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0059 BLACKTHORN ROAD - Health
5TBIackthom RoadM Mills A=046—059 i � V l 6� 3�p, d. b ii LOT 441 !. 20,704.1 ± SF . f �� a � ,4r ROBIN WILUAM WILCOX 4 Nm 31341 'Pt WST>+� 0 THE BEST OF -MY INFORMATION, "PROPOSED PLOT PLA1�T KNOK EDa, AND BELIEF THE BMWTABE, MASS- STRU&CTURES SHOWN ON THIS PLAN LOT Wit,. LC . 3075I- :HAS BEEN LOCATED ON THE GROUND pATE��6 0l.6 SCALE—I = 30 AS INDICATED JOB 6 CUENTEE ETSER ,EN-VI�V l I1�TG -203 _sLwrucl r -ROAD DATE PROFESSIONAL LAND SURVEYOR PO-BOX 713 3Ov D»rs, MA O2WO lw.-508-30-ow FAX 505-W5S-69M C. 1 S8 I PRa4T i 7765-09 t dWg i 7765-CPP-DMG 0 2926 SMWZSAX Blakely Residence Contact: (508)-364-0042 SIDE C 24' 2'-611 21 611 - -- - 8'-61' 5'-3" I � PULL DOM L SAM J 15' SIDE D SIDE B 24' 3' 6' OAFtAOE DOOR OARAOE DOOR 8' 3' 8' 2'-6" 2'-6" SIDE A 59 Blackthorn Road PLAN VIEW Garage Plan & Elevations Marsttons Mills, MA 02648 SCALE: 3/le" = 1'=0" September 06, 20116 Blakely Residence Contact: Bob Kelleher- (508)-364-0042 s� - IF I I JI I CLAPBOARD FRONT WITH AZEK TRIM 59 Blackthorn Road FRONT ELEVATION-SIDE A Proposed Garage Marstons Mills, MA 02648 SCALE: Y4' = V=0" September 06, 2016 Blakely Residence Contact: Bob Kelleher- (508)-364-0042 I, SHINGLE SIDES WITH AZEK TRIM 59 Blackthom Road SIDE B ELEVATION Proposed Garage Mar6tons Mjlls, IVIN02648 SCALE: X" = 1'=0" July 25, 2016 Blak6ly Residence Contact: Bob Kelleher- (508)-364-0042 141-811 El SHINGLE SIDES WITH AZEK TRIM 59 Olackthorn Road SIDE C ELEVATION Proposed Garage Marstons Mills, MA 02648 SCALE: X" = 1'=0" September 06, 2016 Blak*ly Residence Contact: Bob Kelleher- (508)-364-0042 0 O 24' 59 Blackthom Road SIDE D ELEVATION Proposed Garage Marstons Mills, MA 02648 SCALE: 1'=0" Septembers 06, 2016 Blakely ReOidence Contact: (508)-364-0042, W RAFTERS,Ur O.0 olsrHANGERs 2S CEILING JOISTS,16.O.C. VERSA LAM HEADERS-3-1/Y X 9-1/2" VERSA LAM HEADERS PT POST 81 5111 4 61-811 POLYSTYRENE INSULA710 ILL PLATE NCRETE SLAB ON GRADE GRADEzf ME A 41 d Q b 4. A a t 1' A 40 FOOTIN 2, NCRETE 4W FROST WALL 811 59 10lackthom Road SIDE A- FRAMING SECTION Proposed Garage Marstons Mills, MA 02648 SCALE: X" = V=0" July 25, 2016 Blak6ly Residence Contact: Bob Kelleher- (508)-364-0042 SIDE C - 241 _ 1u y1r�� SIDE D veew�em SIDE —B 24' -`--- ----------------- - ----- 3' 811 SIDE A 59 Bfackthdrn Road FOUNDATION PLAN Proposed Girage Mamtons Mills, MA02648 SCALE: V=0" September06, 20,16 Blak ay Reso dense Contact: Bob Kelleher- (§08)-364-0042 J. I a4. RAFTERS,0 O.0 DXS CEILUI 3 JOISTS,I S'Q.C. I (il ADE GRADE 141 -----.------_ --�—__— _ 59 t acktho,m Roark I SIDEFRAMING SECTION Proposed Garage Mar,; tons NY Ils, MA 02648 SCALE: Y4' = 1'=0" September 06, 2018 kwaowc escaw Triple 1-31C x 16"VERSA-LAW 2.0 3100 SP Floor B"m%FB01 Dry 11 span No cantilevers 10112 slope September 6,2016 09.45:16 BC CALL®Design Report Build 4516 File Nance: BC CALC Project Job Name: Blakely garage Description:attic loading- Address: 59 Blackthom Specifier. City,State,Zip:Marston Mills,MA Designer. BC Customer. Bob Keliiher Company. Shepleys Code reports: ESR-1040 Mlw. BO 61 Total Horizontal Product Le aM 24 XM Reaction Summary(Doan/Uplift) (un Bearing Live Dead Snow wind Roof Live BO,3-1/2" 2,88010 1,73210 B1,31/2" 2,88010 .1,732 10 Live Dead Snaw Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. start End 100% 90% 114%_ 180% 126% . 1 Standard Load Unf.Area(Ib/ft^2) L 00-004)0 24-00-00 20 10 12-00-00 Controls Summary value %Attowabte Duration case Location Poe.Moment 26,626 tt-ILs; 47.6% 100% 1 12-00-00 End Shear 3,987 Ibs 25% 100% 1 01-07-08 Total Load Defl. 1.1381 (0.741-) 63% n/a 1 12-00-00 Live load Dell. U610(0.463")- 59% n/a 2 12-00-00 Max Defl. 0.741" 74.1% n/a 1 12-00-00 Span/Depth 17.7 n/a n/a 0 00-00-00 %ABow %Atiow Bearing Supports Dim.