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HomeMy WebLinkAbout0037 CALVIN HAMBLIN ROAD - Health 37 Calvin Hambli "A ' Marstons.Mills - - ` A.= 101 —026 i Commonwealth of Massachusetts Title 5 Official Inspection Form 1, p Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Hcar,,Zl, 14ed Property Address Owner Owner's Name information is / /'j� (�,Q required for every a �s i if v � p�- S p� page. City/Town State Zip Code Date of Ins ection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector In - fin the out forms ` ( atlon / on the computer, use only the tab Li/ • s>G/� key to move your Name of Inspector _ cursor-do not �yv� G use the return ey. Company Name C/ k .ss�5---���,I� Company Address ley VJ City/-rowry 5 Qn hM9 State � Zip Code reea J asQ�VV / / / O_ y Telepho Number License Number B. Certification I certify that: 1 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 syst 1. Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Inspect r'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 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. L5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-?age 1 of 18 Commonwealth of Massachusetts ` Title 5 Official Inspection Form -Ic Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Addres 3 ad s �o✓1e�^ Owner Owner's Name information is 141Q r S'--,.S 14 & ( , /) ��7 O � �S required for every _ �! ✓`/ page. City/Town State Zip Code Date f Ins ection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) Syste asses: 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 Commonwealth of Massachusetts rlw Title 5 Official Inspection Form jSubsurface Sewage Disposal System Form -Not for Voluntary Assessments .3 o�1v� I LM b/,- R� Property Address cnrJer Owner Owner's NameA114? // ,G)')/( ,� information is 40nj f!�s �"p `Orequired for every A hdo P9 - a e. City/Town State Zip Code Date ofinsp/ctinii C. Inspection summary (cunt.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if um aired.s/alarms are re P P P ❑ 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.726/2018 Tide 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage�iDisposal Form -Not for Voluntary Assessments 3 / cSystemalk n l�A��i1,h IC J Property Address Owner Owners Name information is �' S W g /e required for every /OL/ page. City/Town 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 s tic tank and SAS and the SAS is less than 100 feet but 50 feet or system has a septic 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: i 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No / ❑ ,L�n// 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.tloc•rev.7282018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I I c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address �b Owner Owner's Nam information is ;�JCJJr4- // � �! required for every � At Iils f/I p�1o1/ C .7/OV page. Cityrrown State Zip Code Date of nspe ion 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 ❑ �r clogged SAS or cesspool iquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ Ee� 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 ❑ al�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. ❑ EAny 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 C.4. 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.71262018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts 60 Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo -Not for Voluntary Assessments 37 Al/�! Property Address 00 Owner Owner's Name � information is Q rS c CzV 0.)4(fe O-L' �s required for every / ✓ page. CitylTown State Zip Code Date of Insplection 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 �OoPumping information was provided by the owner,occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ as 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 NIA) Was the facility or dwelling inspected for signs of sewage back up? for signs Was the site inspected ns of break out?g 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 any of the failure criteria related to Part C is at issue ( Y ❑ approximation of distance is unacceptable)[310 CMR 15.3O2(5)] r t5insp.doc-rev.7/26=18 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Ofl✓fL�i!'' Owner Owner's Name 1� fjJ information is ITfXfi /,j� wo"required for every / am_ page. City/Town State Zip Code Date of I spec Ion D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms(actual): 3 3� DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: 0 ,�/� 00o 4.,'d N 40", &: re"iC' hes a Number of current residents: Does residence have a garbage grinder? ❑ Yes Ems- o Does residence have a water treatment unit? ❑ Yes L;4 If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 90 information in this report.) Laundry system inspected? ❑ Yes P--ITo Seasonaluse? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? Yes No �c u l� Last date of occupancy: Date t5insp.doc•rev.7/26/2018 1itle 5 Official Inspection Form:Subsurface sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 CG /V10 Pot f,dl&12 Property Address oo�e� Owner Owner's NamAars-L'v 01 S information is - lS A required for every page. City/Town State Zip Code Date of I pectin D. System Information (cont.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow based on 31 1 g ( 0 CMR 5 203): 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: o2CV 6- owtt."