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HomeMy WebLinkAbout0100 BLUEBERRY LANE - Health 100 BLUEBERRY LANE MARSTONS MILLS A= 102- 116- 002 Commonwealth of Massachusetts ��a' /��0 b0°2' �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 100 Blueberry Ln Property Address 4 Owner Joseph Corona information is Owner's Name required for Marstons Mills V Ma 02648 9-29-2020 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. p°rn W filling p A. Inspector Information When filling out # /4903 forms on the computer,use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address � Centerville Ma 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 9-29-2020 In i a(ture 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 , Commonwealth of Massachusetts �m I� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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: At time of inspection this system met or exceeded all minimum passing requirements. This report can not predict the future performance under the same or increased usage.This report is not to be used for bedroom count determination. 2) 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): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts �. lip Title 5 Official Inspection form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �1,A Title 5 Official Inspection Dorm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ E 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �m Ip Title 5 Official Inspection Dorm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ~ ^ ° � 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 I Description: According to as-built this system consists of a septic tank distribution box and a s.a.s of plastic stoneless chambers. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: 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 years usage (gpd)): Detail: This system is NOT designed for use with a disposal. Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form �4 III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills . Ma 02648 9-29-2020 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: s.a.s installed in August of 2009 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �m li� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^ � 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.5 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 1000 gallon per previous insp Dimensions: report Sludge depth: 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? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was functioning properly with no signs of failure or surcharge. If tank has not been pumped in the previous 3 yrs I recommend pumping at time of transfer and every 2-3 yrs there after for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts �m l Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) 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 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): box was functioning properly with no signs of failure or major solid carry over. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Dorm ('t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4' s � 100 Blueberry Ln u— Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Although there was an observation port shown on the as-built we were un able to find it so the exact level of ponding or staining was not able to be determined. Type: ❑ leaching pits number: ® leaching chambers number: 16 biodiffusers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �-P Title 5 Official Inspection Form (/ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): As stated before we were unable to locate the shown observation port so we were not able to determine the exact level of ponding or staining. The area above the s.a.s was dry and showed no clear signs of failure. There was however a slightly depressed area in the layout of the biodiffusers that is typical for these types of systems. I would recommend at some point doing some grading to make the grade pitch away from the s.a.s and not let water stand in this area as well. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doe-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 AN Commonwealth of Massachusetts �. I�-p Title 5 Official Inspection Form yl� Subsurface Sewage Disposal System Form Not for Voluntary Assessments 100 Blueberry Ln emu, Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.)-. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth, of Massachusetts l Title 5 Official Inspection Form �~ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4� L � 100 Blueberry.Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 +feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: pervious passing inspection report dated 3-16-2017 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts �m ,p Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 100 Blueberry Ln Property Address Owner Joseph Corona information is Owner's Name required for Marstons Mills Ma 02648 9-29-2020 every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 e Commonwealth of Massachusetts Title 5 OfficlaI Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name infomuft is requ red f i Marston Mills Ma 02648 3/1612017 required for every page. citYfrown State Zip cods We of Impewon 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 in the area below ❑ drawing attached separately R. O t:7-5^ y. 4o o . o i i t tyro•W3 TM&S OftW hapeotim For c Suhaulew Sewepa Oieposal System•Pepe 15 or 17 A$ Commonwealth of Massachusetts /002- 4- 001;1 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M �< 100 Blueberry Lane Property Address Florence Fagen Owner °�— information is Owners Name required for every Marstons Mills Ma 02648 3/16/2017 page. CityfTown State Zip Code Date of Inspection e.0 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms L5/* �-- on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. ---�f�' Centerville Ma 02632 CityfTown State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3/16/2017 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �vfd frS Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 100 Blueberry Lane Marstons Mills is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 16 Biodiffusers in a 25'xl 1.3'field. The system was found to be in proper working condition at the time of inspection. 