(L x wl value Support rAwnber tkft r BO Post 3-1/2"x 3-1rZ 4,612 ibs n/a 50.2% Unspecified B7 -Post 3-112"x 3 W 4,612 lbs n/a 50.2% Unspecified Cautions Member is not fully supported at post BO. A conned is required at this bearing. Member is not fully supported at post B1. A connector is required at this bearing. Notes Design meets Code minimum(1./240)Total load deflection criteria. Design meets Code minimum(L/360)Live load deflection criteria. Design meets arbitrary(10)Maximum total load deflection criteria. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8'were ignored in the results. Fastener Manufa<turer:Simpson Strong-Tie, Inc. User Notes Access to attic-pull down Page 1 of 2 Triple 1-W,x 16" VERSA-LAW 2.0 3100 Sp Floor BeamtFp01 BC CALCO Design Report UTY I 1 span 1 No cantilevers 10/12 slope September 6,2016 N:45:16 Build 4516 Job Name: Blakely garage File Name: BC CALC Project Address: 59 Bladdhom Description:attic loading- City,State,Zip-Marston Mills,MA Specter Customer: Bob{Ceps Designer: BC Code reports: -ESR-1.040 COmPaW. Shepleys _Connection-Diagram Mist- b. Disclosure a -. COMP101eness and of e 0 e be verfied by anyone��b"on s output-as evidence of suitab tty for o Part►cularapp cOOn.Dutputherebased e T e e on roIMfi building��maywds �design Installation of Boise Cascade engineereda woad products must be in accordance vfih -current Installation Guide and applicable minimum=1-1/2"c-6-1/2" buffing codes.To obtain Installation Guide or ask questions.Please can minimum=4" d=S" f8W)232-0M-bef0ne-6staUNon. e minimum=1"nstall s BC��.BC��'�� cxews from a both sides,.sta99 9 screws bYtoff of the s ALLJOISM.-BC-RIM BOARD,8610, Member has no side loads. P n9 to avoid splitting. BOISE GLui.AM-,SIMPLE FRAMING :mrnectors are:SDS 1/4 x 3-1/2 SYSTEM®,VERSA-LAW.vERS&-Rim PLl1SS..VERSA,RIM@). VERSA-STRANDI.VERSA-S7UD®are Pro naft of SOJW Cascade Wood f HIP Commonwealth of Massachusetts ✓ = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Blackthorn Road-Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 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 1• Inspector: key to move your / cursor-do not David D. Coughanowr, IRS use the return Name of Inspector key. Eco-Tech Rapid Response rQ Company Name 155 George Ryder Road South IN ze Company Address _ Chatham MA 02633 Citylrown State Zip Code 508 364-0894 1328 Telephone Number License Number �' `L9 '' Ti B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CM 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Lwk • P-5 June 16, 2015 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. V t5ins-3/13 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 59 Blackthorn Road -Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Inspector's Notes==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4- 5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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 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 59 Blackthorn Road-Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 page. City/Town 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 151ns•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 >r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M 59 Blackthorn Road -Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 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 1/2 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 59 Blackthorn Road-Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: 'To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of,a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Blackthorn Road-Assessor's Map 46 Parcel 59 Property