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HomeMy WebLinkAbout0037 BRANCH TERRACE - Health 3 I-Branell Terrace Marst6ns Mills A= 126 031 Commonwealth of Massachusetts Wo Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information is required for MARSTONS MILLS MA 02648 7/28/09 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A. BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name � 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 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 W'Oectico was performed based on my training and experience in the proper function and mi ri trance of 4site sewage disposal systems. I am a DEP approved system inspector pursuant to Se ion 15.340 f Title 5(310 CMR 15.000).The system: , ® Passes ❑ Conditionally Passes ❑ Fails7. _N, `t ❑ Needs Further Evaluation by the Local Approving Authority � 7/28/09 Inspector gnature 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 cf 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•09)08 Title 5 Official Inspection Form:Subsurface S e Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information is required for MARSTONS MILLS MA 02648 7/28/09 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) 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: 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•09/D8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRANCH TERRACE ,p- Property Address ZAPPALO Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/28/09 every page. City rown 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 pipes)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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments 37 BRANCH TERRACE u;q -� E Properly Address ZAPPALO Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7l28/09 every page. CrWr own 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 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'/day flow t5ins•09N8 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 i I Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/28/09 every page. Cltyrrown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 / i Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/28/09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts 110 T� Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information is required for MARSTONS MILLS MA 02648 7/28/09 every page. City/Town State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT SYSTEM CONSISTS OF A 1500 POLY TANK D-BOX AND37X10X1 LEACHING AREA WITH HIGH CAP INFILTRATORS 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 Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 07-55/08-41 Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: 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•09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "t 37 BRANCH TERRACE Properly Address ZAPPALO Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/28/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ 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 t/A system by system operator under contract ❑ -Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09 D8 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 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/28/09 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: ACCORDING TO AS-BUILT 1/09/06 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 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.): Septic Tank(locate on site plan): Depth below grade: 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: Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °F 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information is required for MARSTONS MILLS MA 02648 7/28/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cone.) 