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HomeMy WebLinkAbout0023 BRENDAS LANE - Health 23 Brendas Lane' - - Marstons Mills \ A=028-049 4 S I �I I TOWN OF BARNSTABLE LOCATION Q3 B r cndca 5 LANE SEWAGE # 0008 -311 VILLAGE Mars)nrs fn:)15 ASSESSOR'S MAP & LOT o C/ INSTALLER'S NAME&PHONE NO. 9 4, 0 EgcA✓ 2 ') - OG 3 SEPTIC TANK CAPACITY 1 S00 qa 1 LEACHING FACILITY: (type) ,Tbo �Vcl+ar+n-& Cz-) (size) 13xa5 x Z NO. OF BEDROOMS 3 BUILDER OR OWNER 7C�i�ru Xq,m5or1 ram. PERMIT DATE: `I-7. -O H COMPLIANCE DATE: 7-07 9 - OR Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Ai. 34 Az•3� V .32.3�•` fit• . RD nr7� AM- 34-s< q . Commonwealth of Massachusetts .. _ W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments H 23 Brenda's Lane Property Address:. .. .. Lisa &Jeff Johnson Owner Owner's Name information is Marstons Mills MA 02648 7/1.1113 required for 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 A. General Information -:filling out forms on the computer; use only the tab:::: 1. Inspector _ .... � ._ _.... key to move your cursor-do not Ricky L.Wright use the return: ke Name of Inspector Y• - B&B Excavation, Inc: �? Company Name .14 Teaberry Lane -711 Company Address. .e. . Forestdale : :::: MA::. ,.r b2644 .:v City/Town State iZip Code (508)477-0653 S1=14595 Telephone Number License Number .. .. v� s,w 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 El Needs Further Evaluation by the Local Approving Authority . 7/11/13 Inspector's Signature Date The system inspector shall submit a_copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design.flow of 10,000 gpd or greater,:the inspector and the.system owner shall:submit the... report to the appropriate regional office of the DEP. The original should be sent to the system owner ...and copies sent to the buyer, if applicable, and the.approving authority. ***.This report only describes conditions at the time.of inspection and under the conditions of use at that time.This inspection does.not address how.the system.will perform in the future under the same or different:conditions of use. t5ins•3713.. Title 5 Official Inspection Fo S urface Sewage Disposal System Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated 'below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts 172 Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. z For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts.- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments .. . 23 Brenda's Lane M Property Address :. Lisa &Jeff.Johnson Owner Owner's Name information is re.quired for eve� Marstons Mills MA 02648 7/11113 CltylTown - State Zip Code. Dateoflnspectiorr page.... C. Checklist . Check if the following.have been done. You must indicate"yes" or"no" as to each:of the following: Yes No El Pumping information was provided:by the owner, occupant, or Board of Health ❑ Z Were:any of thasystem 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.systems7.. 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 ® El ::.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 . DESIGN flow based.on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins 3M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , M 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name requinform r on is Marstons Mills MA 02648 7/11/13 requiredd for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 .Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 7/29/08 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2'6" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20'feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1'6" 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: 5'8"x5'8"x10'6"(1500 gal) Sludge depth: 6,. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 l I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 4" 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? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appeared to be in working order with Zabel filter present, no evidence of leakage. Pumpibg of tank/cleaning of filter is recommended. 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 l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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.): At time of inspection D-Box appeared to be in good condition with no evidence of carryover or 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 page. City/Town 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/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appeared to be in working order with no sign of hydraulic 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is Marstons Mills MA 02648 7/11/13 required for 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: I Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For. Subsurface Sewage Disposal System Form Not for Voluntary Assessments t 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every MarstonS Mills MA 02648 page.: City/Town : 7/11 M 3 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 q. a _ A► -56O A 2 - 3q C3 _ � � - b3 t5ins•3/13. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >138" 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: 7/25/08 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: Plan on record with Barnstable Board of Health dated 7/25/08 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 23 Brenda's Lane Property Address Lisa &Jeff Johnson Owner Owner's Name information is required for every Marstons Mills MA 02648 7/11/13 page. Cityrrown 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•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable +++� Regulatory Services Thomas F. Geiler,Director • r, , S Public Health Division ' ►' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 r Fax: 508-790-6304 Date: zf/Q Sewage Permit# Z��3 i Assessor's Map/Parcel Installer&Designer Certification Form fry: Mc.g—::,rl4 F55. i Designer: 1',q � We)r(4 S Installer: D �xC`�✓ �t��`-` Address: 12 tn1 . Cro s s'f I 1.,1 J?d Address: 14 T S On 7-Z9 -o (i Z6 14, �as issued a permit to install a (date) (installer) septic system at Z- l�-agenda`s Last, /I P l based on a design drawn by (address) I'�IGrK-k-e (.IC• dated �/2��0� � ��� (designer) r I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical re f any component of the septic system) but in accordance with State&Localoi revision or certified.as-built by designer to follow. Stripout(if requ' . d the soils were found satisfactory. y o PETER T. McENTEE CIVIL No. 35109 staller's Signature) SSIONA1��a PAC (Designer's Signature) (Affix Designer's Stamp Here) PLEASE,RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. TIFICATE 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:bffi-fonw\designemertificadon form.doc YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (Which you must do by M.G.L.