Address Scoff Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16 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 ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have Large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs.of break out? - ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CM 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Blackthorn Road -Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 page. City/Town State Zip Code Date of Inspection D. System Information Description: A system sized for three bedrooms was installed by Joseph DeBarros in 2007. 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 99 gpd 9 ( Y 9 (gpd)): Detail: 2014:37,000 gallons 2015: 35,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: 1 month ago Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 59 Blackthorn Road-Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16 2015 page. CitylTown 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) I ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 59 Blackthorn Road -Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 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: Age: 9+years. Certificate of Compliance for new system was issued 2/5/2007 (Permit#2007-030 at Health Departmet). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5 x 5 x 6-1000 gallon Sludge depth: 6 in t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 59 Blackthorn Road-Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 page. City/Town 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 28 in Scum thickness 2 in Distance from top of scum to top of outlet tee or baffle 9 in Distance from bottom of scum to bottom of outlet tee or baffle 13 in How were dimensions determined? Permit form Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time. Maintenance pumping is recommended every 2-4 years with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M ' 59 Blackthorn Road-Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 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 pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 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 Voluntary Assessments 59 Blackthorn Road -Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 page. City/Town 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 at 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.): Distribution box appears structurally sound with no evidence of leakage in or out. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 59 Blackthorn Road-Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Leachirg gallery was opened and found to be dry. 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 laver 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 Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Blackthorn Road -Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 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 _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Blackthorn Road-Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch ir.the area below ❑ drawing attacl-ed separately LOCATION S LEACHING GALLERY -OF SEPTIC COMPONE NTS —DISTANCES IN DECIMAL FEET DISTRIBUTION BOX 2 q3 A 8 1 24 22.5 2 55.5 56 3 74 65 1000 GALLON SEPTIC TANK 1 A B NOT - TO EXISTING o SCALE DWELLING • -` THIS SKETCH IS BEST VIEWED IN t ' COLOR FORMAT 508 364-0894 \ 2 W 3 BLACKTHORN ROAD t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 59 Blackthorn Road-Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 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: 11.5+ 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: 1/26/2009 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 5.5 feet above the bottom of a witnessed test pit in which no water or groundwater mottling was encountered. 