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HomeMy WebLinkAbout0011 BRACKEN FERN ROAD - Health 11 BRACKE,N FERN 1-�(� . -- - - - --- - A= 043 007 J j O 3 5 Dry\ . y. ........ I , 0 a �.-Do - Q8� k,i --_--- - ------ >:Fi iok-� a PROPOSED FIRST FLOOR P— - PROPOSED SECOND FLOOR FLAN w.osx,mon iwrms.rE wwox uxo. ">�+':oom�,rwa ut•umox uxo. OHl,WN BY:E.T.E. CHECKED BY:E.T.E. DATE: 1/3/20 SCALE: AS NOTED SHEET: A-3 li ' A I 1 f 1 itv Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, o the tab 1. Inspector: key m n r, key to move your � ✓!,`j/� cursor-do not Kevin Cochran use the return Name of Inspector key. Aardvark Environmental Inspections &� Company Name a -e— PO Box 896 Company Address feam n' East Dennis MA -;02641 I Citylrown State Zi)Code 508-385-7608 S113356 _ Telephone Number License Number T GO rn 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 12/10/13 Inspect 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. I (� I� vl t5ins-11/10 Tie 5 Official Inspection Form:Su u c -sawage DisposalSkstem Li, 1 of 17 I � r� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y,N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health- *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 t5'ms-1111 u - Tige 5 dial inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 P a Commonwealth of Massachusetts Title 5 Official Inspection Form _ s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ( 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 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 4 ❑ ® 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 Y2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 e I Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is Marstons Mills MA 02648 12/05/13 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 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•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 page. Cityfrown 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 (f 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 t5ins-11110 Title 5Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No 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: 09/13 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fem Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (f 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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (f known)and source of information: 05/27/08 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 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.): Septic Tank(locate on site plan): Depth below grade: 1.8 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: 1,500 gal Sludge depth: t5ins•11110 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 9 of 17 s Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 2" 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 15" How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): The tank was sound and tight with tees in place and liquid at 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 I , Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 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-11/10 - rdle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 page. CityrTown 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 even 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.): The box was level and fight with no sign of carryover. 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.): Soil Absorption System (SAS) (locate on site plan,excavation not required): If SAS not located,explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): This system has two 500 gallon leaching chambers in a 13'x23'stone field.There was no sign of ponding or failure. 