Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0028 BURNHAM STREET - Health
28 Buriili a�ii Str.eet A=043 -64 tvlai-stnns Mills } e i 1 �I r Commonwealth of Massachusetts 634f ro Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 28 Burnham St. c Property Address Davis y ry Owner Owner's Name c information is required for every Marstons Mills MA 02648 5/13%19 page. Citylrown State Zip Code Date of Inspection tt 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. A. Inspector Information 64- 18081 Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 5/13/19 Inspector's Si ature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r , Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Burnham St. 9,� Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 i Commonwealth of Massachusetts p Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 I Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Per engineering plan 352 GPD provided, 2 bedroom permit Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Occupied Date l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped in 2016 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �tl ro Title 5 Official Inspection Form 1° g Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑I Shared system (yes or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Original septic tank per age of the home, new d-box and chambers 2007 per BOH file Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 12" Depth below grade: 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 or 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owners Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 3" 11 Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness trace-1/2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle >2" 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.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 f Commonwealth of Massachusetts t- - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owner s Name information is required for every Marstons Mills MA 02648 5/13/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t3� 28 Burnham St. Property Address Davis Owner Owners Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 d-box is 12" below grade, carryover in box, no indication of past hydraulic failure l5ins .doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 P P Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 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: t5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Chambers were video inspected and are damp at this time, no indication of past hydraulic failure 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 I TOWN OF BARNSTABLE LOCATION o�S_ v,-r1h,Am SEWAGE#,;04�-30S VILLAGE ASSESSOR'S MAP&PARCEL oy3 y INSTALLERS NAME&PHONE NO.3. kr 11,77--- 508�/�—s3ot9 SEPTIC TANK CAPACrrY 'r^=��' 1,,00069- LEACHING FACILITY:(type)5250 691 ClilWL,6 (size) 13r)loas r NO.OF BEDROOMS of OWNER 2 I/I.S PERMIT DATE: \,L1,300„1W? COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300.feet of leaching facility) Feet FURNISHED BY P.Ap a F 4— 44' n-�- W 3 gi a33 . q0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >132" 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: 2007 NGW 132" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4'seperation per 2007 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping, Site is at 80'msl and nearby surface water is at 40'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �a 28 Burnham St. Property Address Davis Owner Owner's Name information is required for every Marstons Mills MA 02648 5/13/19 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE CATION 8 /j tvt SEWAGE# 2"3a5- r LAGE�,�j/�S%f �/�r ASSEESSSOR'S MAP&PARCEL CLQ 1®3151 INSTALLERS NAME&PHONE NO.