�, U�2U r Prince i s 7�43'30" N 8525'35" E "\ ° j Cove / I OriVe a F t ?18'* E 201.53 / 14 24 26 ------------------ LOCUS 12 76 Baxter Neck Road<' o 0 Prince / 10 N ,' ,, ; 28 Cotuit Ba o��9 Cove , / / // / Driveway _ ——J nve / �SloAof � 6 ,/ / /i 0 22 / / 1/ /� Locus Map Gook 40 Mil ' Liner / 6 �/ � 1.) Assessor's Mop 75 Parcel 32 2.) Book 28886 P 275 2,. / / / I 9 / / 1 / /ST i / , 3.) PI Bk 295 Pg 86 Lot 3 Eight 500 Gallon 4.)))) This property is not in o Groundwater Concrete Chambers / / , , 1 / ! I , Protection District / / 9S• / /� 1 1 -- t I 5.) This property is partially in Flood Zone AE / /Q Clean + 1 shown on Flood Mop 25001C0543J doted 7/16/14 Flood Zone AE �// b / // but // shy 1 1 1 + I I 6.) This porcel is located in the Resource ? Elev = 12.0 / / � / / / + Garage ,. ! I C) Protection Area ' R 1 // a� /l1 6 + I I I o B-6 'o Deck ! j M I U / t , OR t n 1 Z 0 a House #396 4• 12 / / i �' I I i X �so7>�,� 74 // Deck t t 0 16 18 215 / / I 1 Sewage Disposal AS— Built 22 396 Baxters Neck Road 24 Marstons Mills, MA Prepared for: Prepared by: Se Cape tic LLC �ron��� Viola Associates � Ali p p �pHEN9 Lot 3 396 Baxter's Neck Road 618 Route 28 Upland 67,325± SF ++ Morstons Mills, MA W. Yarmouth, MA 02673 =: MC) RE � Wetland 2 100 SF + N0.39398 , (508) 771-4200 Total Area 69,425± SF + oSUFN�O Map 75 GRAPHIC SCALE Pane, 31 30 p 15 30 60 120 ��J /,jl � + 14s IV _00i ( IN FEET ) zo.00' 1 inch = 30 ft. s 14'S5'30 E V. Date: 5/17/19 By: MA Check: SM Project No. AC-167AS CONSTRUCTION NOTES MINIMUM 20" DIAMETER COVERS 9,03ke 28 Morstons Mills, MA FIRST FLOOR RAISED TO WITHIN 6" OF FINISH EXISTING 20" DIAMETER COVER GRADE (OR AS NOTED) 1.) ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE, TITLE 5 (310 CMR 15.000): WITHIN 6" OF FINISH GRADE STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE, AND Install �� D EXPANSION OF ON-SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE TRANSPORT EL=26.5± Clean Out EL=13.8± o o moo° AND DISPOSAL OF SEPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. /\\ \\ \\ X/ X� \ � Water d �'�= Prince / \ \ \ 13.2± f� o Cove 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE IS POTENTIAL FOR /,��j /��' \/ / �� Top D,,ye 0 VEHICLES OR HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 � Liner LOADING, IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. Install LOCUS sy, GEOTEXTILE 3.) TO MINIMIZE UNEVEN SETTLING, SEPTIC TANKS AND D-BOX SHALL BE INSTALLED ON A STABLE 20.4 + FABRIC Liner 4D Mil Baxter Neck Road�o'\o MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. SLAB ELEV. 13.0_ Cotuit Bo " °4 23.5± I � rive 4.) COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK, THE DISTRIBUTION BOX, AND 17.0± C i THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN 6" OF FINAL GRADE, LEACHING 5'± Locus Map FIELDS, TRENCHES, AND OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS MANHOLES SHALL 21.0± / <, f HAVE AT LEAST ONE (1) INSPECTION PORT CONSISTING OF PERFORATED 4" PVC PIPE PLACED Existing 19 0 12.97 12.8 J 3/4" to VERTICALLY TO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP, TIED WITH MAGNETIC o - , 1-1/2" STONE 00 MARKING TAPE, ACCESSIBLE TO WITHIN 3" OF FINAL GRADE. Existing - Existing "' 12.5 I N' (Double wash) Zone: RF DB-6 5.) PIPING SHALL CONSIST OF 4" SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A GAS BAFFLE H-20 Rated 43,560 Sq. Ft. MINIMUM CONTINUOUS GRADE OF NOT LESS THAN 2% FROM THE BUILDING TO THE SEPTIC TANK, EIGHT (8) 500 GALLON H-20 PRECAST 150' Frontage AND NOT LESS THAN 1% OTHERWISE. \ D- BOX 1C.5 CONCRETE LEACH CHAMBERS WITH 4' OF 6.