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-:11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;M 11 Bracken Fem Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 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 rear I,I 27 34 33 38 60 62 fi t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Name information is required for every Marstons Mills MA 02648 12/05/13 � page. Citylrown 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: 20.0 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: USGS maps show an elevation of over 20.0 feet Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-11/10 Trfie 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Ys Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Bracken Fern Road Property Address Linda Maffeo Owner Owner's Flame information is required for every Marstons Mills MA 02648 12/05/13 page. Cityfrown_ State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C,D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file V t5ins•11/10 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION %( SEWAGE# Ok .VILLAGE MJ"` 10} ASSESSOR'S MAP&PARCEL 43 INSTALLERS NAME&PHONE NO. kP v nA t r--r 41 Z F efU Z(F SEPTIC TANK CAPACITY 160,) 14 0 LEACHING FACILITY:(type) (0)Syv 14 o o L:c (size) w 3 Y z 3 NO.OF BEDROOMS 3 OWNER ( cSrN.c 5 S + PERMIT DATE: 5- 2 3 ZooTs COMPLIANCE DATE: Z?- Zook geparation Distance Between the: ' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) / Feet FURNISHED BY (.,i4fe LLC r q2 27-c) �Z 3�t,o `�) v? No. g, °` Fee C THE COMMONWEALTH OF MASSACHUSETTS; Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEf, MASSACHUSETTS Ye �Lpplicatiou for Th5po5a[ *V,tem QCou.Otructiou permit Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. I I i A.4,4A-, f-vr` ROA4 Owner's Name,Address;and Tel.No. M.�►�t,Sfsrr�� ✓ti. S Assessor's Map/Parcel C4 '���p"7_C901 fo gcL..,,►wn 2� �7`51tA+-� I�tiLl Installer's Name,Address,and Tel.No. C4 pcw,JA E"r�(•r`��> Designer's Name,Address and Tel.No. %�O x_ -?(.3 f p 4-4•L v1�yf Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building S,)%[t` No.of Persons Showers( ) Cafeteria( ) Other Fixtures c Design Flow(min required) �3 c gpd Design flow provided 3 31• b gpd Plan Date SQL y O Number of sheets Revision Date Title t �r✓1C.�.v�1 e�'fi"► Size of Septic Tank Lapp q p.( Type of S.A.S. +��-• L �u� Description of Soil /J�, f Cis r ?�K® 3 r Nature of Repairs or Alterations(Answer when applicable) —n !�� Lotb t��l'lt1 /1GaJ -l30 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar ealth. /� S' ne Date Application Approved by Date Application Disapproved by: Date for the following reasons L +N N —— — y——-—— ———————————————— - Permit No. Date Issued INo. co //, a N �I Fee [ v 0 j/ Entered in computer: THE COMMONWEALTH OF MASSACHUSETTS� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLr,-MASSACHUSETTS - ------- AppricatioH for Mi5pogal *pgtem Con0tructioH Permit Application for a Permit to Construct O Repair V Upgrade O Abandon O ❑.Complete System ❑Individual Components Location Address or Lot No. t-1 1�j(�.( (-vf /?t)A4 Owner's Name,Address,and Tel.No. ! Ntkt✓tj�"Lv rVti`IIS T4p""*15 r�gT Assessor's Map/Parcel (� ?�, d Q --(�C� t �✓ ���a� '��" �� �r Installer's Name,Address,and Tel.No. ` Q Pam, � k P Designer's Name,Address and Tel.No. -7G 3 -�1 t L ", C✓ray j t I c/ R i) , ct 487 �- Ce_u,rc�.t(lr J �( 7-? 3 �i,✓e�r j ra � � ✓Wd Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building +-Av+���, No.of Persons Showers( ) Cafeteria( ) f Other Fixtures Design Flow(min.required) 33 o gpd Design flow provided 3 gpd Plan Date 5-Z 2 " O Number of sheets Z Revision Date Title 1 ! ��✓ ^^ �'^ Size of,Septic Tank I Cuo 4#a C Type of S.A.S. (7—) 500 �i✓I �= � �. Description of Soil /Lt C*i (� Z. '-- 3 FS t Nature of Repairs or Alterations(Answer when applicable)j', `� l QD a q(n L ; Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in J accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boardsof`•ealth. Signed Date 2 3r- 2 O o 1, Application Approved by Date 5/CI?310 T- Application Disapproved by: Date for the following reasons J A • Permit No. 1 Date Issued _ ___ _ �as.'�owvr.wq-a�tswrpw�+�r�efar•+iarir -, .+lT''n'►'�'gry'q!'►�►�erR�•ir.