-it doe: not give you permission to operate.) YOU must: first Obtain they necessary sigr),IIU�s on this form at 200 Main St.., Hyannis. Take thel coml-)I(I-ted farm to the town Clerk's 0ffice, 1 st. FI., 367 Main St., Hyannis, MA 02601 (-mown Hall) and get the Business Certific;a(e that is required by Iaiw. DATE: CA Fill in please: APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS: a3 SS�end � Line_ , t; ` �•�36 Madan M: ks ' TELEPHONE # Home Telephone Number ` '44, 8SC 5' J2 NAME OF CORPORATION: NAME OF NEW BUSINESS: QI TYPE OF BUSINESS l.aty)-scanI C, . IS THIS A HOME OCCUPATION? YES NO / 0��� ADDRESS OF BUSINESS ce a 's �n M'�s o MAP PARCEL NUMBER (/� (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual h s be rme�ef th t requirements that pertain to this type of business. MUST-wOMPL` WITH ALL (l �q t 7Al=?001 JS MATERIA!S RF01'11,67'_ ,. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS ( C IN UTHORITY] This individual has b in of the licensin r re is h ertain to thi type of business. U I(1�O Authorized Signat e** COMMENTS: 6 TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: QzuoT \scp:n0 BUSINESS LOCATION: to kk Kkk- cog& INVENTORY MAILING ADDRESS: 4 > '��e��a� Ln. f�f�a ns M;l�s TOTAL AMOUNT- TELEPHONE NUMBER: aSao CONTACT PERSON: -�escn EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: La,\bsIc �N INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants f Qom\ Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) f \ Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) s� Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes ✓ Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS A plicant's Signature Staff's Initial No. �'"' t Fee ! ®� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for �Nzpoal �&pgtem Con0trUCtion Permit Application for a Permit to Construct( ) Repair(/)� Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. oa 3 rN6cc�Ln n{ wner's Name,Address,and Tel.No. Mgrs+ons ILLS l54 3ohnsbn Assessor's Map/Parcel _ !1/ �;7j -e 7 Installer's Name,Address,and Tel.No. D signer's Name,Address and Tel.No. To be LT- C, ► LF�y_�3fi6 X L c;} tort s l� s Wo�� L� Type of Building. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building s,1clo D_c.L, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 D gpd Design flow provided gpd Plan Date 7 126 W 0 F Number of sheets Revision Date Title r joo6ee +t C S Size of Septic Tank 4-6$0- 1,40Q Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Zg d Application Approved by �— Date � Application Disapproved by: Date for the following reasons 2 p Permit No. OG ^ J Date Issued -7 +- -L - _ -- .:n w _ r rs« yu^ . •. ' A r r,.-,}� ,;r�X„- ^'ys 4. No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: !?: Yes +» PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for aiopaal �bp.5tettt Con.5truction Permit Application for a Permit to Construct( ) Repair(#")' Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components 1 Location Address or Lot No. -a nC`a 5 Ln n � wn"'er's Name,Address;and Tel.No. Mctr� tuns 7 � 15Ci Johnsen Assessor's Map/Parcel g 4/ �13 t nd 6.S 1--L-), AA . �1 1 1,5 Q A Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -R(;be.2� U1 ��uy Ili ( � [�vcs{ l�n �`n�jln2er ,n wU� S ; F. 1 Ll Type of of Building: 1 t r ,;R Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building e e,t r t A No.of Persons Showers( ) Cafeteria Other Fixtures y; Design Flow(min.required) 3 3 gpd Design flow provided gpd Plan Date -7 �_ZJ ,U Number of sheets Revision Date Title_Pr000s e.n _ 1 I c r , ' Size of Septic Tank 62 (i Type of S.A.S. Description of Soil I F j Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: 1 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 Booaarrd"of Health. C/ Signed �Ut}��t� Date Application Approved by ^ Date 77—,L Z'd Application Disapproved'by: Date for the following reasons . Permit No. �G ^ 7 Date Issued -7 _lp '6 - --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( `�) Upgraded ( ) Abandoned( )by t1 Y,(_A\1 CA at 3 (F'c1t`�a 1. Cam("l / has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 7—4 �d Installer 2vhe_rz_r L ► L f-& Designer rL S .. #bedrooms Approved design ofl wj O gpd The issuance of this permit shall not be onstrued as a guarantee that the syst�( 221 ]c 'o �esiigned�. ..'Date �/ I / Inspect`r� -------------------_—_ —=----------- /�f l� -- -No. 00,4- FeeTHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=igpo!9a1 Q�p5tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) System located at 2 3 ( (1(`�(� �(� a �` r1I and as described in the above Application for Disposal System Construction Permit.The applic 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 of t`hys+ermit: Date d Approved by } Town of Barnstable P# Department of Regulatory Services oFT►,E, Public Health Division Date P� 200 Main Street,Hyannis MA 02601 BARNSTABM MAM W °�fo cur" Date Scheduled 6 Time Fee Pd. Soil S(tLability Assessment for Sewage Disposal Performed By: 1 Cicr Witnessed By: 1 tsC A A ` ,c C-�V,a i, .!:r-:!.v._.,..:._..i:......r:......r:::............:....:..r.. ...I..r.r. .r.. .. ._!.. , .. ... .. .. r......_r.....1..�.................r,._....i.!.I.............,.I.r...:..:r!:...r:.!... I:.�.::+.:! :.., ..... ...r .....r......... .ks...... .....i....................ir.....I.:...:.... .r... .,:.!..... ]�.i r .._.. .. .: i ........-:.. r :.:..:..L.,. .�:.r......r...:......,..: MIN....... ......... .........: .. r�.. ..II.. 1. 5,:... :,. :, �rl,=;;;:rr ;���.4��{,d !II,�T��\�+ll,,!.;t�.� �.� ,�'����,\ .. Location Address Owner's Name oZ3-- renclgs Lcane T�� rey �O�'�5°`� MG(5tvn5 Mill 's Address � (encagS �-an-e. tillll5, M/A Assessor's Map/Pazcel: U 2q 0 4 9 En ineer's Name NEW CONSTRUCTION REPAIR V/ Telephone# 4i 17- Land Use Slopes(%) 6 - Surface Stones Distances from: Open Water Body 2V ft Possible Wet Area 2ZEQ ft Drinking Water Well>hyt� ft Drainage Way ft Property Line 70 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to.holes) co Ln r-- l ' w r Parent material(geologic) CL`� ��v` Depth to Bedrock 3 t Depth to Groundwater: Standing Water in Hole: from Pit Face 4144 Estimated Seasonal High Groundwater !:.,.._r.:....................r..._... ... ..._..: ..::.,� :. ........:__..............r......._!.. .. {� �.r..r... .r... .. ...