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HomeMy WebLinkAbout0261 BLACKTHORN ROAD - Health A604B7L096TOORN ROAD.,! /I►ZSToll1S . e Commonwealth of Massachusetts Title 5 Official Inspection Form ' s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w o2 c4,, Oiw Property Address —7-- ,L h C�-/ of ✓i✓� Cw ner Cw ner's Name / information is 1� required for every page. (Ayrrown State Zip Code Date of Inspectio 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. Mrt:When fillingng out out for A. General Information ms <J on the computer, use ony the tab 1. Inspector: key to move your I cursor-do not use the return Name of Inspector key, -'� Company Name Company Address 14 0C) City rrown n C) State Zip Code Telephone N r License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 C R 15.000), The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs urther Evaluation by the Local Approving Authority -9 Inspector's Signature Date ' t_.. The system inspector shall submit a copy of this inspection report to the Approving Authority[(BoardQ 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 god or greater, the inspector and the system owners all submitVt e report to the appropriate regional office of the DEP. The original should be sent to he systeWwnef— and copies sent to the buyer, if applicable, and the approving authority, U ****This report only aescribes conditions at the time of inspection and under the condition.sof urse rz>7 at that time. This inspection does not address how the system will perform in the futtlYd under the same or different conditions of use. t5ins,3113 Tille501Acial Inspection Form:Subsurlace Sewage Disposal System-Pagel of17 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F Property Address r � �lavtp loH�oS a✓ner Cw ner's Name / information is �rS4, 0� 6 vir required for every / /f A,/ page. Citylrown State Zip Code Date of Inspe tion B. Certification (cont.) Inspection Summary: Check A,B,C,D or E / always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15,304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass, Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5rts-3/13 TiUe5Official ins pec bon Form Subsurface Sewag a Disposal System-Page2o117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a Q/�G 4,--Y' vve 4 Property Address I ✓Io�o� �oS Oov ner Owner's Name information is �� required for every page. WTown State Zip Code Date of InspectioT 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 mannerwhich will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Ire pectlen F arm Subsurf ace Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 1% c 4--t �✓� �� Property Address I A u1 Ow ner Owner's Name information is q required for every ✓ o/�S , //S �,4 �� 6 V U 6 , page. City/Town State Zip Code Date of inspectio 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 le\,el 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'Y13 TNe5OfAcial Ins pecNonForm:SUcsutace Sewage Disposal System-Page 4of17 Commonwealth of Massachusetts --- Title 5 Official Inspection Form Subsurface Sewage Cisposal System Form - Not for Voluntary Assessments Lo Property Address Ow ner ON ner's Name information is /sT 0✓rI / ' �o` �T d✓ l�° required for every 114 A4 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: ❑ Cy' Any portion of the SAS, cesspool or privy is below high ground water elevation, ❑ 2 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ l� Any portion of a cesspool or privy is within a Zone 1 of a public well, ❑ l� 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,OOOg pd. ❑ The system f ids. I have determined that one or more of the above failure criteria exist as described in 310 CM 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: 7o 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, t51ns.3/1 Title 5 official Ins pectlon F orm:Subsuface Sewage Disposal System-Page 5of 17 Commonwealth of Massachusetts w� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r G/ �/4-7 61 Property Address info rmation is ner ON ner's Na me / required for every __ �f /' "' /� /�', G�b � 2 oz j page. Cityfrown State Zip Code Date of In ection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes o � were umping information was provided by the owner, occupant, or Board of Health ❑ 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 ofwater 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) lJ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? ,r''�❑ Were all system components, excluding the SAS, located on site? L1 ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,.depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)J D. System Information Residential Flow Conditions: 2 Number of bedrooms (design): Number of bedrooms (actual): 3�0 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): l5lns-X13 Title 5 official Inspection F orm Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Forme - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address h vfq �ro %'o� �oj ON ner Owner's Name information is �s�m✓�J /' /ll required for every page. City/fown State Zip code Date of 16spectioh D. System Information Description: / 00 //o / f 6 /C o�� rfT� �N 7// T�ro � V Number of current residents: 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 Seasonal use? Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Y-e's No Last date of occupancy; �t—=0��`�-- Commercial/Industrial Flow Conditions: Type of Establishrr ent: Design flow(based on 310 CM R 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: Wins'3✓13 nse 5 Official inspection Form Subsurface Sewage Disposal System•Page 7of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9d Property Address Owner Owner's Name /S �t f information is required for every page. City/Town State Zip code Date o Inspect' n D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: r Source of information: Was system pumped as part of the inspection? ❑ Yes 9"'No If yes, volume pumped: gallons Howwas quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (If yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): 16ins,3113 Tide 5 Official Irepec;bon Form:Subsviace Sewagoolspceal System-Pape 8of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ✓1 V" Property Address Iq / 0C 0 -1 ✓!0 /"0 c" /0 Av ner O+v ner's Name 1 14;1 :57 information is Gi�S / �lr C S / required for every nil page. City/Town State Zip Code bate of Inspecti n D. System Information (cont.) Approximate age of all components, date in l Iled (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer (locate on site plan): 6 Depth below grade: feet