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 °M 59 Blackthorn Road -Assessor's Map 46 Parcel 59 Property Address Scott Manley Owner Owner's Name information is required for every Marstons Mills MA 02648 June 16, 2015 page. CitylTown 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 GEOHYDROLOGICAL PROFILE — NOT TO SCALE 2 IN O W -aoo PRECASTnissms, 2 ' � � DRYWELL O BOTTOM OF LEACHING �— PER DESIGN PLAN LEACHING IS ABOVE HIGH GROUNDWATER In NO GROUNDWATER MOTTLING SEEN t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 /TOWN OF BAR/NSTABLE N LOCATION SEWAGE # fa,97— 0-10 VILLAGE `Iyoriraw-s ASSESSOR'S MAP & LOT '116-5-1? IN,iTA .LER'S NAME&PHONE NO. 3_U9-el2e)47$8 ,Los4g /,.� SEPTIC TANK CAPACITY /000 LEACHING FACILITY: (type) 2-J 00 t614i A—S- 'r (size) NO. OF BEDROOMS .3 / BUILDER OR OWNER PERMIT DATE: f--2 G—0 7 COMPLIANCE DATE: 2-S-0 7 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ���.�%rl ov�h Rom aA4� oFL►ovsE � �cl� � ��b s G7, � $b' .,ti 3 v1 IG. 7y, • t�cTa� Pd�T � © ohs jo- V�.�T� � No. + Fee_-��� �~ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplication for ig ogat 4 gtem Cougtructiou Permit Application for a Permit to Construct Repair rade Abandon ❑Complete System pp (�,�y p (cYlJpg ( ) ( ) p y ❑Individual Components Location Address or Lot No.S7 Q1V CA- /,Pew 2 W. Owner's Name,Address,and Tel.No. w/G4'a/ ioc&^*Th Assessor's Map/Parcel _s- SA Wr Installer's Name,Address,and Tel.No. rD$_ 80 Designer's Name,Address and Tel.No. S�oB y~ 573I 3 ✓tss'cpti 17z v/ONrOS EN�i� %rir� �,var��5 40 r/V w /= Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank .Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Ans Aee when applicable) cy� �/',S`t oerN �lrvdhdl 7 " Ano _r?0`1/_ Ayrcv 17-(fox Date last inspected: Agreement: The undersigned agrees to ensure.he 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. Sign p Date Application Approved by ate Application Disapproved by: Date for the following reasons Permit No. Date Issued No. J�'30 '; Fee Entered in computer: THE,COMMONWEALTH OF MASSACHUSETTS a , r ..0C7BLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes \� 01ppYtcatton for Mi5pozal *pgtem Cowwucttou Permit Application for a Permit to Construct(&)- Repair(4)✓`Upgrade(`) Abandon O ❑Complete System ❑Individual Components Location Address or Lot No.SrQ a C�/�ld�� ' Ownel's Name,Address,and Tel.No. �r Assessor's Map/Parcel y6 y ' -s� SAW Installer's name,Address,and Tel.No. - % 177f2 Desi ner's Name,Address and Tel.No. Joseph C1 c l��rras t��►S/ih���'rihy �,vur�lr<c� 491 yS3/3 $! r�rr/d lT �1iQr.� J, .� ! R Gras s F,r_ Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures s- Design Flow(min.required) gpd Design flow provided., . gpd Plan Date Number of sheets Revision Date Title ` ON Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answ when applicable) r4.11'l411 2-J-Oa `4 f Lr146.4 cv,i� y 'St o�i= F1rv�H Idi_=�a "5'704/_' Date last inspected: z, Agreement: The undersigned agrees to ensure th-_construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 or the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign l / .1.�-< < �,y {�• Date ApplicationApproved by //or/ �'!`u ate r Application Disapproved by: ,Date for the following reasons _ Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (f ompYtance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( L ) Repaired Upgraded ( ) Abandoned( )by )o.S CP4 0-e d/4rra5 at S 9 L31#4 kr4or,? Ra4e/ /oorSrotis M1,115 has been constructed in accordance with the pro//visionsof Title 5 and the for Disposal System Construction Permit No.n(��/ na dated Installer ✓6W 4 o{ 4610Yr DS Designer bedrooms Approved dgsign low _ �3 ' gpd The issuance of this permit shall not a cc rued as a guarantee that the system` ill func'ti, designed. ^-� Date- _ � S�� Inspector ———— No. 1?