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 u L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth,of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: * This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "( 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 page. Cityrrown 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 Officiaal Inspection form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 page. Cityrrown 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 CMR 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 W Title 5 Official Inspection Dorm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'P 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 page. Cityrrown 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 quanlity 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Mspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 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: system repaired 8/13/09 per town records 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 6" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official lnspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 100 Blueberry Lane Property Address Florence Fagen Owner Owners Name information is required for every Marstons Mills Ma 02648 3/16/2017 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 3" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tank should be cleaned now and again every 2 years for proper maintenance. Outlet tee intact, water level even with outlet invert. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 page. Cityrrown 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-3113 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 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 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 0" 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 was video inspected and found to be in good condition, no rot, water level was even with outlet invert. 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 'y 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 16 Biodiffusers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. consist of 16 Biodiffusers in a 25'x11.3'field. No signs of past failure, no lush vegetation, soil and stone dry with no signs of past saturation. 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 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 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.): 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official lnspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 page. City/Town 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 in the area below ❑ drawing attached separately 2©' f n 0 o Q 150W•3113 Title 5 offidal lnspedbn Form*Subsurraos Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 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: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,..'` 100 Blueberry Lane Property Address Florence Fagen Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/16/2017 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information— Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i TOWN OF BARNSTABLE LOCATON Ob Vok"O X011 LV., SEWAGE# '—)CAA VILLAGE ASSESSOR'S MAP&PARCEL 10-1 INSTALLER'S NAME&PHONE NO. � � SEPTIC TANK CAPACITY i,�pe, LEACHING FACILITY:(type) ;p�u ,,��� (size) NO.OF BEDROOMS OWNER, PERMIT DATE: 6A 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 3001eet of leaching facility) Feet FURNISHED BY IIf (�- =20, T� ^ W � •3�r e \7,, y `4o` ® 2 c . No. ljl � ; FEEL 0 y e �� C�0►�'l[MONW SSACH. SETTS e�v�-I ra , Board of Health, q fid: APPLICATION FOR DISP UCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑Complete System A Individual Components Location Vl /N IA.11f Owner's Name �A b 1 `� FLO c.F, Map/Parcel# 107- ( (0 Address Lot# /00 Telephone# Installer's Name QG Designer's Name G�N�b� 6 Address P. & .Z® 26 1:0T u�fl AL6 Address fZ- �,,. CQs� gOri� p� Telephone# 5 0 v_ C.,-L$_ 0-0 Telephone# SOS, _ -7 l3 Type of Building �1NC)LB T-A-M1LY Lot Size �s sq.ft. Dwelling-No.of Bedrooms 3 Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) gpd Calculated design flow_J 3 a Design flow provided gpd Plan: Date -7 -7-J Number of sheets 2,, Revision Date Title Description of Soil(s) t�l_ � SOI L Labs Soil Evaluator Form No. Q 2-G Z (m Name of Soil Evaluator 14C1"h-%G Date of Evaluation 4-4-se q? DESCRIPTION OF REPAIRS OR ALTERATIONS IZ P 4-m- 07j SA l LS r Ae-B A C-va 3?t The undersign ees o install the abo cri Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr , to not t place tern in ration until a Certificate of Compliance has been issued by the Board of Health. Signed / Date ig- �o Inspections No. T�V ( � 0:;� FEECOMMONWEALTH - ; 'U _r? "r• env►-�rQ d �� � J Board of Health, MA. APPLICATION FOP, DISP05AL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑Complete System Individual Components Location (3 vl-,f /rl/ io,/� Owner's Name Fpt, 1b pS '� oR.6),,c.6 Map/Parcel# I UZ 11 (O DQ;,•, Address Lot# 0 v Telephone#, Installer's Name PA'3T&-•6 LA Nn Designer's Name ��NbbQ_ L WCM_1CS Address �, Address +�,v B f Z og F ogs�lb.p L..