►��►�raNiMa��rww�lRb�vriY ri�T��a�'�lr�+MTl4�►���a�ar< THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS orCertificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ) Upgraded ( ) Abandoned( )"_by at J VJ. has been constructed in accordance with the pro isions of Title 5 and the for Disposal System Construction Permit No. dated 5 �� Installer e.J� ✓�✓IS<< t!t-�- Designer ��(�-�eyft� �. t���11'� #bedrooms Approved design flow S 3 gpd The issuance of this permit shall not be construed Qas a guarantee that the system will function a�es fined. Date Inspector �., ,^._i-►� r W nl4T �iro=o�asr�+ (+ +/+J►��/�+'eN'T�,w+f�l+F��+Mgs�+►JAwl�.�a►�t+�+M�sra►+rs!R #+.!wsr�ra��siMfrawwisPsNi_r.��lwar�!4lgs+w.�i�.i+r.r�.��i r 4�e No. `' i�` ✓ t ( �� Fee THE COMMONWEALTH OF MASSACHUSET f S\L PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ai.5pont *p.5tem Cott!5truction permit Permission is hereby granted to Construct ( ) Repair (�54_) Upgrade ( ) Abandon ( ) System located at 11 J�A�I.�,� �-�Jr+ V�f ,i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date(f this permit. Date 3© � Approved bye t yyv(-- y f J i Town of Barnstable Regulatory Services Thomas F. Geer,Director Public Health Dlvs><on � ` Thomas McKean,Director 200 Main:Street,Hyannis,MA 02601 Office: 508=862-4644 Fax: 508779.0-6304 Installer&Designer Certification.Form Date: Sh?!d` Sewage Permit# '�?� Assessor's Map\Parcel 6y3"dO7 Designer . : .a..; H� ,rr51 Installer ,�wt'c�{ _ .� �•�•: [:J Address:` J 2-le/ 1 Address On 5'2 3. 2aos w'�` !�rk1 was issued a permit to install a (daze)- (installer) septic system:at // !A� Q �„. � �� . based on a design drawn by (address) kr G Cc .: dated ZVO 9(designer) I certify that the septic.system referenced above was installed substantially according to the design,.which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with.major changes .(i.e. greater than,l.0' lateral relocation of the SAS or any vertical relocation of any component of the septic systein).but in accordance with State.&Local°Regulations. Plan-revision or ce fied a&4@lf by designer to follow. PETER T. N f , o McENTEE : staller S.S., azure) CIVIL &: No.36109 FS$/ONAIL�N0 Designer's Signature) (Affix Designer's Stamp Here) PLEASE RZTURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD.ARE } HECEIVED`BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc !� i 05/27/2008 16:03 5084775313 j ENGINEERING WORKS PAGE qy01 �f Town of Barnstable P / ! Iwpartment of Regulatory 3ervlem i Public Health-DivrWon I I Date taaa ; 2m Main Street.Hyuinle MA 1 Date Scheduled ..Fee Pd.,Ll�.L.� i Soil Suitabilit asal � y Assessment for Sewage 'p y wed 8r•� � lr\c Cnt�;���wltoetaed By: w. o�' r + LOCATION&GENERAL INFORMATION j r Location Addtat r! C3r�4�KPa rr—�in �' t opera r 716.«-r, Fora r I i]A40h13 t—✓;r1't} �Mt�IS j Addeo /i f , i Asse W.MepTamE 6'•y3 rOO7 'fi t 6nglcea'siAtnme'�q.P4cJ;�w G� (�''�:SrJ 4 •� VV/ NEW CONST U=N tend the Slopes(%) ' j ffi¢flac St.. Dlsuneee from-opes W.tc holy 7 ft t bk Wet Area�2 _ �t Drinking Water well 1T1 ' ! i n„t pey !n Rmperty une (Q /fie 01h. a 1 SKETCH:(Sleet name,.Hmmelons of lot raiact locations of root lobs et prat ta17r wc;t a wetlands fo pmaitttlty to holm] + u i I I ti r L j f pmut material G' �>J�tNa��- Depth'W Bodrock� tI A ii�! ° Depth to Groundwater.snndmg Wad in HI le: �j Weeping f-m Pit iFa« N i pstlttured seasonal High(hwnclwatw ,{ r j DETERMINATION FOR SEASONAL HIGH WATER TABLE # / Method Und, D Ohaetyed staadmg in abs.bola I --—In. ept 1 Popth to weeping fiian side of obs hate:i in. amuodwatee Agluattttsat, ,.-h• ! lodat Well A R"ng;Dart I allot Well level Adj.