- 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.726/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name GII rs information is required for every page. City/Town MtateZip Code Date of I pecti D. System Information (cont.) 4. Ty;7S: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): Approximate age of all components, date installed (if known)and source of information: /awl✓ 04LsvoaL - /Vy► .S-/4s YOU Were sewage odors detected when arriving at the site? ❑ Yes No 5. Building Sewer(locate on site plan): Depth below grade: feet �o Material of construction: ❑cast iron I 0 PVC ❑ other(explain): 1.0 Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 6Sinsp.doc•rev.V262018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �3 7 Cc; lov, �G���I N ed Property Address QI�Yl� Owner Owner's Name Ainformation is Arar4005Wil� required for every page. City/Town State Zip Code Dateofifspec7on D. System Information (cost.) 6. Septic Tank (locate on site plan): Depth below gr e: feet ;ter' f construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness y Distance from top scum of to to of outlet tee or baffle P Distance from bottom of scum to bottom of outlet tee or baffle bK How were dimensions determined? — Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): yN I✓� ✓! ✓�2eC�C• Gv� � _Gr� �S lv! t� O,C! 0�1 ► —-- — t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 10 of 18 I f Commonwealth of Massachusetts �- Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 P Y rY J 9 7 GaI yo✓t Aa r4h,, ted- I L Property Address S Ode�r Owner Owner's Name information is Q/ S�OiRf � d- j /0111 required for every _ / y (/ page. City/Town State Zip Code Date of Ins ction 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.7126/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address 37 C� IV?0 401^1 0/0 Oohs Owner Owner's Name information is d �a / s d• required for every Q1rs Ohs � S _ / �✓1 v�' page. City/Town State Zip Code Date of Insp ctior 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 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.): �414 AV /* jeu, Onsp.doc-rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal S tem Form -Not for Voluntary Assessments IVIVI Property Address Owner Owner's Name information isA"arsrequired for every �,� �s �1, page. City[Town State Zip Code Date of In ectio 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: ❑ leaching galleries Lc�) number:leaching trenches number, length: Elleaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: --- _— t5insp.doc-rev.7126=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 ca Property Address ol Owner Owner's Name �fl /,,� information is M.,5401 /S Il J � 6 1 S X required for everyII��JJ page. Cit ,7own State Zip Code Date of Ins ectio D. System Information (cost.) 11. Soil Absorption System (SAS)(cant.) Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Si 421e* ki w-4, I�i�I I./ Opt- 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 P Y 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.7126/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3 ! h�muj Property Address C Owner Owner's Name information is ars�N'S �• lS ��/�' V �� required for every page. City/Town State Zip Code Date of Ins ction 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.7262018 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 VA Property Address Owner owner's Name II information is 0�7'S"J1D �• /�/ �j� l�!/ required for every page. City/Town State Zip Code Date of In pecti n D. System Information (cost.) 14. Sketch Of Sewage Di posal System: Provide a view of sewage disposal system, including ties to at least two permanent reference landmarks or nchmarks. Locate all wells within 100 feet. Locate where public water supply enters the buildi . Check one of the boxes below: ❑ and-sketch in the area below drawing attached separately t5insp.doc•rev.7/2 612 0 1 8 Tide 5 Official Inspection Form:Subsurface sev age Disposal System•Page 16 of 18 TOWN OF BARNSTABLE LOCATION _3 7 Cgl ,a f/��G�/1i Pal SEWAGE# 20149- 5'13 VILLAGE MtfP00eS ML/ ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. IareA V e 94A Vs S a8-%n?7 SEPTIC TANK CAPACITY /DUD LEACHING FACILITY:(type)2-L6.9c4 7 i=,e :kx size) 3/ X 3 NO.OF BEDROOMS ��73 OWNER /,744 PERMIT DATE: /Q- 14-AD COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.(Ifany 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 d,D, 1 • y .p 3q3., r v p � � I lob � 1 Commonwealth of Massachusetts �d Title 5 official Inspection Form I. Subsurface Sewage /Disposal System Form -Not for Voluntary Assessments Clqlvio 4" Property Address Owner Owner's Name information is required for every � � 1J /a)a page. City/Town State Zip Code Date of Insp ction D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells ( --- Estimated depth to high round water: fe p g g 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 ❑ served site (abutting property/observation hole within 150 feet of SAS) Checked with to al Board of Health-explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS.database-explain: You must describe how you established the hi h ground water elevation: ,`1 /a n 01- X.5 if Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 r Commonwealth of Massachusetts �a Title 5 Official Inspection Form e Subsurface Sewage Disposal S stem Form -Not for Voluntary Assessments 39 � / Property Address Owner Owner's N m a 000 information is L `/ required f r rt��s od 6 S o every /• w o2 page. City/Town State Zip Code Date of Ins ection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. L" B. Certification: Signed& Dated and 1, 2, 3, or 4 checked Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (F ure 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 Commonwealth of Massachusetts Title 5 Official Inspection