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 IS CLEAN AT THIS TIME APPEARS TO HAVE HAD LITTLE USE 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I� Commonwealth of Massachusetts WTitle 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information for is MARSTONS MILLS required for MA 02648 7/28/09 every 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 El other(explain): � Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora i Subsurface Sewage':Disposal System Form-Not for Voluntary Assessments '+ 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information is required for MARSTONS MILLS MA 02648 7/28/09 every page. Cityrrown 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.): BOX LEVEL NO LEAKAGE 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: t5ms•09108 Title 5 Offrial Insp ection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts MR Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information is required for MARSTONS MILLS MA 02648 7/28/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): NO OBSERVATION PORT FOUND COULD NOT OPEN CHAMBERS NO SIGNS OF 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•09A8 Tice 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information is required for MARSTONS MILLS MA 02648 7/28/09 every 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.): t5ms•09108 Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/28/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at 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: ❑ and-sketch in the area below drawing attached separately t5ins•09i08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRANCH TERRACE Property Address ZAPPALO Owner Owner's Name information for is MARSTONS MILLS required for MA 02648 7/28/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 5'feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record lf,checked, date of design plan reviewed: 7/28/09 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: El Checked with local excavators, installers-(attach documentation) ❑ Accessed.USGS database-explain: You must describe how you established the high ground water elevation: Before fling this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09I08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 BRANCH TERRACE Properly Address ZAPPALO Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/28/09 every page. City/Town 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 t5ins•09A8 Title 5 Offxial Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 -01F BAR NSTABLE LCo C ATION SEWAGE # VILLAGE_W 0 ' \.S A SESSOR'S MAP & LOT J31 INSTALLER'S NAME&PHONE No. SEPTIC TANK CAPACITY 1-5-ow j LEACHING FACIL=: (type) /T�—r �' (size) 10" / NO. OF BEDROOMS BUILDER OR OWNER � - s PERMITDATE: ��—31 COMPLIANCE DATE: D �S Separation Distance Between the: fMaximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 4l Lb LAI L j I, -(, ,s 1 TOWN OF BARNSTABLE LOCATION `��`� �� L' — SEWAGE # VILLAGE ' 1\ S A SESSOR'S MAP & LOT 3_) INSTALLER'S NAME&PHONE NO SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) r� NO.OF BEDROOMS — t f, BUILDER OR OWNER PERMTTDATE: �� � � -� COMPLIANCE DATE: 0� S Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i G� t�CJ . ?00 1 � i I i i , i 61, _ IC -fiu 5:3 r tt`` d Town of Barnstable Regulatory Services � COPY t Thomas F. Geiler,Director i6yq �0 KAW Public Health Division ed. k Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office; 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Forth Hate: 1110106 / Resigner: _Shay Environmental Services,Inc. Installer. Robert Septic Services. Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth MA On 12/30105 Robert Septic Service was issued a permit to install a. (date) (installer) septic system at 37 Branch Terrace, Marstoris Mills,_MA based on a design drawn by (address) Shay Environmental Services.Inc. dated December 29,2005 (designer) XX 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. r — I certify that the septic system referenced above was installed with major changes (i_e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. �tt1 aF AA40- 4 r _ a` O�IRMEN cG �fttaller's Signature) E. SHAY eta; t 181' i I&TSG�f. s �---_K14 _ (Designer's Signature (A ix I)esi p Mere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH TH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q;Hcaith/Scptic/Designer Cenification Form 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, 