&CW Ad],Ofwmdw9tar Lot_ PERCOLATION TESL' '11-MAWLTills Hole 8 [ 1911te at 4" at 7l ncpthofPme , i tnae ;I ., �►M V ! ` Cr Start Pro-soak Time® i0 Z7 Bnd Pre-satk � A I r Rare MinAnch iS ¢ Site SWtabitity Amentagnt Sitc Patead l�4 Site Auks i Additimml Tadao Needed(Y" i I odg<aal Public H„ahb'Di�;�ea Observation Hole Data+TO Be Completed on Hack-- --- j ' aitelf pp acdatioti tent is to be conducted within 1001,of wetland,yqn must first notify the (f Barnstable Conseirvation Division at-least one(1)week prlOr to beipn!cege l f I Q:13Xn VERCPORIN.DW., ' i 05/27/2008 16:03 508477E313 ENGINEERING' WORKS PAGE 03 ' t DE"OBSERVATION HOLE LOG Hole# owth hem Sail Horizon Soil Tetlnoe soil Color f Sail pttur �, lu 5laf mm(ia.) (USDA) (Muaun) I MntillkaS lSuuoar�,&hbd Bnal¢us j %Graven; �� tl , ep a ' DEEP QBSERVATYON HOLE LOG Hole Depth fiam soil Halms i Soil Tatme Sal Color ; Soil Other ; 'i Suraee cm.) j 1 (USDA) (Maosclq ! htoftAng (MM Mn.Srmra.Bmwm. °s f I i i ' � u _3 13 5 L a ,•LS'/' i ., I' `3 j f i i I II [ ! Dt",O ON HOLE LOG i Hale# i j Depth$om soil Haim Sail Texture Soil Cola � Sail Otter Surface(m.) j' . ' (USDA) (Moods) , Motala; (Structure,SbUd.Ba ddim i i l I e: j I i ! DEEP;OBSERVATION HOLE LOG i Hole# t s �I D fiam sal Htxi m Soil Tcim Soil Color ; Boll Other epth g Sottiu+s(in.) f cmS ) (Matselq MOttUnS (mmdum stwm.BOaldeie t i ! 1 t I y Above S00 year fbafl boom No VO"Sao you bMdUY No Yca....� ; i i i z Wimin t00 yar t)�od boandady No_�,4 Yd bring itteldw Does of least four feet of naturally occurring pervious tneterkal exist in all areas observed thrquglwut the I' I area proposed for the soil abaotptioli syster`,n? :. i If nut,what is the depth o'.F naturally occ"Ag pervious nm. al? i. ' ) O�)r(&tc)I have passed the soil evaluator examination approval by the �� i Depiutment of Bnvironcoemtal Protection and that the above analysis was performed by me consistent with . path of the required training,"prdse and experience described in 310 t R 15.011. 'Y !1 Signature J� "` 1 `— J UatE I a 4 j I Q LSBVlF PERGPORM.DOC 4 TOWN OF BARNST�JABLE LOCA.TION7 ,9'ACr�� SEWAGE # 8q 6 yam' VILLAGE /`�,9✓p{cwl f% ��1' ASSESSOR'S MAP & LOT Lq3- O7— 01:7 INSTALLER'S NAME & PHONE NO.At--/ f R.,.1Re�„R Y 7 z- C Z35-- SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) /, GG� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 21 �3j 3s_ 25 y� 3 7.5 No... FEs.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3 _ 7 _ G u,s?..................OF......Aa.raS_Ae Z/G.....---.............................................. Appliratiou for Uhipoii al Workii Tomitrurtiun ramit Application is hereby made for a Permit to Construct (A) or Repair ( ) an Individual Sewage Disposal System at: -'�� ..........Io 2.. 7--- ..........................................................._ Location-Address or Lot No. ..................... W.----- � ;e a+�43u9...-•--•---- f _c �C!_... s"11...t�Gr_i�.PX........----•-....-•••-----• Owner a Address a _....._... r ----------------- ----------------?1� �sf, _.._%1.1N/ ........................................ Installer Address f� �/ d Type of Building Size Lot...__..__¢____________-----Sq. feet U Dwelling—No. of Bedrooms..._:L1j'Gam_______________________Expansion Attic w) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------------------•-............- W Design Flow...................................5 '_._gallons per person per day. Total daily flow...........................3!a®......gallons. WSeptic Tank—Liquid capacity_1-400-.gallons Length ... Width..4.71d'. Diameter_______ _____ Depth.ar.L-B. .. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No......asw........ Diameter------►_6.......... Depth below inlet.....&1......... Total leaching area...-.Z57....sq. ft. Z Other Distribution box (X ) Dosing tank ( ) ~' Percolation Test Results Performed by------ �___. s�sa.la.i......................•................ Date...:;IA ,�.._________..._. aTest Pit No. I.._..A-------minutes per inch Depth of Test Pit-----/ ....... Depth to ground p ............... Test Pit No. 2................minutes per.inch Depth of Test Pit-_-____-_...____-__ Depth to groun AF . ........ ------------------------------------------------•--------------------------------•---•---•-•-----•------ --------- --•............ O Description of Soil d °� J.__�.e. tnl ��+v�,mJ ......•-----•----------------•-------•--------••.. ......... STEPH�N 'U .....--•---•--•.................... �Z� fGr�I urn ''�x��gD------...........---•--------......-----•-•----......---••- .....