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HomeMy WebLinkAbout0216 BRIDLE PATH - Health 216 Bridle Path. _ - -- Marston%Mills A= 125=049 J h TOWN OF BARNSTABLE LOCATION 19 Co iU rc01A ( 1 4^ SEWAGE# 0 10 (0 2- VILLAGE M , !� ASSESSOR'S MAP&PARCEL /,2, y? E , INSTALLER'S NAME&PHONE NO.. f yZf %002&j SEPTIC TANK CAPACITY 15-u U k4 o o LEACHING FACILITY:(type) I& &C (size) /C(.f y Ao NO.OF BEDROOMS 3 OWNER G.e�C'za.✓tyl.� �� PERMIT DATE: �2 2 a to COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility v li Feet Private Water Supply Well and Leaching Facility Of any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within r 300 feet of leaching facility) Feet FURNISHED BY `4lp!r /iCL Pa y T/ ')e-S C.tC L � I /h 1 do 3 AS g No. /tp Z— Fee��o Entered in computer: ✓ THE COMMONWEALTH OF MA p SSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposar *pstem Construttion Vermit Application for a Permit to Construct( ) Repair V) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 21 l �;ca 4e � � p.l #t_i Owner's Name,Address,and Tel.No. (j a olGt C. S7U t Assessor's Map/Parcel i Z j� H9 n✓.�-n C. 3_e. Installer's Name,Address,and Tel.No.Cq 911w�n Designer's Name,Address,and Tel.No. / n O 3 L7X 7b� �'C.C�I(.Q.3/1�� !�� `� �..-aa+i�✓� /IC�R„v Type of Building: Dwelling No.of Bedrooms Lot Size Z�� Ell 2 , sq.ft. Garbage Grinder( ) Other Type of Building S#'n If IY No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 '3 O gpd Design flow provided SS - Z- gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 10 00 CiM C► "ti, Type of S.A.S. CDTZJ1-e-(ems 5 2-6 lac- 3613/3i�1 l J Description of Soi ae� 01Cw, Nature of Repairs or Alterations(Answer when applicable) �x�►tt� apt,L Q-�K L 1�4,) 1040 _fib n 7—aox {s, Date last inspected: 2 c 1 (3 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 Application Approved by r Date Application Disapproved by Date for the following reasons Permit No. �,_,C/0 '��6 Z. Date Issued l0 . 0 1J" �j� "..✓ A. No. �"�O ` 2 w ,. _ . Fee A30 THE COMMONWEALTH OF MASSACHUSETTS ;'Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(pplicatlon for Disposal 6pstem Construction J)ermit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 21t, f; �t � r(� is Owner's Name,Address,and Tel.No. C,"I"'I� h 11 A C. 3-a--Q-e 5 x"-,A • Assessor's Map/Parcel �Z�J N9 Installer's Name,Address,and Tel.No.C a pt a,c2z Eh�r pre,^ Designer's Name,Address,and Tel.No. P 0 Sox 7b3 �•�•t 'cF1tn;� Z�S�f C�ra„�.� // Type of Building: Dwelling No.of Bedrooms 3 Lot Size 8/ q12 ± sq.ft. Garbage Grinder( ) Other Type of Building S i'Pi w ��r, �, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 O gpd Design flow provided 3 SS . z-- gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 1000 �AL 'S "�, Type of S.A.S. �J1Ca-c 2-6 f}rC 36 J 3,3,�) Description of Soil rf 014.1 Nature of Repairs or Alterations(Answer when applicable) CX`5 �� �Q{ ,L t}'jyt C /�`l) /Oy014 1.. Date last inspected: Z- O 1 (7 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 ►yI) Application Approved by Date 6 -� ;Lc)(l/ Application Disapproved by Date for the following reasons i Permit No. 7—a1 b 16 Z Date Issued (O .;L 0 ----- --=-!-----------------------------•--------=--------- =-----=----=--------------=---- =-=- -------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired P ) Upgraded( d ) Abandoned( )be y (�A�Q• f CLe t✓ h�9 at 216 (,A -e- ek dwk has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No?010 _16 Z dated Installer C4"O"J;iv . Designer \�-( . i )LeAn r ' #bedrooms 3" fv Approved design floj$g 3 5.57• 'L gpd The issuance of this perm t shall not be construed as a guarantee that the system wil Nctlon as desi ;e , (G U � �` Date �Q � d �� Inspector a No. %010 ' /6 2- - - - Fee THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS Misposal 6pstem Construction 3pPrmlt Permission is hereby granted to Construct( ) Repair(K Upgrade( ) Abandon( ) System located at a ((o 13ei A l-<_ e M /y.r S �,•�S �`l•\� and as described in the above Application for Disposal System Construction Permit. The applicant recognized 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 this permi . Date (t1/Z/�� Approved by r 4 • Town of Barnstable " ' w Regulatory Services Thomas F, Gciler, Director l•(nAANl9TABLP., t Public health .Division \� 699v , "Thomas McKean, Director. 200 Mahn Street, Hyannis, MA 02601 Offkc: 5A.862-4644 1 Date: _Ct� -21 l 0 Sewage Permit#_210 lt� Assessor's Map/Parcel a' ri ( Installer &_Designer Certification )Form Dusigncr; �M( E r r c 6c i) - J'o e..,_,....,. .;_.. , j)c._,_.-._... Installer: Cp e"w;de- f rtt.ec P N s i- r.. Address: 0 �x I u2. 3 i /0 01) c ors-7 was issued a permit to install.ra (date) septic system at 2r N 1e ��� based on a design drawn b� ._..__.-...- .-.._.. --.._.._...................__.._..... --.._....._,_.._m,.......-...