�./ SEPTIC TANK CAPACITY // J,ODD�j/� ,,r�S il�(s LEACHING FACILITY:(type) 560 CH� �Lffl�t/ r�� (size) /3�x �f NO.OF BEDROOMS ' o� OWNER PERMIT DATE `vI aC O? COMPLIANCE DATE: ' Separation'Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300;feet of leaching facility) Feet FURNISHED BY b eeA� w� i ,� 3 - o /j 2 qo No. d�0 1 e Fee `v v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplication for �Bigp gal �&pgtem Con.5truction permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.go ( ST. Owner's N me,Address,and Tel.No. Assessor's Map/Parcel C Lo 3 1 rerj 1 t;il- 0 Installer's Name—AAdress, e ff a arld Tel.No. S. _ Designer' ameAdAdd`els and Tel.No. — cct.l�i l cr s Type of Building: Dwelling No.of Bedrooms Lot Size oZ 0 88 sq.ft. Garbage Grinder (X/Q Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -31'60 �2 o1f3 gpd Design flow provided 35a and Plan Date 3vk-n C) Number of sheets IQ Revision Date Title Size of Septic Tank l D0 l3/1Ur! ' Type of S.A.S. 00�9 cm, Description of Soil O"7 510XIOX /66h R "' �d G, /aY/O bl b 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 and of Health. ff In Signed Date Xij 9"w Application Approved by Date 7� 3 —O 7- Application Disapproved by: Date for the following reasons Permit No. d OO-7 — 3 ;L Date Issued 7 `'50.0 No. 4 f Fee ti THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTHIDIV.ISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rpprication for Mizpo�ar *pgtem Col gtruction Permit Application for a Permit to Construct( ) Repair(k"'Upgrade( ) Abandon( ,)' ❑ Complete System ❑Individual Components Location Address or Lot No.RE5-au�W,4 At-if ST Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Oy 3 U 3({ Installer's Name,Address,arLdd Tel No. Designer'sName,Address and Tel.No. k A1z 1c Ast 5A1W--it" N4. Type of Building: © v` Dwelling No.of Bedrooms C C Lot Size a 68 C� sq. ft. Garbage Grinder (x/� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) � aG gpd Design flow provided 3SD, gpd- Plan Date �y,�a� © Number of sheets of Revision Date Title Size of Septic Tank J,000 6,d �C d/�a/ Type of S.A.S. ,0069 C#1 A' _ Description of Soil 0'77754q07 r 0AN 10YRY13 �("� toy sj4%IJ /Q 2 6 6 ya 4-- l3a" - Meg sA�► �` 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 �Gr.C!'�ra Date al�,;��/,.Zcy Application Approved by tU - Date If 'J Application Disapproved by: Date for the following reasons Permit No. 9 0 D-7 ' Date Issued -7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( V1 Upgraded ( ) Abandoned( )by at C)B zu r'n f-FA S1 hAr)7o o t �r�U has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -.-1 o U 7 — 3 Z S dated 7- 2 U• U 7 Installer-?1C(' &cr-/4� � Designer #bedrooms Approved design flow ,A gpd The issuance of this permit shall not be ns(rued a guarantee that the system 11-V�Iunction as designed. e � Date / ��,/� 1 Inspector 1!4 ! No. a _ V Fee Q'(� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwigpogal *- p5tem Congtruction Permit Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon System located at �S 8V 11 KrH t11`7 �9 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. 