Material of constructi��4OPVC ❑ cast iron ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition ofjoints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: feet Ma en -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: Sludge depth: l5ns-3113 TiOo 501ficid Inspection Fcem Substeaco Sawago Dispose)System-Page 96f 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address I Ow ner Ow ner s Name ���111��� information is 1 required for every G>.IA?Iif page. Cityrrown State Zip Code Date of Inspection' D. System Information (cons) Septic Tank (cont.) 2(7- / Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle / Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? X4 A je 6-r ce Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, e\tdence of leakage, etc.): _ Cov►�iTiOvj , �--- 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 1,9ns-3/13 Title 5Ofhciai Iris pectlonForm Subsu-face Sewage Disposal System-Page 10of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address © f4 A Ow ner ON ner's Name i information is required for every a �S / �/ /� 6" C y e page. Citylrown State Zip Code Date of I spection 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 workng order: ❑ Yes ❑ No Date of last pum ping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required), Is copy attached? ❑ Yes ❑ No l5ns•3/13 TiUe50ffidd Inspec6onForm:Subsurface SewapeDisposel System-Pape 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 6 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 7 4,, Property Address N�/ t GNo oti /of oN ner ON ner's Name Ci r information is ,Hf !/14 //l /�i� 01)6 4(9 CA,) /,/ required for every page. City fTown State Zip Code Date of nspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan):,____ &/' ` 4-I 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.): //a 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: t5rls•3/13 Title 5Officiel Inspection Form Sut�eurlace Sewage Disposal System•Pepe 12 of 17 Commonwealth of Massachusetts Y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments g G �✓f`�l J/v� 7e—J Property Address t/1 C?"( a &4 o O c.- lO f Ow ner Owner's Name /information is required for every S page. City/Town State Zip Code Date of Ins ection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins,3113 Title 5Offloial Ins pec Uon F orm SubsLesce Sewage Disposal System•Page 13d 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ON ner Cw ner's Name 14 information is ��� �,,,f ,4 � �� 9 62 j �y required for every _ page. City/Town State Zip Code Date of I, pection 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.): t51ns•3113 Title 5OfWei Inspection F orm'Subsurface Sewage Disposal System Pape 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a Property Address P1 /t n 4� lof Ow ner ON ner's Name inforrnation is I /�// �� � �'v� b o2 required for every tirST�4l � _.._ page. Cityfrown State Zip Code Date of 16spectioff D. System Information (cont.) Sketch Of Sewage Disposal Systems Provide a view of the sewage disposal system, including ties to at least tw -permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate ;!hand-sketch re 'Gblic water supply enters the building. Check one of the boxes below: in the area below ❑ drawing attached separately t Y� t i rid 1j}Y�I��'{1y f Gw, fsF s 3 °P 27 s Swine ;.. water 3 t J $efVlCe / d , - �4y Blackthorn Road talm-3/13 Tlae 5010clal IropecOonForm SvL*Wace Sewageolopoed System-Page 16 of V Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Ow ner CW ner's Name Information is required for every f-�o✓� f �� �� � a � � page. GtyrFown State Zip Code Date df Inspection D. System Information (cont.) Site Exam.