-- .... (4tddress) - , I'C, e c i e% '17'1 G dated S 'A e, t 12'01 0 / (designer) V I ocrtifv that the septic system re tbrence*d above was installed substantially according to the design, which may include minor approved changes such its lateral relocation of the distribution box and/or septic tank, . Stripout (if required) was insp, cted and the Suil crc faund Sat isfactc�rs. _ I ecsrtify that the septic systefl7 referenced above was installed with :iiajor changes (i.o. grer.?ter than 10' lateral relocation ofthe SAS or any vertical relocation of any cornponcitt rat tlic septic system) but in accordance with State & Local Regulations. Plan revision or certified US-L)Uilt by designer to folk», Stripout (if'req nspected and the so'l!s WI.Irc fou1:id satisfactory. ��ruFWA,,�� C1�UtiC!tl,.l. (In.. Her's Sign ire) AL Designer s Signatctr (Affix es i e s rnp l{rre) PLE' Sf; Iu,rURN I O B AR.NSTABLE PUBLIC HEAL'' DI.VISTUN. CERTIFICATE OF COMPLIANCE WILL NOT_B . ISSUED UNTIL OTH `I' . 1S FORM .A.ND AS- BUILT CARD ARIA, I21?CEIVFD BY THE BARNSTABL PU)BLI(' III+'',' ,t-'ri:I DIN'ISION, TIIANX YOU, 1 i I I 7.0 'A J 99PI 9J 7 R 0 C; 9HT?I"q-qNT°nN�0r WA 90: ZT 0TOZ— TZ—Nnr oF� Town of Barnstable P# -� 6 Department of Regulatory Services Public Health Division Date a ib39 �� 200 Main Street,Hyannis MA 02601 Date Scheduled / P Time l I D Fee Pd. ` 6 Soil Suitability Assessment for Sewage Disposal Performed By:- ((-,(A&eA PC Z4- A-e,1 , E1-T, cse, Witnessed By:—D6 ✓: �5 Location Address LOCATION& GENERAL INFORMATION 21 Ut e 1 e �� Owner's Name LYV Address ,2 1(0 3 r- at V,l Assessor's Map/Parcel: 1 I-/ �� Engineer's Name C 4 - / �iw,� 'E..��rr10.�,� � Sc-5 EFaS r)2ert,?5 NEW CONSTRUCTION REPAIR 1/ Telephone# �Zlc - `(o Z 508-27 3'0 3 77 Land Use 51g4e- autA(�'M Slopes(go) 0 l Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well 50 ft Drainage Way _ ft .Property Line 7 /0 ft Other It SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) Sew, atF&ai P1cr% Parent material(geologic) Depth to Bedrock 712 8'(os S Depth to Groundwater. Standing Water in Hole: 7 12$ 10g5 Weeping from Pit Face 712 8&b$S Estimated Seasonal High Groundwater 7 (26 u b$S DETERMINVION FOR SEASONAL HIGH WATER TABLE Method Used: DtteCE 60SUOaAC04 Depth Observed standing in obs.hole: 7.12 8. in, Depth to soil mottles: Depth to weeping from side of obs.hole: t 2 b in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,factor__^_ Adj.Croutidwater level PERCOLATION TEST Date -5-� Thne /o 4H Observation Hole# Time at 9" Depth of Perc Z.8 y 6 Time at 6" Start Pre-soak Time @ /6:30 Ad — Time(9"-61') End Pre-soak l0,36 AK Rate MinJlnch L 2' Site Suitability Assessment: Site Passed 4e S Site Failed: — Additional Testing Needed(Y/N) AJ Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPrIC1PERCFORM.DOC i i DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. -Consistency,%Gravel) o-y Y-�1 A 16yr 34 8- 28 6 LS 16yr 5/6 2b-14 tj-CS 'Z.57I& Ime 5Y0,%jr0 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ~' Consistency.% ray o- pY 17 Fil S 28 15 . [ S ,0 Yr516 2$-126. C, n-CS 2,5Y`% - %ease` Sid%sro�e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes ..._ ` Within 500 year boundary No°Z Yes Within 100 year flood boundary No,.,`�I. 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-5 If not,what is the depth of naturally occurring pervious material? -- Certification /0 27^9 q I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertire and erience described in 310 CMR 15.017. Date Signature Q:\.SEPTICIPERCFORM.DOC „ m UUHere Ln Postage $O Certified Feeti p Return Receipt Fee O (Endorsement Required)C3 Restricted Delivery Fee O (Endorsement Required) Im c13 Total Postage&Fees $ CD Sent To . . S Garr Y�1A--- Street,-Apt.No.; � or PO Box No. �--------------------- ED City,State,ZIP I Certified Mail Provides: o A mailing receipt e A unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. e Certified Mail is not available for any class of international mail. ® NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be,restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 i SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY e Complete items 1,2,and.3.Also complete A. Signat item 4 if Restricted Delivery is desired. X ❑Agent e Print your name and address on the reverse Addressee so that we can return the card to you. B. Received by(44rinted Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1.Article Addressed to: If YES,enter delivery address below: ❑No 66or "21� (� 3. Service Type ❑Certified Mail ❑Express Mail I r ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. l Y 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number f 7008= 18°30 0002 0500 i 9731 I (rransfer from service labeq f r ++ r PS Form 3811,February 2004 Domestic Return Receipt 102595-o2-M-1s49' UNITED STATES POSTAL SERVICE , F,%i,.f.4v Mail 10Oa.9t*. .Paid y M 1 * , • Sender: Please print your name, address,.