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4" DIAMETER SCHEDULE 4 STONE ON ENDS AND 1.5' ON SIDES Setbacks PVC (OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE CAPP „ t EXISTING �85 ---� k--25' AT END OR AS NOTED. 1 ,500 GALLON Longest Run 5 0' Front 30' LEACH CHAMBERS Side 15' 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO (2) FEET BEFORE SEPTIC TANK 9.2± PITCHING TO THE SOIL ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED TO FLOW PROFILE {END VIEW) Bottom Rear 15' ASSURE EVEN DISTRIBUTION. Prince Liner 8.) GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRU T ES Cove / NOT TO SCALE Bottom Test Pit EL = 5.5' 3.5 IN ORDER TO PROVIDE A WATERTIGHT SEAL. / 1982 Perc test 10 G.W. EL = Top o1 1982 Perc test #�j1055 EL = 0.5 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEW a �__SI°pe Map 75 DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. °c� ,3 Parcel Parcel 33 t f 10.) IN ACCORDANCE WITH 310 CMR 15.221, ALL SYSTEM COMPONENTS SHALL BE MARKED ITH 8 a18t N 85'25'35' E I 201.53' I MAGNETIC MARKING TAPE, 1424 26 I 11.) THERE ARE NO KNOWN WELLS WITHIN 150' OF THE PROPOSED SOIL ABSORPTION SYS FM. 2 �1a 8 r 12.) FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL RE pPT OF t2� �/ 1E xisttn Leachin Are6/ / 28 I THE CERTIFICATE OF COMPLIANCE, THE PERIMETER SHALL BE STAKED AND FLAGGED TO RE EN i 70 / P¢r. Test �i to be obendo�ed / / 29'� I � � . to / / Driveway 10.3 / / per Tit! / USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. / // 1 5� 20 22 1,Existing J 500 Galr 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING THE Instoll4D Mil /�///� H 9.6 /ice I Tank/ DESIGNER. Liner a // / / J��r / 28.7/ / ! 14.) THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE - / / 7 // n-s, - I sT t / BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE ' //12 s 17 W,,SEt l 1 16 SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE APPROVED PLANS, 48 HOURS ADVANCE NOTICE IS REQUESTED. 2?a* i l O /�/ y Install T8� 23.6 1 1 I \ I I 15. LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR Flood Zone AE /� 8,3/ out^ c tZ•Z 1 ; ) Elev = 12.0 % � Garage 1 � DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO 8 ?S0 " ' l / /I l I I o COMMENCEMENT OF ANY WORK. THIS INCLUDES, BUT IS NOT LIMITED TO, REQUESTS TO DIGSAFE, / 0 ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. 18 y / I 16.) CONTRACTOR SHALL VERIFY THAT ALL WASTELINES ARE CONNECTED BY WATER TESTING WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS / / O o• s o° t 17.) CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY U SEPTIC SYSTEM COMPONENTS. 10.8 nr'' Q I I M � I 10 i� i/� / �'' b / I q _ I (1) 18.) TEST HOLES COMPLETED PER STATE ENVIRONMENTAL CODE, TITLE 5. SOILS CAN BE See Excavation � o z Q VARIABLE AND TEST HOLE DATA IS NO GUARANTEE OF SOIL CONDITIONS IN OTHER AREAS. IF NOTE: Note (5' overdig) 7 /1s� // o ?s,. / I a I SOILS DIFFER FROM THOSE SHOWN IN THE SOILS LOGS, DESIGN ENGINEER IS TO INSPECT THE LOCATION OF UTILITIES IS APPROXIMATE AND ALL t 4 House #396 / 1 1 0SOILS PRIOR TO PROCEEDING WITH INSTALLATION OF ANY SEPTIC COMPONENTS. UNDERGROUND AND OVERHEAD UTILITIES MUST BE ; 17.g / I I DETERMINED IN THE FIELD PRIOR TO COMMENCEMENT � � / / i I 19.) EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND AND OF ANY WORK, THIS INCLUDES, BUT NOT LIMITED TO, / / /21.4 N I II Q) ABANDONED IN PLACE OR REMOVED AS REQUIRED. AREA TO BE COMPACTED TO MINIMIZE SETTLING. REQUESTS TO