•--- ALLY ....... ...... W •-•----------------------- .................................................................................................................................. •No:382t-16- - VNature of Repairs or Alterations—Answer when applicable•----------------------------------------------------- a -------------------------------------------------------------------------•-•------------------•-----•--•-----•----•-•--.....----•--•-•---•--•-•-••••......--•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste in accordance withG'""�� the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the r��✓ef system in opera-tiop until a Certificate of Compliance has been issued by the board ofjiealth. Signed ---------- - -- --------------------- .... ........... ----------------- //, &/ ... Application Approved BY - .......f Date Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------------- ............. .... .....................---................ ...................................................................-----------...------...------------ .1-----------........................... Date PermitNo. -------- ------ ----------------------- Issued ---- ..............�.e....................------. -- 1 Ivo... y L. ... FPS.... .�.�.. ...... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _lufto.!?...................OF...... ....................................................... , ppliration for 0iip.a ial 10orkii Towitrnrtiun ranfit Application is hereby made for a Permit to Construct O(,) or Repair ( ) an Individual Sewage Disposal System at: Al 7-APi✓ � C��YPa r�5' /1//ecc S �o J- .... .. • ........ Location•Address or Lot No. .... »1.�:E:i.4a1-..�*.._..rr�e .. n c`?��sJ / .. ............................. <_....... jjs ... Owner K0_�4 1 Ad ss �yle/:r �:� C W ! �� � /I!`I%iJf7iJ?.... s / ..........•.............................. Installer Address � �7 Type of Building _ Size Lot----.._:.s.................Sq. feet Dwelling—No. of Bedrooms___..!_.11+'SC........................Expansion Attic a) Garbage Grinder (4) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ------------•----•-----•------•-'.,.._._ ...- . ...... .. . ,..... C� WDesign Flow................................. ?" ___gallons per person per day. Total daily flow............................-..-...-........gallons. WSeptic Tank—Liquid capacity_6—O..gallons Length_:.'_`y'�... Width_A`--{6rS_. Diameter_---.-.".. Depth.c:�_'_. ..... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._--.!?.�_�--------- Diameter------1.0..__._._. Depth below inlet................ Total leaching area..-25 ....sq. ft. Z Other Distribution box (X ) Dosing tank ( ) ~' Percolation Test Results Performed by...... _..._ .c .3....................................... Date...:F1Gr---- -•--_-.-..._.--. 04 Test Pit No. 1-----A-------minutes per inch Depth of Test Pit,._.Z�_........ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •----------•••--•------------------------•-•--.......•--•-•-----.......,............._-••--••........................... OF O Description of Soil - -... ozFn... ula..o 1......... ------------------------------------ . -•''-•- U .....................................................:1-"'•"•"'-'-'-"-'--'-'-'•'••"----•'......_.........'-----'-•---'-"'••'"--'-••......-•'•'-..... sr tEN W ................................•---•-------._........"-•'-•------•------...----•----....._-•---------•------------•--....--- "'---'.--•-.. .......AL•EY-N....... •.. UNature of Repairs or Alterations—Answer when applicable------------------------------------------------ .....WILSOU...... ..... ••-- •--'-•-•-'-------•..................•----..._.....""•-•'---"•'-•'•'••'•"•""---•-'-"'•'•'-'••----'.........--•--.....