-%i` -; ­ I �""��x', . D S4 � Y W1j 0 DA0 r °F sIH*E r , Town of Barnstable Barnstable l Regulatory Services Department i DARNSI'A ' 9` Public Health Di t6; �0 V1S1011 a At�D ' 200 Main Street, Hyannis MA 02601 0 2007 Office: 508-8624644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205009731 6/1/2010 - Georgeanna C. Bell 216 Bridle Path Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located 216 Bridle Path, Marstons Mills MA was last inspected on May 20, 2010,by Robert Paolini, a certified septic inspector for the State of Massachusetts. ' The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within one(1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future, enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the / „computer,use 1. Inspector: ' /► ��0 only the tab key, to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Furth e Evaluation by the Local Approving Authority 5/20/2010 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•09/08 Title 5 Official Inspection Form:Subsurfac ewage DMage 1 of 17 T Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for, Marstons Mills Ma. 02648 5/20/2010 every 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 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 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every 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 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: A 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every 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- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 16.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No, ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200.feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09108 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 ,M 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09108 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 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2008:156,000 g ( y g (gpd)): 2009:159,000 Detail: 2008:427 gpd. 2009:436gpd Sump pump? ❑ Yes ® No Last date of occupancy: Date 010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No ` Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09108 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 ,M 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Capewide Enterprises,LLC. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 1000 gallons How was quantity pumped determined? Measured Reason for pumping: Tank pumped 4/30/2010 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every 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: 1977 new leaching pit installed 1993 Were sewage odors detected when arriving at the site? Yes No 9 9 ❑ Building Sewer(locate on site plan): Depth below grade: 14"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 16"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Sludge depth: lit t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M s 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every 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 0 11 Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 14" 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.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every page. City/Town 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has'two outlet laterals.Evidence of solids carryover.Stain line observed over inverts.no evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 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 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.New leaching pit is in hydraulic failure.Pit was full at time of inspection. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 216 Bridle Path (Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every page. City/Town State Zip Code Date of Inspection ID. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ❑ Zoom Out iJ J J In i/ 3agC�3 2 .. ::..:t' Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER (`nn..rinhf')Ont;_7(1Al1 Tn...n of P—nefnhlo RAA All rinhfe rocon,. http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=125049&mapparback= 5/21/2010 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every 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: Bottom of LP 35' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 216 Bridle Path Property Address Georgeanna C. Bell Owner Owner's Name information is required for Marstons Mills Ma. 02648 5/20/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE , LOc ATION f 0.3OC'I,0�e ®A fry .SEWAGE VILLAGE M,+Oes-to.ASS A41ZZ'S ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. J, A4AC&A,6eK SEPTIC TANK CAPACITY LEACHING FACILITY:(type) P/1"' (size) / o ad NO. OF BEDROOMS.PRIVATE WELL OR PUBLIC WATER BUILDER OR,OWNER DATE PERMIT ISSUED: - cJ' 3 DATE _COMPLIANCE ISSUED: ' a. 43 VARIANCE GRANTED: Yes No l� 4 � ' o IS e t ` I No.. ." FEE_$....30 ✓�, THE COMMONWEALTH OF MASSACHUSETTS .J� BOARD OF HEALTH TOWN OF BARNSTABLE .