Form p in Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Calvin Hamblin Road Property Address John R Dutra,Trustee-Pine Tree Trust Owner owner's Name information is Marstons Mills MA 02648 October 6, 2010 required for every page. Cityrrown 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 q. General Information fillingng out out forms on the onlythputer, ( �`% (7"" use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr use the return Name of Inspector key.. Eco-Tech Environmental 1r�v Company Name 43 Triangle Circle Company Address Sandwich MA 02563 Cltyrrown State ! Code 508 364 0894 1328 Q o Telephone Number License Number o Z — 4 O B. Certification -� I certify that I have personally inspected the sewage disposal system at this addressed WA the information reported below is true, accurate and complete as of the time of the inspetn.The inspection was performed based on my training and experience in the proper function and mainte nc?of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Se n 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority SOctober 6, 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. (-�o . i D I� t5ins•69M Tide 5 drficiai Inspection Force:Subsurface Sewage Disposal Sys •Page 1 or 17 it Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Calvin Hamblin Road Property Address John R Dutra,Trustee-Pine Tree Trust Owner Owners Name information is required for every Marstons Mills MA 02648 October 6, 2010 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 31.0 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-08108 Title 5 Official Inspection Form:SUbsUftaw Sewage Disp=1 System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form li Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Calvin Hamblin Road _ r Property Address John R Dutra,Trustee Pine Tree Trust Owner Owner's Name information is required for every Marston Mills MA 02.648 October 6, 2010 page, City/Town state Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cunt:): ❑ Observation of sewage backupor 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 15irre•09108 Title 5 Official tnspection Force:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments - 37 Calvin Hamblin Road Property Address John R Dutra,Trustee-Pine Tree Trust Owner Owners Name information ie required for every Marstons Mills MA 02648 _October 6,:2010 page. Citylrown 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. El 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`arrimonia nitrogen and nitrate nitrogen is equal to or less.than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No a_ 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 El 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow Win$•090We 5 OffmW Inspadion Farm,Subsurface.Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts - -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Calvin Hamblin Road Property Address John R Dutra, Trustee-Pine Tree Trust Owner Owner's Name information Is Marstons Mills MA 02648 October 6 2010 required for 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. ❑ 0 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 6 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system,fails.'I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. , E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped'Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15ins-09108 Title 5 Official lnspectlon 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 37 Calvin Hamblin Road Property Address ,John R Dutra, Trustee-Pine Tree Trust Owner Owners Name information required for every Marstons Mills MA 02648 October 6, 2010 page. Cltyrrown 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 ❑ Z Were any of the system components pumped out in the previous two weeks? El ® Has the system received normal flows in the previous two week period? ❑ Z 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 NIA) ® ❑ 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. El ® 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: 3 3 Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 1.6,203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins-MM Title 5 Official Inspection Form:Subsurface Sewage,Disposal System•Page 6 of 11 Commonwealth of Massachusetts FTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Calvin Hamblin Road Property Address John R Dutra Trustee-Pine Tree Trust Owner Owner's Name information is required for every Marstons Mills MA 02648 October 6, 2010 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 159_gpd_ -- Detail: 2008-2009 Sump pump? ❑ Yes ® No Last date of occupancy: not determinedDate Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatslpersons/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: IS,=-09f08 This 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 C"OnlmOnWealth of;Massachusetts a. Subsurface Sewage Disposal System Form -.Not"for Voluntary"_Assessments 37 Calvin;Hamblin•Road Proper y.Address John R Dutra;,`Trustee.