-6 Address w• pss - '2-D �anS S Telephone# 5 o a_ t►f ?,_ 3 av Telephone# SO? tl-77_ S-%1 I / t Type of Building 71 NUZ TA VL'Y Lot Size /U, Z sq.ft. Dwelling-No.of Bedrooms Garbagetgrinder ( ) Other-Type of Building No.of persons i Showers ( ),Cafeteria ( ) Other Fixtures u Design Flow (min.required) gpd Calculated design flow 3 Design flow provide_.� 7 a gpd Plan: Date 7 ' J 9 Number of sheets 2, Revision Date Title ° Description of Soil(s) i7Uhth l S01,L µ4AC Lobs Soil Evaluator Form No. Z G Z Name of Soil Evaluator Date of EvaluationT.+t�✓ l J� Y DESCRIPTION OF REPAIRS ORALTERATIONS 9S P&-.fZ r�b b I t'6 n W;A C_ra �)r v The undersigned&ag�eesDo install the above.de cri� Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not t place em in o ration until a Certificate of Compliance has been issued by the Board of Health. Signed/f Date f d Inspections No.abb I-C /V FEE OJO COMMONWFALT14 ®F MASSAC14USETTS Board of Health, Q/JRNSTAORIZ , MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( );Repaired (Upgraded ( ),Abandoned ( ) by: AST m-G x c A��iti 23v at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) an the approved design plans/as-built plans relating to application No. dated Approved[esign Fl [ (gpd) Installer PAS CM-,cam XIA v MTI Designer:T:o�GiN�-MLI Jo W6n_t:�-S� Inspector: e Date: 1310 The issuance of this.permit shall not be construed.as.a guarantee thatffie system will function as,des igned._ 1 No. ' I FEE Board of Health, �ARI.>5'i 1�F3 MA. DISPOSAL` SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(J) Upgrade( ) Abandon( ) an individual sewage disposal system ` at ((TD Q L US Ciei2cZ`r L N . NA tA t _ t as described in the application for Disposal System Construction Permit No. (� dated Provided: Construction shall be completed within three years of the date of thispermit.(All local conditions must be met. Form i 55 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 5::J. Board of Health ._ f, Town of.Barnstable P#AM L Departinent of Regulatory Services i Public Health Division Hate1/6 G q MAgs _-�-- �s.sa3y 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. ' Soil Suitability Assessment for Sewage Disposal Performed By Witnessed By: %c1�,��• � �iC LOCATION& GENERAL INFORMATION Location Address Owner's Name �s • �� t:7 �� �G�1�4 1 Y�e�(kcr.S �9�.� Address too \31.rek e" t� Assessor's Map/PareeL 10 Z — t l fo —O O Engineer's Name NEW CONSTRUCTION REPAIR Telephone# 5-6 2�`737—Li'% (P 87 Land Used �� �� Slopes(%) Z. Surface Stones Distances.from: Open-Water Body 2L> ft,- .Possible Wet Area e�'l 45'3 ft Drinking Water Well ft Drainage Way 7 L s'd ft Property Line ft .Other ft SKETCH:(Streetname,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) i® NT d'R 1a6 G Parent.material'(geologic) Cl 4 Ot� sti, Depth to Bedrock .Depth to Oroundwafer. Standing Water in Hole: . Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR.SEASONAL HIGH WATER TABLE Method Used: Depth Observes standing in obs.hole: in. Depth to soil mottles: In. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well.# Reading Date: Index Weli level,_.:,_�-_._•, Adj,factor•,,,,4,..— Adj.Groundwater level , m PERCOLATION TEST bate '1 hne L1 A14_ Observation Hole# Time at 9" Depth of Pere y.2 y Time at 6" Start Pre-soak Time® 1 G 'rime(9"•6") End Pre-soak G Rate Min./Inch. f n < 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:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole#; ._ Depth from Soil Horizon Soil Texture Soil Color Soil r Other . Surface(in.) (USDA) (Munsell) Mottling (Structure;Stonea;Boulders.. Consist v A $� luf /$ s� 1<oy� S% A)A" s-/ b!w - ► �;Z v Z=5 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.: . Consistency, A a 16 Cc 94 -t 3 z c 2- � Ste' z�s�y -7/3 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,.Boulders. Consistency, Graivell e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stopes,Boulders. Consistency. Flood Insurance Rate Mau: Above 500 year flood boundary-,No Yes _ Within 500 year boundary No X Yes Within 100 year flood boundary No— Yes Death of Naturally Occurring.Pervious Material Does at least four feet of naturally occurring pery ous material exist in all areas observed throughaut'ahe area proposed for the soil absorption system? C If not,what is the depth of naturally occurring pervious matertal7 Certification It �a CL I certify that on (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 vrtth the required tr ' 'ng,expertise and experience described in 10`CM}t 15Ai7.' Signature G—=-� Date Q:IS.EPTlCVERCFORM.DOC 08/15/2009 05:44 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Services Thomas F.Geiler,Director Public Health Division Thomas McKean,Director 290 Main Street,Hyannis,MA 02601 00"icv: 593-%24644 Fax: 508-790 6304 Ins er&D r Cedowftrm Dane: f 1 Y Sewage Permit# Z.004- Z-5a Assessor's Mnp\Parcel Designer: t 'nvLxh,!, vor6i M�- Inistemer: R-S} fe- �t a.•4�C� Address: I?- W'C*v s s'ip-t l cal (44 Address: .r 0• l&, 12ir of Frk>+Cl" o4 d z( `'i F;;t.f.L c Lt P%4 D'rG yy on 8 • (4- O 9 fag+0ce C-•c..