���lirtt i���fur �i►�>�uu�l �urlt,� C�ugtu�r�rtiun .ermit Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: 216 Brid.lesDath Marstone Mills ••-----•------------------------------- -•--•-----•••----•••-•---••--------------------•--•-•-------...__.......--•--••--........---•-••-• Location-Address or Lot No. G. Bell Owner Address W J.P,Macomber Jr. - Installer Address go UType of Building Size Lot............................Sq. feet �.. Dwelling x No. of Bedrooms----------------3-------------------------Expansion Attic ( ) Garbage Grinder ( ) pa„ Other—Type of Building ---------------------------- No. of persons------.--..--..-..---------- Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.-..--.-...gallons Length---------------- Width---------------- Diameter..........--.... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------._--- ---- Diameter.................... Depth below inlet..--................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-' Percolation Test Results Performed by........ -------------••••---....-------------•--•-----••--------•---•--•• Date........................................ 0.4 Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------.--_-. Depth to ground water........................ �+ -------------------------------------------------------------------•----..................__._............................................................... 0 Description of Soil........................................................................................................................................................................ x Sand & Gravel v ....-•---------•----•----......•--•......................•••---.......•••-•••--------------•--------------••-----------••-••------•------•.......----••--------•-••••------.............---......__--•-- W x Adding 1-1000 gallon leaching pit U Nature of Repairs or Alterations—Answer when applicable..-............................................................................................. to •-ex .sting 1-1�JJ0._gallon tank and 1-1000 gallon leach it . . Agreement-. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian e has bee✓ sued by theb rd f health. 6/8/93Signed ��;.... ........... ........ :...... ► Dace Application Approved By ................... .......................... .... . �9� J� Application Disapproved for the fo lowing reasons: .......... ........... .......................................................--...--........................ ...... ...... ................................................................................. . ... . ...-- --...---.................................................. ........................................ Dare PermitNo. ........ 3...—..... �.. .................... Issued ............................................. Dace ...w•«,..,,.,,..€..rl.,_.:,..,.-Y�.r. .R-:a,.;:M..-.. �,...�..-w -... �.. .,....,.:••.,y.,. .. .. ....- . _-�-• ..�r. ,...,... ... ...,tr: *�'«.---t �.rr....:.r, ---:.,,,...,_.....,�-.•..-•...^ / -7 No-4:5.-_..715..�-�.. 30.00 / ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE' �' ,���rlirttti>arYt fur �1i1�.�n�u1 �nrlt,� C�>l�>~t�tr�rttun �rrmit Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: Bridles ................................................................ ................................................................................................. G. BPIl Location-Address or Lot No. Owner Address a ............ nher Jr. Installer Address Type of Building Size Lot............................Sq. feet t—t Dwelling X No. of Bedrooms----------------3-------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons--_-_--__-____-____________ Showers ( ) — Cafeteria ( ) dOther fixtures .--_--------------------- ----------------------------------------------------------- ----------------•-••••-••-•••••••-•-•.........•..._.....••... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity_-_--_.--__gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench— No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by`......................................................................... Date........................................ Test Pit No. 1.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ...-•---•---------------•---•-----•.........._...------••••.........••-•--••........._...._.._...............•-••-••••-•----•••-•.........._.......---....... 0 Description of Soil......................................................................................................................................................................... x Sand & Gravel v .....-•--•------•-••----••-••......--•-•.....•--••••-••-••--•----------------------••-----•-•---------•----------------..._...-----------•-------•-------•----•---•--•--.............................••-- W - ---- - - ------------------------------------- ---_.-.....---- ------ - •--......••-- U Nature of Repairs or Alterations—Answer when applicable.-_Adding 1- 0 ;a�...ot1,_.