4V� Date 3 d ^ 0 7— , Approved by —�- I 1 e U x. Town of Bnsta:ble. P# Department of Regulatory Services ' Public Health Division Date , Mesa%6.1s$ 200 Main Stree4 Hyannis MA 02601 EED ritA'1 � . Fee . Date Sch eduled Pd� >�'oi Suitability Assessme`it for Sewage Dis osZl a n/� Q /"lit''+ Witnessed By: "' VOW;&_ Performed By:j� • is LOCATION& GENERAL INFORMATION Location Address 2.6����"l 5T: ; Ownei's.iVame �L D f�Sz� IVI.1 L L g I Address 2-9 T3 0 N`E�� e7 ,lVl/��STb S lam• ,,{{ Assessors Map/Parca: �T21 A)34 (. Engineer's Name`7 &�et 1 A4� lz.j M d/ Z o NEW CONSTRU�TiON REPAIR X Telephone# So8 3 Z•' Land Use n - Slopes(%) Surface Stones Distances from: Open Water Body. >.! b fc , Possible'Wet Area Sa 0 ft Drinking Water Well Z ft ti `Y 1Jrainage Way ft Property Line y ft Other ft dons of ist holes&pert tests,locate wetlands in proximity to holes) SKETCH:($treet name,dimcnsiods of 104 exact loca �0���� S 17 ore S PlAl )0 � .i i kYt- 0A S Parent material(geologic) 0 �) Depth to Bedrock Depth to GroundwaOr. Standing Water in Hole:' : .fir;."" Weeping from Plt Fgee Estimated Seasonal high Groundwater �✓J D&EPMATION FOR SEASO"L HIGH'WATER TA 3LE Method Used: ., ln. Depth dbsperved standing in obs.hole: in. Depth to sqU cllottl= Depth toiweeping from side of obs.hole: I in. OroundWater Adjustment - Index Well# Reading Date Index Well level •. AciJ.,faot0r•,,, Adj.droundwater Laval.•„e, I C= PERCOLATION,TEST Date e Observation l I Time at 9" .. .�._--.—. Hole# �r Depth of Pere _ 6 Time at 6" J v-- c� Start Pre-soak Time.@ - I . End Presoak ! • Rate MinJInch I L 2M t Site Suitability Ass0sment: Site Passed °_, _ Site Faile4 Additional Testing Needed(YIN) Original:,Public Health on D ivisi Observation Hole Dat a To Be Completed on Back---�— ***If percola#tin test is to be conducted within 100' of wetland,you must first notify the Barnstable 6 servation Division at least one(1)wedk pixor to beginning. DEEP OBSERVATION HOL&LOG Hole# I Depth from Soil Horizon Soil Texture Soil'Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc %Gravel) Sftu 4OA6a Iv N A- lom l 120k G A4 D 2•s 7/q DEEP OBSERVATION HOLE:LOG Hole#_2- Depth from Soil Horizon , Soil Texture 'Soil Color Soil Other Surface(in.) " ` (USDA) (Munsell) ,'Mottling (Structure,Stones,Boulders. •nsis ena %Gravel) ZN_w'Zvi Z`S DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling ,(Structure,Stones,Boulders. onsiste c o Gravel) ' II I DEEP OBSERVATION HOLE LOG Hole# NLPL- Depth from Soil Horizon Soil Texture Soil Color Soil 1, Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consistency. I r Flood Insurance Rate May: Above 500 year flood boundary No_ Yes. Within 500 year boundary No X Yes Within 100 year flood boundary No 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? - ES 1 .3 If not,what is the depth of naturally occurring p rvioe us material? ; Certification I certify that on (date)I have passed the soil evaluator examination approved by the Departme Environmental Protection and that the above analysis was performed by me consistent with the required trai ' expertise an experie ce described in M CMR 15.017.. Signature Date 0 Q:VSEPTICU'ERCFORM.DOC AQ '�q, Regulatory Services Thomas F. Geller,Director MAS& �` Public Health Division °i Thomas McKean,Director 200 Main Street.Hyannis,NNIA 02601 Office: 508-8624644 Fax7 508-740-6304 Installer&Designer Certification form Date: �vG• Designer: ,f A 2 2 u`r.c �� �� Installer: ��'y�e / � a Address: :address: ��5� S tab(,..,�C of ► ��. Cod��� �S��rfl�t�/� CI�Ei.S'J� OnS_,_�_' ��a�,� '�t�,� c�ec�I ,s � % as issued,a permit to install a (diate)I (installer) septic system at 2 v rM��h I S based on a design drawn by (address) dated �� (designer) 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above �vinstalled oration oith f any compoor changes nent ereater•than 10' lateral relocation of the SAS o any 4lations.-4Plan revision or of the septic system]but in accordance with S, to & Lroc � certified as-built by designer to follow_ ;��r�.cf., S 41 ---� /V '1 (���taller's St 1E. FG I j T / igner,s'Signattue) (Affix Designer's Stamp Here TURN TO B ABLE TE PUBLIC HEALTH DIVZSIO1�iF4 VIT4NDAAS- pI,EASE RE NOT BE ISSUED C�TIL BOTH 'THIS OF COMPLIANCE WILLIII BUII.T CARD RECEIVED BY THE BARNSTABLE PI,sBLIC)FIEALTH DIVISION. �eH Ar�IK YOU. Q:deiijageoc/0esigner Certification torni L �;..