�———O Fee�_p�"�_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS =0tgpo!5a1 �bpgtem Con!6tructton Permit Permission is hereby granted to Construct ( 4-) Repair ( 411 Upgrade,( ) Abandon ( ) System located at _S`q 1314e 17-ko rh R I r-� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons ction ust a completed within three years of the date of this pvii Approved by J Y t U arse a ��r ✓ LO•CAf ION � S E W A G PERMIT NO. .5-7 ��-� VILLAGE INSTA LLER'S NAME A ADDRESS B U I'L D E R OR OWNER DATE PERMIT ISSUED ]� � 1 DAT E C 0 M P L I A N C E ISSUED - �pf Town of Barnstable P,,oFt"E r°wo Regulatory Services " Thomas F. Geiler,Director * BARNSTABLE, 9� NAS& Public Health Division ptED tAA't A Thomas McKean,Director 2.00 Main Street,Hyannis,MA 02601 Office:. 508-862-4644 Fax: 508-790-6304 Installer & Desicner Certification Form Date: 1 2_6�" 4.7 Sewage Permit# 2 doh--O'O Assessor's Map\Parcel L O J Designer: r5i'l*, yg(D rus Installer: Address: CXbs S. e�d Address: "Z-- On < --5"_ O ,f o �pLi f,� � �'�o� was issued a permit to install a (date) (installer) i septic system at ��� C-C- }�'`o`r^ M based on a design drawn by . (address) dated 111 C� (designer) .I certify that the septic system referenced above was installed substantially.according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (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. Stripout (if required) was inspected and the soils ' were found satisfactory. Ul M4ff9�yG _ o PETER T. (Installer's Signature) mC VILE H No. 35109 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 03-09-06.doc f Town of Barnstable P# I/le v ' ' Department.of Regulatory Servri Public Health Division Date �- MANS. 200 Main Street,Hyannis MA 02601 O MJa� l Date Scheduled \ Time / c Fee Pd. S 'l Suitability Assessment for Sewage Dis osal Performed By y L %j r4,-e- Witnessed By: LOCATION& GENERAL INFORMATION Location Address ;7 Owner's Name K 51 910CAf'11 ores �Zy� cl,',S- dOA s M i) I f Address Assessor's Map/Parcel: (� —� � Engineer's Name NEW CONSTRUCTION REPAIR K Telephone# �� °�Z—7— C3 Land Use f5 d�K'�t'tA Slopes(Rb) I Surface Stones AJ�A, Distances from: Open Water Body 7 ft Possible Wet Areal OO a ft Drinking Water Well 2 l�V ft Drainage Way 7100 ft Property Line Zp ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands n proximity to holes) 0/ 2,01 ` Z 9 Parent material(geologic) JACie►k Depth to Bedrock 7 I o Depth to Groundwater. Standing Water in Hole: N� Weeping from Pit Face , /A Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: _ — in, Depth to soil mettles: in. _ Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. VV Index Well# Reading Date: Index Well level Adj.fhetor. Adj.Groundwater Level J PERCOLATION TEST Date F 3 Time I�I��00 Observation Hole# I Time at 9" Depth of Perc J 2 Time at 6" I Start Pre-soak lime @ I O Z Time(9"-6") End Pre-soak Z edCLIJ 0,6 � �S t J1� ` `,�� Rate MinJlnch Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. consistency, Gravel) 0 -6 A L l a � �$ CZ M- C $ &\vd 2.51 & DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil' Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% 1 o- A `th, to - Zq IS to ye-/6 46 —1 SO c L. i-1-C SC,rtok Z IS;Y`l DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nsi to c Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones'.Boulders. n siste Flood Insurance Rate May: Above 500 year flood boundary No_ Yes . Within 500 year boundary No Yes„.. Within 100 year flood boundary No-,V--- Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y65 _— If not,what is the depth of naturally occurring pervious material? Certification I certify that on _ J=(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trainin ertise and experience described in 310 CMR 15.017. Signature Date Q:\SElynMERCFORM.DOC ttvl 1i ✓�L 1C,LT-:- i �2caaNC PLJCi\Ay lip 33b G.P.D. 4_95 6.