- 0 Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells �O / ypkl,` Estimated depth to `sigh 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 and 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: S� s4e V"-? 05-7�Ile cl /�4e- �14(k,7 CY Before filing this inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 50ffidel Inspection Form Subsurface Sewage0lsposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address l / ON ner ON ner's Name information is required for every page. City/Town State Zip Code Date of ins p ction E. Report Completeness Checklist Inspection Summary- A, B, C, D, or E checked [D-"Inspection Summary D (System Failure Criteria Applicable to All Systems) completed 0-1 systemInformation— Estimated depth to high groundwater 3—"Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ns•3f13 Tite 5Offlcial Ins pecton F orm Subsurface Sewage Disposal System-Page 17 of 17 maiulunrmm�mnnnnwmumtlmmm�lmnmmumxmuwxnlualmnxmnnnxmtltlmW IamnlxtnntmnminnnmminnmmtllownnlaminnmmmmnlmmmlWmmuntmlml,minnlnunnlmmnmmnmmmmMnlmm�nminmanminlmnuwWwwlnaxxumnxMWaluununlnnMwxxawwmmnunlwlttW R SEVACK RIEQ(JIIREMt-.ImI oa D Cf) I� I RIeN y g" FRONT ;30' CE: BOLA 3843 PAGE 49 SIDE 15 IVut R11-9 SUO Is located In F.E.M.A. ZONEREAR 15' C. p a�nnnmmmw.Mmm�t,mrwnMtunmlwwlMnmmmxMmuauammtnxmlxn.MM,.uMwaWu."'.,m®um.xMawn.m"'^+„'mu'ow"Mnmm.m^^••a"""u•• (W NnE aglalvn►rE) („?, _.... ....._._._._-- _.. iw.a,.umntmumn axtR�ltlmm 14-450I.90' 1 1 1a111B4A41N IBIIMIu�IC!•it�luw.unnixtuox. .. �11 xonmmwtalnmamnWma7151 Iumumtmtmrmmm�mnmmmnuaMxxmnmmuxawlWmml auawnlmmuunanwnMnul fY1�PtlP°1�P1 U� IL ^wvol••w•.w„•�ow-v-vr�1•wrw•�.• v�•�••w-,r�••w••w-wrw-dam, LI>�24f 9.�'7� r•m•rl�•�v.•,r•,,,.�rrv^a��r•a " � � t�/oH rnla Cn . �. 43,817 Sara 1 , ACRESOR Ilk lJa��l/frlgl 07' to � I y l 284.65' c� RVk�v amxtmwnnm.ttwx.wmnulMatMnnmwM I.tmm�w.tnmamM.n. n.uxxunmumnn F�� tanutnOltltta.ntmmmultm.m/m1a11twamntOt11mmM1amtxMfOltxx111 j W aMnauntW InawnnlnwmunxntxmlmnnnnmtMnuuvmnnnnnannnmmmammannnlmlwtnxmmmmuommmlmnmmlwlmmalmunwmtMlwnntmxlmnutwmmaammanlwum,lmmwanmwwa WnmxumwmtmxlnxnumowMM j �mtxtxllmclmtltmtmlml axaxxxa1111wtIn1lnY�wnaltta1n11Mat1naptlnnumlmlmultmlNaanmxa111xxnIWO1111mMIn1111tt11MttxwxxbtW.11IMWI.NIIIIa1Mlmmttlmn11111aI111mmItltlmltapnntxnlmaminlmlWna1111nanwnl.lamtxMltwmwlmmmllMmtxxmmwmtlutxua.tuMxMMYttxtMtmtMlwl.tttM Scale.-9�-� 40° Proposed Additions Flan er:�e m% al 0 _ 20 40 6C1 80 " 900 FEET � �tMmw,IttMw �.r stuns .Mills, MA - -Januarys 23, 2001 . tmnntmwxMnmwnwmmnlmmlmuummotxnomtwmm�tnxlxulmlMumaumumlmmmlnlmmaumWaxmnmaxwmulwmunmwliuxllmnmwnnmmmmnulmmwmummtmmw xntltmmmwmtnwxmmt.ntumtwauxnm.Mmtmautamtm W tnnax.tmntmwntmmltmmtn V TOWN OF B RNSTABLE V LbCATION�(I!I k ��� (R SEWAGE# v+SIQ C.IAGE 6405 ASSESSOR'S MAP&PARCEL NAME&PHONE NO. �r•IC� o rl � SEPTIC TANK CAPACITY Off LEACHING FACILITY.