�}.... ..:..::..:. .v: :::. r �:u: ....al.!.............r........:....r..� :.:..::.:,•..::.:::� .....:...........,......................................._......__.................._......._..........._..................._._.. Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level _._._..... ;:... :..............................!.._...................i..r...:.......i.!...:.._�...r.:........:.r.._.....:..,.r...,..r..._.:r:� .. . 1' .. ..,r::.::,...... ate................:r..:_:.:.,-:,:::. :....:..........:..:!..:.......:..........�..._r..;..:.:..»r....r.. ._.__r._!..r:...............�+I�C�'. :.T.+.��`�C.LI�1.T ".. p _.._....!.....:...,.ir.....r...._.. .r..rr. .r rr ..�rr..r.. r r.r _..�......_... r.r_. ::................. _ Observation Hole Il 51 Time at 9" Depth of Pere S Z 2 -J Time at 6" Start Pre-soak Time @ 1 Time(9"-6") End Pre-soak (I 7 r„ Rate Min./Inch Z—Z Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-------- Q:I­lEALTH/WP/PERCFORM : —. ................................:................. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % 0 Z — C I� .., 5`G 5/3 P:.. . B ER?VATIOI .... « < <><<<...H.o e..#............... .......................... ..O i Pexltire - Soil Color Soii Other Depth from Soil Horizon Soil Surface(in.) {USDA) (Munsell) Mottling (Structure,Stones,Boulderes. % Gra el) tQ ns/a �`f 5-/3 f :.::...:.... ...D ER :A 'I. :::..IULIJ. le. .;:: <:: :: : .:: .: ::::::: . ::::#:......................::::.::::::.:.:.::: :.:::: Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. e o Ora el) ....:..:. ......L......::...:::::::::.:::::::::.:::.....:.:....:.:.::........ :......:......................:.. t.e:::::......................... Depth from Soil Horizon Soil Texture Soil Color Soil 0 h r Surface(in.) (USDA} (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) s f Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No 4 Yes Within 100 year flood boundary No< Yes ' r Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? a s If not,what is the depth of naturally occurring pervious material? Certification I certify that on lV% (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required traini ,expertise and experience described in 310 CMR 15.017. Date ^^��, 1,9 l U $ Signature L-- �pRv; CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory \ss c► Report Prepared For: Report Dated: 1/22/2008 � � Lisa Johnson Order No.: G0844766 23 Brenda's Lane Marstons Mills, MA 02648 Laboratory ID#: 0844766-01 Description: Water-Drinking Water Sample#: Sampling Location 23=Brenda''s,Ln._Marstonss;M Mill - A� Collected: 1/10/2008 � n Collected by: L.Johnson Received: 1/10/2008 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested Lead 0.0012 mg/L 0.0010 0.015 EPA 200.8 1/11/2008 Water sample meets the recommended limits for drinking water of all the above tested parameters. i .` en v?t , � � m F3 C0 In ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 2 Barnstable County Health Laboratory �Ch \y+shC Sc`% Report Prepared For: Report Dated: 1/22/2008 Lisa Johnson Order No.: G0844766 23 Brenda's Lane Marstons Mills, MA 02648 Laboratory ID#: 0844766-02 Description: Water-Drinking Water Sample#: Sampling Location 23 Brenda's Ln.Marstons Mills,MA Collected: 1/10/2008 Collected by: L.Johnson Received: 1/10/2008 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as nitrogen 0.94 mg/L 0.10 10 EPA 300.0 1/10/2008 Copper 0.15 mg/L 0.10 1.3 SM 3111B 1/22/2008 Iron ND mg/L 0.10 0.3 SM 3111B 1/22/2008 Sodium 15 mg/L 1.0 20 SM 311IB 1/22/2008 Total Colifbrm Absent P/A 0 0 SM9223 1/10/2008 Conductance 190 umohs/cm 2.0 EPA 120.1 1/10/2008 pH 7.6 pH-units 0 SM 4500 H-B 1/10/2008 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved B (Lab ctor) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Asssor's 'map and lot viumber © (A �." SEPTIC Sy 'TEM PST E 1. Sew ge Permit number ::... .. ...:, ... TAtLED IN C► PL'IANCE INS �'� 3 WITH ARTICLE 11 •;S . T Y 1TE �yo�THE rp�o. l TOWN O F B A,R.N S' I ANC roves . QY ca- p t d �. ca BAMSTAHL 9�. 6 9 ..BUDDING INSPECTOR a` r 10 CI; APPLICATION FOR MERMIT M ....:Asx.A.....:jo....... ........... .. TYPE OF .CONSTRUV'Ok ...........WOO ..... . ........ .............................. L� s -�� .9..: .� ece�6 ...19.�7= _... �0 THE INSPECTOR'aF B�tt� G The undersigned hereby applies for-a permit according to the following information: -Location ...........5 Z 7.........W°e A .... ............ .....A�'IA.�. .........: Proposed Use 'A? O/L A 01'1 ...............................................................................................................................:............ Zoning District .........A....vrz'............................................Fire District ......C¢n vl� f V� is pp ,...QS`1 1..�. ..... Name of Owner ....��d)A� C`.aR,,( ,f�- �, Address ...f B.s..6 0-4 -7-L a.ts�ws Af, 1 ......................... Name of Builder ....�•.A.w.6.. «-.... ...Q.L,:xr. Address Z wtr! r ST xsri/!/S .... Nameof Architect ......................SUM -...........................Address ...............:............:...........................:........ . Number of Rooms •+ Q�® ................... ............................ . .....,.....................Foundation .......CQ.Y.?...a..2.:......f.'t.C............... ..� . Exterior .......7F.4,�t7"+?lt .:.....�.-.��........................................Roofing ......As pa:1 r Floors V.f1.�DSaK�.A ......`t...C.gICeT.........................Interior ............ ,..............:. Heating ...........�L e c" +2t. ..................................................Plumbing ..........................wT ................................. Fireplace ............................................................................. .Approximate Cost .. .80.4.0.E®, ......... Definitive Plan Approved by Picnning.Board _ _ ___-------19____, Area Diagram of Lot and Building with Dimensions (2—L.. Fee ... ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable r garding the above construction. Name ............ ....... .....`Il.�........................ .................. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA if �`� _��4�� '�r�� � � ��� a '. �.. •�- e y s e s{ < �a,��t ���°4` �s g � v � {: fit s i '�1V'f �i a �av,a. 