= Pine.Tree:Trust. Owner Owner's Name information is to,ns:",Mills required for every Mars MA" 026%�8 October 6,20110. page. C(tyfrown State` Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other;(describe below); General"Information Pumping R:ecordsa Source of information Was system pumped as part of Ehe inspection? ❑ Yes ❑X No if yes, volume pumped: gallons. How was quantity pumpedcdetermined? Reason fo_r pumping Type of System; ❑X Septic;tank, distribution box:;"soilabsorption system El Single'casspooh ❑ Overflow cesspool Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El 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/Aksystem by system,+operator under contract, 'Tight tank. Attach a copy of:the DEF appro�+al.: Other(describe): tSins•09108. Title"A O(.W.61 Inspection Form:Subsurface Sawage Disposal System•Page'a:of'17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments " 37 Calvin Hamblin Road Property Address John R Dutra, Trustee-Pine Tree Trust Owner Owners Name information is Marsons Mills MA 02648 October 6 2010 required for every t page. Cilylrown State Zip Code Date of Inspection D. System Information (co.nt.) Approximate age of all components, date installed(if known)and source of information: Age 36+years. Certificate of Compliance issued 12/13/1973 Board of Health permit#433). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ❑40 PVC ® other(explain): Distance from private water supply well or suction liner feet Comments(on condition of joints, venting,evidence of leakage, etc.): Plumbing inside basement is behind finished walls and not accessible for inspection. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ED concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) i If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 9:5ftx 6 ft x 5 ft(1250 gal) Sludge depth: 4 in lsins•ogloe Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts _ - Title 5 official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Calvin Hamblin Road Property Address John R Dutra Trustee-Pine Tree Trust Owner Owners Name information is Marstons Mills MA 02648 October 6 2010 required for every , page. Citylrown 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 n/a Scum thickness 1 in Distance from Sop of scum to top of outlet tee or baffle nla Distance from bottom of scum to'bottom of outlet tee or baffle nla How were dimensions determined? ermit application Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inside surface of concrete riser on outlet end of tank was coated with a pronounced scum layer. A distinctive black staining indicative of prolonged effluent contact was observed at the cover interface. Outlet tee is missing and should be replaced at time of system repair. Grease Trap(locate on site plan): Depth below grade: feet Material of construction:- El concrete ❑ metal ❑fiberglass 0 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 (Sins-Me Title 5 OfrKial Inspection Porn:Suhsurtaca Sewage Disposal System-Page 10 0117 Commonwealth of Massachusetts _ - :-_- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Calvin Hamblin Road Property Address John R Dutra, Trustee--Pine Tree Trust Owner Owner's Name information is required for every Marstons Mills MA 42648 October 6, 2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cons.) 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 1pumping', Date Comments(condition of alarm and float switches, etc.); *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-09W rills 5 Mew Inspection Form:S❑bwrfaea Sewage Disposal System-Page It or 17 Commonwealth of Massachusetts Title 5 official Inspection Form -- s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Calvin Hamblin.Road Property Address John R Dutra Trustee-Pine Tree Trust Owner owner's Name information is required for every Marstons Mills MA 02648 October 6, 2010 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): 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-OW08 Tille 5 Offrcial Inspection Form:Subsudece Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Calvin Hamblin Road Property Address John R Dutra, Trustee Pine Tree Trust Owner Owner's Name information is required for every Marstons Mills MA 02648 October 6, 2010 page. Cityrrown 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.): 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 09ma Tdle 5 Official Inspeolion Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts -- Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 37 Calvin Hamblin Road Property Address John R Dutra,Trustee- Pine Tree Trust Owner Owner's!Name information is Marstons Mills MA 02648 October 6, 2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cons.) 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•DWIR Title 5 Official Inspection form:SubsuAace Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Witte 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not.for Voluntary Assessments h� 37 Calvin Hamblin Road Property Address John R Dutra, Trustee- Pine Tree Trust Owner Owner's Name information is regained for every Marstons Mills MA 02648 October 6, 2010 page. Cftyfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: © hand-sketch in the area below ❑ drawing attached separately i JOHN 0 37 CAL' MARsra r r 15uis•0@108 TAIe 5 Ofridal[WeOm Form:Subsurface seivoae oisposaf system•Page is of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments 37 Calvin Hamblin Road Property Address p Jo hn RD utra Trustee-Pin e Tree Trust Owner Owners Name information i e Marstons Mills MA 02648 October 6,2010 required For every , page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Site Exam: El Check Slope ❑ Surface water ❑ Check cellar Shallow wells Estimated depth to high ground water: 30+ft feet Please indicate all methods used to determine the high ground water elevation: El 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: El Checked with local excavators, installers-(attach documentation) Accessed USGS database explain: Barnstable GIS maps You must describe how you established the nigh ground water elevation: Barnstable GIS maps indicate property is over 