------------------ N_o'30216 Agreement: ► Gww The undersigned agrees to install the aforedescribed Individual Sewage Disposa Syst QM with �a/te/8f the provisions of TITLE 5.of the State Environmental Code—The undersigned further agree place the system in operation until a Certificate of Compliance has been issued by the board ofjiealth. y- ► Signed eL ' ... . ...... ......... - r.Application Approved By ............. - /! .. Application Disapproved for the�ollo�wing reasons- -------------------------------------------------------------------------------------------------------------------------------------- ............................................................................................................................... ............................................... .. .. ............. ........................................ Date Permit No. ........ %..'-- ! --...................... Issued ............... ------------------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ;7 '_/Q�s ------...... OF�-- ................. .7'.�:'�G QLErtifiratje of (ILIkIIrityliance THINS TO CERTIFY That the Individual Sewage Disposal System constructed or Repaired ( )by ..........-- -- ..................................... ..................... ------�---�-�- --------�....------------------------------------------------------------------------------ X'V� Installer at ..........................��� ���f ..�',�' �� ��� �e'c�✓I!..S /��✓—'G.3 has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .. ...% - ...-.�................ dated .........----------...............---------.---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT 9E CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------------------------------.......................................... Inspector ..............--•-. -- ------.-----.....--.......---------- . .......-------- THE COMMONWEALTH OF MASSACHUSETTS BOARD --�OF HEALTH ..........................................,OF....S--1+ i✓.>�7°'�5'Q.�s ....................... NO._ '_a/....... FEE.... .-�..... " . � �-� Permission is eby granted'- _.::... .............................................� -........_.. to Construct ( or Repair ( an Individual Sewage Disposal System at No... ®T` ._. �' Crs! *�• i4. �1"�i •-•-•---•-•................. Street as shown on the application for Disposal Works Construction Permit No :�Z1� Dated.......................................... -"--'.................. Dated ..r).......................................................... VBoard of Health / DATE. / •-•---(....----•---•................ f[ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS V \ C 71I � ��4i1-�/.�lpcn/ _ //o � 3• = 3� �P.O Tom.'�;:; . 7- _ _ /� •� _ - — - - � , y/7 `� g Oil,fz�.5�=1-�•.sir---USF�i)iaav c�4.�.L.�i�- ►�- �y=� � /7�3 s•c x Z.5 z L/VS G,/� za' \Pjz�r o moo:. v' /a7 5/• °F /off .zJ-_ _1°� e . TZ5TAL D�,S/c,,,,/ z 52y e�.R. /eeteC _ 2�-tTC - /"/,✓ Z M/n/, ole,L&ss /67 • /per .f� /�o /GM � —' �':'? /07' / % '�"fd 3. 1 5 ��Sta UPA9q STEPHENG / v+i✓Sr.4 G. .,e � ALLY�2 p N �n TO llJ/T.[f Imo/ /� F(a, G1 WILSON . \ / .��No.30216�® GIST I2F�'6VE ALc_ /oCP /05 TE.S�'f/ac E f' 57�y o ; J _ _ L�A/5U/TZ1Fj[�CroQ7E�/4L T• M oc o 3 D Sr�i3 xvL I `.Ioo.Q.. Box /,vim G.4G_• /.w /D 3 n GQ1 C /D y0 ['00• , o• CGQC.y a AEW /r w. 7-.v.v.�• d •r /O ��� ;t �oc� :• � .z /o y�/ ; G'E.2T/F/EO PG OT F�L:QN • rb _��O v � Z-0 7- �✓o W4r�ea T.:1.4�°7-1dE A::&un/D47-1d,1&,t1eWA1 �E•�Eov Got1PGY.S 1.v/T//TiyE'S/��/,/.�t%E ANp.SETI�AG/= .eEQ!//•�'EHI�ivrS o� Th'� B.axrB,e �• ,c/Y.E; /,uc. ToWiv of ��./5r�ti3L�•�tvp /S Ivor- •2.Eois,�.ec=�.�arvo.s�ievEyo,� G ac,cr�,o PV17- 0/,Y 7'!/E' Fl aopoLd/iv. �a J T//lt.d!-✓lit/ /S �/ .;. ', . : .. ; .24048 aAt, E� ��,r ���'�S1EaE� �`• A N ` x 101,78 700- — — — 9&— — 0E� 95,77 River Rd x 10,8 r x 101,45 j _ LOCUS Rona okeby � � c X 100,05 �Bc Rd o KerN O� �. f700 Ica 170.00' o 101.65 101.68 j 1 _ 2..__ — -- 9,9,62 1 205 a ! 10 0.7 6' ~�pRO-23' y q ,, 0 , 101,2 8 f..,� ! PO��y� AN i: P::.:S r., I T FT-❑A t 101.85 `��� so`o�o j 1100,39 94,40 p x 1 ;,, I Paved Drive f X t L,:.. i 99.74 , ,::_� c } j 98,8g j LOCUS MAP 100.65 w- _ 2 101.79 101.10 94.15 NOT TO SCALE 56. ..�-_..