�ea.chrig ..pIft to an 1-1000 gallon tank and 1-1000 �:allon leach pit . -•••....... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. t Signed -------4 ............F/8/93:...... f Application Approved By ----- ----- .��r. .,.. ................ - _............. ........ t Da Application Disapproved for thef�Lowningq easons: ........ ...... ............. .... ................................. . ...................................... �J ............... ......................................... ........... .................................... . ................. .................................. ........................................ Date PermitNo. --------- 3..r (�--- ------------------- Issued ........................................... ..................... ---------_--------,----- ———————————— --------- —---_------- ----- ----- f. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CZer#ifi ate of Toutplianr e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX)K by ----J...P.Macomber Jr. ..........._........... ... _....._ ....._.... ........ -- ..... ................... ......... Inscdlcr at16 Bridlespath Marstons Mills ....2 . ---------------------------------------- ----------------------------------------------- --------------- - ... . .............. has been installed in accordance with the provisions of TITLE 5 c The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..._. � ..--�._0.. j.... dated .............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----........ ........ ....................... Inspector ... .I ------------------•---...---....................-------------------- ---------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.--G TOWN OF BARNSTABLE FEE.... ....30.,.0�.2 .. ........... Dispinal Workii Tonstrutuan "amit Permission is hereby granted...J.P.Macomber Jr. to Construct ( ) or Repair (X)o an Individual Sewage Disposal System at No.-•••••..216 Bridelspath Marstone. Mill Street as shown on the application for Disposal Works Construction Permit Dated.......................................... r q Board of Health "DATE............. •--------------------------------------- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS '00-tATION SEWAGE PERMIT NO. VI<LLAGE l , AA&4 S r:u� 44 i//�; INSTALLER'S JoHN k.�a To&MCKA D RFkSCS 150 Walnut Strpat West,Bamstab{e,. Mass. ,02668 B UILDE R OR OWNER DATE PERMIT ISSUED ld - 2C ' 77 DATE COMPLIANCE ISSUED � �_ � s-;?,7 rM . *. ' �� ,� .. � � �`� �1� Y4 �i. i 0-;-7 No Fizz.......I...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH ApplirFation for j3hipwi al 10orkii Tonitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at Pike.. Tt ._M.A ifi�n�s �s. ----•••------------•-------•-•---•----------- -- ......-- ....._.............._.--•-- .. Loeation-d{ddress �� t - -•-•- u = -- -�=�-.................................•. ...... � .2- 13 ( -C� k o 12.or-.. .t.......bY !),s W Own / �s' �l Addre .. / � -- Ins er Address t a d Type of Building Size LoP �_,._._„ ___._.._..Sq. feet U Dwelling—No. of Bedrooms_•_ -Expansion Attic ( ) Garbage Grinder (410) p4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures . ------.•------------------------------------ ---------•--------•-•...-•-.... W Design Flow...............3�----._.._.._..__.__.-gallons per person per day. Total daily flow..........�,k ;_......_.__..._..._.._gallons. WSeptic Tank L Liquid'capacityl.4.�? .gallons Length................ Width------- Diameter_______....._.__ Depth................ Disposal Trench—No. .................... Width•............._..... Total Length.....__.._.._'3�-. Total leaching area....................sq. ft. x / 4, Seepage Pit No.....)-------------- DiameterkX_!�--------- Depth below inlet.......__._.:W..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank 0-4 JJ Percolation Test Results Performed by....... j.t, Date...l-t'�.:�f_ _7 ... Test Pit No. 1................minutes per inch Depth of Test Pit--------------ss__ Depth to ground water........................ fH 4 (s, Test Pit No. 2................minutes per inch Depth of Test Pit------------_,__..:."Depth to ground water----------_............. L.;. -- f _ O Description of Soil C� '_ ^/" �„`�'/ � .:.._ :.j- �3 �� �`"= `�, - ����--. --- le4l r 2� =- --- -.... - •. W A U Nature of Repairs or Alterations—Answer when applicable._______________________•_____._____________------_--------___-__-_._------------_-------------. -•-----------------------------------------------------•---------------•------•--..........------------------------------------------•--------------------------------------------------------••.-----. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary Code—' The undersigned further agrees-not to place the system in operation until a Certificate of Compliance has be iss e(d b the bo rd of health. Signed �r`�� r[------------------------------•--------. ................................ Application Approved By ......__-=:.�% :__.