&vr-�*W` was issued a permit to install a ( ) (installer) septic systeem at da 0)U*_&eff7Y 4ark based on a design drawn by (address) dated -7, (design=) I ca-ft y that the septic system referenced above was installed substantially according to the dt&W, which may include minor approved changes such as lateral.relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater 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 cued as-.built by designer to follow. PETER Y. McFNTEC s lees Signature) CIVIL No,35100 F�1,9 T F�S1pNAL (Designer's Signature) (Affix Designer's Strop Hem) U"E ..BETURN To, �KLYs� I�F_PUBLIC xtsxox CEi ►U -29 MZLIAM iWI � NOT BF IB�tJ D 0111L UQTH =Lffl M MM AHMT, CAM AU T Q.kiealth/$epticMajguw Certification Form.3-26-64.doe ti TRANS. NO.: CITY/TOWN: APPLICANT: �aslcr-Q �'er-- ADDRESS: ►c?oG�'+ DESIGN FLOW: 3`L C) gpd REVIEWED BY: DATE: 7��5 N/A OK NO MM Legal boundaries denoted [310 CMR 15.220 4 a ✓ - Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)W] Locus Provided L310 CMR 15.2204(t)] ✓✓ Plan proper scale? (1"=40'for plot plans, 1"=20' or fewer for components) [310 CMR 15.220 4 Easements shown 3.1.0 CMR 15.220 4 ./ System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]-if not, a variance is required 310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) 310 CMR 15.220(4)(d)] �✓ Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. 310 CMR 15.220(4)(e)] System Calculations 310 CMR 15.220(4)(f)] daily flow ✓ °� septic tank capacity(required and rovided ✓�/ soil absorption system(required andprovided) ✓✓ whether system designed for garbage grinder ✓ North arrow 310 CMR 15.220 4 Existing and ro osed contours 310 CMR 15.220(4)(g)] ✓ Location and log of deep observation holes(existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220 4 h and i Location and date of percolation tests(performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match load' rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)(j)] v Observed and Adjusted groundwater(method for adjustment / given or indicated) [310 CMR 15.103(3) and 310 CMR ✓ 15.220(4)(n)] Address Sheet 1 of 9 N/A OK NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water.supply within 250 feet of the proposed system location in the case ✓ ✓ within 150 feet of the proposed system location in the case of private water Kply was Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. 310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR J 15.220(4)(m)] ' water line cross see 310 CMR 15.211 1 1 Profile of system showing invert elevations of all system components and the bottom of the SAS. 310 CMRl.5.22 .4 o ✓'� Stamp of designer [310 CMR 15.220 1 and 310 CMR 15.220 2 Stamp of Registered Land Surveyor(required if construction ✓ � activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate(two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405 1 k Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.134 Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103 3 Benchmark within 50-75' of system 310 CMR 15.220 4 Materials specifications noted?[various sections of 310 CMR 15.000] System compone nts not>36" deep (unless Local Upgrade Approval or LUA requested) 310 CMR 15.405 i ] IL Address Sheet 2 of 9 N/A OK NO 2 - Size OK? 310 CAM 15.223(l)] � Inlet tee located ten inches below flow line [310 CMR 15.227 6 Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter 310 CMR 15.227(4)] Note regarding installation on stable compacted-base [310 CMR c � 15.228(l)] Separation between inlet and outlet tees(no less than liquid depth) 310 CMR 15.227(2)] ✓✓ Inlet/Outlet elevations at least 12" above high groundwater (except as descri�ed 310 CMR 15.227(5)) or permitted for / upgrades under LUA[310 CMR 15.405(1 k ] Minimum cover 9" (Tanks.buried.more.than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 ty � �✓ CMR 15.232 3 Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" 7/07 310 CMR 15.228 2 Access to within'6 of grade -one port for systems<I 000gpd, two fors stems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from build ng foundation 310 CMR 15.211 1 Buoyancy calculation Required/Done 310 CMR 15.221(8)] ✓' H-20 Where appropriate? 310 CMR 15.226(3)] Setbacks from resources. 310 CMR 15.211 Required when other than single-family dwelling or flow>1000 d 310 CMR 15.223 1 (b First compartment 200% daily flow; Second compartment 100% daily flow 310 CMR_15..224 2 .and .3 . "U" pipe through or over baffle, outlet of each compartment with as baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 9 s N/A OK NO "UMRm@-- Located at least ten feet from any water line? [310 CMR ✓ 15.222(2)] Disposal piping it least 18" below water line(when water and sewer cross, see 310 CMR 15.211 1 1 Cleanouts required/provided ? 310 CMR 15.222 8 / Thrust blocks s fled in force mains? 3-10 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable 310 CMR 15.222.E Proper pitch on all runs? (.005 within gravity-distributed trenches j and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/Peachfield below pump chamber Endca s or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR ✓ 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe ✓✓ types allowed Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided?(when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9 310 CMR 15.232 3 Inside minimum dimension 12" 310 CMR 15.232(2)(b)] Minimum su ¢" 310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] " Ire,a Capacity(emergency storage above working--design flow)? [310 CMR 231 2 Proper setbacks 310 CMR 15.211 same as septic tanks Watertight.20-in minium access manhole at least 20"MUST BE TO GRADE 310 CMR 15.231(5)] Service components accessible(not too deep with piping, disconnects accessible Alarm floats - alarm on circuit separate from pumpsspecified? Exceeds two unips must have two pumps operating in lead-lag mode. 310 CMR 15.23 1 6 and 8 ] Stable Com acted Base [310 CMR 15.221(2)] . Address Sheet 4 of 9 08/11/2009 08:56 5084775313 , ENGINEERING WORKS PAGE 01 _. ..._ ... _._.. ._ .. . n:' -7, q6 _ 630 N/A olio NO Calculations correct? 4 feet of naturally occurring material demonstrated?[310 CMR — -- 7 15.240 1 R uired aration to oundwater? 310 CMR 15.212 - 777 e ed as double washed 310 CMR 15.247(2 System Venting requif&&provided?.(system under driveway or >36" d 310 CMR 15.241 Inspection ports specified and within 3"final grade? [310 CMR A 15.24 13 �/ Breakout requirements met? (No violation of breakout elevation 4 within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Docent Chambers and Gal. in trench configuration supplied with inlet =20 ft. 310 CMR 15.253 6 Each structure v?M one inspection manhole(if>2000 gpd must be tograde) 310 CMR 15.253(2)] �► Aggregate 1'minimum-4'maximum. 310 CMR 15.253 1 2' sidewall credit maximum f310 CMR 15,253 1 a In bed configuration, inlet eve 40 ft. 310 CMR 15.253 6 Width 2'minimum 3'maximum f310 CMR 15.251 l 100 feet-maximum length 310 CMR 15.251 1 a' Minimum separation 2x effective depth or width whichever great / 3x if reserve between trenches 310 CMR 251 1 d Situated along ntours 310 CMR 15.251(2)] Breakout OK? j 10 CMR 15.211 1 4 and Guidance Documern minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252 2 d Maximum separation between lines and outside of bed 4' [310 CMR 15.25 2 e Aggregate depth below discharge pipes 6" minimum, 12" maximum.1310 CMR 15.252 2 DC ✓ Separation betwma beds IV mina m. 310 CUR l 5,252 2 Bottom area in calculations only [310 CMR 15,252(2)(1)] Address )6C) `�� °'� `S.JI^t Shed.6 of 9 N/A OK NO Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240 1 Required separation to oundwater? 310 CMR 15.212 AggreSate specified as double washed [310 CMR 15.247(2)] System Venting required/provided?-(system under driveway or >36" deep) 310 CMR 15.241 Inspection ports specified and within 3"final grade? [310 CMR 15.240 13 Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Doc et gam Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253 6 Each structure with one inspection manhole(if>2000 gpd must be to ade 310 CMR 15.253 2 A ate 1'minimum-4'maximum: 310 CMR 15.253 1 2' sidewall credit maximum 310 CMR 15.253 1 a In bed confi ration, inlet eve 40 ft. 310 CMR 15.253 6 Width 2'minimum 3' maximum 310 CMR 15.251 1 b 100 feet-maximum length [310 CMR 15.251 1 a Minimum separation 2x effective depth or width whichever greater 3x if reserve between trenches 310 CMR 251 1 d Situated alon cpntours 310 CMR 15.251 2 Breakout OK? 10 CMR 15.21 1 i 4 and Guidance Document minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252 2 Separation between beds 10' minimum. 310 CMR 15.252 2 Bottom area used in calculations only 310 CMR 15.252(2)(i)] Address Sheet 6 of 9 Buo ancy calculations needed ?Provided? 310 GMR 15.221(8)] Address Sheet 5 of 9 N/A OK NO Pressure Dosed S�.stem 7 Provided pump and piping calculations as required 310 CMR 15.220(4)(r)] Pressure dosing lequired on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] ' If used in gravelless system-make sure jet is directed as not to scour soil interface Guidance Document Inspections once per year(systems<2000 gpd)or quarterly >2000 dgood to note on plan 310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification pf 310 CMR 15.255 3 ? Impervious barrier and/or retaining wall ? Guidance Document Impervious barrier installation must be supervised by designer v 310 CMR 15.255 2 Retaining wall must be designed by Registered Professional Engineer 310 CW 15.255(2)(a)] Side slope not exceed 3:1 ? 310 CMR 15.255 2 Breakout requirements met? [310 CMR 15.252(2)and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended 10 CMR 15.255 2 e Check DEP'Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge L to scour soil interface ' Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a rote on the plan regarding the requirement for perpetual maintenanceagreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has a licant submitted a coRX of a maintenance a Bement? Are the variances listed on the plan? [310 CMR 15.220 4 RLS Stamp necessary on plan if a component is within five feet of property[ine 310 CMR 15.412(4)] Address Sheet 7 of 9 New construction or increased flow proposed - [Refer to 310 CMR 15.414 Address Sheet 8 of 9 N/A OK NO b $p Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and Zz 310 CMR 15.216,- also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? 310 CMR 15.214 2 Are the nitrogen loads proposed in compliance? [310 CMR / 15.216 1 ], Him Pumping to septic tank ? µ[ 310 CMR 15.229 Shared System 51fl-CMR 15.2901 f , ,1 1 Address Sheet 9 of 9 TOWN OF BARNSTABLE BAR-W N2 3752 ' Ordinance * or ' Regulation WARNING NOTICE Name of Offender/Manager pfir � AddressPf— of Offender fL�/MB Reg.# Village/State/ZipMA r -r__On ,All tmuls MA ASS# Business Name am pm;/� n 20 _ U Business Address Pt� e og of Eefor i g officer Village/State/Zip U a r Location of Offense 20 E )Q w (�(Ennf�/or�cing Dep. /�Ilivision „ Offense � � \ Ys.