(type)'-�-TI^-e-ry-4x45 (size) NO.OF BEDROOMS j OWNER PERMIT DATE: Carff TTMq5E DATE:�'✓►`il S 6t log 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 ? I j 3 26 27 6 Water Service Blackthorn Road o TOWN OF BARNSTABLE LOCATION ito1 1J�AC.I� i��0�n RCS. SEWAGE # '$r-I,LADE ASSESSOR'S MAP & LOT 7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /OW Q LEACHING FACIL=: (type) 1" _ (x(o (size) 01N NO.OF BEDROOMS 3 BUILDER OR OWNER R4josewl L PERMITDATE: COMPLIANCE DATE: 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 A DGC. ii g4 -37- FD f i y B (341c. ` 'pcch O ► a35 3► 1-ke -ate " .5 a -c A I ILI N S W A G F PC R91T NO. V-1 LACE N 7 A L L ER'S NAME AR R F S S UILDEP 0 F OWNER U A T E PERMIT ISSUER RAT F COMPLIANCE ISSUER r � , v o �15 lk . �, TOWN OF BARNSTABLE ©/ AV Z/�f �/ �'!�®// /'� SEWAGE # 7�J LAGS !v`4�J ASS /�� / S _- ASSESSOR'S MAP & LOTdy�� Alf/ lON TALLER'S NAME&PHONE NO. d�' SEPTIC TANK CAPACITY 1152'k9 mil!' LEACHING FACILITY: (type) (size(.-3) .16_-4 NO.OF BEDROOMS 3 BUILDER OR OWNER c:57� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 ohin c' ' Feet Furnished by o L-3 O � �p V., L Fee a No. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pphCatton for Migpoml *p!Aem Con5trurtton VCrmtt Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. ZOO f $c.E1GxTtic�l3A7 �QfgA "Devc.i", SrePN,EIu J ^v ►� ,.L&s MA- o zC z1® o`L' "` �� M ;%Rs-ros �i MArtsrows M:�Ls Mr4 Installer's Name,Address,and I.No. Designer's Name,Address and Tel.No. 13osz7'pr-t.oTrl , c4XI5 Jot-t,`( PP-E. ►► SHw o/ Rjes-r l,rso✓E So. ya2.ntr,u��.r 398- ►2�39 Type of Building: Dwelling No. of Bedrooms Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 ® gallons per day. Calculated daily flow gallons. u Plan Date /SAY 1"f, I` (o Number of sheets i Revision Date Title _-, TF ;>ZA" Z ! 6LAc&-rrio,e,J Rw44 r c>z Sre-PrlEnr Description of Soil 1_41,4M r" bra o c- 4170D ,UM A—P5E -5'hNT, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of TitIV of the Elivironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by is d --- / Signed Date Application Approved by 62 --� Application Disapproved for the lowing reasons Permit No. / z - e1.t5 Date Issued d :c;2,-1s.�- L .,c:.r..v.'.:.a�.,.• .., ry�,rv,w,...,�,k �,,,e ,_ .. .,,,.w+ . ,.^r, /.�...©. / r ,:.1•....:,�. Yq_{;�.,....n•..ra': _ ..e...•vp..,7 �. Ale No. - " Fee _ ` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC-HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS" Application for Migoga.Y *pgtem Cou$truitiou Permit Application is hereby made for Permit to Construct( )or Repair( )'an On-site Sewage Disposal System at Location Address or Lot No. Owner's Name,Address and Tel.No. Z(p I e,#,Ae IcT14o&0 tZvgD 'VevLsN, SrEPNEN ,1 M ARS rows Wl .its �Mf} oZt ?,If* o`'a M14(. goo HZO MOaSToN5 M++-1-S M14 Installer's Name,Address,and el.No. Designer's Name,Address and Tel.No. k�o2rlLltLoTT! CI}RrS jot-L't p.E, s 11 $Plgo( sReST �Alen+c�u*tt 398- i2-99 Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building i No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow gallons. Plan Date /,V/4 Y OYI, J 97(o Number of sheets Revision Date Title _Ti ?'i' ;;VAN ZCoI aLAc&TNQjeN R-AO r=o. STEpfIEN De'/Llej Description of Soil Joe a V"i CoA'eSE S'AN�7 + GIeR✓��* ' r Nature of Repairs or Alterations(Answer when,applicable) Date last inspected: n Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system -in,dccordan'ce with the provisions