��D. to LL AeEA = lso F- s. . ) l' TOT,a L `L�ESIGtiI = 425 G.RL7. L P rt Ci�x S Tt>To L. Uh L_`f Fc_Aw = Plr-fdGDLQTIOLJ SZATE: (l+��.I 2kti►J 021�55. P�OP� / Al + Te-S7r ., o- ,. Q,•f, .- jw A 4 PPS Est tw. lv, 9 f SOX ��S Ti�NK (Q SePTIC A• w " 4,G r` PIT � \-V i-rW WASMAD STOWS C SZ T'IFIEt:) PI.bT• c::L Lc7GATIOI j ILLS Ab ttJ�pr u c Sco.L�- C� A'T As NKsr ..,.. 8 1�3F'8 GGtZTiF,{ Tt4A-r TNrr fto P UWFZI..,'Slaau►� Pt.AL`.1 TZ FEtzEklGE 'W�ZL"-s. b►mil ���1r1t�LVS �t/1'T'{-� Tt-!� �jiD�.'LI►-ate �-�.-,. A1.1t� Se-MACK k'CQuiizEm&-QTy OF TNT Z--U'T' AA tZc-Gtsrclz�u` I•-A•Wo 5vr*vaYov% TI-415 VL-AW 15 UOT mb,-->GID L._1 pN oSrevVkL-Lr� a MA-5e! A•ppt_.I GAti.J-T' �. WOr IBC-- uSCp i`u 17cr TCC'.Mt�hl l.�r I_tNc=S A'`�wti. 514620 V s Finc f �X THE COMMONWEALTH OF MASSACHUSETTS BOARD HE L r"*' -" .--------- F....... .. . -------- ------ Aliptiru#ion for Disposal Works Tonstrur#inn Prrutit Application is`hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: A.....:..........,MA/_QS_'1'q&4 ...... ............./-(J�----- ................. Location-Address or Lot No. fd ;�1/. .. f` �2a,! /u..........._... X... a'��C.... Owner Address sf �e �u---------------- ---. ./p .T.� ....�1 ��' Installer Address d Type of Building Size Lot....°x�Q_�_C�. __Sq. feet U Dwelling—No. of Bedrooms.........rf} .!�.6K.-.`_____-_._-_Expansion Attic ( ) Garbage Grinder ( ) 04'4 Other—T e of Building No: of persons......77�lf.0......... Showers — Cafeteria d Other fixtures .......... ................ W Design Flow............................................gallons per person per day. Total daily flow............ Q_..C-,0'P....gallons. W Septic Tank—Liquid capacity_/ate .gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........I.......... Diameter.................... Depth U,elow-Ainlet........_......_._.. Total leaching area..................sq. ft. Z Other Distribution box (/ ) Dosing tank ( ) Percolation Test Results Performed by.........� /Y- -�Q__ E....._l '_ _�____ Date......8�f_pp/?Z_-•----_- � a. Test Pit No. 1.04i.O m niftes per inch Depth of Test Pit-----ly.......'__ Depth to ground water__-__- ..►s Test Pit No. ................minutes per inch Depth of Test Pit................. ; Depth to ground water........................ -------------- - - ----------- ---------------------------------------••••----•-----••----- -------•.............. .......... O Description of Soil---------------- r_3.�...__,4Qe !!/.....?". S U.�?Sa!/L ------------•14S /} ! �T�' .................... .f ----------------•- --------------------------------•-•-•--•------- W ----------------------••••• ................................ U Nature of Repairs or Alterations—Answer when applicable.---______________________------------------------------------------------------------------- 4 �. .. ti Agreement: The undersigned .agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board f health. t Sig e = �'- --- - .Gt!11...... S__ .!./. .�..._ 3w Application Approved By..... , �• ,. { 'rat? Application Disapproved for the following reasons: ............................................................................................... .............................................................................................................._..._.._...._._._._..._.............._..........._......