�U � IV� 1�/1 KQ �� At) Facts MAKIV O�� 12,A`�4 ./A] P-CAP- VAff) 4 /Vf) jCL V Ads 0' e X�ev ' -e L?P-- This will serve only as a warning. At his time no egal action has been taken. It is the goal of Town agencies to achieve voAuntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-FROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W qI® 3752 �. Ordinance or Regulation WARNING NOTICE Name of Offender/Manager 0100104oMA(-" .l' A rA;A « F(( � Village/State/Zip r i`<t #hf ii 4` �, a / ! Business Name ,- /pm,,: on j /f 20 ``Business Address 1--)1?( ' 1A . . ,,o . 5' gnature of Etforc'ing Officer Village/State/Zip / Location of Offense )0 LALMOk, taail b_l�) > Dept/ ivision' Offense'duor-,Aklceee.c i �.,T`"� f I al J f A 1� f (1/ �`#Y t � If �I Facts ��t� Y A (� 01 1 ", 1 �l 1AJ � This will 'serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve vojluntary compliance of Town Ordinances, Rules and Regulations..,_ Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town.. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W -r a Ordinance or Regulation WARNING NOTICE 11 ell, Name of Offender/Manager-7 P oin , i 2 � � ,t..� � Y ��. � sl� /MB Reg.# yr Village/State/Zip } J _ ix� ; ( #' Business Name /am/pm, /on IV 20( 17——r — 2 "Business Address Signature of Enforcing Officer -Village/State/zipV L * Location of Offense Jr)0 ..yr/. ;a, 1., �M e!��[. � i'(. 'r !•.r'{ i i.�` ' Enforcing Dept/Division 0 f f en s e 1 �, i Facts 1 � �! t'�.t .f .. - ' ,Ia`( This will serve only as a warning. At this time no Xegal action has been taken. It is the goal of Town agencies to achieve volluntary compliance of Town Ordinances, Rules and Regulations._- Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. +,4 1 �� rf 1021 �6002 �' " 102116002 ff VC }" �pp 000501 �� 0000000 " LOT 100 U, FAGAN,THOMAS B&FLORENCE r 1 , 00000768 100 BLUEBERRY LANE � MARSTONS MILLS MA 02648 FAGAN,THOMAS B&FLORENCE 0285 �1�, 4424/097 iw 1anf 1 0 0 x 0.0 �i n - `, 100 BLUEBERRY LANE ' 0140 F��� F 0102 qg 4„ L0CA�T1614 SIrlACE PERGIlT 130. VILLJAA,GE IgST LLER'S WA CIE 0 ADDRESS eA C9 0?to O UILDE Q 00 0 C3ER i d AIDATE PERMIT ISSUED DATE COMPLIANCE ISSUED -- -2- � e Ai� No. ....a ��` Fes$ .. .................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® F' HEA T ................OF..... .............................. Appliration for U44puiiaf Works Tnnitrnrtinn ranfit Application is hereby made for a Permit to Construct ( ) or epair ( ) an Individual Sewage Disposal Sy ..2Z.. . Q .c _. _...... _ .r_... .�. ` O �ation-A ress ....... . ...d. /a ..... .-- •...... �- - '9in� Installer Address Type of Building � Size Lot. _-._ :Sq. feet. Dwelling—No. of Bedrooms 2................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ?% No. of persons Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------•-•. • W Design Flow....1&[1..............................gallons per person per day. Total daily flow-------X.R4-........................gallons. WSeptic Tank—Liquid capacity allons Length...�.F....... Width------1��...... Diameter................ Depth......_..... x Disposal Trench—No..................... Width.................... Total Length___....._._ _ Total leaching area.._.......--//_-l--- sq. ft. Seepage Pit No......./.......... Diameter...._........ Depth below inlet..... Total leaching area...2i� .sq. ft. Z Other Distribution box ( ) Dosing ,a ( ) Percolation Test Results Performed by---.'... I/ _. .._._/-'Nyi 9AA. Date- �-_q_., 14 Test Pit No. 14...&&_minutes per inch Depth of Test Pit.................... D th to ground water- d�_!�,. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -•---•-----•---------------- •--•-----------•--------•. ---------•....•---- O Description of Soil...... " C�. -- 7...... llvoJ n r?_�?' ................................................ _ -- U -------------------•----------------...................................... VNature of Repairs or Alterations—Answer when applicable............................................................................................... •••----•--------------------••-•---•------•----------•------•--------------------..........--•--•----•-•------•-------............................................................................... Agreement: *at gned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with TITLE 5 of the State Sanitary Code—The undersigned further agrees not lace the system in r ' to of Compliance ha n i by the board oelthSigned --.- e n^-9.............. •----•-----------•roved By--•-•------••. ------• -- ---- - ------ - --- -------------•--•....---•- Date pproved for the f Towing reasons---------------••-----------••------------------------------------------------------------ ...................... ....................................•--------------------•--•------------------------------•----...........--------------------------------------...-----------------------------------•-----------••--- Date Permit No g.5_-.��'.�------------------------- Issued..... -- -�-�� ....................... --_--'.. - ------ Date r � FE �a ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD PF H EA .............................. Appliration for Disposal Works Tonstrur#ion Urrmit Application is hereby made for a Permit to Construct ( ) or-Repair ( ) an Individual Sewage Disposal 11 Sys a . . � z/0'.. ,- M.) ��& e; ..................................... ,/ cation-A dress .'j or t / i .tr✓e?C�9.. �/ � •.,. y�- f Qer l Own �it l 2e,,.? G f/*�wf,�/VEy � .r3l�. ... .- •.--•--•-• '�a ...--- •-----. .••-•-••--• Installer / Address Type of Building 's OOG ue-*r✓- Size Lot_ _... -'.Sq. feet U Dwelling—No. of Bedrooms..-..��____________________ __ _Expansion Attic ( ) Garbage Grinder ( ) • ---••_•••-- No. of ersons.