__=,111 k [ _.................... /, ....... Date � ���(. Date Application Disapproved for the following reasons:............................................................................................................. ...................-..................................................................................................................................................................................... Date 0a- /ql- 77 Permit No. - . Issued. =-------------- --------------------- Date No......................._ ......... ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH - a"ti► '.........OF........ .... ..r..............................................•------•---- Appliratiun for Disposal Works Tonstrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sy t 1 ....{� : .: 1 -Al . ...... ...................................... Location- ddress or _..... .: - ._ .......................................................... l ._ba.. ©off .. %....... � J !.I. ........ W Owner F ..._... ......:................................•---......---............_ ---•-- -- Address ........ Installer ddr �� - Sq. feet � Type of Building Size Lo __ V Dwelling—No. of Bedrooms.. _.......:_ _.__.Expansion Attic ( ) Garbage Grinder (4) aOther—Type of Building ____•_______________________ No. of persons............................ Showers ( ) Cafeteria ( ) dOther fixtures ----------------------------------------------------------••••-•--••---•---••••-•-•••--•-•---•••------ W Design Flow.________. ...- ----------gallons per person per day. Total daily flow_____....��......................gallons. WSeptic Tank Liquid ca.pacit��44,P.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width_ ....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....)-------------- Diamete»✓Q ......... Depth below inlet____.. ...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank '~ Percolation Test Results Performed by.._._._ __i2:0................ Date._/(-__--- Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to ground water........................ rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ........... x(jDescription of Soil........... .r !L4 .----- .._ !-- .. . ......-- ---..... . UW ...................................................-----------------------------------------•.......................................................................................................... Nature of Repairs or Alterations—Answer when applicable................................................................................................ ----------------------------•------------------------------•---------------••--•--------------_........................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITiE 5 of the State Sanitary Code—The undersigned further.agrees not to place the system in operation until a Certificate of Compliance has be is e lb the rd of.health. Signed . --.. :.:. Date 7 Application Approved BY`" 5. = rf ---- ----•------- t® "..='-� --T-----•-- Date Application Disapproved for the following reasons:............................................................................................................... - ••-----•....................•-•--•••----.....••••--•-------------•------•••-------------•- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARDS OF EALTH Trztiftrttte of TomphFattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -•- - ;I Est. ler ;r at 4----------- --------- has been installed in accordance with the provisions of 5 of Tlfe State Sanitary Code as described In the. application for Disposal Works Construction Permit N .......�t y" '` "- -�.- -- -- ------------------ dated-- --Q.:: -------- ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM Wi L FUNCTION SATISFACTORY. tf DATE ¢ 'll ............... ... - �` I ......_....-------------------- Inspector:-•-- THE COMMONWEALTH OF MASSACHUSETTS 701 BOARD OV HEAL LzA 1 .......: ............................:...OF..---.........- L ........................................ ........... No .......... FEE...:.A>............. Disposal Workg Tunu#rudiun rranit Permissions ereby g anted......................................- .•• ..............................-------•---....-----------•--.......-----..............___..._..._ to Cons. t ) r ( I divid 1 S . i isp at No. ' _. ._ - ... . -- .. • Street as shown on the application for Disposal Works Construction P r It No Dated �_......1'__'r................... �7 d of DATE. /.Z_-mod _. soa i� FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ,.- ••/• l ` ` J- "1 TA/v .4'ACNiN.0 p/T R :MD"RE k.9•./5e' 12"BEL0iN �6YT�R CC7 fyC��'T� •CO vESF ,�"P1/C•P/PE L BE 19�'OU �I T TO G/Q.4`®� j . f/✓ Fi'�.TR�1 CONC'FZETE O/Y_ l�!'.eR Sf/A. L1: L3E USE1� e COYERS�: PER FT.. I IF %%V :DR/✓EW,-4 yh ==fCC) PIA�Flcr M•- t v .; __-_. C LEAN -5A N O _ -- — L/QU/O LEIIeL 4.. CAST .... .. - 2�LAYER % } IRON P/PE O G Cy A L. o 0 0 o G1F 1/8.