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' Public Health Division Date 'd o. 367 Main Street,Hyannis MA 02601 BARNB'TAELE, ' y MA39. ''rfottn�� Date Scheduled Time Fee Pd. ,Soil Suitability Assessment for Sewage Disposal Performed By: 14\1C-kA/"�Et-- PMIrA (135C- G900F) Witnessed By: GLE:r4 +AA,?.9106TM LOCATION;& GENERALIN:FORIVIA'TI.ON : ' Location Address 1517 \A)NY-E5Y Owner's Name D RQbER-T pj0 U KQUE 5A,�44 ST;-,1bLE t MA Address - Bpi I l 46 /Parcel: MAP 2� , PIMP-C..EL 6q I�A�ST°t� MILL.S� MA Ma p Engineer's Name 155C_ G1°.00P NEW CONSTRUCTION x REPAIR Telephone (790.65c�-7c)8l 1=ESlDE1�4TIA o < I °/Land Use Slopes(/o) b Surface Stones Distances from: Open Water Body R Possible Wet Area R Drinking Water Well R 1 Drainage Way R Property Line R Other R SKETCH: (Street name,dimensions of lot,exact locations of lest holes&perc tests,locate wetlands in proximity to holes) 5 ITT �RD I Parent material(geologic) PK0&L_A(-iA L_ Ott' WA 5H Depth to Bedrock >12� Depth to Groundwater: Standing Water in Hole: N Q 14 E Weeping from Pit Face N 0I-AE Estimated Seasonal High Groundwater ::.:::..:::..::.. �y�yy;t�r..} .}� }��y fi. �t y� y� �t �} `y yy�/y ��r .. . �t i;' :'>r 2; > i/L1'PrRLYlll',i��A l`( 1 Oil E-A"NSO1`A-11 ClilY KY� 1 iy 'T �.J i. :-..: Method Used: NO ADJVSTM lT 1;EGtvlM Pit P__ 13,6 t(, Depth Observed standing in obs.hole: in. Depth to soil mottles: --- - in. Depth to weeping from side.of obs.hole: - -- in. Groundwater Adjustment R. Index Well#_ Rrading Vate: index Weil level. Adi.factor __ Adj.Groundwater Level ... :: ; PER:COLA TOlV TEST : ::::<:»::>:::::n try: mot.rime .11,po ... .. Observation Hole# TP'I TP--Z Time at9" 44 G J_- 15 Mill, Depth of Perc -52) O -59� Time at 6" Start Pre-soak Time Q �l'Zg 44•Oeo�) Time(9"-6") End Pre-soak :Rate Min./Inch Site Suitability Assessment: Site Passed x . Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant bESERVATT()N Ti0 LC?+G �ioIe# � '. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Co enc %Gravel 0_Z A LoAA.Ay to W-4/2 HOOE \/Ep f'R►A�ua 2" l a sA to o�t'l 2,5 Y 6/6 N o H e FPPID-G: 18T�� G cOA5 rad Z,5 Y 7/(o I-005E , 5-lo% G 1LAVEL DEEP OBSER.vATI�N HQ.LE LQG Hale Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistencv.%Gravel) 0 —5 A Lo 5,kND 4/2 rtat-lE VERY yA�APY oAM Z. 5 Y 616 H OHO IWIFILE 2.5Y /(o LooSE yd�lE 5At-�D TlP 1BERVATTON HULE T1b Bole# Depth from Soil Hori�n Soil Texture Soil Color Soil Other Surface(in.) )r (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel ;: t P.::..:B: ERVATLON.HQT, <:.:::.: ...,. :::,::::. :::::: :L.:..:G.::.:::::.:: .:: .Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Cgrisistency.° r el Flood Insurance Rate Maw Z O N E L Above 500 year flood boundary No— Yes X Within 500 year boundary _ No_X Yes Within 100 year flood boundary No Y Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YE If riot,what is the depth of naturally occurring pervious material? Certification I certify that on 10112 OY) (date) I have passed the soil evaluator examination approved b, ;the y Department of Envirgnmental Protection and that the above analysis was performed by me consistent with the required trai ing,ex ertisea d ex,, eri nce described in 310 CMR 15A17. Si nature x - `"-- g Date 5 2-'J 3 u`a N 52'1 WA460 y 0 N N o2RR1oE N 22 SEPTO OAARV PlR^� :+fPi1C ' SFr 1 sEPMC r N/►� e13 RO 29 D �� j� AS9E��DR3 MI1P Ap 10 A MAP 28 PARCF7 PM PARal e3 sEpnoA�E Am ROM KIF Ito // fo0 + � I ► eacARrsT. 2 1 1 SEFMa IWr arm im*P p 1 1 04A AD.Errs csiam AlC�B All"NOWWAR) l� Al PAt 7ma))o 20 Wd 114 CIA ROAD A(RMIcA�1�e � SEPlIC N/F steno N 9"D 2 M;M'w 21 oul'o7 ROAD► a N/rA OM N i a BSC TRANSMITTAL To: Town of Barnstable Date: May 23, 2001 Board of Health Proj. No: 4-8297.00 367 Main Street Project: 527 Wakeby Road Hyannis, MA 02601 We are sending you: ®Attached ❑Under Separate Cover Via: 384 Washington St. ❑ Overnight Delivery ❑Taxi ®Regular Mail Norwell, MA 02061 ❑Messenger ❑Direct from printer ❑ Other: Tel: 781-659-7981 The following items: Fax: 617-345-8027 ❑ Change.Order ❑Drawings ❑Prints ❑Samples ❑Copy of Letter ❑Photocopies ❑Reports ❑Specifications ❑Digital Media ❑Plans ®Other: Soil Logs No. of Copies Drawings No. Date or Revision Description 1 5/23/01 Soil logs and test pit plan This information is: ®For Your Information ❑Approved as submitted ❑Resubmit _Copies for approval ❑Unchecked ❑Approved as noted ❑Return _Corrected prints ❑Preliminary ❑Disapproved ❑Submit _Copies for ❑Revised Plans ❑Returned for corrections distribution ❑ Final Plans ❑Sent for your review&comment Remarks: Signed: � i�A� Note: If enclosures are j t not as noted,please cc: contact us immediately. Michael R. Petrin HADocumentAtransmittal.doc COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ` DEPARTMENT OF ENVIRONMENTAL PROTECTION =,` f � 1 �• y 4 S� 2':•. s .. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A -CERTIFICATION Property Address: 527 WAKEBY RD MARSTONS MILLS,MA 02648 Oq C' Owner's Name: ROBERT BOURQUE Owner's Address: BOX 1646 MARSTONS MILLS MA.02648 1 Date of Inspection:3/2/01 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS j x Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX,508-564-7270 CERTIFICATION STATEMENT 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 ,A inspector pursuant to Section�15.340'of Title 5(310 CMR 15.000). The system: X Pass'es', _ Conditionally Passes _ Needs Furth Evaluation by the Local Approving Authority Fails E a Inspector's Signature: lAds+,1,t4 Date: 3/2/01 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)wrthm.bJ 4 30 days of completing this inspection. If the system is a shared system or has a design now of 10,000 gpd or greater,the M ' inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be ! g sent to the system owner and copies send to the buyer,if applicable,and the approving authority. 34,A Notes and Comments THE SYSTEM PASSES TITLE V IN1'ECTION. RECOMMEND PUMPING SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****This report only describes conditions at the time of inspection and under the conditions of use at that thee.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 lncnrrtinn Fnrm A/1 5/)f1f1J1 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 527 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: ROBERT BOURQUE Date of Inspection: 3/2/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: r X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 { CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: `' +! THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. 