30 feet above the groundwater table. Before filing this Inspection Report,please see Report Completeness Checklist on next page. lsins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts _ Titre 5 Official Inspection Form t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Calvin Hamblin Road Property Address John R Dutra,Trustee-Pine Tree Trust Owner Owner's Name information is required for every Marstons Mills MA 02648 October 6,2010 page. Citylrown 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•09108 Tilts 5 Official Inspedon Form:Subsurface Sewage Disposal System Pago 17 of 17 IL 4OiN(oDvBARNStABLE LOCATION :fALN I N t*ll&Ul\( SEWAGE # VILLAGE (,,r�,i t3�S �� <S ASSESSOR'S MAP & LOT 0 2 INSTALLER'S NAME & PHONE NO. o. y-3 SEPTIC TANK CAPACITY i S00 LEACHING FACILITY:(type) a. Q �o S (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No JOHN C�JTRA ' C,u.Cc�y 37 CALVIN HAMBLIN RD IMARSTONS MLS MA 02648 ; 6 I A f t t ' - TOWN OF BARNSTABLE LOCATION SEWAGE# 2Q/0 ^ y23 'VILLAGE 1;-1o/,019ifs 6 f// // ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. ,10Je, `j U.t 64?/ O-OS S OF- SEPTIC TANK CAPACITY /0d0 LEACHING FACILITY:(type) .� -Zl;l LLj `rl"15 JC size) �� X NO.OF BEDROOMS OWNER �Dl�Iyl �yTr'!4 PERMIT DATE: (Q - Qb—/D COMPLIANCE DATE: //— 2 "/O 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 `�G.? r w Z r�sp�_c rioh Pori -3p ' S -L � � /0-0 cc No. !)nn)0 q23 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pprication for Mtpool *pztem Congtruction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ?j C CIIVi M k lh��l FQl Owner's Name,Address,and Tel.No. J 6H'W DUTRPrr `�1 arV oit5 vu.,I Is 3� 64tw� Hi�16�11 ��( Assessor's Map/Parcel ` r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ���1°I co� .�01✓/` lVl III �'ri a ie C`r c�q- 304 c 4. 515,6 Type of Buil ing: Dwelling No.of Bedrooms 3 Lot Size 13 44 sq. ft. Garbage Grinder ( ) Other Type of Building C>411'g6-C No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 776 gpd Design flow provided 3 S, 3 gpd Plan Date &f 2,01 2010 Number of sheets � Revision Date Title Sewge ®i SpoStiI S y&m 01-14 Size of Septic Tank IZS 0 Type of S.A.S. 10 h6 &A i 4oser S Ctip Description of Soil -T o p So;l , S ub SB,,I I', Nature of Repairs or Alterations(Answer when applicable) p yym p, ���� � N�4 eyj'c� Lac4 SY5RM - 4 51-0 D- bo T- -qad L600 ki- SY'5�fW per A101 ET E - 3 X Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed , Date Application Approved by Date /V 1/2!7—//0 Application Disapproved b Date for the following reasons Permit No. �d 1 L1 Z3 Date Issued l — 2 2-3- Fee No. ' _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC ;HEALTHf DIVISION.- TOWN OF BARNSTABLE, MASSACHUSETTS Yes �. Ytcation foroacrp5teut Cou�tructtoueriuit w Application fora Permit to Construct O Repair O Upgrade( ) 'Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. Sj 7 C_e(Vi h I H q jh1 !I K �� Owner's Name,Address,and Tel.No. S ON NO DU7RA, �1arylon5 M. !is 3� egtV;-1 Hk4 11 Qq Assessor's Map/Parcel ' 2 6 rS S I Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �`l 1 C�V�►holkDwr M � 'q'r l q C bl e lM Z56 � 364 Type of-Buil ing: i Dwelling No.of Bedrooms 3 Lot Size Z�) G 44 sq.ft. Garbage Grinder ( ) Other Type of Building C>OW61 No.of Persons Showers( ) Cafeteria( ) Other Fixtures j Design Flow(min.required) �J�?7� gpd Design flow provided S 3 gpd x Plan Date QG'I 20, 201 o Number of sheets Z Revision Date Title Sewge o t S P oS4( !�,Yr4*P N1 01-m Size of Septic Tank Type of S.A.S. KoA'►E+riser Wo (4P Description of Soil .j o Ip So l , Subs`®, ! h9 pd- 6gf5-e S,N 4 1{ Nature of Repairs or Alterations(Answer when applicable) P U►41 P, {� �bgNt�y e K;S](i LPuCy a,f Lel4hic Sy4�P per �IG4 &TE - 3 VB i 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. C f' Signed Date Application Approved by Date ,/U Application Disapproved b : Date for the following reasons Permit No. Lj? 3 Date Issued - 2 U' rt THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by / at 3 7 (,q I V I ►1 H4In 1 1 1 - has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2010- 92 3 dated (U 26 /0 . Installer Designer Orl v,a 1) • C004 4h01'Y s #bedrooms t'. Approved design flow d i gP The issuanc e oft is termit shall not be construed a a u p s guarantee that the system will fnctro�n/i/as designe2i. Date . ,1' /0 Inspector . l " v No. �01 (7 - (4 2-7, -.-, -�--- -- -- . -----+Fee - I THE COMMONWEALTH OF MASSACHUSETTS i PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS Mi5po5a[ A�pttem Con5truction 30ermit Permission is hereby granted to Construct ( )� Repair ( ) Upgrade ( ) Abandon ( ) System located at 3-7 i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. -Provided: Construction must be completed within three years of the date of this pe Date /D -zC)- / l7 Approved by Town of Barnstable Regulatory Services • Thomas F. Geiler,Director RASMABM 9c� 039 Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Designer: �Av14 �� C6vG110tNOWR R5 Installer: Address: -43 TR%WG,I.r- CtRCLC- Address: gZ ef~ SNOWWW, MA. 02563 Wills /o - 20 -/0 On 44 6�a Q�430,6f-al was issued a permit to install a (date) I (installer) septic system at ';7 C A-L U t tV (L M E41 I) lZ D based on a design drawn by (address) �DU&fq �Q)1W lz dated 00- 20, 'W 10 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. IN OFA4,48. 