of TitIV of the E vironmental Code and not to place the system in operation until a Certifi Cate of Compliance has been issued by is d Signed , Date 7��g/��0 Application Approved by Application Disapproved for the t9iowing reasons s Permit No. 9 - +kI Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CE TIFY,that the On-site Sewage,Disposal System installed( or repaired/replaced( )on �`��"'�� by ro► y for ,.i as / .S` ' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Use of this system is conditioned on compliance with the provisions set forth below: No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS =igpv2,a1-:--*pgtem Cougtructiou permit Permission is hereby granted to r`Y to construct(y)repair( )an Ori-site Sewage System located at AJQ IA4 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. All construction must be completed within two years of the date below. Date: ` , Approved by / -- - ------ ---------__ PROJECT .TITLE �- L P3 ' JJ �1 I f S t G 0 4 mi l� 6�0 P ED oo I O — � '• � � cry f I, �- I , e 1 tD 1 PREPARED FOR Central Construction Company, Inca Z - Steve Devlin •President 261 Blackthorn Drive Marston Mills,MA 02648 s 508-42U-1340 SCALE 0 r DATE DWG NO. DESIGN ,,V)(fV-i CHECK DRAWN JOB NO. SHEET OF PROJECT - RO TITLE t la.-4,4cvmi 1' I: 2T o 11 3 a-�v sr�-S JJI I ; r 2 its S Y I 2)1 PREPARED FOR i b ti Central Construction Company, InC. �b S l President J i Steve Devlin • residen j 261 Blackthorn Drive•Marsions Mills,MA 02W 508420-1340 1. SCALE 0 l DAT r ' " �' •, E I U� DWG NO. [ � CHECK f i DRAWN JOB NO. SHEET OF PROJECT TITLE LN Ct 71) I • I i 2Z (> t - - PREPARED FOR t a Central Construction P entry ons ction C®m any, Inc, 24 Steve Devlin ^'President ► t s ":{ t 261 Blackthorn Drive•Ma rston Mills,MA 02648.508 4201340 tom_ SCALE s i v it 0 t DWG NO. DATE ---...------------- <. DES[G N '. ;N i CHECK DRAWN SHEET Of JOB NO. I� \ 1 , t i PROJECT TITLE ncelk— t'i- POSTS cc oA) fz,0 z- R PREPARED FOR �� s1 T-d*j� . , ! r P�s-T �'� � � Central Construction Company, !n� Steve Izn Deo ' t �21 z �unsM�: 261 Bladdhom Drive Marston MMs,MA 02648.508-420-1340 SCALE _ — -- � - E I i - � ' r N DATE .. DWG NO_ DESIGN CHECK I DRAWN -— 4 RROJECT'.TI TLE . n.Jib d�/ i FOR PREPARED _ I Central Construction Company, Ini Sieve Devlin •President 261:Bladcthom Drive•Maatons M&,MA 02648.508-420.1340 SCALE � t i Ia R DATE DWG NO. DESIGN CHECK �l _ ! y DRAWN i6b'Nn SHEET OF r. PROJECT .• . ... TITLE .__ e f�k Sn .. _..! ...I _:•"• sue.--•>~�+. i IL 1 111 !' r 01-1 R 9-7-4� 20 e r - -- --- - I r4� � ea �tsfai t I I _ PREPARED FOR 1 _ s � Zt IF1i _ --- -- -,- __-- �, Central Construction Company, Inc. Steve Devlin •President 261 Bludoorn Drive Morstorts AM,MA 02648.508-420-1340 I pill , i SCALE S E �L1/t��t�aJ s �'= s k. DATE DWG NO. _.._ ._.._ ._. ...... ... i DESIGN Q cdtt CHECK DRAWN Z ! JOB NO. SHEET OF - - _.- PROJE CT TiT_ LE y I l � �•191 r - .-► fAzi3t1 Izer I ILI U � u u ../ r PREPARED FOR 10 s-r w,0sG �6 IL -— Central Construction Company, Ini - -- - - .---........ Steve Devlin•President , I 6].Blndcthom Drive•Morstoi s MSS,MA 02648 50&4XI340 SCALE �e d= ► 71 1 DATE _._ DWG NO. I I r DESIGN RJ a� CHECK _.__. .. r DRAWN k ; .I nR`Mn SHEET OF 1 � , C _.. PROJECT -TITLE_ = QJE • �I �3L -c�j7 r 71 . ._.__�) c ee Fa! !U f�L?3J PTA Ps I .� f PREPARED FOR P it"! 