^ BASIN `1. , " B A S I N 100.0E 2 01,43 101,0 99,52 \\ ❑,aK l jf, ' ,�f I ' , 1 � GENERAL NOTES: 100,19 r �,' 96 (� 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SEE NOTE 11 X ;�... .: f j EXISTING/; � ` , BOARD OF HEALTH AND THE DESIGN ENGINEER. M1,10 '_ HOUSE (, 11)' 101,16 100 9 ` T� 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS r` ��TOF=102.28 1( 1ob,99 I 1 a OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE EXISTING LEACH PIT 9B � ��*, SEPTIC/C❑V 1i.a x t LOCAL RULES AND REGULATIONS. TO BE PUMPED, FILLED W/ �� ,� /(Assumed) SAND & ABANDONED 100,43 'J `/ ;I 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Ug f/ /� / ', ] l TO IIVSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. �, 1 RUCTION DIFFERING w, �?.. �\ ,, , - ,. ,- /l,, 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION 95.61 A Lot 7 l �1 SEPTIC TANK ~ 98`� � � '�"' 01,47 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN EXISTING '' 1 41�7f S.F. ENGINEER BEFORE CONSTRUCTION CONTINUES. S, TOP OF TANK, EL.=99.83t `� �` "?<,\I00.70 101,09 0.35± AC. � � Z 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. � Map 43 � �� 6 THE THE DESIGN TRACTORENGINEER OWNER NOT TOENO�IFYIBLE THE FOR OCAL BOARD OF OF Benchmark set � ` =o � � HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. - --- 100,69 Parcel 7-6 „ :� Left car. bulkhead 100,36< j , O 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. EL.=101.52 c O '� � B. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS ``'98 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 100,65 x l 4 95,60 DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE M THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING \� _ CONSTRUCTION._ _ ---EC"1%PEDS 1 1 'I. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS —�0— ` 6 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND LEGEND OF 4 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY P��t� Mgss9� 98 80 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. EXISTING CONTOUR PETER T. x 100.98 EXISTING SPOT GRADE McENTEE PROPOSED SEPTIC SYSTEM UPGRADE PLAN W EXISTING WATER SERVICE o CIVIL No. 35109 1 BRACKEN FERN ROAD, MARSTONS MILLS, MA G EXISTING GAS SERVICE �'EG/StE`�E� �� Prepared for: Thomas Forest, 11 Bracken Fern Rd, Morstons Mills, MA 02648 U UNDERGROUND WIRES Engineering by: Surveying by: SCALE DRAWN JOB. NO. a EngineeringWorks WARNER SURVEYING 1"=20' P.T.M. 180-08 TEST PIT Z'�" 12 West Crossfield Road 22 Long Road Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET N0. BENCHMARK 5/22/08 P.T.M. 1 of 2 (508) 477-5313 (508) 432-8309 1 Y A NOTE: TO PREVENT BREAKOUT, THE PROPOSED " FINISH GRADE SHALL NOT BE < EL:98.3 ' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. 3 5" DIKOUTLETS SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. ; INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL RISER & COVER OVER ONE CHAMBER ANDSET TO 3' OF F.G. TO SERVE AS INSPECTION PORT I_ 15 5",I f� 16' 2" T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ( � � —.L EXISTING F.G. EL.=101.3t F.G. EL: 101.5t F.G. EL: 101.6 15.5" �_i 12„ �, 8,� L = 30' L = 5' 6„ j ' CAP S=1% (MIN.) @ S=1y (MIN.) 2' LAYER OF 1/8" TO 1/2" 4'SCH40 PVC 4"SCH40 PVC DOUBLE WASHED STONE 063 0®®® (OR APPROVED FILTER FABRIC) 2" �o" 14„ 6' aaaaaaa 3/4" TO 1-1/2" DOUBLE H- 10 LOADING eases®a EXISTING : 48" LIQUID INV.=98,50t WASHED STONE LEVEL 4' �WIDTH 4' D—B O X GAS BAFFLE INV.=98.02 INV.=97.85 PROPOSED D-BOX EF .2' i N.T.S. EXISTINGSEPTIC TANK INV.=97.80 -500 GALLON LEACHING CHAMBERS SURROUNDED WITFL STONE AS SHOWN H-10 RATED TOP CONC. ELEV.=98.6 — BREAKOUT ELEV.=98.3 ®®a ®® ®® ® nEaEa NOTES: 1) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=97.80 -- ®a®a ®®aa® ®aa®B U �®®GRADE ON A MECHANICALLY COMPACTED SIX a66a ®aa®ah- 33" INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.=95.80 ' ' 3' N j ry- ®® ®310 CMR 15,221(2). ®�®®®® 2) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 23.0' Z 3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE T.P. EXCAVATION OR G.W. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. LEACHING--SYSTEM SECTION 4) MAXIMUM COVER OVER SEPTIC TANK, D-BOX & S.A.S. NO GROUNDWATER, EL.