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. ,a Answer yes,no or not determined;(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a 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 exfi:ltration 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. ND explain: n/a '# i, n/a 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): i _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled'or replaced ND explain: n/a n/a 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 _obstruction is removed ND explain: n/a `'' Page 3 of I I +y? OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS x' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A t )' CERTIFICATION(continued) . Property Address: 527 WAKEBY RD,MARSTONS MILLS,MA 02648 u Owner: ROBERT BOURQUE Date of Inspection: 3/2/01 C. Further Evaluation is Required hy`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 of-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 within150 feet of a bordering vegetated wetland or a salt marsh S U1 7 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 an&SAS and the SAS is within 50 feet of a private water supply well. ,z, _ 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 n/a ` "This system passes if'the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and ;.1} volatile organic compourids`indicates that the well is free from pollution from that facility 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. �f 'r tilts 6y�, 3. Other: n/a . +l. t 1 wf, ai F' Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 527 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: ROBERT BOURQUE Date of Inspection: 3/2/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ' _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool - _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] (Yes/No)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: `' k To be considered a large system the`system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. X You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above): r 'y 1 yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located m a nitrogen sensitive area(Interim Wellhead Protection Area—I WPA)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 largte'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. 4 Page 5 of i l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 527 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: ROBERT BOURQUE Date of Inspection: 3/2/01 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? j X _ Was the site inspected for.signs of breakout X _ Were all system components,excluding the SAS, located on site? 5 , X _ 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? X _ 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: Yes no X Existing information,'For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[3 10 CMR 15.302(3)(b)] I 3 5 j Page 6 of i l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 527 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: ROBERT BOURQUE Date of Inspection: 3/2/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3V",i[Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR`15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no):NO Water meter readings, if available: n/a Last date of occupancy/use: n/a,, OTHER(describe): n/a x GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part'of the inspection(yes or no): NO If yes,volume pumped: n/agallons',:How was quantity pumped determined?n'a Reason for pumping: n/a TYPE OF SYSTEM X 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) , _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1970 Were sewage odors detected when arriving at the site(yes or no): NO r, a Page 7 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 527 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: ROBERT BOURQUE Date of Inspection: 3/2/01 BUILDING SEWER(locate on site plan) Depth below grade: 8" Materials of construction:_cast iron _40'PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): THERE IS TOWN WATER ' SEPTIC TANK: X(locate on site plan) Depth below grade: 2" Material of construction: Xconcr`ete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" H 5'7'i W 4' 10"" Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle:28" Scum thickness: 4" ; 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: n/a 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 SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING y NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. GREASE TRAP:_(locate on site plan), Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum-to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage.;etc.): n/a , 3 i 4, 7 i Page 8 of 11 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) . 1 Property Address: 527 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: ROBERT BOURQUE Date of Inspection: 3/2/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a ., Capacity: n/a gallons Design Flow: n/a gallons/day x { Alarm present(yes or no): N/A a` ' Alarm level: N/A Alarm in working order es or no):NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a mj DISTRIBUTION BOX: _(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert; n/a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into ' t or out of box,etc.): n/a ik PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a i r t � pl t i . Q Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 527 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: ROBERT BOURQUE Date of Inspection: 3/2/01 4. !Y SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a `} innovative/alternative system . Type/name of technology: n/a •1.:S •r Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT fj; { HAD 1'OF LEACHING LEFT AT THE TIME OF THE INSPECTION. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) �t'6 Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a +: Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): f' n/a n Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,SYSTEM INFORMATION(continued), Property Address: 527 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: ROBERT BOURQUE Date of Inspection: 3/2/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. AA 45 q A667 ° A R bN in f Page I 1 of 11 " OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 527 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: ROBERT BOURQUE Date of Inspection: 3/2/01 SITE EXAM _Slope _Surface water _Check cellar _Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with lo�-al;e;: cavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET IGar f. i Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 527 WAKEBY RD MARSTONS MILLS,MA 02648 Owner: ROBERT BOURQUE Date of Inspection: 3/2/0.1 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. f9aR. AA 45 �gb7 oA 88 bN 3416 C TOWN OF BARNSTABLE LOCATION .��� SEWAGE # VII-LAGE �® t �C ASSESSOR'S MAP&LOT INSTALLER'S NAME&!PHONE NO. ►. SEP77C TAN r K CAPACITY LEACHING FACILrTY: (type)— t0 iT (size) O,IQ NO.OF BEDROOMS BUILDER OR OWNS-, SATE: �gb_COMPLIANCE DATE: Separation Distance Betweedthe: Maximum Adjusted Groundwater Table to the$ettertre¢bea } �-�1 ' Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 'A Feet j Edge of Wetland and Leaching Facility(If any wetlands exist I •within 300 feet of leaching facility) IFurnished by��-� . Feet r b3, bit i TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY k o o C) V+ I S LEACHING FACILITY: (type) (size) I 0 0 0A L NO.OF BEDROOMS BUILDER OR OWNER \)U� PERMTIDATE: 1(�L fI b COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 -� C�C..�'� � . o6 �, bS , k RE 4 �® COMMONWEALTH OF MASSACHUSETTS i CEIVEO EXECUTIVE OFFICE OF ENVIRONMENTAL AFF h NOV 2 5 1998 DEPARTMENT OF ENVIRONMENTAL PROTECTION TOWN OF BA ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 f HEALTHDEPT. 4 WILLIAM F.WELD 2;TRUDY•COXE Governor Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Lt. Governor R.ti Comiaissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOI PART A 1 j �,• CERTIFICATION '6`°� Wt i b 1�, r`�1R'R-ST-UW �ulkS Address of Owner: tR�L,O�\L vU Property Address: s 2�1 "1 l Date of Inspection: I 1 ki-I O c() (If different) Name of Inspector: M Ir;I r,,--\- 3 1�CC-1 I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CtiIIR 15.000) �A -tTON �(SI Company Name: T — --� L 02 -4b Mailing Address: i'� .k �,� P�h�r-e- , Telephone Number: ��;- `l'1 CERTIFICATION STATENIE`T 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: , Passes s ' _ Conditionally Passes Needs Further.Evaluation By the Local Approving Authority Fails n . Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design now of 10.000 gpd or greater. the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer. if applicable, and the approving authority. I\SPECTION SUNMIRY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CbiR 15.303. Any failure criteria not evaluated are indicated below. , COALIIENTS: S �t h.. �4 0..AA o t` - + 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. Indicate yes, no, or not determined (Y. N, or ND). Describe basis of determination in all instances. If"not determined% explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection: or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exriltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/3/97) P2ee 1 of 10 J . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORINI PART A CERTIFICATION (continued) . Property Address. , Owner: Date of Inspection: B)SYSTEM CONDITION LY PASSES (continued) Sewage back p or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to-a broke . settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe obsery tions: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required puping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the$�°and of Health): broke pipe(s) are replaced obstruct\on is removed C) FLRTHER EVALi:ATION IS REQUIRED B ' THE BOARD OF HEALTH: Conditions exist which require further evalua'on by the Board of Health in order to determine if the system is failing to protect the public health. safety and the environment. 1) SYSTEM MILL PASS UNLESS BOARD OF ALTH DETEP-N LL\ES THAT THE SYSTEM IS NOT FLICTIO;N-D;G IN A • 11L- NXER ti%KCH WILL PROTECT THE PU IC HEALTH AN-D SAFETY AN-D THE ENti'IRO`11ENT. ' _ Cesspool or privy is within 50 feet of a surfa a water Cesspool or privy is within 50 feet of a border g vegetated wetland or a salt marsh. 2) SYSTEM NNTLL FAIL UNLESS THE BOARD OF HE. TH (AN-D PUBLIC WATER SUPPLIER, IF APPROPRLaTE) DETER�IL�\ES THAT THE SYSTEM IS FLNCTION-ING A ALaNNLR THAT PROTECTS THE PUBLIC HEALTH AND SAFETY A:`"D THE Ei-VIRO\"PENT: The system has aseptic tank and soil absorption system ASS and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and a SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the AS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bact is and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammoni nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation of valid). 3) OTHER (revised 04/25/97) Page 2 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORINI PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D) SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 31 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what w' I be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clog d SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface water due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an ov rloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available vo me is less than 1/2 day flow. Required pumping more than 4 times in the last year NNOT due clogged or obstructed pipe(s). Number of times pumped _ Any portion of the Soil Absorption System. cesspool or pr' y is below the high groundwater elevation. Any purt'on of a cesspool or privy is within 100 feet a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zo I of a public well. Any portion of a cesspool or privy is within 5 feet of a private water supply well. Any portion of a cesspool or privy is less an 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the ell has been analyzed to be acceptable. attach copy of well water analysis for coliform bacteria. volatile organic com ounds. ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each f the following: The following criteria apply to large sy ems in addition to the criteria above: The system serves a facility with a sign flow of 10.000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environ nt because one or more of the following conditions exist: Yes No the system is wit in 400 feet of a surface drinking water supply the system is ithin 200 feet of a tributary to a surface drinking water supply the system s located in a nitrogen sensitive area (Interim Wellhead Protection Area -IWPA) or a mapped Zone II of a public water su ly well) The owner or operator of ny such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CIv 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04125/97) Page 3 or to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: S20 WoSWD'A Owner: - Date of Inspection: ' 1 yj Check if the following have been done: You must indicate either "Yes' or "No" as to each of the following: - Yes No Pumping information was provided by the owner, occupant, or Board of Health. . _ None of the system components have been pumped for.at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components. excluding the Soil Absorption System. have been located on the site. x _ The septic tank manholes were uncovered. opened. and the interior of the septic tank was inspected for condition of baffles or '—C tees. material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub Surface Disposal System. �A Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 15.302(3)(b)) t I I l i I I . 1 1 (revised 64125/97) Page 4 of 10 t ; i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C j SYSTEM INFOILMATION Property Address: Owner:—r- Date of Inspection: ` FLOW CONDITIONS , RESIDENTIAL: Design flow:�3O ¢.p.d./bedroom for S.A.S. Number of bedrooms: 02, Number of current residents: O Garbage grinder (yes or no): Laundry connected to system (yes or no): 4 Seasonal use(yes or no):_t�,,S Water meter readings. if available (last two (2) year usaee (gpd): U�r �� "�' 0 0 Sump Pump (yes or no):I_ Last date of occupancy:PLt�k"O COMNI ERCIAL/INDUSTRIAL: Type of establishment: Design flow: Gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENEFUL LNFORNL-kTION IPC,TiPI\G RECORDS and source of information: 6Jm 4RC.0\j1&3 System pumped as part of inspection: (yes or no) heO If yes, volume pumped: Gallons Reason for pumping.: TYPE OF SYSTEM Y\ Septic tank/distribuxiea—b+ax/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) i I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: a-1 Min S Sewage odors detected when arriving, at the site: (yes or nu) I i i i (revised 04125197) Page 5 of 10 y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART,C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: %k\'-k vb BUILDING SEWER:. n ` (Locate on site plan) ("v Depth below grade: Material of construction: _cast iron_40 PVC _other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) 'SEPTIC TANK: -S (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal. list age_ Is age confirmed by Certificate of Compliance _(Yes/No.) Dimensions:, VUO A Sludge depth:—I t, �( of outlet ter or baffle: Distant from top of sludi:e to bottom n 3\ Scum thickness: LA tl Distance from top of scum to top of Outlet tee or baffle:_ ,t Distance from buttom of scum to bottom of outlet tee or baffle:_ How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles. depth of liquid level iUl lotion to outlet invert, structuralntegriq, evidence of leakage. etc.) c�5 ti ( (N G 'C v.CVL Cp GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) I 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity. evidence of leakage, etc.) -- I frevissA 04125197) Page 6 or to i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C -SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: i TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or 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/day fAlarm level: Alarm in workine order _ Yes: _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches. etc.) ►ISTRIBL'TION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: 1 (note if level and distribution is equal, e%idence of solids carryover,/videnceage into or out of box, etc.) I i 1 PUMP CILLN BER:_ (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: i (note condition of pump chamber, condition of pum s appurtenances, etc.) i I 1 i (revucd 04/ISi97) Page 7 of 10 ' 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 21 IN01L'L-b8 Owner: Dow Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): S (locate on site plan, if possible: excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: j TYPe: leaching pits, number:1�6y,16 leaching chambers, number:_ leaching galleries, number: leaching trenches. number length: i leaching fields. number, dimensions: overflow cesspool, number: Alternative system: Name of Technology:. Comments: (note condition of soil. signs of hydraulic failure, level of unding, condition of vege ion tc.) t 6 CESSPOOLS: (locate on site plan) I Number and configuration: Depth-top of liquid to inlet invert: Depth of solids laver: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: 14t) (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.) (revised 041I5,197) Page 9 of 10 r� t. . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S2'j Wad Owner: Voy.� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where puhlic water supply comes into house) LAI I V 5 I I i 1 p3 - �1 53 c�5 I • i I l i trerued 01:25,971 Page 9 of 10, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ��,- SYSTEM VtiFORA1ATION (continued) Property .Address:S 2 /-7 �•kp� . Owner:Dwo Date of inspection:�� "1 ! Depth to Groundwater" -�`cet Please indicate all the methods used to determine Hich Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, obse-3tiun hole. basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Map> Check pumping records Chuck local excavators. installers XUse USGS Data Describe in your oun uuriIs hou vuu established the High Grnundµatcr Elevation. Must be eompie:ec:'i � (d�y l C a �,,t��c� � �6 toc,L� �j�V�T'cC �a� r t trr.i%d 04:_5 07► 1,2ge 10 of 10 i r LEGEND Wakeby Road y26o5 Q6°�'� ` N - 100,85' �9IeG -_ .............__. EXISTING CONTOUR ® 0 Q0 O EXISTING WELL 8rendo'o Ln o G EXISTING GAS SERVICE c � - BENCHMARK CbI Z c,0 Q p%n95tone ZA 4 Ra APN 028-049 OCUS 65,4602:5P 1" LOCUS MAP _ NOT TO SCALE — GENERAL NOTES: `� W� — — — — +� — � 5317.5a - + 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. of 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ~' /•� LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: 310 CMR 15.405(1)(b): OQ 1) A 2' variance to the 3' maximum cover requirement, for no greater than 5' of cover. S.A.S. shall be vented and H-20 Rated. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. i R° BENCHMARK: a 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING /////NO 23,— _ /, /, ,•, , /,�%, /`` '' STAKE#TACK SET FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN I 70 5� /1 cJT�( WD• / �� ELEVATION - 101.80' ENGINEER BEFORE CONSTRUCTION CONTINUES. /;, , ' , , �/ `` (A55UMED DATUM) Tor 103.46j/ , 2 �0 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. / 7. WATER SUPPLY PROVIDED BY PRIVATE WELL. ✓ -� 8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. —ram _ 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS "� I , AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE � ` ° DIRECTED BY THE APPROVING AUTHORITIES. l AY S�. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE To SRE A THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 343.4V - CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND _ ,_-n-- REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. Pc' 195.15' SEE SHEET 2 OF 3 FOR 20 SCALE 532°10'43%V PLAN REVISION I P�� pF Mgss9� 7/28/08—ADD PROPOSED SEPTIC TANK PETER T. yG PROPOSED SEPTIC SYSTEM UPGRADE PLAN Q M CIVIL EE 23 BRENDA S LANE, MARSTONS MILLS, MA BRENDA'S J No. 35109 Prepared for: Jeffrey Johnson, 23 Brenda's Ln, Marstons Mills, MA 02648 LANE 6 SjE� ��Q Engineering by: Surveying by: SCALE DRAWN JOB. NO. F E��� EngineeiingWorks HOOD 5URVEY GROUP 1"=40' P.T.M. 197-08 12 West Crossfield Road 18 Route 6A Forestdole, MA 02644 Sandwich, MA 02563 DATE CHECKED SHEET NO. 0825 (508) 477-5313 (508) 888-1090 7/ / P.T.M. 1 Of 3 ( op LEGEND 317.50' 5340 19'03V — ......... ......... EXISTING CONTOUR �tk x 100,98 EXISTING SPOT GRADE °c�'IQG OW� EXISTING WELL 5 Q� °"� G EXISTING GAS SERVICE w APN 028-049 °�� �� ~` TEST PIT W 0 �. BENCHMARK o G5,4GO_SF rn 1 i / //x No, 2.3 , -- . 5TY. WD. FR. s / TOF = 103.46�. ;'`% ;; -- LVC?C7DEC7 -- BENCHMARK. c 9Alk STAKE #TACK SET ELEVATION = 10 I .80' (A55UMED DATUM) 1, .• _/00 .a TP PNVIED yy6, l lei° A°I ,..raw`":y� 01.54 147t TO -_ O LO O .w. ..- Op PROPERTY CORNER �—_� •- ss T1 23'-- -I 1 n0S 99 -- N N35°45'46- 343.4 11' `� z PROPOSED SEPTIC TANK -- �_ t � r ~\ PLAN REVISION 1500 GALLON CAPACITY 9k i n .-- 7/28/08-ADD PROPOSED SEPTIC TANK INV.(IN)=96.90t PETER T. ✓, `a �_ — ❑ c� - --- PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN N R EXISTING SEPTIC TANK ' MARSTONS MILLS, MA CIVIL (PER TITLE 5 INSPECTION-3/2/01) 23 BRENDA S LANE, o. 35109 TO BE PUMPED, RUPTURED & 9 �F S1 e� �� FILLED W/SAND OR REMOVED Prepared for: Jeffrey Johnson, 23 Brenda's Ln, Marstons Mills, MA 02648 $ E� Engineering by: Surveying by: SCALE DRAWN JOB. NO. �k EXISTING LEACH PIT EngineeringWorkr HOOD 5URVEY GROUP 1"=20' P.T.M. 197-08 ,72 i7k��c} TO BE PUMPED, FILLED W/ 12 West Crossfield Road 18 Route 6A DATE CHECKED SHEET NO. G� SAND lic ABANDONED Forestdole, MA 02644 Sandwich, MA 02563 7/25/08 P.T.M. 2 Of 3 (508) 477-5313 (508) 888-1090 I 4 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:96.65 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-80X PROPOSED S.A.S. I (3) 4" DIA.OUTLETS INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL RISER & COVER OVER ONE CHAMBER AND " SET TO 3' OF F.G. TO SERVE AS INSPECTION PORT I_ 15.5" 16 2" T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE i • EXISTING F.G. EL.=100.3t F.G. EL: 100.5f F.G. EL: 102.1(MAX.) VENT LA � 12" L = 27' L = 4' 6„ • c� S=1% (MIDI:) na S=1`'; (MIN.) 2' LAYER OF 1/8" TO 1/2" -• . 4"SCH40 PVC 4"SCH40 PVC T 6• , DOUBLE WASHED STONE a., (OR APPROVED FILTER FABRIC) 14" ®®®®®®® 3/4" TO 1-1/2" DOUBLE H— 10 LOADING 2„ INV.=96.90 48" LIQUID INV.=96.65 WASHED STONE INV.=96.36 LEVEL 4' 5.2' 4' D`—B 0 X AFFLE INV.=96.19 GAS B PROPOSED D—BOX EFFECTIVE WIDTH 13.2' N.T.S. AM AM AM INV.=96.15 PROPOSED SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNQED WITH SjOIVE AS SHOWN SEWER CONNECTION H-20 RATED 7' OUTSIDE OLD TANK INV.=97.00t(VERIFY) TOP CONC. ELEV,=97.16 BREAKOUT ELEV.=96.65efl ®® ®® ® ® ® ® INV. ELEV.=96.15 ® ®®® NOTES: 1) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND ®aa®® ®112130013 Ea 39„ TRUE TO GRADE ON A MECHANICALLY COMPACTED OREM ®a®®a I- ®® ®®®® ® ® ® ® SIX INCH CRUSHED STONE,BASE, AS SPECIFIED IN BOTTOM ELEV.=94.15 N > ®E0 Ea ® ® ® 310 CMR 15.221(2). 3' 2 X $,5'=17.0' 3' z ®Lz-®®®Ell ® ® ® ® Ea 2) INSTALL INLET & OUTLET TEES AS REQUIRED, 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 23.0' - 3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE T.P. EXCAVATION OR G.W. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. I EA-CHING SYSTEM SECTION 4) MAXIMUM COVER OVER SEPTIC TANK, D-BOX & S.A.S. NO GROUNDWATER, EL.=89.1(TP-2) = 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 M. 20'° DIA. COVER l SOIL LOG -'. 4" KNOCKOUT 4 KNOCKOUT 62" DESIGN CRITERIA ..i DATE: JULY 18, 2008 (REF#12,288) SOIL EVALUATOR: PETER McENTEE PE ` WITNESS: DONNA MIORANDI R.S. NUMBER OF BEDROOMS: 3 BEDROOMS HEALTH AGENT ,END OF HOUSE,; 1 " -4" KNOCKOUT SOIL TEXTURAL CLASS: CLASS I ELEV. TP- 1 DEPTH ELEV. JP-2 DEPTH DESIGN PERCOLATION RATE: 5 MIN/IN 101.8 A 0" j' 100.6 A o"SANDY LOAM SANDY LOAM DAILY FLOW: 330 G.P.D. 4/2 10YR 4/2 500 GALLON CAPACITY, H-20 LOADING DESIGN FLOW: 330 G.P.D. b 101.3 6" '100.1 6" GARBAGE GRINDER: NO ry ° �k6 ti BSANDY LOAM BSANDY LOAM CHAMBERS TOYR 5/8 10YR 5/8 EXISTING SEPTIC TANK.: 1000 GALLON CAPACITY ^oV' a 99.8 24" 98.6 24" N.T.S. h' C1 C1 _ h• � bILT LOAM SILT LOAM REQUIRED: 7 _ PLAN REVISION LEACHING AREA (�30) 445.9 S.F. N � 5Y 5/3 5Y 5/3 , 74 .', � 9s.G c2 � 46" 97.6 C2 �6' 7/28/08 ADD PROPOSED SEPTIC TANK 40" USE 2-500 GALLON LEACHING CHAMBERS IN SERIES �� ` PERc �_ PROPOSED SEPTIC SYSTEM UPGRADE PLAN po �... - .� - SAND _ _ '2 SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES a� N ; MED: ` ' 2:5Y 6/4 MED. SAND 23 BRENDA'S LANE, MARSTONS MILLS, MA SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F. ' 10i GRAVEL 2.5Y 6/4 BOTTOM AREA: 13.2' x 23.0' = 303.6 S.F. ` 2-� 1 10% GRAVEL Prepared for: Jeffrey Johnson, 23 Brenda's Ln, Morstons Mills, MA 02648 \'13' I Surveying by: SCALE DRAWN JOB. NO. TOTAL AREA:................_....................................... ..........................44&4 S.F. 90.8 PEiRC R 138" 89.1 138 Engineering by: ATE <2 MIN/IN. ("C" HORIZON) Englneer9ngWorks I100D SURVEY GROUP NTS P.T.M. 19 —OS 12 West Crossfield Road 18 Route 6A DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 C.P.U. I n�/ ! NO GROUNDWATER ENCOUNTERED DATE CHECKED SHEET N0. S.A.S. LAYOUT OUT Forestdale, MA 02644 Sandwich, MA 02563 / / P.T.M. 3 Of 3 (508) 477-5313 (508) 888-1090 7 25 08