- B.. ,t i AW D157. i • • •' • . • o o ° n u WA S HFD 57rI NE BOX iv . .. �� � ,:'��°"• - ,° _- _ � v p. � e.e eEFFECT7VE °�;' , o Q_ L,�� �; P o o ° • • DEPTf/ • • e !r�A o WASHED SMNZ- ' `-. .c• " .. - _{ p,a ago� e • •j . • • o . . ° • , « _. - 'I s v• a �t, ° • •I • e • • o . . D o v �-- PREC,r4S T SEEPAGE - IAIVeKT ELEVATFlo /ONJ` �0 0 0 °. ° a'Lo , o, • . . � e as. ° o P/7 OR EQU/V INVERT AT IF - Y• 6'tT D/faM. _ INLET .SEPT/C. TANK. 96' _FT �. FT. O/,1lYJ u -�SEE;T.�I®UL,.4TlG'7t/, f' OUTLET SEPTIC TANK J9 , - f /NLET D/STR/BUT/oN BOX r T. SECT/ON OF _ GDuNo ��7,�I rFR TABLE I OlJTLETD/STR/BL/T/6llV BUX 5.'�_4$_ FT -. I/1/L�TSEEPAGE SEWAC3E -®/eS/clOoSA L- SY. TE/>'1 ZEACH11Vea DES/GN C�/TER/R "R SCALE :.%� _ I'_ O U/MENS/Oh! .�NFT. � , r 'AIUMBER MENS/ON C =_'F ,y ' GAR®AGED/SPOSAL_ UN/T ---- __ ,'`"_ ;•SO/G LD.G.' r • - - TaTAL EST/M.4TEp FLObV 33 SO!•,L TEST A/ SO/L TES7-#,2- a �' MdER OF SEEPAGE P/T5_ �__ -' EtEY. ���-r ELEY —_ 0,47E OF SOIL TEST T_ 10, 3`+7�E LE'AC H//vG NE6t P/T 8 SC�7 FT.. 1/n C c �,, RESC/LTS i�//TNESSED BY' BOTTOM LE�1CN/NG PER p/T .,SQ. RT. _. PE/VCOLAT/ON FATE / V�Q M//V..1/NGN rwd PERC0L.AT/O N RACE RE SERVE.lEAC'N/iVGAREA_ �_54). FT. � ROBERT P. Y / a BUNIK6zS •: 9 _ -.. A\ roo.221 0�� , y. r r .. v • - G _Ye M iaY.4h;X-1-3 ; MA$3 No G DUN EN _ _ • TL�°4' CO P - :.SO Y,�iYM�fJ7 MA E'R E� Z� s orc 7•� , s af ti 4�?se y RORERT P. No.22162 �p�� LEGEND • : , ' EXISTING SPOT' ELEVATION Ox0 CERTIFIED PLOT PLAM EXISTING. CONTOUR - — p - - -- " 71 kcFfNl-SHED POT«.EL€V,A:T.!CN I= p > _ �y L 3 FINISHED CONTOUR - 0.---- '�-?. �. I N APPROVED :-BOARD. OF HEALTH -'DATE -AGENT - ----- SC:ALE; DATE.= OctV?11977 ELOREOGE NG�' � ENGINEERING CO / -- CLIENT'S'. '� ..__ I CERTIFY THAT, THE PROPOSED° EGISTERE fREGISTERED�, '7,20,5 d, JOB .NO. ._._ BUILDING SHOWN ON THIS PL A*,.a a, 'ENSUCIVIL LAND CONFORMS TO THE ZONING. LAWS RVEYOR GINEERS' SURVEYORSy DR. BY _- -- OF B'A>RNSTA LE , MAS$^ 33 Ni` .hAAIU 5r 712 MAIN ST. CH. BY Aw :;0, YARMOUTH MA , . HYANNIS, MAS; SHEET-1 OF -DATE' f`' ' 'REG: LAND SURVEYOR >; a , ' s a�. f•, 3 T.O.F. EL.= 57.6'± INISH GRADE OVER D$OX= 56.3'± 4"SCHEDULE 40 PVC MIN.* SLOPE 1 FINISHED GRADE OVER BIODIFFUSERS= 56 2' - rj6,5' GENERAL NOTES PROVIDE EXTENSION RISER SLOPE @ 2%MIN. ` WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION ACCESS BOX TO WITHIN FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE " METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL 3 OF F.G. (ONE PER ROW) ' F.G. OVER TANK EL.= 56.2'± 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. @ FND. EL.= 56�3� 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE 1 t DESIGN ENGINEER. PROPOSED 4" 9"MIN. 9"MIN. EXISTING 4" 36"MAX. 36"MAX. TOP OF SAS/B.O. = 53•rj6' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE SYSTEM UNLESS OTHERWISE NOTED. - - 6 3 3"DROP MAX 3" 9" L = 23'_ PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN " " 2"DROP MIN MIN.SLOPE@l% + JOINTS(TYP.) ELEVATION =53.50' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A I �f 10" 4"PVC IN FROM " 1.08' t 13" 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF \-*53.6 ± SEPTIC TANK 4 PVC OUT TO 0 59, (TYP.) 7.13"(fYP) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. . LEACHING FACILITY + 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. 12 6 , ' I " 6. THIS SYSTEM CONTRACTOR CONTRACTOR SHALL OUTLET TEE 53.30' MIN. " 53,13' 53.01 52.42 (lald flat) 2.875 (34.5 ) IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF 5 0, (TYP-) 7, LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE (TYP.) 5'MIN. FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY REQ'D 14.375 NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 20.0' AND DESIGN ENGINEER. ! 5 OUTLET DISTRIBUTION BOX (Nf'') 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 57.06'ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 45.83' BIODIFFUSERS END VIEW ON A NAIL SET IN CORNER OF BULK-HEAD AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET ) EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 20 - BIODIFFUSERS PROFILE 9• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT I' CROSS SECTION VIEW (BY ADVANCED DRAINAGE SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE DISTRIBUTION 20 - ARC36 (#3613BD1 BIODIFFUSERS TO THE DESIGN ENGINEER. *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR DISTRIBUTION BOX DETAIL l 1 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING '� i tit* + • , TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM SWING-TIES SCALE: 1"=20' '� • PERC NO. 12961 APPROPRIATE AUTHORITY. DESCRIPTION HC-1 HC-2 ` ` + " + E . INSPECTOR: David W.Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS EVALUATOR: Michael Pimentel E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE l/ 777 xK THEY SHALL WITHSTAND H-20 LOADING. BIODIFFUSERCORNER(1) 20.1 33.1 �� � fj � - � � � C.S.E.APPROVAL DATE: Oct. 1999 BIODIFFUSER CORNER(2) 34.4' 43.3' ` 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. • � - �`` � w ,� ;� �' ,�• �° DATE: May 28,2010 BIODIFFUSER CORNER(3) "` 40.8' 35.0' k `' K �' ,�3 ' +. TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE QQ- OJT, . ZONE 2 ,` M Q MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. BIODIFFUSER CORNER 4 29.7' 21.0' k ELEV TOP= 56.50' O r + +► + REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, <45.83' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ELEV WATER= �r 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN (2 PERC RATE_ <2 min./inch ��J a w==${ � ) SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 04 00 �� "'� �,.� N a F @ r+rtik p ,�r'' a �� S i -.aeLzr r o ti I DEPTH OF PERC= 28"-46" 16. PROPOSED PROJECT IS LOCATED WITHIN: g EXIST. DISTRIBUTION BOX TO BE ABANDONED / / ��� ry ~ TEXTURAL CLASS: 1 ASSESSOR'S MAP 125 PARCEL 49 I ( PROPOSED DISTRIBUTION BOX . (1 3) - EXIST. LEACHING PIT TO BE PUMPED, FILLED ' • rs � .� ` � LOCUS �` OWNER OF RECORD: GEORGEANNA C. BELL WITH CLEAN COARSE SAND PER 310 CMR �-p I ( t� 1 0" 56.50' ADDRESS: 216 BRIDLE PATH 15.255(3)&ABANDONED (TYP OF 2)- PROPOSED TOTAL 20 ARC 36 (#3613BD) 4) '111 BIODIFFUSERS IN A FIELD CONFIGURATION HC-1 , �a, +; Fill MARSTONS MILLS, MA 02648 4" 6.17 .h\ 5 * A Loamy Sand .n • > ° 8" 10Yr 3/1 55.83' FEMA FLOOD ZONE C FP 2 PROPOSED INSPECTION PORT WITH #216 HC-2 g • !' COMMUNITY PANEL# 250001 fl015 C ACCESS BOX TO GRADE(TYP OF 5) + B Loamy Sand Q / 566 \ EXISTING 17. DEED REFERENCE: LAND COURT CERTIFICATE 100697 Q- TP 1 �* LP 56.5' 3-BEDROOM y y '.. r° Nf -`` s 10Yr 5/6 O�� �\�F DWELLING 28" 54.17' 18. PLAN REFERENCE: LAND COURT PLAN#38325-C �ti cr, -1'V�fi OO \ a h / \ �� TOF = 57.6'± '�}. " x .,,� () Perc - t�, LP \ �, II = 19• ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 52.67 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY ANY LIABILITY FOR SEPTIC SYSTEM UPGRADE JC ENGINEERING-WILL NOT ASSUME A Medium-Coarse Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. C 2.5Y6/6 / 2 - -�- �o „ r�s��,vf MAP 125 ,_ ._. a r a, 5-loggravel) PARCEL 48 (loose) o \ #216 I I" M \ EXISTING ,- \� LOCUS PLAN 4 ui \ 3-BEDROOM Qy } \ I �`` '� \ ; DWELLING �' / �\ SCALE: 1"= 1000' " ' u u / EXIST. 1,000 GAL. SEPTIC '�"\� 128 45.83 J TOF =57.6'± /+ / TANK TO BE UTILIZED AS \ PART OF THIS DESIGN No Mottling, Standing or Weeping Observed �J W \�\ DESIGN DATA TEST PIT DATA LEGEND LU Benchmark / PERC NO. 12961 Nail Set in B.H. Comer o INSPECTOR: David W.Stanton, R.S. \ Elev.=57.06' CO J w ` Approx. M.S.L. -+ 3 EVALUATOR: Michael Pimentel, E.I.T. 50x0 EXISTING SPOT GRADE ' NUMBER OF BEDROOMS(DESIGN) C.S.E.APPROVAL DATE- Oct. 1999 o MAP 149 DESIGN FLOW 110 GAUDAYBEDRooM - - 50 - - EXISTING CONTOUR DATE: May 2$,2010 PIARCEL 45 TOTAL DESIGN FLOW 330 GAL/DAY -�50 PROPOSED CONTOUR \ I TEST PIT#: 2 DESIGN FLOW X 200 % = 660 GAUDAY ELEV TOP= 56.50' E/T/C EXISTING UNDERGROUND UTILITIES P�( MAP 125 USE EXISTING 1,000 GALLON SEPTIC TANK PARCEL 49 LL ELEV WATER= <45.83' -W-W EXISTING WATER LINE 28,492 S.F.t I PERC RATE- TEST PIT LOCATION MAP 149 DEPTH OF PERC= PARCEL44 INSTALL 20 - ARC 36 (#3613BD) BIODIFFUSERS TEXTURAL CLASS: 1 EXISTING 1,000 GALLON SEPTIC TANK SYSTEM CAPACITY .. PROPOSED 4 SOLID SCHEDULE 40 PVC PIPE (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ-FT.)=GPD 0" 56.50' (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING I DAY 4" Fill 56.1T 0 PROPOSED DISTRIBUTION BOX Loamy Sand A 10Yr 3/1 PROPOSED ARC 36(#3613BD)BIODIFFUSER J p0�s TOTALS: 8" 55.83' TOTAL NUMBER OF BIODIFFUSERS: 20 TOTAL NUMBER OF COUPLINGS: 0 B Loamy Sand TOTAL LEACHING AREA: 480.0 10Yr 516 TOTAL LEACHING CAPACITY: 355.2 28" 54.17' REV. DATE BY APP'D. DESCRIPTION PROPOSED SEPTIC SYSTEM UPGRADE NOTE: PREPARED FOR: EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FRONVI THE Medium-Coarse Sand CAPEWIDE ENTERPRISES DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAIL LETTER C 2.5Y 6/6 "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO,ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST MODIFIED (5-10%gravel) FEBRUARY 18, 2010). TRANSMITTAL NUMBER=W000052. (loos) LOCATED AT 216 BRIDLE PATH NOTES: MARSTONS MILLS, MA 02648 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. 128" 45.83' SCALE: 1 INCH = 20 FT. DATE: JUNE 1,2010 0 10 20 40 80 FEET No Mottling,Standing or Weeping Observed � 6 of MAss��b 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THEPREPARED BY: CONSISTENCY WITH TEST PIT RESERVED FOR BOARD OF HEALTH USE o�° JOHN L. os�� JC ENGINEERING, INC. PROPOSED LEACHING FACILITY TO ENSUREC i CHURCHILLJR. DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF cI L rlo a s 7 2854 CRANBERRY HIGHWAY HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. A�o�R � EAST WAREHAM, MA 02538 3.) PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2 AND THE SITE PLAN 508.273.0377 Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1830 ESTUARINE ZONE WATERSHED. SCALE: 1"=20' ---- _ .. __ ------ - - - I