9 DAVID cyGN D. �+ COUGHANOWR (In taller's Signature) No. 1093 K /� SgN1TAR\N (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC-HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. .Q:Health/Septic/Designer Certification Form Town of Barnstable Department of Regulatory Services DAM��t�, Public Health Division> Hate Ocf 200 Main Street,Hyannis MA 02601 Date Scheduled 0 Tiine - Fee Pd: Soil Suitability Assessment for Sewage is osal v Performed By: Witnessed By: ✓r LOCATION& GENERAL INFORMATION M -�. E /L ' 'A { ( CGI ► qob�(Gl Owner's Name 704 P) 0or{/ �r 5 t/4�/(1 1�5 Address C(� Engineer's NameN REPAIR Telephone# Land Use Uco•l,r!o 1 �p Slopes(g'a) Surface Stones �b Distances from: Open Water Body 00 tft Possible Wet Area too ft Drinking Water Well V ot/ + ft Drainage Way. t ft Property Line to i ft Other ft r SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) CALVIN hAMR-N ROAD ; GROUNDWATER ADJUSTMENT i, EXISTING GROUNDWATER LEVEL f BASED ON TOWN OF BARNSTABLE I GIS DEPARTMENT RECORDS. INDICATED GW 41.00 INDEX WELL SDW-253 ZONE B i4 READING DATE SERT, 2010 I READING 47.6 ADJUSTMENT 1.8 , ADJUSTED GW 42.8 O Z —� p � � 1 I 3 cn CO . a cn Parent material(geologic) y(ate 441,11 ovfi�56 "J rn Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face d Estimated Seasonal High Groundwater_see �6al.C DETERAIINATION FOR SEASONAL HIGH WATER TABLE Method Used: yVe Depth Observed standing in obs.hole: Depth to weeping from side of obs.hole: In, Depth to Soil mottles: ln, GroundwaterAdjustment In. Index Well# Reading Date: Index Well level ft. .R Adi,factor.,,�,� Adj.Groundwater Level,e D FEndPre-soak . on PERCOLATION TEST 1�gte loll �rinte. Time at 9" % erc �g6 t►� /� -'-' Time at 6" Vt _�„- oak Time @ °�� VV Time(9"-6") 0.. t Q Rate MinJlnch 2 YN Q� Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(YIN) `y "t'i' Originali Public Health Division ,.! Observation Hole Data To Be Completed on Back----- If Percolation testis to be conducted within 100' of wetland,you must first notify,the Barns6ble Conservation Division at least one (1)week prior to beginning. I,;r t7_.h�Q\E,TICkPERCFORM.DOC S 0 I L T E S T L 0 G.. . ' SOIL EVALUATOR: DAVID D COUGH ANOWR. R.S. WITNESSEO BY: DAVID STANTON. HEALTH DEPT. PERC NUMBER: 13108 , TEST * PIT I PAARENDTU MATERIAL:EPROGLAC ALD OUTWASH - f PERC AT 66 in -- 2 MIN/INCH IN C SOILS 1 ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 74.80 0-6 FILL 6-7 0 LOAM 10 YR 3/2 NONE FRIABLE 7-9 A SANDY-LOAM -10 YR 3/3 NONE FRIABLE 9-38 B LOAMY SAND 10 YR'4/6 NONE . - FRIABLE 71.63 38-126 C MED-COARSE SAND .7 - 10 YR 6/3 NONE LOOSE - C 64.13 ;TEST PIT 2 POARENOTU MATERIAL: PROGLAC ALD OUTWASH PERC AT 80 to - 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 1 75.00 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING t I 0-B FILL 8-10 0 LOAM 10 YR 2/2 NONE FRIABLE i 10-12 A SANDY LOAM 10 YR 3/3 NONE FRIABLE 12-40 B LOAMY SAND 10 YR 5/6 NONE `FRIABLE 71.67 40-132 C MED-COARSE SAND 10 YR. 6/3 NONE LOOSE � 64.00 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C n i to c Gravel i 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 t b1,od Insurance Rate Man: Above 500 year flood boundary No_ Yes .=✓_ Within 500 year boundary No Yes witi,in 100 year flood boundary No. V� Yes _Depth of Nabtrally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed.for ti;e soil absorption system? tee-S If not,what is the depth of naturally occurring pervious material? Certificatiw i I certify that on Nod ��� (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 wit the required aining,expertise and experience described in 310 CMR 15.017. tt+OF QE �.st a?. DAVID ti Signature_ °�""l Date CC (q I Z0 10 0. COMGHANOWR c � Q:\sEPTlCTFRCFORM.DOC O EVAL� SANDPIPER CORP. 62 PINE NEEDLE LANE HYANNIS, MASS. 02601 TELEPHONE 771-0670 A 1 ^ 1 41$ 4 � r r 1 No.':�p...... Fsic...02�1.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OX HEALTH Ce ( -t..........OF.......... ................ .. .... .... :� / '- '"! ..........G., l 2 t Appliratinn -fur Uhip oal Works Tonotrnrtinn Vrrmit Mqlcation. is hereby made fora ermit to Const ctr Repair ( ) an I iv'dual Sewage Disposal fSysta --•----__- . --_-__ ...• .•-- -- ------ ---o -_.A- _-------- �'�.... oc Address or t o. ' — ue .._._.. caner --------------------------•---------•-•-•--.Address_.. Installer Address d Type of Buildipse' ize Lot...-------------------------Sq. feet U !v/ - ._.......................... ( Dwelling—No. of Bedrooms--------- ..................Expansion Attic ) Garbage Grinder ( ) pi Other—Type of Building ---------------------------- No. of persons.---____---_______-_----_- Showers ( ) — Cafeteria ( ) dOther fixtures . .. ���---_//.�� W Design Flow. ............... _. __ . anon ,per ers n per day. Total daily flow._. .O_U_.-____.-..--.-.-gallons. W ' -q P on Leng Width...... Diameter Depth R; Septic Tank Liquid ca ac all x Disposal Trench No. Width t Total leaching areasq. ft. Seepage Pit No,t_::�- Diameter .._._ ept elow t let____________ ______ To 1 leaching area---__P z Other Distribution box (�) Dosing tank ( ) J)a-,44W { Percolation Test Results�Perfprmed bY-------------------------------------���----/....................... Date----•------------------•--------------- a . Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water...----..--.--._-..___ LL, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-.------_-----..-__---- -----••---•------------------------------------•-------------------- ...........................--......................... ............................... 0 Description of Soil------------------------------------------ --- --- U -------------------------------------------------- - - ------------------------------.