� C A T ION St W A G E PERMIT NO. V lLACE �olNSTALLER'S NAME & ADDRESS a � S UILDE R OR OWNER `ODATE PERMIT ISSUED DATE COMPLIANCE ISSUED ,,,. � a-c,l` � �� q� :. �' i a �� � �� 9S � ,� THE COMMONWEALTH OF MASSACHUSETT4 /�!✓ BOARD OF HEALTH b �� Q A To�.1�1.- ..................OF...i........� 4tv .n..s+ able,._........---...........---- 111 Appliration for Disposal Works Tonstrnrtinn Prrmit Application is herby made for a Permit to Construct K) or Repair ( ) an Individual Sewage Disposal System at: g t, V............... v r ..h m...... ....... ..M�6'.���5-----•.N1-i.�.�.�............•................•---• . Location-Address or Lo No. ... .n-----..... . ....._c7: er ....M s- h...t . :...._1Lk5 Owner y�ddre Installer Address dType of Building Size Lot.2-2•(Pgg......Sq. feet U Dwelling—No. of Bedrooms....T� .......................Expansion Attic ( ) Garbage Grinder ( ) 1 Other—Type of Building :991l.C.h'.1..... No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. . W Design Flow........... ..........................gallons per person per day. Total daily fl�_ rotal __......�J_3�_.®_..-......._....._._.._:gallons. WSeptic Tank—Liquid capacity..9®.gallons Length.B._.G ..... Width..�.._.0... iameter________________ Depth..`�_...�.__- x Disposal Trench—No. ................... g of g ----------....sq. ft. Seepage Pit No.._:._..�__.__.__._.. Diameter_._......®.._.... Depth below inlet...._(4........... Total leaching area.4t 6......sq. ft. Width................. . Total Lengthleaching area Z Other Distribution box (./f Dosing tank ( ) Percolation Test Results Performed by..... P .0 ............ Date....` e dA- ..sq.............. `1a Test Pit No. 1................minutes per inch Depth of Test Pit.•$_9............. Depth to ground water...Ao.n!�tf...... G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 •---------------------------•-----........----•-•-•-------.�................_.....Z.....-- O 1o!mL ...:A.'� --..��.6 Q.t1..- 3 1.Z Med;v°°r�...::sAr..c.�__-•-----.•.....-- Description of Soil ®.�. ......... f.... _ ---••. . x w ....-•-----•--- --------------------------------•-----•--•-•---•------•--------------.....---••---••----------•------•-----------•-•----•---•-•-•-•--------•---••--••---•-----•----•---•-------------•-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... •-- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•-----•-•--•--•--...... Agreement.- . The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with e ro -is' l o I 5 he State Sanitary Code—The undersigned further agrees not to place the system in o r do I Compliance has been issued by the board of health. ---..-----... -e r1------------------------------------ AD _.... /`9 D A ca ion Approved By......... =� --•--��/---f �J -------- Date lieation Disapproved for the following reasons----------------•----•------.....----•-------•-•----------------------------•--................-----•--•--•--•-- ...........:...•--•---------............................-•-•----••--------........------•----......----------._......_........-----------•-----....---..... --••--•-----•- Date PermitNo.......................................................- Issued-....................................................... Date 1 No.._0..�Znkiv_o FE$.....,.?�..1................ THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH .......... ........OF..-......... .C1. � ....._..._-.._---------_--_.