0, I v_ Central Construe Company, Inc Steve Lea An +President 261;Bladdhom Drive•Marston M ,MA 02648.508-420-1340 — - - SCALE ' -- DATE DES[GN . S.r3� DWG NO CHECK I DRAWN t JOB'NO I SHEET OF - : PROJECT• - x.: __ P TITLE �1cc1 .-—Zt1J�1T!0► I 1 ' IC POOR -CO N c11r�.T�_. - - -- � • II PREPARED FOR } A Central Construction Company, Inc. i ( Steve Devlin•President a r 261 Blackthorn Drive•Marston M11h,MA 02648.508.420-1340 } SCALE. I I c' DATE DWG NO. DESIGN l CHECK ` t DRAWN � ,.. ' - • � ------�C)lj..�__..'L•1 U � Ti.y�f.. � I — 1 - . JOB N0. SHEET• OF Z. _ _ _ _ ROJECT_ P TITLE ' -- 4m + �- 2asz PREPARED FOR . 16' rN\ e L57'k4 N 0jV-, �C Central Construction Company, Inc. - sure ob °°°'— Steve Devlin•President 261 Blackthorn Drive•Marston Mills,MA 02648.508A20-1340 v ! _ SCALE � I 60 6C Prat unl i 0 DATE DWG NO. Sfif,� DESIGN CHECK DRAWN z. f „ :: JOB N0. SHEET O PROJECT TITLE I it - I - - — — — ._I ,�Pr 1 . PREPARED FOR' 1'+ 1`i� Central Co st action Company, Inc. L Y. e Devlin •President �3 41ri7 \ 26181a thorn the 6 Marston Mills,MA 02648.508420-1340 S ALE Zyi= — r) -L 30, " - 0 1 -t1i ATE DWG NO. -- DESIGN , S CHECK DRAWN JOB NO. SHEET OF PROJECT _TITLE - I�a�'IT� So►.,� tur3{j - -----�� �i-�l�t(.�-Tl+4Uu l?� y ..ykc Tt �✓� '�y �b pccl< Pr -juilc.% Wo-c, 2 (2LI L N � � I PREPARED FOR Ij �6-4(.0 c, t3do�) v— s Central Construction Company, Inc. Steve Devlin •President 261 Blackthorn Drive•Marston Mills,MA 02648.508420-1340 Zy-2 y :- - SCALE. 0 r ` DATE DWG NO. u rJ �i-- DESIGN S 0 i, _ CHECK ft. xi ,,• ;, DRAWN OF JOB NO.. SHEET , -- , ___ � - ,- , ­­ . - , , - �_ .- _ - , ��_ 4, -,, - . -I ��--,, �,'!-� ,_-�,. , ,�- .. . - ­ L­ � ,�,i­ � .� ." "I -��. . , -''_. � � I , , 1.,.-'.,:, 1� 4�7�­ , -t�-­­-�..: ­7 -.��111 -.1 I I - I "�. � -11 � .":� � .- � ,�� ., _�', ."- I" I�'w-�,_I.", �.­.� ­­ �� � �, - , . -, , -- - -�- ,� -�, - , '� I 11�7 .1_._, .,�-- - ---- -_ - . � - - - - , �� � -1 " 11 - . - - , I "11 -7��:­ 1- _­,_ �,;, - - ". � � 1. �. �- .-I, ,- . . , -�,,-,-�,,_: " ,��,;_ . � , � , I � I ,� I : I -- . - � - I A ,s, , 1��,1 I I ." - � - I , , . 11 - . - 1, f : ;,- . � - I ­� .,- -. . --. . . I I . 1, � . . ,,.�" -; .. I .: _��' � �, - �-�'�, � : , , � 0, -, -, -.,-�: I - � I :I g - , . � ��, . � , -1, __ .: �", 4i` -1 -�,:, . �. ,.. .%,,� F , �, � , -�', .. "�!�. 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I . � . . ,% I'�� � - . ., I � I - I I . 1� . - � � I I . I . ,�, ..,. , I. . - , :, , , - t . - . I . I - ,� i I I I I I 11 .11 I I I I I I �, � � � � - I I :��� I � . .. I I I . � - . . 1., .� - � 11, ., .1,� :. - I . 1. , . , I !O� ,,.,,;, � .. �� � I -�- I .1 , ; I - � .I � .I I s : 1,� I� , I . . I - " . - � ,� .�. - - I I I- . I t I . I - I'- � , I� I � - " I . I - ­1 � I � � _ " .III�I.. ' % - , 1 _ . I I - M. . I. I1I-,I . Notes: t; . . � 4 � ,, E. � .' . - 1 nle§s otherwise noted t e1. d.: : ,.. .. a-1I /L� / I . _1d',�- -.I o n.I..._. s) I.I"LI ,t. -1,IZ IIII: �. re u cI �t.I.I�I ..1iI I I'o. I,Z- I I,n ,I _ . . 0 � ' .. - �I IIIi I. I , IIII I. . I _- II�� � I. , .I� .I� I II1II ,a �I .I I I- 1 �III- . - - ��-- �.I I - � ,I I -I, II� - ��II­ -�� I� III .I. � .