DIGSAFE, ANY PRIVATE UTILITY COMPANIES / / / / I I I X AND THE LOCAL WATER DEPARTMENT. �� 12 7/ / / I % I I 14 76.0 � iB' // 2d i I I I m l I. 4' } -8.5' 8.5' 8.5' 8.5' 8.5' 8.5' 8.5'-�1�8.5'--�f�4' ) Assessor's Mop 75 Parcel 32 2 I I I I I I 2.) Book 28886 Pg 275 3.) P�IBk 209�rPg 186 oLOtln3o Groundwater 2 2a� t �e, 5 �� SQ "' P P Y 1 I Protection District 1 �� 5.) This property is partially in Flood Zone AE(? t\ I co shown on Flood Map 25001CO543J dated 7/16/14 \ -J 07 6.) This parcel is located in the Resource \ 1 Protection Area 1 e ..= 1 -, Mlop 75 Lot 3 I Parcel31 Upland 67,325± SF Wetland 2,100 SF D-Box 11 ^_•.___ Total Area 69,425± SF 1-aid of Mas Test Hole #1 (EL=16.5±) TEST HOLE LOGS Test Hole #2 (EL=16.5±) �e s \� SYSTEM DESIGN CALCULATIONS o Depth Elev. Layer Soil Class Soil Color Comments Depth Elev, Layer Soil Class Soil Color Comments I SEWAGE DESIGN FLOW REQUIRED: 6 BEDROOM DWELLING C� Scott A. N- " 145>4 0 McGann I 0"-48" 12.5 Fill 0"-48" 12.5 Fill >3' 1 110 GPD / BEDROOM = 660 GPD REQUIRED ,. 3�',0• w , 48"-53" 12.1 A Sandy Loamy 10YR 3/2 48"-53" 12.1 A Sandy Loamy 10YR 3/2 U #1224 ti SEWAGE DESIGN FLOW PROVIDED: EIGHT (8) 500 GALLON LEACH CHAMBERS 53"-72" 10.5 B Loamy 10YR 5/6 53"-72" 10.5 B Loamy 1OYR 5 6 WITH 4' STONE ON THE ENDS AND 1.5' STONE ON THE SIDES �co •I'D 20.00' Sand Sand / doh �� S 1a•55.30" E 72"-132" 5.5 c Medium 2.5Y 6/3 72"-132" 5.5 C Medium 2.5Y 6/3 Vt = [(33.5 x 8.83) + 2(76 + 7,83) (2) x .74 = 666 GPD PROVIDED she ed �p,�c� Note: Sand Sand 666 GPD PROVIDED > 660 GPD REQUIRED � '� This pion is only valid for current regulations and may DATE OF TESTING: 5/3/19 SEPTIC TANK CAPACITY REQUIRED: 330 GPD X 200 not be suitable for future regulation changes that may occur. SOIL EVALUATOR: SCOTT MCGANN SEPTIC TANK CAPACITY PROVIDED: 1,500 GALLON SEPTIC TANK (EXISTING) BOARD OF HEALTH AGENT: DAVID STANTON Proposed Sewage Disposal System PERCOLATION RATE: LESS THAN 2 MIN/INCH (91" Depth) (C Layer) A GARBAGE DISPOSAL IS NOT PERMITTED WITH THIS DESIGN FLOW NO GROUNDWATER ENCOUNTERED 396 Baxters Neck Road I CERTIFY THAT I AM CURRENTLY APPROVED BY THE EXCAVATION NOTES DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT TO 1) EXCAVATE ALL MATERIAL ABOVE SOIL HORIZON C (SEE DEEP OBSERVATION Prepared by: Pr 310 CMR 15.017 TO CONDUCT SOIL EVALUATIONS AND THAT HOLE LOG) AT APPROXIMATE ELEVATION 10.5, FOR A LATERAL DISTANCE OF 5' Prepared for: THE SOIL ANALYSIS HAS BEEN PERFORMED BY ME CONSISTENT WHERE POSSIBLE) IN ALL DIRECTIONS BEYOND THE OUTER PERIMETER OF THE LEACHING AREA. All Cape Septic LLC WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE ( GRAPHIC SCALE DESCRIBED IN 310 CMR 15.017. I FURTHER CERTIFY THAT THE 2) FILL MATERIAL SHALL CONSIST OF CLEAN GRANULAR SAND, FREE FROM ORGANIC Viola Associates 618 Route 28 RESULTS OF MY SOIL EVALUATION AS INDICATED ON THE MATTER AND OTHER DELETERIOUS SUBSTANCES, WHICH MEETS THE TEXTURAL 30 0 15 30 60 150 396 Baxter's Neck Road West Yarmouth ATTACHED SOIL EVALUATI FORM, ARE ACCURATE AND IN CRITERIA PUT FORTH IN SECTION 15.255(3) OF TITLE 5. MA 02673 ACCORDANCE WI , 15,100 THROUGH 15.107 3) SCARIFY THE BOTTOM SURFACE OF THE EXCAVATION PRIOR TO PLACEMENT MOrStonS Mills, MA (508) 771-4200 OF FILL INTO THE RETAINING STRUCTURE. alIcopeseptic@gm ail,Com 4) PLACE FILL ONLY WHEN BOTTOM SURFACE IS DRY. ( IN FEET ) Scott McGann, C tified Soil Evaluator 1 inch = 30 ft. Date: 5 07 1 Sheet 1 of 1 B / / 1# Y: MA Check: SM Project No. AC-148S ® : 1 � o r 0. 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