__ Appliratiou for Di,spu.ial Work.5 Tomtrurtinn Vrrmit Application is hereby made for a Permit to Construct (Ki or Repair ( ) an Individual Sewage Disposal System at: I i 1•� !�.......... U.�. .. 1 -••.._:__.___•----• - .S -Q ...._...M_,._1._ .. Location-Address or Lo No. ..c�.s1..........A45_......(7 �� . !``� !=- 2 1.. _ ��.v..��. .......... Own/err ` Add/r+e s ........................................ Installer Address Type of Building _ Size Lot_-. �__-_-_Sq. feet U Dwelling—No. of Bedrooms------__L_4 ?'D......................Expansion Attic ( ) Garbage Grinder ( ) P 4 Other—Type e of Building p,l yp ..... No. of persons____________________________ Showers ( ) — Cafeteria ( ) a Other fixtures _______________________________ _ _ W Design Flow__._...__.5.5..........................gallons per person per day. Total daily flow........3-�'�--q.......................gallons. WSeptic Tanc.—Liquid capacity.99'00_gallons Length_ .`_ "-_._ Width._?-IL!Q'_' Diameter________________ Depth__S_:-_cb. x Disposal Trench—No_____________________ Width......__.._..___._.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....____A_.___._.... Diameter_._...__l_Q�-__.- Depth below inlet.__.._'/....... Total leaching area_-&�§......sq. ft. Z Other Distribution box (,,�f Dosing tank ( ) } aPercolation Test,.Results Performed by..... ______________ Date____' �. +9.ga` ____......__.. ,a Test Pit No. 1..:.............minutes per inch Depth of Test Pit.-S-1-1............. Depth to ground water_._ Test Pit No. 2.........%.__._minutesper inch Depth of Test Pit____________________ Depth to ground water........................ O Description of Soil----- -`3 f - C✓1 l_a a' f' r1 x c, _--•--•--•-•--------- x = .............-.................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable._______________________________................................................................ ---------------------------------------------------------•-•---•--------•--•--------........------------.....---------------------------•---------•-•---••----•--•----------------•-----....-------_.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with t e ro si o TI S :" he State Sanitary Code— The undersigned further agrees not to place the system in o r io r ifi f Compliance has been issued by the board of health. Da Apca on Approved BY _ .Q-------------- ODate lication Disapproved for the following reasons:--•--• -••-----------•--------------------•----••-------•-------------------------•------=--••---•---_____---- .........................................••--•--...--------------------------•--.._..._..--••------••-••----•----•------------------••- =---•---------------•-..__....-----•••-----------•-•-_-__------ Date PermitNo......................................................... Issued_..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS �. BOARD OF HEALTH ..................OF.............. �-n.. ?�. .................... (Irr#ifirate of Tuutplittnrr THIS IS TO CERTIFY, That the Individual Sewa e Disposal System cpnstructed ( 4 or. Repaired ( ) by-- a ` = 'f __ � ....._.�c_e� ----t�J�S�. �--n :_ ��.....# F1( C*N.. Installer - ' at......l..O:`�:-�•••t�......g'-`aa. ��.................................. _tZV s.----�:.l�__�-------------•- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.. _______ dated................................................. 4 THE ISSUANCE O THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A UARANTEE THAT THE SYSTEM WILL RUN9TION SATISFACTORY. DATE......7 _Z dV ............................................. Inspector............ ------ ............................................................ YA THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH . No.-...I.y'. 8� ..4� ?. ..................OF............ . ._ .. -.. . 1:_.. .......__........... FEE.. .__............. a �i���a��tl nrk� �un�#rttrtimrn rrutit �� Permission is hereby granted.....j4b��__k___-. ._.___..___- to Construct ( X< or Repair ( ) an Individual Sewage Disposq System w' at No � _A--.!-$_..._.._ U-�-r�h!r r�"-. '.... �.:5 _ .__._ _!�� (VA A -- ---- ---- -------------------------- street Ni as shown on the application for Disposal Works Construction Permit No..................... Dated_ '.._....._.._........._.. ........................___ _________ ... _------ _------ - ao V _ -..,, Board of Health )."'' DATE.......................................•------.................................. FORM 1255 A. M. SULKIN, INC., BOSTON J C076 Date: 5/30/84' Log Number: Bottle 4� ' BARNSTABLE COUNTY HEALTH DEPARTMENT SUPERIOR COURT HOUSE V BARNSTABLE, MASSACHUSETTS 02630 ° 1yAS$ ° DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2511 EXT. 331 Client: Jack McKeon Collector: Fred Clifford Mailing Address: 14b GreatMarsh Affiliation: Clifford wellrl ing Centerville, MA 02632 Time & Date of Collection: ' 5/28/84, 1 :00 p.m. Telephone: Type of Supply: well water Sample Location: Lot 18 Burnham Rd. Well Depth: 551611 Marstons Mills Date of Analysis: Parameter Sample Result Recommended Limits Total Coliform Bacteria/100 ml 0 0 pH 5.6 Conductivity (micromhos/cm) 58. 500.0 Iron (ppm) 0..85 0.3 Nitrate-Nitrogen (ppm) 0.09 10.0 Sodium (ppm) -- 20. Water sample meets the recommended limits of all above tested parameters. Water sample has higher than average levels of nitrate. Future monitoring is recommended (2-3 times per year) .' . The low pH of the water may shorten the useful life of the house's plumbing. xx Water sample may present aesthetic problems dde to high 40-A Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. Water sample is not recommended for human consumption due to Retesting is suggested. REMARKS: Iron is not a health hazard. CC: Clifford Well Drilling CC. Barnstable Board of Health Lab Director ; 11/7/83 Nib • :<�IW�e�J�') 72)W1+ !K ," Atx�,yy y ,u 5' U —Zd� ►� � � f V � r y't ;.,i.'r t 5« - ., •.;# I � c E,�i+ c .!,.•t r t "r'ta r k � ac4 451#rg. �fri�.s u' r �1r tt r it tip v \ u'X/F I•' r+ L1 1 "'y S "3� "• _'r; -"x:.`��'S H`';? � N ./ iv Le s1 c+5� riI -{Q . 0\ 1' scpTi c�� � � 1 �Y EX/ A':it✓3/nN` �. �. OF. I M ✓o x ; 40o/�kK m, o' OR A ' ��� \ ` i V ,+ ` s •`_ � $ �''� a :., r x.t�i'.t'f` Jq"r t3 o 1A �: C 7? x s l I v r7N'. .3..i�'�.tq -41 c- lam F2p'llDA/tR� fy ff 4 - T ` �� \ � t �• � �!.. � � fit.{' {L V /. 2�. Z. J NK MOTE %NAW L0&AT/ON OF 4IVY 4XISTIh/� .;I�NDE�Cil��3llMp SErW�%ei4 T/.--S sh'OWM o nr TN/S PI-A A4 IS.4 PPROX/�'9 7'� ,0�✓GY°�4 s. DETER MJ M 'l? x �iebM / DR�?/�T/On/svAPL��v 'f�!(E-,vA✓..CvNSTRUcTic1 , /V U s 145%L»- Fd/ Dh;J�'l,t►c►�5 jnrCJ R R '-!�.•4 S i4` i� S"rJ : pF �Ny c/ri L/TT/C.S o M/7'TL�,D. 0R /A//ECCtJ0y�9-T�GY �t3j r-t" �4 VaP LEGEND ERTIFIED PLOT ; PLAN4 w E1:IS TIN 4 SPOT ELEVATION ` 0x0 �tvf ► �; 1 'EXISTING CONTOUR p ��� FINISHED SPOT ELEVATION o� �o��a�r o a4x�c� P1/4 �5 7;a,, 57 �'f 1�4X FINISHED CONTOUR E�okEo IN. APPROVED BOARD OF- HEALTH .: - ����� „3r ► IVn ©ATE AGENT su SCALES LDREDGE ENGlNEER/N6 CO. IN M`''�Eo''/ CLIENT. ,�.. �. i 'CERTIFY THAT ,THE",PROPOSE`D: g EGISTERE REOISTEREO JOB,.NO. ,p� BUILDIN4' SHOW • ON THIBI P LA N=;t CIVIL LAND CONFORM TO THE ZONINafi� �dws'j ENGINEER �SURVEYO DR.BYi °OF 'BARN8TABLEt,.; MA"SS. ; 712 MALN STREET CH:*T N.YA N N I S NI Q 3. 9 SHEET`L OF ;� ATE REG.' LAND 7 SU;RVt`Yr4 IVOTE : /F E/TNER T/•f,E.SEPTIC TA.IVk DR r• 20 FT MIN. Z--ACHI.-VG P/T ARE MORE THAN /I"BE.L0PV /D PT M/N• .�sR/4 DE, A � O/AM ETER CO�yC.�'ETa�r COi/ER SNALL BE BWDuGHT TO 4RAOE.