004em st-i C • J kk AY ,hereby certify that the engineered plan signed by me dated 121 3D 1 a5=concerning the property located at �nn Cyr, Tect'ccR, M. i S meets all of the following criteria: • This failed system is.connected to a residential dwelling only. There.are.no.commercial or business.uses,associated with the.dwelling. • The soil is.classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests.at the site without a health agent present. • There is noo increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) . B) G.W.Elevation .3 +adjustment for high G.W. 42. . _ 4-5•�60 DIFFERENCE BETWEEN A and B , OSIGNED : DATE: p OS NOTICE Based upon the above information; a repair permit will be issued for bedrooms s: maximum.. No additional bedroom are authorized in the future without engineered septic system plans. 10 .Z 53 Le�-rt\ r y cl 1 gASeptic\percezemp.doc 1 sr No. ✓ 3 Fee �V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pprication for Digpogal *p5tem Congtruction Permit Application for a Permit to Construct O Repair O Upgrade Abandon O ❑ Complete System ❑Individual Components Location Addressor Lot No.37&w k— ernke-e— Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 63) c`' L—O 1 S (Zoa"e Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. o Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building 2-e.51 Oev' t4-C No.of Persons Showers( ) Cafeteria( ) Other Fixtures y Design Flow(min.required) gpd Design flow provided -3 33, q© gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank I d Type of S.A.S._�� �� �7.� ,L-�f 6rt a✓L S Description of Soil COt4F?�. S Nature of Repairs or Alterations(Answer when applicable) Q�✓ jO ��Si 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 t is Board ealt . Signed Date Application Approve Date Application Disapproved by: Date for the following reasons ot Permit No. �5 —[q Date Issued ��` t w 1 R —! ; Fee O` a P THE COMMONWEALTH OF M SS CHUSETTS Entered in computer: tit I�UB C HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS, Yes 2pplication for Migont 6pgtem,Con!5tructtou Permit { � S Application for a Perntit to Construct O Repair(, ) Upgrade(00eeAbandon O ❑ Complete System ❑Individual Components . r Location Address or Lot No.3 7'3r4A Ter(,,A e- .Owner's Name,Address,and Tel.No. Assessor'sMap/]?arcel '��_ b3' Mt �.,_ (� 1 S ' oNe� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building e,I, -&Si ceort14 L No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided —3 33, c gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 5 ow 11>6 Type of S.A.S. �� ,� =Tip--,L"T,/art v✓L S Description of Soil J=a AWL Nature of Repairs or Alterations(Answer when applicable) P�✓ 1►/ 4­tS- Date last inspected: Agreemenx: .� 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:'J of the Environmental Code and not to place the system in operation until a Certificate of --Compliance has been issued,,by this Boa�dfaIt Signed Date Application Approve b Date .3d _ Application Disapproved by: Date t - for the following reasons Permit No. � '�j (0 Date Issued - -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal S stem Constructed ( ) Repaired ( ) Upgraded Abandoned( )by at as been constructed in accordance / with the provi s gf_Title 5 and the for Disposal System Construction Permit No. 5`�O5 dated /C7�/3c7< Installer a _e r-�-5 Designer � O A V #bedrooms cam. Approved de is n flow 3 30 gpd The issuance of this pe it shall not be construed as a guarantee that the system fill func/ti,'n11as design 0 Inspector d. Date 1 if -----�—,.(--——c---------------------------------- No. l i -- —�J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1=fgpo5ar 6pgtem CoHgtructiou permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( t-,)ZAbandon ( ) System located at 3 ,r g K G L.�t�srV e,C and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date f this a it. Date CD bs Approved b�y 04/08/2016 23'.02 FAX (a 002/002 n • Town of Barnstable Regulatory Services 1,;2- �63 Thomas F, Geder,Director `P Pubizc Health Division gip " Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office; 508-862-4644 Fax: 508-790-6304 Installer& DesilZner Certification Form Date: l/10/Q6 j V/ Designer: Shay Environmental Services, Inc. Installer: Robert Septic Services. Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street MA 02536 Yarmouth MA On 12/30/05 Robert Septic Service was issued a permit to install a (date) (installer) septic system-at 37 Branch Terrace. Marstons Mills MA.based on a design drawn by (address) Shay Environmental Services, Inc. dated December 29, 2005 (designer) XX 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, r I certify that the septic system referenced above was installed: with major changes (i.e. ,greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. 4Ctt OF prgSs� c EN CA Caller's Signature) a. EI. U SHAY No. 1181 t (Designer's Signature Q6zr (A ffix Des1 " p Here) PLEASE RETURN' TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION THANK YOU. ' •-- Q;11calth/8cptic/Desiper Cenifiention Farm •HAND N+NAM'' *NOTE: ALL PIPES ARE TO BE 4' SCHEDULE 40 P.V.C. SECTION A -A ALL OWLET PM FROM THE - 10' min. from 0151RBUTION sox SHALL sE Existing Foundation [house to septic tank PROFILE VIEW OF ADDITION TO LEACHING SYSTEM SET uxi roR AT uusT 2 FT. 'r croNCRE1E i TOP OF FOUNDATION ELEV. 100.00 (Assumed) tank covers nvmt be 0-BOX Dover must be SetheRAin a in o/ iMid+ed grade mod" a In. ae fkdehee �� Orede aver Septic To*-9e.00 Grade aver D-Dow- 9s50 Her SAS SAS- sea0 3- of 1/r' - 1/2- Washed Peast '� 3-$'OURET <\ KNOat0UT5 �n i 3/4- to 1 1/2 ' Washed Crushed Stone SS' OUTLET ,r M.ET .01 S 0.02 3 HOLE H-10 4'PVC(CAPPED)MSPEC110N PORT 10 BE ` J d• s• . i ��� T. Box 3' Nadm" COW Top OF Stem- Ekm. -97.Ss M15rALLED AND TO BE 1911iN s'OF GRADE 3 e'x!7/RSOr Ter/ 5�0.01 15• NEW ergreater 1as' 1.7s• Rke� �* r%.rr., ; ri 00 1,500 GAL �. s- MCI-Per foot Cr EMeeR<e Depth 4' - SCH. 40 T Flint Extsr FOUNDAT� o, to SEPTIC TANK n PLAN SECTION CROSS-SECTION 'µ CONCRETE FULL '0 1 H-10 0 401 ri 0.83' (10 inches) 5 Units E 625' 30' r'' w "I _--- - Y PROFILE $ 6 ti.o1 3/4--1 1/r 1 0 3' 3' 3 HOLE H-10 DISTRIBUTION BOX \+� ; SYSTEM 0 LE compacted Corr. o o 3725' NOT TO SCALE �sooa 4. - _ �r Not to Scale e c 1 020 Fhet►t wtr t C '0 3.5= I - -I 3.5' 1 Effective Length �*errs�oltwrEo i 5 o h 3 �1 � SOIL ABSORPTION SYSTEM (SAS) / e In.of 3le-1 I/r o 10' o GENERAL NOTES meted stone < Effeeeve Vrtdth INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE O'BRIEN NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 5' STRIPOUT ALL AROUND o 1. Contractor is responsible for Digsafe notification, Verification of Utilities e TO ELEV. 88.50 or Med. m Z (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes. Z 9ottorn of Teet ttob t o«. s0 2. The septic tank and distribution box shall be set E w Groundwater Observed _ e~•� NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 10" level on 6 of 3/4"-1 1/2" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. E p M 40 POLYETHYLENE LINER FROM ELEV. LOT #36 4. This system is subject to inspection during installation LOT #35 I °� 96.50 to 92.25 AND TO EXTEND by Carmen E. Shay - Environmental Services, Inc. j / i i 5. The contractor shall install this system in accordance / TWO SIDES AS SHOWN �96 with Title V of the Massachusetts state code, the approved plan and Local Regulations. I `J 245.00 �! �9 Failed/' 6. If, during installation the contractor encounters any Le9eK Pit soil conditions or site conditions that are different jA0k� _ New 150TANK ���� from those shown on the soil log or in our design SEPTIC 1 I I installation must halt & immediate notification be �/ made to Carmen E. Shay - Environmental Services, Inc. i O b O 7. No vehicle or heavy machinery shall drive over the 104,5 septic system unless noted as H-20 septic components. EST HOL #1 8. Install Tuf Tite gas baffles or equals on all outlet tee ends. W3 I --------_ O i ELEV.= 9 . 9. All Distribution Lines shall be 4' diameter Schedule 40 NSF PVC pipes. O i �'''- --- OG� '��/ i _ _ ____ 98 10. All solid piping, tees & fittings shall be 4" diameter Schedule 40 NSF PVC pipes with water tight joints. EXIST. 