--•=`-------------_-••••••--•----- Date PermitNo......................................................... Issued...................................................... Date THE .COMMONWEALTH OF MASSACHUSETTS M? BOARD OF HEALTH `' ........... 7+ "�2.....0F........�r... ..... ............. t wwprtifiratr of Tomplianrr .� THIS TO RTIFY, That the Individual Sewage Disposal System 'constructed ( J-o-r Repaired ( ) „� ✓ er ......... . a." ... .. has been'installed in accordance with the provisions of T I ` of T}e State Sanitary Code as described in the application for Disposal Works Construction Permit No ° ._®_.1-------------- dated-.-. 7 ........ THE ISSUANCE OF THIS CERTIFIC4jE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 1 DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTHY lY ........OR...... . ... i .........................••---................ eZ....... ... . No............. ........ FEE.... ..:...:..:.:: t ro 1 Tonsti ion anti# Permission is ereby granted._ -f' '_.....----••....... ............ .............. to Construct air ( ) an Indio• Sew � osal S f 1/7 A. Street as shown on the application for Disposal Works Construction Wit N _/'. ___ Dated_._. -" .......................... ........................... Board of He k a % DA .F •-.-••-•-•••............................. FORM 1255 HOBBS & WARREN, INC.,. PUBLISHERS �•� NO.--•-----4 - .... THE Fps.._._- U'............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® HIE LT a4� -----'....................... Appliration for Elaipniial Workii Tnntrnrtion ramit 1� Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ........�.�1� �..d.. E4. .T1L tt .fl/....An........... I. j�?S o� _./.yP� �ly��� s /�.j.. iT Y......... /!Y [F r�" �cation- e. /Y. ,•�------.ss or Ct.N Owner Address a ......___+ �'' - -•-----. ' 't�7,l x_V.............-BOY JI......_67y...e2?-A!_e('f:__;7r.._.��4 Installer Address Type of Building Size Lot----A�.Q__j2Q__Sq. feet U Dwelling—No. of Bedrooms---._.___7-.f A-6-4............Expansion Attic ( ) Gaj'bage Grinder ( ) 44 Other—Type of Building -------I.._............... No. of persons-----Tli-0.......... Showers Cafeteria ( ) Other fixtures . ♦ 'S_ff0� '' .Lf __._ t6 --•----•-------•-------•---•_r.....................•. W Design Flow.............................................gallons per person per day. Total daily flow__.______.___�.30___ e°A___gallons. WSeptic Tank—Liquid capacity_j.C.C.Ogallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .......A?________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------/.......____ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (/ ) Dosing tank ( ) Percolation Test Results Performed by........6AKA-6AL in.N_�_�_•___IN_C_=______ Date.......?'/_�6_17�`--------- . Test Pit No. l.�,fl�dixtWgutes per inch Depth of Test Pit----/y.�........ Depth to ground water______ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------- _ .•-•••-••...........--••---•••-•-••-------- Description of Soil ' . .S�i� ------ -- -- - _ ------•---6--'__67-- IEY�.------•------••--r�-�"---•--_----------- x �� F I -- :--- U �... W ------------- Z' U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •--------------------------•------•----•--•----------.•.--..-----------•------•-----------...----•-----.._..----------------...----------------•-"----•-----------"-----------------------•-------•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I 1�LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Corr_pliance has been issued by the boar f health. Sigd-•••-_. . . _......... - ......... ..... .................... ------ �j` ate Application Approved B Date Application Disapproved for the following reasons---------------------------------------------------------------------•--•-------------------••---••••••.._.....