--------s"y� -------•---••--- Showers — a Other—Type of Building - p __ ( ) Cafeteria Otherfixtures ------------------------------------•------•----------.••--•••-•-•---•----•••• ---•-••--••••••-••----•---.._..•-•...._.-•-•••-•...._•---------------- Design Flow_._ ll .............................gallons per person p�,r day. Total daily flow._____3 .........................`_gal�,pns. W Cyt Gizro ` 9 Septic Tank—Liquid*capacity/.____.__gallons Length________________ Width...__.�t'____.__. Diameter._________.__-__ Depth_�>:.._.._.. Disposal Trench—No ____________________ Width.................... Total Length__________ -______• Total leaching area._._____.._.__.._ rsq..ft. Seepage Pit No._____�........... Diameter.___. U.___-__. Depth below inlet.................... Total leaching area-_ ..........�_.ksq. ft. Z Other Distribution box ( ) Dosing ftank Percolation Test Results Performed by.... ./_•.�-.- __. Date................ ... t a Test Pit No. 1L...p_,_minutes per inch Depth of Test Pit.................... D pth to ground water_._ ' ri (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground-,water----------`_......... _. ----------------------- --- -------------- ------ ----------------------- ------- ------------ - ............................................ Description of Soil o ----g --•-•---------==��� '�"`� �GG�J O i -•------ ---••---------------------------------••-------------- V ----------- ------------•---;--------•-----------•----------------------•-- W ... A �::•.-------� �`--- ��'` � ��:----••--• - Nature -•-••--•--••----•-••--••••-••-••--•-••••-••-••••••••-••••- U Repairs or Alterations—Answer when applicable------------------------------------------------------•••---- -••-•••••••••--- .............. r " Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with th provision, of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in o rat it der •- to of Compliance has'b n iss�u.,ed by the board I haealth. ---- Signed_ , f--- -- c-- �j� l Date ation Approved By............. - ~" ! -- -- •--------•--------•-------- ........................................ Date PPliea.tion Disapproved for the 11owing reasons:---••-••••••-•-•-••-•-•-•--••••-•••••-••------------•-••--••---••--•--•-----••-•--•----------•-•-•-=--•-----•_.. --------------------•-----....--------------•-----------------------•---•---•-----------....-•-•-•----------:_.__..-•••-••-•---••••------•--•--•-•-••••---•---•-•-••----•.-.---------------•-•.._._..•- ,w,. Date Permit No.-•-•�- -•- - Issued.:_:--i` 7-' Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH ................`Ji✓ ...........OF......:...•'Lf.2/ l/';r!..�.. ................................... (Irrtifirair of Tontplittnrr THIS JS Tj0 CE fzTIFY/`that tlIndividual Sew�g� Disposal Syste �coostructed ( ) or Repaired ( ) by.. - s 1 C' ---......� __`t L l�'.7 C :, ?.-y'' z ' 'lJ...... . /t1��. y y In taller - has been installed in accordance with the p70,-isions of TITIF 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..................................�zr_-_____•_. dated__--___._�____--_ �-`✓ •••- •• - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRU D AS A GUARANTEE THAT THE- SYSTEM WILL FUNCTION SATISFACTORY. x DATE..............: ...."'� :. ........................... Inspector...................... =. ..... --- •••-• ..... THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH U .............OF._....../�). , .. J����-•=--..._....._........._.. FEE..- ................. iopoaorko��ttr�tion ertni Permission is hereby granted........ ``, Z�--------•-------------•-------•--•--------------------•---•---------------•-•-•-------._...---•--••----....---•--- to Constru t ) or R epa �aniidouGl Sewage evage Disposal System . ..at ..... .. !... ..- Street PBoQd ` 7-- tr�as shown on the application for Disposal Works Construction Permit No._ __ Dated_____________•••--•••----------------•---•---- --------- =•-•---`of Health DATE.......... FORM 1255 A. M. SULKIN, INC., BOSTON R . e +, •R`h "s t' 'Tn"`F �'+� 2"�- 3 # 7, „{ T - v ,x".r{} ty,;-. �' tf• UT �~+ y� � •x. 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'.�:.eu�+n �c zza.'«,rs<w_.te�'=•rs�-'�a%'L+3a-':`.`ems _s„ f., LEGEND ' N LOCUS —— —— EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE EXISTING LEACH PIT $.H.�- OVERHEAD WIRES ,�°j TO BE PUMPED, FILLED m PLAN BK 138/PG 25 (Lot 100) �y�SAND AND ABANDONED (�, EXISTING GAS SERVICE J` m Q EXISTING SEPTIC TANK W EXISTING WATER SERVICE �� ? o Shubael TOP OF TANK, EL.=99.00f ® TEST PIT fi o 0 0 Pond INV.(0UT)=97.67f BENCHMARK Lakeside Dr Calvin Hamblin - Flint St Road �5 �9C)56 - stockade fence_ N 03'00'00_E 9(9 _ _ __ 91 00'f°� _ x (VENT o $5�102:00' ���\ i LOCUS MAP ' edge of leoring '' ���� NOT TO SCALE 100,13 f —25�---I TP-1 ,�-,, q) GENERAL NOTES: r---r---T---sue—1 I r---r---T---�---�� 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL q) BOARD OF HEALTH AND THE DESIGN ENGINEER. + i I 9 I� 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 1 L___L___11--- TP-�2 8� o OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE O i I" Benchmark Set LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: ��� —310 CMR 15.405(1)(b): o `� i Bulkhead Corner 1) A 2' variance to the 3' maximum cover requirement, for 5' of .v `0. ���0 ', : EL.=f01.04 (Assumed) max. cover. S.A.S. shall be H-20 and vented. 