1 O 11. Municipal Water is Connected to ALL OF The Residence and Abutting GARAGE EXISTING �I :-- _ ( 0 Properties Within 150 Feet. I �� 2 BEDROOAf • - I THE PROPERTY LINES ARE APPROXIMATE AND O I t�\ i, SOUSE j I COMPILED e O SCOTT ASSOC SURVEYORSHoPLAN BY S. DENNIS.DENN S. MA T , O v 1 LOT #34 l �� EXIST i37 = yam_ ( ENTITLED "PHEASANT PLACE SUBDIVISION PLAN", MARSTONS MILLS, MA SHED I I 1 I = • 2. S DATED SEPTEMBER 1965, PLAN BOOK 198 PAGE 43 I 23,900 Squaw Peet +/- \ �\ ; I 'f I LOT #37 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN \ ` I ASPHALT 1 I I - • IT SHOULD BE USED FOR NO PURPOSE OTHER THAN THE SEPTIC SYSTEM INSTALLATION. `r I DRIVEWAY \ l I 1 1 • I EXISTING LEACH PIT TO BE PUMPED OUT& FILLED IN PLACE. I 1 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE ' FROM THE EXISTING LEACH PIT TO BE DISPOSED 0B.2 IiF HOL 1 OF AS PER BOARD OF HEALTH SPECIFICATIONS. 117 ELEV.= 98. ,84' THERE ARE WETLANDS PRESENT WITHIN 200' OF THE PROPERTY ` EDGE OF WETLANDS -� �� ' i I / 1 t ASSESSORS MAP 126 PARCEL 031 207.350 LEGEND \` ``--'---------------------------------------------------`� ----------�= , `�----°�6-,--------- -----�- ---- ------------- DENOTES PROPOSED F1 04X 11 SPOT GRADE 3-2e GAM.ACCESS MANNO ES BRANCH TERRA CE PROJECT BENCH MARK X 104.46 DENOTES EXISTING �. ..,- •- _- - SPOT GRADE (40 FOOT RIGHT OF WAY) TOP OF FOUNDATION ELEV. = 100.00 (Assumed) PL o PROPERTY LINE PERCOLATION TEST PROPOSED CONTOUR THE ACCESS COVERS FOR THE SEPTIC TANK. Note: Remove soil down to el. 88.50 - - - - - -97 EXISTING CONTOUR DISTRIBUTION BOX AND LEACHING COMPONENT Date of Percolation Test: DECEMBER 22, 2005 SHALL BE RAISED TO WHIN 6' OF OR MEDIUM SAND LAYER & replace with �.••�,,�,���z���.,._-.�,.,`.�` Test Performed By. CARMEN E. SHAY, R.S., C.S.E. p FINISHED GRADE Results Witnessed By. WAIVER.(per BARNSTABLE B.O.H.) clean coarse sand w/perc. rate less than or DEEP TEST HOLE & STEM REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EQUALS EXCAVATOR: Shay Environmental Servic II or equal to 2 min. In. before & after placement PLAN VIEW ON ALL OUTLET TEE ENDS Percolation Rate: Less Than 2 MPI 1 8" I n !� �� q /� p PERCOLATION TEST LOCATION ��. / (5 FOOT STRIPOUT ALL AROUND AS SHOWN) F4040VANX COMM` 1 Test Hole Test Hole - 6 FOOT STOCKADE FENCE No. 1 No. 2 mlt d.varc. r •tY ssaT DEPTH SOILS ELEV. DEPTH SOILS ELEV. ,,,,zT T r mYr ur.t to aettet Oulu r 0 9&00 0 98.00 1� T-� w P SOT P LAN,s'-r s ES2 1-0'men. ' FILL >; D--84• 9,.0o D•-64- 9,.Oo OF PROPOSED SEPTIC SYSTEM UPGRADE sandyr L _ ,_� :;+� 7. „_ _ --�,� -__•_. Loom PREPARED FOR w 10'-D• "s -s' 10 rR 3/2 10 VR 3/22 .CR OSS SECTION END-SECTION 84'- W1 A. 90.50 W_ 90-1 A. 90.50 M S. LO I S A. ROONEY Loamy Sand Loamy Sand AT TYPICAL H-10 LOADING 1500 GALLON SEPTIC TANK 10 TR 5/6 10>R 5/0 #37 BRANCH TERRACE NOT TO SCALE n 90'- 114 Be 88,50 90"- 114 Be 88.50 0 20 40 50 Mo-�„e �,• MARSTONS MILLS, MA Sand Sand 6mmmmiiiiI Design Calculations zs Y 7/4 zs Y 7/4 14'- 16 Cr 84.50 le- 16 G 84.501 „ �ZN OF M PREPARED BY�j C A Number of Bedrooms: 2 Equivalent to 220 Gal./Day (330 Gal./Day Min. per Title V) SCALE: 1 =20 �o=��A M N Ct`1 RMli N E. �J Ht1 Y Garbage Grinder: No Leaching Capacity Proposed: 330 Gal./bay Minimum (Min. Per Title V) c Septic Tank : - 2 x 330 Gal./bay = 660 USE NEW 1.500 GAL Septic Tank. ENVIRONMENTAL SERVICES, INC. SOIL ABSORPTION AREA: Using percolation rate of <2 min./Inch O 1 0 P.O. BOX 627 Bottom Area: 0.74 gal/sq. ft. x 372.5 sq. fL 275.65 gallons Perc #1 ~� �F Sidewall Area: 0.74 gal./sq. ft. x 78.72 sq. ft. = 58.25 gallons Depth to Perc11 SISTER EAST FALMOUTH, MA 02536 Providing: - 333.90 gallons Perc Rate= 2 ssumed VARIANCER U S�NIrF��P�' TEL/FAX : 508-539-7966 Groundwater Obse O or ELEV. 91.00 Use- (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, Observed ESHWT 84 1. REQUEST A VARIANCE TO REDUCE DISTANCE FROM SAS TO A FOUNDATION SCALE: 1"=20' DRAWN BY: CES DATE: DEC. 30, 2005 TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE ADJUSTED H2O Elev. = None -Unique Adjacent Wetland FROM 20' To 15% A 40 MIL RUBBER LINER HAS BEEN PROVIDED. ON THE ENDS. NO STONE UNDER. ELEVATION OF SURFACE WATER EQUAL TO OBSERVED GROUNDWATER PROJECT#SD852 FILENAME: SD8526PP.DWG SHEET 1 OF 1