-- ........................................................... --•---••--•-•--•--••-•---•-------•--•--•••••-•-•••-•••-•-••-•-•---------------------------------------------------------------------------- Date PermitNo---------------------------......................................................... Issue---1�f -7 .=..... Date pf F NOTE: TO PREVENT BREAKOUT, THE PROPOSED • `' PROVIDE RISER OVER D-BOX' F.G. EL: 97.5(MAX.) FINISH GRADE SHALL NOT BE < EL:93.5 FOUNDATION TO WITHIN 6" OF FINISH GRADE VENT FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. EXISTING F.G. EL: 99.Ot F.G. EL: 97.Ot MAINTAIN 2% MIN SLOPE OVER S.A.S. 4" SCH 40 PVC PERFORATED PIPE WITH SCREW CAP SET TO WITHIN 3" OF FINISH 2-500 GALLON LEACHING CHAMBER IGRADE TO SERVE AS INSPECTION PORT. INSTALL RISERS W/COVERS OVER INLET IN SERIES WITH STONE ALL SIDES & OUTLET TO WITHIN 6" OF FINISH GRADE INSTALL RISER OVER CHAMBER _ L =44' L =4'(MAX) WI HIN 6" OF ON FINISH AN AND SET COVER FINISH GRADE 4" SCH 40 PVC '4" SCH 40 PVC ..---2" LAYER OF 1/8" TO 1/2" n as as013.2' OUBLE WASHED STONE 10 101 1a' 63010 ® S= 1% (MIN.) ! 1% (MIN.) aaa�e®® (OR APPROVED FILTER FABRIC) �� - 2' EFF. DEPTH aaaa210uio NV.=94.20 �-3/4"-1 i/2° a EXISTINGL V.=94.37) ��_ 4' 5.2' DOUBLE WASHED �p,S f PROPOSED D-BOXSTONE BAFFLE EFFECTIVE WIDTH = INV.=97.00t EXISTING EXISTING 1000 GALLON SEPTIC TANK INV.=93.00 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING TOP CONIC. ELEV.=94.0 —BREAKOUT ELEV.=93.5 PIPE INVERTS PRIOR TO CONSTRUCTION. INV. ELEV.=93.00 aaaaaaaaa®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO aaiaaaa®aaaa GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.=91.00 2 x 8.5' = 17.0' 3' INCH CRUSHED STONE BASE, AS SPECIFIED 3 IN 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 23.0' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. (3) 5" DIA.OUTLETS 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE LEACHING SYSTEM SECTION AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. NO G.W. AT EL.=85.5 (TP-1) ll SEPTIC SYSTEM PROFILE 1 12" N.T.S. !, 15.5" O c 8" 6" 2" DESIGN CRITERIA D—BOX J / NUMBER OF BEDROOMS: 3 BEDROOMS // SOIL LOG SOIL TYPE: CLASS I ',BACK OF HUUSE / DESIGN PERCOLATION RATE: 2 MINJIN. i DATE: JANUARY 3, 2007 (P-11608) DAILY FLOW: 330 G.P.D. l! SOIL EVALUATOR: PETER T. MCENTEE P.E. DESIGN FLOW: 330 G.P,D '1 WITNESS: DON DESMARAIS-HEALTH AGENT ���.�;� � GARBAGE GRINDER: NO INVERT ®®®® O ®®®� TP-2 De th LEACHING AREA REQUIRED: (330) = 445.9 S.F. ®®®®®®®®®®® 37" i Elev. TP— 1 Depth Elev. �_ ®�®®®®®®®®® 74 __. .... . 24" 97.0 A SANDY LOAM 0 97.2 A SANDY LOAM O EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 1UYR 4/2 10YR 4/2 1SECTI 96.5 B SANDY LOAM 6" 96.8 B 6" SANDY LOAM USE 2-500 GALLON LEACHING CHAMBERS IN SERIES ON 1UYR 5/5 10YR 5/8 SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F. 94.9 25" 95.2 24 13.2' x 23.0' = 303.6A S.F. 4" KNOCKOUT N SILT LOAM G1 SILT LOAM co a rn C1 BOTTOM AREA: 20' oia, COVER 5Y 5/3 nN 5Y 5/3 TOTAL AREA: 448.4 S.F. 48" 93.4 46„50"4' KNOCKOUT O�4" KNOCKOUT 62" 93'0 C2 C2 DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 G.P.D. PERC 4" KNOCKOUT 62" PROPOSED SEPTIC SYSTEM UPGRADE PLAN M-C SAND -C AND 59 BLACKTHORN ROAD, MARSTONS MILLS, MA 2.5Y 6/4 t Prepared for: Michael McGrath, 59 Blackthorn Rd, Marstons Mills, MA 02648 500 GALLON CAPACITY, H-20 LOADING I $.A•S 1 N 11 PROP• Surveying b M Engineering by: Y 9 Y: SCALE DRAWN JOB. NO. CHAMBERS __ 85.5 138" 87.2 120" EngineedngWorks HOOD SURVEY GROUP N.T.S. PTM_ S r 07 KT.s i Iti— 12 West Crossfield Road P.O. Box 1724 DATE CHECKED SHEET NO. 1- � 23 LAYOUT NO GROUNDWATER OBSERVED Forestdale, MA 02644 Mashpee, MA 02649 S.A.S. LAYOUT PERC RATE <2 MIN/IN.("C2" HORIZON) (508) 477-5313 (508) 539-7799 1/15/07 P.T.M. 2 Of 2