--------------------------------•------•----•------------------- W ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of,Repairs or Alterations—Answer when applicable---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------•-------------------------- --------------------------------------------.-.-.-------------------------------" Agreement: t The undersigned agrees to install the afore"described Individual Sewage Disposal System in accordance with the provisions.of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has the issued by the board of heal . Sig .. k .......1.`......�l------ •------------------------ ----• •-•--..---- Dat Application' Approved B �/ . . ------• --•••• � -.- PP PP Y � � Date Application Disapproved for the following reasons----------------------------------•---•---------•--...------------------..........-•--•----- ......---..._------ ----•...-•-----------------------------------------------------------------------------------------------•---------••----------••-•-•--••----------•------------------------------------•----•-•-••-•--- Date PermitNo........................................................ Issued........................................................ Date __________________________________________------__-- ------------------------------- No.. .....-----. . . THE COMMONWEALTH OF MASSACHUSETTS BOARD O [HAEAL Xppli6tiott `fur Dhip al Workii Cnoitptrurtinn Vlermit Application,is hereby made for a Permit to Const ct or Repair ( ) an In iv' ual Sewage Disposal Syst at ----A--` .. ..... ............... � �� ' + j l.l... r - C or o. - c dd ess --------- ---------•.--- - }_ Wner Address-i r e w Installer` ---------------------------------- ddress s d Type of Buildivg/ ize Lot_.- _____-_•--.--------Sq. feet U Dwelling(—/No. of Bedrooms. ._ Expansion Attic ( Garbage Grinder ( ) -.._- p, Other—Type of Building ....... ................. No. of persons---------------------------- Showers '( ) = Cafeteria ( ) Other fixtures ----------- •-------------------------------------------------------------•----- ----------------------- -. ,} w Design Flow- .............. : -G�_ allonyhFr p per day. Total daily flow_---___ -_. ___:-------.-gallons. WSeptic Tank• -Liquid capacit 0 all on Leng ________________ Width---------------- Diameter----.. .........iDl)tli , � r• Disposal Trench No...__.._...___'_.... Width... 0 1" Total leaching area-. _.rs ft. ' x -_ /dam � . �� Sq it Seepage Pit No.______ ___________ Diameter -_•_ -_._ epth Blow i let..__._ __ Tot 1 leaching .trea._ ..�+'� z Other Distribution box ( �) Dosing tank ( ) /Na Percolation Test Result91 Perfprmed by--------- --- - ------------ - --- 'Date-----------_-----r-:--------r......... aTest 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------------------------ ------------- fyi ------------------------........................................................ Description of Soil------------------------------ ,:- . ---- x v _------ -------- ��."''�-= ---------------------...-----...-•••••-----•. ------------ •-•--•...... ----- wF" V 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 Article NI of the State Sanitary Code—The undersigned further,agrees not to place the system in operation until a Certificate of Compliance has bee iss ed by the—board of healt Signe --- .000 Application Approved By... �........... , /at ' . .• ..... �. Application Disapproved for the following reasons------ - -=----?----------------------------------------------------- --------- - •--------_-'=--:......------ ------------------------------------------ ------------------------- ................. Date PermitNo........................................................ Issued...°..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE"' H t .....................OF.... �: ..... .. ............................ r . Qlrrtifiratr of Tvutpliat rr T IS 46 TO CE�Q- FY, t the Individual Sewage Disposal System constructed ( 4___01_r Repaired by - --- - -------- ----- at..... ------ -• ------ _ j has been installed in accordance wdth the provisions of article I of The St ` �1ntt•1ry4Co e as escribe m .the`- application for Disposal Works Construction Permit No.____:___._ __ _ "dated � .rr-. THE ISSUANCE OF. THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS:" d�4R` 'NTEE THAT THE SYSTEM: WILL F CTI N.;SATISFACTORY. r v DATE------'`::.,r� ......................... Inspector._.---- --......... . . .... ...... THE COMMONWEALTH OF MASSACHUSETTS -BOARD OF HEALTH Dispailittl jark,i CEO mitrurtion Vrrm it Permission s ereby granted = =-------------------------------- --------- -------------------------­ to) '- ` 3 Constr ;?Fe pair an Individ age Di o f m at No.-- ---- --- - - ) ••--- ------ ------- --_..... lL_�!l f. _(_. . Street i••. -ry as shown on the application,for-Disposal Works Construction P I No.._..___. D dj ._? _.. ! .., Boar c . d h V-3 of Healt DATE-•----• -------------------------••- r s FORM 1255 HO BS & WARREN. INC.. PUBLISHERS c ` b - CONTOURS , �� `� VARIANCE REOUESTED MAY BE GRANTED IMMEDIATELY BY HEAL TH AGENT OR HEAL TH INSPECTOR. EXISTING - - - - - - - 50 310 CMR 15.221(7) - COMPONENT DEPTH T MINIMAL GRADING PROPOSED @ V TO FINISH GRADE. 36 in MAX REQUIRED z N o `.