1p0, T I ' I 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR o i; TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. b 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING o p '60 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 00 a `�� DECK ,EX/STING ;-® 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. z ��, IM64 HOUSE (#100) o0 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF TOF=101.71f� ii ' p i THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 1 oo HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. �1 X N 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. Gravel I NO GAS I0p,16•• r 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 1 Drivewo 3 Lot 100 I �; i AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE Y 10,200±S.F. i `: q, DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR' TO VERIFY MAP 102 rl �; �� THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PA CEL 116-00f o, i i CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS ' �' a k� IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND !� v LO-2-.o0---1-00 - v ,. OF MgSS REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). ,�---f S 03'00'00" W �J j =`�P� 9cyG 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE / o PETER T. INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. McENTEE -' 9 o CIVIL "' 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND edge ofipavement �' g8s No. 35109 IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. AFC/S1��`�°�6 PROPOSED SEPTIC SYSTEM UPGRADE PLAN s E ��� a 100 BLUEBERRY LANE, MARSTONS MILLS, MA � BLUEBERRY LANE Prepared for: Pastore Excavation, P.0 Box 1289, Forestdalle, MA 02644 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. FAGAN, THOMAS B & FLORENCE Engineering Works, Inc. 1"=20' P.T.M. 162-09 100 BLUEBERRY LANE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. MARSTONS MILLS, MA 02648 09 (508) 477-5313 7/25� P.T.M. ' 1 Of 2 q NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:95.33 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. 21" 5-6EAL'INLE " INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT 2" 2" T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE CHARCOAL F.G. EL: 100.3(MAX.) VENT EXISTING F.G. EL.=100.Ot F.G. EL: 100.Ot l MAINTAIN 2% GRADE (MIN.) OVER S.A.S. F4 'nINSPECTIONCi L = 25' L = 8'(MAX) PORT 0 S=1% (MIN.) ® S=1% (MIN.) 4"S;H4U PVC; 4"SCH40 PVC s^ N Top View Section ° 6" 11.3" TO 14° D-BOX EXISTING 48" LIQUID INVERT LEVEL ADD GAS BAFFLE INV.=97.17 PROPOSED INV.=97.00 4 ROWS OF 4 UNITS AT 6.25'/UNIT = 25.0' INV.=97.67t D-BOX INV.=94.94 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 4 OUTLETS (MIN.) EXISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER BACKFILL WITHXtEAN NATIVE OR 75" PERC SAND TO TOP OF CHAMBERS NOTES: 1) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE BREAKOUT EL.=TOP EL. : ON A MECHANICALLY COMPACTED SIX INCH CRUSHED TOP ELEV.=95.33 STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). INV. ELEV.=94.94 FILTER UNIITSC 2) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM ELEV.=94.00 (RECOMMENDED) NO 3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE I III�IIIII�II AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 2.83' 4 CONTRACTOR SHALL VERIFY ALL EXISTING PIPE 5 MIN. ABOVE BOTTOM OF I� 76" - � T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=11.3 INVERTS PRIOR TO CONSTRUCTION. EXISTING SUITABLE PROFILE NO GROUNDWATER, EL=88.8 MATERIAL - SEPTIC SYSTEM PROFILE 4 ROWS 16" ADS BIODIFFUSER UNITS WITH NO SEPARATION BETWEEN BETWEEN EACH ROW & NO STONE TYPICAL SECTION 16" N.T.S. KTA 1 1.2" SOIL LOG 34" � DATE: JULY 9, 2009 (REF#12,626) SECTION NOD CAP DESIGN CRITERIA _� SOIL EVALUATOR: PETER McENTEE PE(SE#1542) I WITNESS: DAVID STANTON R.S. 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT NUMBER OF BEDROOMS: 3 BEDROOMS HEALTH AGENT SOIL TEXTURAL CLASS: CLASS I BACK OF HOUSE DECKcS, ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH MODEL 16" HICAP DESIGN PERCOLATION RATE: <2 MIN/IN 9 14" 98.6 14" EFFECTIVE LENGTH 75"9.8 FILL 0' 99.8 FILL 0 LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT DAILY FLOW: 330 G.P.D. �-� 98.6 TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DESIGN FLOW: 330 G.P.D. �- ASANDY LOAM ASANDY LOAM SIDE WALL HEIGHT 11.2" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. GARBAGE GRINDER: NO Sl) Sty 10YR 3/3 10YR 3/3 OVERALL HEIGHT 16" • LEACHING AREA REQUIRED: (330) 445.9 S.F. S 9 �0.,9 98.3 1 g" 98.3 B B . 18' OVERALL WIDTH 34" 4640 TRUEMAN BLVD 74 St�� 3, SANDY LOAM SANDY LOAM HILLIARD, OHIO 43026 10YR 5/6 10YR 5/6 13.6 CF Emse EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 94.8 42" 94.8 60" CAPACITY PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED - --------- - C1 PERC C1 (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. T M-C SAND 54" M-C SAND N i i r`? 2.5Y 6/4 2.5Y 6/4 USE 4 ROWS OF 4 - 16" (H-20) ADS BIODIFFUSER UNITS PROP. S. �� 20% GRAVEL 20% GRAVEL PROPOSED SEPTIC SYSTEM UPGRADE PLAN W NO STONE FOR AN S.A.S. WITH DIMENSIONS 11.3' x 25.0STONE FOR AN S.A.S. WITH DIMENSIONS 11.3' x 25.0' --------------- �l 92.8 C2 84„ 92.8 C2 84" 100 BLUEBERRY LANE, MARSTONS MILLS, MA (HIGH CAPACITY INFILTRATORS MAY BE SUBSTITUTED) -25 M-C SAND M-C SAND Prepared for: Pastore Excavation, P.0 Box 1289, Forestdalle, MA 02644 SIDEWALL AREA: NOT APPLICABLE 2.5Y 7/3 2.5Y 7/3 S.A.S. AYOUT Engineering by: SCALE DRAWN JOB. N0. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) 88.8 132" 88.8 132 En ineerin Works, orks, Inc. NTS P.T.M. 162-09 16 UNITS x 6.25 LF x 4.7 SF/LF = 470.0 SF PERC RATE: < 2 MIN/INCH ("C" HORIZONS) 12 West Crossfieldd Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 x 470 = 347.8 GPD - NO GROUNDWATER ENCOUNTERED (508) 477-5313 7/25/09 P.T.M. 2 Of 2