(�AN EXTRA CONG4�E WN. jD o/PE tIE.4VY CAST /RO/V CO{/�R .S.,YAI-L- BE C/S�O EG,I0.7 COVERS PFRTFT IF/N DR/✓EN/Ay i ,a 2% Miw. COJVC,eFTE (f ApE Co I�ER CLEAN SANS - ** BACA LL = - L/Qu/D LEVEL ' :. .• -. / 4«CAST 2'LAYER I ON t90 p; o o " o a'o 41F -��8. MIN.P/TGN GAL. ' a • • . . .. . .. . . > >. •„ yv.�SHFD S7t�NE %4'PER�'T.:: SEPTIC TA/VEC D/sT. ' • • • • . . � . I Bay v t • B • • • • ♦ � .•p l .• • 0 1 IEFFECT%✓C • •' 314�- a • •.t pEPTH • ♦ • • o o WASH.EO .STONE t • •37-7 0,0 S T ERA E PRECA SA • E o l / 3 t i. . • • • • • • . a o P/7 DR EQU/V. s a.� auv :�I /NlieRT ELEf� T/ /!3 • EL 930 _Is l /NYERT.AT Ot11A.DI VG to Z o FT. . S/9° G"� oa-t (,iT D/f1M. f' lNL ET .SEPTIC TANK /U l; d FT p�T G�t�. c i 3Y L: FT. O/A1 M. C�u`E 7�90L/L.4TlON� 464171-FT SEPTIC TANK /INLET D/STR/6//T/ov BOX l o,0.0 AT GROUND. INTER TABLE SECTI . . ON OF 0VrLE7D/37'X/Bt/T/O!V OOX" 99.8 FT. INLET LEACRINCr PJT 0!-a Fr SEAVA64E, /SP4SAL .SYST.�M :'LEACH/NG P/T TAdWl.AT/DN dcALE %s'; a I=O" MENS/ON s ITT. DES/Sty CA/TERlA D/ A D/r1HYS/aN 8 —IFT, N/JAlBER.OFBEL>i?OOMS 3 G/MEIVS/ON C _FT, iLItN• c�+Re,�cG,Eo/s.�os�L uw�r N SOIL LOG - _ SOIL TEST TOTAL FST//�IFtTEQ.. FlDH/ 33O a4L�Aa4v SOIL. TEST At- SO/L TFST#2 � NUMBER tEAcx/Ns PITS /: f^gLEY. l 1. �-�L�Y ,c>ATE DF SOIL TEST . 4 S/OE 11�ACt1lNG PER P/T. /Sr. S� /■T.' RES[/LTS AVITNESSED 90 TT01W L rmACN/NG PER P/T�So. A77 n - 3 v�i-/"f. 64,. . . PIER CCLAT/ON MATE AE/ TOTAL LEACHING AREA ZE- sip. FT s��3So�<` FwRCOLAT/aN RATE/k2 r MJN�IJVCH j .?ESERI�ELEAC'NlN6AREAx SQ. FT. • 3 - / z w ZN of MAssq S/+nit� L U T I T3 f/l�Zlt/1i�4'Mj 5�' A /Vj�4- ' ORSE A p no.io9si o�� `_ EL`DI?EDCsE EJNCr/NACR/NG /NC 9o�FGisY�Q`6�`` tL. fJq p 7/2'MAIN S'f's S HYANIv% , MASS. t Frs/ONAI 6� w ND.G/TOIJ/Y�? Y4�AtTER EIVCOUNTEREO., Ejo"S T /YlC I�' /�I TE 5 q • - j: 4: A GROUIti/O WETTER .4T.ELs�t/ Z r u• Nd_ S40 37 S/y�r `Z pP r. I LEGEND PROPOSED CONTOUR z ��rFq 90 SP RIVER , ... BENCH MARK 98 PROPOSED.SPOT GRADE —— 98 —— EXISTING CONTOUR TOP OF CONC BOUND �.. + 96.52 EXISTING SPOT GRADE �Dd ELEVATION = 80. 55 .�®® �'� ��RV •piG s�� BARNSTABLE GIS DATUM W— EXISTING WATER SERVICE `tom 183.87 ft � 1 TEST PIT �0 — ------------— — — — — — — — — — — — — — — — — ------------------------- — -----— — — — — — — - — — — — — — — — — — — �' pA \�S S �. ------------------------- GA Existing Lecchpit R t j (Note 10) ab LOCUS MAP N.T.S. i m�- TH-1 , ��� i C GENERAL NOTES: ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL TH-2 1 BOARD OF HEALTH AND THE DESIGN ENGINEER. I 2S, 4j� �� 1 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS j �/ 1 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE \ LOCAL RULES AND REGULATIONS.Oqo . a� X 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR �( / TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE C) O : b co DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO' THE DESIGN 3N�� � �� ENGINEER BEFORE CONSTRUCTION CONTINUES. 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 ------------------ —,� �n O 0, �\ HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. W cn 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. I O ~I— `� / 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. / 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING j • / / / CONSTRUCTION. 10. EXISTING LEACHING PIT TO BE PUMPED, CRUSHED AND FILLED / 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY OF MASS t. AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY — / ya q�y 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING / o� DARF'ZEN G LOT 4 , 14. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW �O / r i FOR'THE USE OF A GARBAGE GRINDER j AREA = 22688 sf +— �, 2 ° PviE`c.�R 15. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING N0. 11 0 S NITAR\P� I — — — — — — — — — — — — — — — — — — — — — — ——�a.00 ft - PROPOSED SEPTIC SYSTEM UPGRADE PLAN 28 BURNHAM STREET, MARSTONS MILLS, MA EDGE OF . PAVEMENT MAP. 043 Prepared ared for: Karl Davis SURVEY REFERENCE: ' LOT.-034 Engineering by: Surveying by: SCALE DRAWN JOB. NO. LCP#.'97781 DARRENM.MEYER,R.S. Eco—Tech Environmental 1"=20' DMM- PLAN OF LAND BY CHARLES N. SAVERY, PLS POBOX,01 (508) 364-0894 DATE CHECKED SHEET NO. DATED: AUGUST 18, 1972 _ i EAST SANDWICH,MA 02537 508-362-2922 07/27/07 DMM 1 of 2 NIA k r 3 T i+ ELEV. TOP FOUNDATION "NOTE: ALL COVERS TO BE MARKED WITH MAGNETIC TAPE (Existing) = 89.02 F.G.EL: 86.0 FINISH GRADE=81.50 F.G.EL: 84.0 F.G. EL: 82.0 _\ a v. MAINTAIN 2% MIN SLOPE OVER LEACHING AREA COVER OVER LEACHING = 3.0 FT. a• COVERS TO WITHIN 6 OF GRADE _ 2" OF 3/8" DOUBLE WASHED STONE 3/4°' — 1-1/2" DOUBLE I..' • L 20 WASHED STONE '- SCH— 4�F 4�� SCH 40 PVC _ ' e L = 11 4" SCH 40 PVC (MIN.) 10 I t4" S= 1� (MIN.) 6 ®®®® O "EE3 A' TEESS ARE TO BE © S= 1% (MIN.). . , ®®®®®®4" SCH 40 PVc INV.79.50 2 EFF. DEPTH ®®®®®®INV.81 .03 iNV.79.50 EXISTING OUTLET GASj P 4' 2 X 84' BAFF . ROPOSED DB-3 . EFFECTIVE LENGTH = 25' H-10 DISTRIBUTION BOX INV. 81 .28 EXISTING 1,000 GALLON SEPTIC TANK INV. ,ELEV.= 78.0 GAS BAFFLE TO BE INSTALLED ON NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BREAKOUT OUTLET TEE AS MANUFACTURED BY PIPE INVERTS PRIOR TO CONSTRUCTION ELEV.= 78.50 TUF-TITE, ZABEL, OR EQUAL 2) D—BOX SHALL BE SET LEVEL AND TRUE TO TOP CONC. ELEV.= 78.75 GRADE ON A MECHANICALL COMPACTED SIX -INV. ELEV. 78.0 �®®' o ®®INCH CRUSHED STONE BASE, AS SPECIFIED IN — WM 0 E3E3 310 CMR 15.221(2) ®®®®®®® 3) REPLACE EXISTING 1,000 GALLON SEPTIC ®®®®®®® ' TANK WITH 1500 GALLON. SEPTIC. TANK BOTTOM EL.= 76.0 Emmmuamum IF FAILED, DAMAGED, OR UNDERSIZED. 4' 5 FT. 4' 4) INSTALL INLET & OUTLET TEES AS REQUIRED SEPARATION 5.50 FT. EFFECTIVE WIDTH = 13' SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 70.50 _ SOIL ABSORPTION SYSTEM (SECTION) N.T.S. (500 GALLON LEACH CHAMBER (H-10) LOADING) SOIL LOGS DESIGN CRITERIA NUMBER OF BEDROOMS: 2 BEDROOM EXIST. (No proposed increase in flow) / 3 BR DESIGN DATE: JULY 20, 2007 SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN MEYER, R.S., CSE DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONNA MIORANDI DAILY FLOW: 1.10 G.P.O. HEALTH AGENT DESIGN FLOW: 330 G.P.D. Elev. TH-1 , Depth Elev. TH—2 Depth SEPTIC TANK (VOL. REQUIRED): 330 gpd x 2 = 660 gpd (USE EXIST. 1,000G SEPTIC TANK) 82.0 A SANDY LOAM 0" 81.50 A 0" GARBAGE GRINDER: NO (not designed for garbage grinder) 10YR 4/3 SANDY LOAM LEACHING AREA REQUIRED: 330 gpd/0.74 = 445.94 S.F. 81.33 B 8" 8092 B 10YR 4 3 7„ USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS (H-10 LOADING) SANDY LOAM. WITH 4 FT. ON ALL SIDES: 251 x 13'W x 2'D 10YR 6/6 SANDY LOAM 10YR 6/6 BOTTOM AREA: 25 X 13 = 325 SF 78.58 C1 41" 78.0 Ct 42" i SIDE AREA: (25 + 13) X 2 X 2 152 SF TOTAL SQUARE FEET PROVIDED = 477 vs. 445.94 REQ'D. 1' DESIGN FLOW PROVIDED: 0.74(477 S.F.) = 352.98 G.P.D. vs. req'd 330 GPD PERC 077.33 'l OF Mq S9 PROPOSED SEPTIC SYSTEM UPGRADE PLAN MED. SANG MED. SAND D 2.5Y7/4 2.5Y7/4 28 BURNHAM STREET, MARSTONS MILLS, MA ` o. 1140 Prepared for: Karl Davis , i fG�$TE O. Engineering b Surveying b SCALE DRAWN JOB. NO. � � 9� 9 Y� Y 9 Y�72.0 120° 70.50 132" DARRENM.MEYER,R.S. Eco—Tech Envi—nmental N.T.S. DMM PERC RATE <2 MIN/IN. ("C" HORIZON) PERC RATE <2 MIN/IN. ("C" HORIZON) SgNIiAR\a Po sox981 (508) 364-0894 NO SHEET NO. GROUNDWATER OBSERVED J}'� EAsrsANDwicr+MA ozss� DATE CHECKED NO GROUNDWATER OBSERVED I, 'l 2�l" / . _-.I. 50e.,362-2922 07/27/07 DMM' 2 of 2