` ,[/ \ / ! , - VARIANCE TO 60 in COVER REQUESTED. �� -A a caw �J CnLv►N 00 = ��� ` ' HAM&-IN STREET N O J< 80 _*_ 80 ROAD co F<3O \� �_ _ T <w + cn o z / 1 \ _ LOCUS N = ;<o BENCH MARK f �;'32s f- Eoc V wa muoiu}i �N� CORNER OF / _- `\�� E OF P ` ,ie MARSTONS >a Ln RICK WALL 78 VE 110 OA'/v MILLS. MA B �_ �ME^/T lO F �I1. ELEVATION = 76.63 :' cb BARNSTABLE ISIS DATUM 78 LOCUS M A P NOT TO SCALE o (!) �- ' IIIIIIIIIIIIIIIIIIiIuu � / ��' `� 2N�V Illllllllllllllllllllllil W 76� LEGEND r DaZe Z (=j ''illl III III � � / \� � `� evi Wuj UOF lulluuuluuulllllu z = W / \ +' / �, \p EXISTING > Illllllllllllllpumm lu a�- w / Q 1250 GALLON J �3U1 a~ mm�llllllllll �--� U / \ _01 ?aa Illllllliliiiiiiiiiiiiiil = Z O / 1 w SEPTIC TANK Q �v a �g nm Iluullllllll U W J e ,n IIIIIIIIIIIIIIIIIIIIIII / e , EXISTING LEACH O Illlluuuluuuulllli Q `� PIT/CESSPOOL Z LLJ~ N LL w I % w LLiL X IIIIIIIIIIIIIIIIIIUWu O 74 j \ O� in Illlllluuluumull„ J 3 ���5,j UTILITY POLE $ D-BOX 0 W cv `- W pl ,11I nl 111 ll I I I II Z W m Illllllluumuuunl N � O�� Oi �i A'91iE0 �s TEST PI T gM W IIIIIlllluulllulllll / / ®x DRAIN U LLJ p IIIIIIIIIIIIIIIIIII / �O,o `� l/�O/[7 �\ ORlVE� DECIDUOUS CONIFEROUS to 3 N ��' I O.� C �9 y TREE o0o TREE Of X \ Q4b i2-M Ii2-P cn F p cD JZ Q R �'�/ / `�`� 68S1'v0,�, U ~J m m a N !p�/ ti� ��fC� X \ \ INCHES-NUMBELETTER ESTER DENOTES TYPE. FERS TO DIAMETER Lij lN e 0 U7 Z m I m O ` I 2 TIO I �l O-OAK M-MAPLE P-PINE C-CEOAR w 2 W L ❑ N WO �� O LL hj o Ln U O O Lli 72 I tic TR , \ \ / jN OF aq ZH OF Mq W C F Q Ssq SSq a W co00 m m tiF J a - / s o-00 ' DAVID tiG o`' DAVID J k Q co / \ fl, db�i2-o I 0 D. �, f� s� / \ I8-0 /mm - COUGHANOWR % " COUGHANOWR VENTPIPE / `� / No. 1093 GISTSVL s0 4 CENSE 0Q v N N \ \ r- I / % / S4NIT PN E AL P Z I � - z / / 74 Z J p Z j c \ / . T SEWAGE DISPOSAL SYSTEM PLAN 0 � �m� z J \ '9.Q \ / t��� �G'�, -TO SERVE EXISTING DWELLING z o J ry 0 "m c~n 1 LOT \ �\ \ EST. owO R of Dco oRA LL Q o II m X ^ I \ q, n m AREA = 23644 sF +- �-- e� � 37 CALVIN HAMBLIN ROAD L_L_ z + W LO L <, / 1995 ��' MARSTONS MILLS. MA N W4 tiq tiF / O m •� (n \�_ \ '9 �O \\ � �2 • ��T ON��� PROPERTY ADDRESS W ` �\_� \ ` OBI �'GAS / 43 TRIANGLE CIRCLE ASSESSORS MAP 101 PARCEL 26 O u `�_ \ �F GATE SANDWICH MA 02563 PLAN BOOK 24 7 PAGE 14 4 O ap W Ln Ln W PLAN -2/eB F��� N ��r v 506 364-0694 DATE: OCTOBER 20, 2010 H c" c" \ JOB E T E-3 4 0 6 PAGE I O F 2 VERSION. pt �� SCALE: 1 In = 20 Ft �� GARBAGE GRINDER IS NOT ALLOWED THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM 20 0 20 I ���� WITH THIS DESIGN. DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER 6 10 20 SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. DATE OF TEST: OCTOBER 19. 2010 S O I L T E S T LO G W°INESSEDBY:EVALUATOR: DAVIOSTANOTON" HEOALHREPT. DES IGN CALCULATIONS PERC NUMBER: 13108 DESIGN FLOW: 3 BEDROOMS X 110 GPO = 330 GPO TEST PIT 1 NO GROUNDWATER ENCOUNTERED SEPTIC TANK: 330 GPO X 2 DAYS = 660 GALLONS PARENT MATERIAL: PROGLACIAL OUTWASH USE EXISTING 1250 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL CONDITION. PERC AT 66 1n - 2 MIN/INCH IN C SOILS IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 74.80 (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL ABSORBTION SYSTEM: INSTALL 10 ADS HIGH CAPACITY BIODIFFUSERS (160OBD) 0-6 FILL 10 UNITS x 6.25 FL / UNIT = 62.50 L.F. 6-7 O LOAM 10 YR 3/2 NONE FRIABLE 62.50 L.F. x 7.90 S.F./L.F = 493.75 S.F. 493.75 S.F x .74 G.P.O. / S.F. = 365.3 GPO 7-9 A SANDY LOAM 10 YR 3/3 NONE FRIABLE USE 10 HIGH CAPACITY BIODIFFUSERS AS CONFIGURED BELOW 9-36 B LOAMY SAND 10 YR 4/6 NONE FRIABLE - VL = 365.3 GPO > 330 GPO REOUIREO 71.63 38-128 C MED-COARSE SANG 10 YR 6/3 NONE LOOSE REFER TO DEP APPROVAL LETTER TRANSMITTAL a W000052 FOR CERTIFICATION 64.13 OF AOANCED DRAINAGE SYSTEMS BIODIFFUSER SYSTEMS. NO TEST PIT 2 PAARENOTU MATERIAL: PROGLAC ALD OUTWASH PERC AT 80 in - 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL COLOR SOIL OTHER NOT TO 1250 GALLON SEPTIC TANK SOIL (INCHES) HORIZON TEXTURE SOIL(MUN LL) MOTTLING LEACHING GALLERY SCALE DIMENSIONS AND DETAIL 75.00 CONSTRUCTION DETAIL USE EXISTING UNIT IF STRUCTURALLY SOUND 0-8 FILL USE ADS HIGH CAPACITY BIODIFFUSERS IsI600BD1. GRAVELLESS 6-10 O LOAM 10 YR 2/2 NONE FRIABLE INSTALLATION - USE DEP APPROVED INSTALLATION PROCEDURES. NOT TO Ir, SCALE 10-12 A SANDY LOAM 10 YR 3/3 NONE FRIABLE 31.25 F t �, TAPER 12-40 B LOAMY SAND 10 YR 5/6 NONE FRIABLE 71.67 40-132 C MEO-COARSE SAND 10 YR 6/3 NONE LOOSE °J 6 N O 4.00 (D GROUNDWATER ADJUSTMENT Ln EXISTING GROUNDWATER LEVEL cl cl BASED ON TOWN OF BARNSTABLE ao GIS DEPARTMENT RECORDS. 3125 1 t N :,t r '• E INDICATD`GW., 41.00 r INDEX" WELL SDW-253 InLET OUTLET Z O NE� ,. ) B END END .; READING DATE SEPT. 2010 CROSS SECTION VIEW ADJUSTMENT ., 1.8 T —► �3 MLOw LInE —► a A'OJUSED� GW ,42.8 USE H-20 _ FROM i a In RA TED UNITS BUILDING 10 ,n 14U TO in 11.3 in tvr*rl' An O-Box 16 OID GAS LEVEL BAFFLE NOTES 34 ,n 12.83 Ff.) 68 ,n 15.66 Ft) 34 ,n (2.83 Fhl 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. SEPARATION BETWEEN M-ETAND OUTLET TEES 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED DISTRIBUTION BOX SHALL NOT EXCEED LIQUID DEPTH FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. CROSS SECTION VIEW 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS DIMENSIONS AND DETAIL USE SHOREY 08-3 H-10 OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. SEWAGE DISPOSAL SYSTEM PLAN NOT TO 12 ,^ 5) EXISTING LEACH PITS TO BE PUMPED, FILLED AND ABANDONED. SCALE MIN 6) INSTALLER MAY CHOOSE TO MOVE VENT PIPE TO A DIFFERENT LOCATION. --► Y -TO SERVE EXISTING DWELLING FROM 7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES O C TANK " � - ` TO JOHN DIJTRA AND APPLIANCES, AND BIANNUAL PUMPING OF THE SEPTIC TANK. to 0 ro SAS 8) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT O 37 CALVIN HAMBLIN ROAD MARSTONS MILLS. MA PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. 6 ,n STO1SE BASE 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL 155 ��• CROSS SECTION VIEW ECO-TECH ENVIRONMENTAL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. ETE-340BI OCTOBER 20. 2010 2/2