� II . . . ' Q MAR ' I I methods and materials shall,-conform , to . Title Vbf the state environmental 'code - T ON HYDRANT­TOP,._OF,,7AG SOL " I . - - .1562 and any�applicable local regutotions. - r , ' -- eptic jonk d �box,. . ,j - - ATION 1 10000 ASSUMED Precast concrete �s ELEV ) 1:. and eaching -facility to withstand H-10 .x - -- ­ . loadngunless Onderpavement, drives," - " - - I I 1 . or tra velled wa where H-20 loadin . i y g "', . h6/1ply. " J. All pipes in the sytem sh0// be schedule "". I s . 0 r-equol.,�. -I "I, . .I 0 - - . I ,; 4_ No field modifications to the 'sewn ge� ., - . disposal. system shall be made without t;. ­ � . ­ . , . L . . , 0 t - I I - . i' � - . . 7 ph.o n appr vc engine �� - - I + 15 , + 96 88 and the local board of health I . , � - . ..1 . b m is-not -designed for a , O� .. + 97.88 9 5 7his syste + 98.48 _ .�RIVATE - a Iunit.T0 N (40 W E P ) 97.1 ­1BL . s site is located in FE.M.A. ZONE C. . " 98. 6 ThI , CB � FND / - 9127 �L-2 6 44 I r _ " \ /- , . > - - 4 C -� a a ZONING DISTRICT RE I _ . �. 0 PROPOSED . ­ - SETBACK REQUIREMENTS-0 D-BOX - ,1 - - - - -- -35 FRONT 30' - . . ,,,:'*:- + 97.9 1 1 SIDE .1 5 PROPOS - LOT 1,50GCAL RE • . . ,SEPTIC TA K 0 .4 I 97I8043,817 S.F.: , ;� IOR - i_' 6 . t , �- .. . 2 PROPOSED 28 LONG ASSESSORS MAP-47 PARCEL 9 W - 1.01 ACRES M - 97.7 , 8,0 4 X 4 WIDE X 2 DEEP * , � LEACHING TRENCHES bO N I + 98.2 0 C, 12. I BOOK 9433 PAGE 49 0 . 3 BE DROOM � . 0 . y 97�8,+ N R 8 DM / q / , , 0 I - OBSERVATION HOLE D Design Flow: j BEDROOM4200 . I . _ INDICATES JJO GPD BASED 2 MINANCH PERC ,, INDICATES OBSERVED ­. . '- : :PERC , , , � TEST - ,, 92 , + . z ­ ,t- - . 1 k ,- 4. - k97.6 - -____ , .. . - ' . + 1 ep Ic Th� Rquiremets: ,�_ . ' _1 98.1 + 975 S n - I. . .. Y� I 97.5 e . I + 97.7 + - - - - � Qr �jtf L7.= 98.2 J30 GPD ) ,200 0 = 660 GAL.L - - -: .1 LCB/DH OAM & C8/SAVERY . , SUBSOILFND - . FND Leachin FaclI fty1Pr6vidid284.65 9 . 1 . . Pit 4o. : I I� II..I�1 I 1 ..I I, 11I 1I II .I .I1I II ..- 1 IIII � a I , II , I. 1. .". I I I: �III ." - I �I . ., � I - II � L I a - , a I. - 1� 1� .I� I.. I� � � � II .. I -_ I. u . N63'1437 W MEDI� -97.1 AIG R.' SHORT P.E. BASED ON PERC < 5 MIN INCH CLASS 1 SOIL -6, + Tes ty I y I 074 GP /SF II LOAD RATE D I. _ COARSE 10/9/87 " � + 96.87 . s e - X-4! K1 I � . + 9 .1 . SAND I USE. 228! ONG TRENCHES DEEP DE ,,'� 98.2 + 97.5 • �L+ 1 . +98 - ' '&' JERDNG PO IF = 32 GPDWitness: . 56 X 8 Sf tf X 0.74 GSJ GRAVEL. NCH • , 2MN.I I I Perc Rate: / PLAN MEW Ad H.G.W. 7 . "SCALE: 1 =30 . . BASED ON *EU SDW-2U - -V . ZONE 9 , I , , . - . NO .W . BOTTOM . SITE PLAN r1 . . . - " 2V1 BLA KTHC?RN . ROAD - tMS) irst'2' To 96 Laid LevelMOTONS M/LL - - . . _ � MIN. 27. SLOPE OVER LEACHING TRENCHTOP OF FOUND. EL98.2 . . � � I \0 F -I BARNS�"ABLB 4- PVC 0 1/4-/ LOE P. . I -- . . 1\ P, JOLLYI -., - . � . . . 4 Peiforoted 'PVC CIVL - Mm 3%54 �- R OR. I - PREPAEDF 1 ­ eas one Sep�ic9�-. I a D EVLIN k rank 0 0 0 . SEPHEW ,, .. ox . .l- PREPARED BY-Gn . 96.1 9 .3� 95-9 - , , .. .� - � . 6. _ ­ 1 9 ,� �, Ch ris I Jc 1jy:, 'P.E I . . - / �.- "- 11 shadyrest &Ive southyrmouth.Ima 4�(508) 398-1299 � �o - 4 I I/ I3.3 a 5I I_ 1 wai�ed tone .. . . ,_ , � . -� . .1 ,� . , I GRHIC "SCALE " -_ nc �Propose ,te6chih re . * : ­ g - IP� i" 1 , - . t - 30 01 IL '- , SYSTE M PROFE t " , to To Sc - � I ,�I 1 , � I - � I : 1- I I II. , I inch I 1 -30 fL'_'I, '. DATE: MAY 14, 1996 . - . . _ ­. _ ­ - - - ­ 1_ ­ _- . - ­1 a � -- ­ .- I� - I I I . ; � . � I ._­ . ­ - I I i I