=90.5 = 102" SHALL BE 36 5) CONTRACTOR SHALL CONTACT SOIL EVALUATOR PRIOR SEPTIC SYSTEM PROFILE TO INSTALLATION TO EVALUATE SOILS AT LOCATION OF PROPOSED S.A.S. N.T.S. 4" KNOCKOUT _ SOIL LOG 20fDIA. COVER DATE: MAY 14, 2008 (REF#12,198) 4" KNOCKOUT 4" KNOCKOUT 62" DESIGN CRITERIA � SOIL EVALUATOR: PETER McENTEE PE \�, l WITNESS: DAVID STANTON R.S. 01 `EXISnNO, ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH NUMBER OF BEDROOMS: 3 BEDROOMSc HOUSE (#11),\ 1 4" KNOCKOUT SOIL TEXTURAL CLASS: CLASS I .rof rozae, 101 6 A 1 0" 101-5 A 0" �(Assumed)� SANDY LOAM SANDY LOAM DESIGN PERCOLATION RATE: 5 MIN/IN � `` �" 101.1 10YR 4/2 10YR 4/2 DAILY FLOW: 330 G.P.U. �'/ B SANDY LOAM tOYR 5/6 SANDY LOAM 500 GALLON. CAPACITY,. H-10 LOADING DESIGN FLOW: 330 G.P.D. 6/- 99.6 24" 10YR 5/6 GARBAGE GRINDER: NO o Ali)N� 8 6 C1 1 98,3 38" EXISTING SEPTIC TANK.: 1000 GALLON CAPACITY h SILT LOAM C1 CHAMBERS 10YR 5/3 LEACHING AREA REQUIRED: (330) = 445.9 S.F. ---- CM �' 1 N.r.s. -i 98.1 42" .74 �; 1 C2 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES w� !� 54" PROPOSED SEPTIC SYSTEM UPGRADE PLAN MED. SAND SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES MED. SAND 2.5Y 6/4 11 BRACKEN FERN ROAD, MARSTONS MILLS, MA a- --- 2.5Y 6/4 - SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F. -3.2-4 BOTTOM AREA: 13.2' x 23.0' = 303.6 S.F. - Prepared for: Thomas Forest, 11 Bracken Fern Rd, Marstons Mills, MA 02648 9 Engineering by: Surveying by: SCALE DRAWN JOB. NO. TOTAL AREA:................................—...........................448.4 S.F. En ineeri Works WARNER SURVEYING NTS P.T.M. 180-08 90.6 I 144" 90.5 132" 9 l 12 West Crossfield Rood 22 Long Rood DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 G.P.D. S.A.S. LAYOUT PERC RATE <2 MIN/IN- ("C2" HORIZON) Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. NO GROUNDWATER ENCOUNTERED (508) 477-5313 (508) 432-8309 5/22/08 P.T.M. 2 of 2 a r ,i LEGEND . N 98 —— EXISTING CONTOUR °p ® River Rd x 100.98 EXISTING SPOT GRADE 95.77 a OCUS 00 FLa x /V I Wov-eby Roo 03 SET CRAWL SPACE SLAB QT EL.98.5 or BREAKOUT ELEVATION OF m e K �N O� 6' �e< R � e S.A.S., EL.98.3 (DESIGN) I100 N 88 25 24" E '' I oo� a I I C0� x 170.00 100,76X AN Cn x�x — _= A.S:�--�1 100.39 99.747 1 EX. S O 11 I I / rn 94,40 LOCUS MAP 1 0. PROPOSED PA LED PR/VE / " 1 NOT TO SCALE ' GARAGE � 14 12' (SLAB) 0D I 98,8 p I PROP. D.DN -� 99,52 94.15 \ 1 (CRAWL) 51.9\� BASIN FLOOD ZONE DESIGNATION Z \ 101,08 1\ FLOOD MAP 25001CO541J\ 1 EFFECTIVE 7/16/14 100,19 Deck •� � \\ �\0' 1 � � NON_ HAZARD-ZONE X Nt,' �- ZONING CLASSIFICATION: ZONE RF 10, 0 p EXISTING 101A6 , 96 SETBACKS: FRONT YARD=30' HOUSE (#11) I 100 1' o SIDE/REAR YARD=15' EXIT. SEP�C TANK TOF=102.281 9 Q LOT AREA = 87,120 SF \ \ \10 Dr/ (Assumed) 00,99 x �1 I �1 0 WATER PROTECTION J STATE REGULATED ZONE II sw I II y �{ WP - WELL PROTECTION o 95. 0 BH J SALTWATER ESTUARY PROTECTION OVERLAY DISTRIC \ 98\ 94.83 RESOURCE PROTECT ION9 , I 47 WIND EXPOSURE CATEGORY \ x 95.8\ �'.\� I � Exposure B \ ` � \ LOT 7 96 �, 100, 100,69 I i 1 \ \ 15 417t S.F. I ' 1 NOTES: 3 � x I � \ 0.35f AC. 1) TOTAL NUMBER OF BEDROOMS II \ �D/Nc I _, SHALL NOT BE INCREASED \ � O s \\ -,"rBgCk C � II 0 � t� 2) ALL ELEVATIONS ARE BASED ON AN �h ASSUMED DATUM. \98 \ 13 ��p)\ 'T 1 1 3) CONTRACTOR SHALL CONSULT WITH / THE APPROPRIATE UTILITY COMPANIES SSB, FOR ANY UTILITY RELOCATION. 100.65 X t95.60 4) THIS PLAN REFLECTS THE PROPOSED \� ly v BUILDING LOCATION AS IT RELATES TO ��VVOFMASS9 \ " _ _ I ZONING SETBACK REQUIREMENTS ONLY. OF ga�� TERRY yes x�tolz _ — ECT/PEDS I Mgss9�yG " ANN WARNER �N 100,06 E PARCEL ID: 043-007-006 o PETER T. °p N0.38721 g McENTEE � P i 98-8.0_ X PROPOSED BUILDING ADDITIONS CIVIL N ` �oN� f 11 BRACKEN FERN ROAD, MARSTONS MILLS, MA No. 35109 G/SiER� 0 , Prepared for: Julius Paider, 55 Burt Avenue, Northport, NY 11768 Engineering by: Surveying by: SCALE DRAWN JOB. NO. OWNER OF 0 Engineering Works WARNER SURVEYING 1"=20' P.T.M. 258-14 PAIDER, JULIUSUS G IV & ELSYE D 12 West Crossfield Road 22 Long Road (�(J 55 BURT AVENUE Forestdale, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. NORTHPORT, NY 11768 (508) 477-5313 (508) 432-8309 1/9/20 P.T.M. 1 Of 1