HomeMy WebLinkAbout0101 CAMMETT WAY - Health 1 )I CAMMETT WAY, MARSTON MILLS
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Town of B -nstable P#
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Department of Rekalatory Services
Public Health Division DateBEA
. IKA.98.
16 y ems$ 200 Main Street,Hyannis MA 02601
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2 ) Fee Pd' 1069
Date Scheduled v ' '/ CD, Time _
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`oil Suitability Assessr?z n for S e Disposal
1 W 1"1 ' ' Witnessed By:
Performed By. M �/��� � `E 1
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LOCATION & GENE_ RAL INFORMATION R 0SAe►D
Location Address 10 t CA-A4112EtT W� Owner's Name
M • 114 J LL`_S �� i Address M. AAt 114 tvA
Assessor's Map/P4rcel: D ! I / D 1 O I Engineer's Name f) jJ M/1E f&#-
NEW CONSIRULnON REPAIR x j Telephone# SV!�69' 360 - 331 1
�ES ��1Jn�V Slopes(35) l• Surface Stones
Land Use �'U �•
y > �-00 y 2 A Drinking Water Well �ft
Distances from: Open Water Body ft Possible Wet!Area
i
w ft Property Line y l O ft Other ft
prainage Way •
SKETCH:(Street name,dimensionsbf lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
sEe- o SITE p
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LLt r.,
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cs =0
kn i
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4arent�material(gedtt gid
Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: N l I Weeping from Pit FpCe
Estimated Seasonal jjbgh Groundwater
DtTERMINATION FOR SEASONAL HIGH WATER TADLE
Method Used: lo, Depth to soll[mottles: In,
Depth obi erved standing in obs.hole: in, prpundwnter Adjustment ft
Depth totweeping from side of obs.hole: i _ A ,f etor- �.� Adj,Groundwater)evel.,,s,
Index Well# Reading Date Index Well levd1 -
I
PERCOLATION TEST . Date. TInse -
Observation / I Time at 9" q -.----
Hole#
Time at 6" �J.� •-•-------
Depth of Perc
10 O S j Time(V-G7
Start Pre-soak Time.@ --
�Qto
End Pre-soak
Rate MinJlnch
` Additional Testing Needed(Y/N)
Site Suitability Assessment: Site Passed X Site Failed;
Original:.Public k;e`alth Division Observation Hole Data To B e Completed on Back—
***If ercola ion testis to be conducted within 100' of wetland,you must first notify the
P � ; eek prior to beginning.
Barnstable C44servatlon tDiNision at least one (1)w F
f
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
p�— A v S, l�►2-�v w j
MEv—tSowe 2 �l
• 1
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel)
DEEP OBSER ATION HOLE LOG Hole#
Depth from Soil Horizon So' exture Soil Color Soil Other
Surface(in.) (USD (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
DEEP OBSERVATION HOLE LOG Hole# N&-
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) ( SDA) (Munsell) Mottling (Structure,Stones.Boulders.
Consistency, Gravel)
F
i
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes -y__ �—
Within 500 year boundary No� 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?
If not,what is the depth of naturally occurring pe vious material?
Certification
I certify that on T (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the requir 06K_,RAV/UA_/L
training,expertise and experience described in 3,10 CMR 15.017.
Signatur Date 1111`1 ►V
Q:\.SEPTIC\PERCFORM.DOC
TOWNfIOF ARNSTABLE
LOCATION USG w SEWAGE #
VILLAGE 0 S � S ASSESSOR'S MAP & LO - t
INSTALLER'S NAME&PHONE NO. //��,
SEPTIC TANK CAPACITY Uoo
LEACHING FACILITY: (ty ) ���.�� (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTTDATE: 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 l
�kc
� 5a�
o 1
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TOWN OF BARNSTABLE
LOCATION SEWAGE# ,?V/Z
VILLAGE M,g/^, tOKS /' 11f ASSESSOR'S MAP&PARCEL 0 9 -/D
INSTALLER'S NAME&PHONE NO.' JOS- '20-�y38 Lo6,0 44
SEPTIC TANK CAPACITY 00
LEACHING FACILITY:(type),?- (2siU) Sx
NO.OF BEDROOMS
�J i
OWNER JOl�`1 //lOSl9l /0 J/"•
PERMIT DATE: 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
G'��/tyl�lt t,(J69y
31,G.�
pQ-0 Cj_ 2= 33.-
37,7,,,
i Cock C3 L3
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No. ;)A 12 Fee 11)0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:��
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
0(ppliLation for bisposal 6pstem Construction permit
Application for a Permit to Construct( ) Repair(y pgrade( ) Abandon( ) kjeornplete System. ❑Individual Components
Location Address or Lot No. AOM C w O ner's Name,Address,and Tel.No.
lWa`'s r®y-' w;/If .o/fh Res 14R i O
Assessor's Map/Parcel dyqD 5.4,W-,G
In taller's Name,Address,and Tel.No.50 8 -Z/t O-�/71Y Designer's NK�a
Address,and Tel.No.,SOS-�(�Q-2 92-2
��s�p�i 0 13arros �1gy�=y' tis rN6
�
Type of Building:
Dwelling No.of Bedrooms Lot Size to D'a O sq.ft. Garbage Grinder( )
Other Type of Building ,�,h 4 �; ,.,,[" No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ???G gpd Design flow provided 3 Lf Z- 2-5 6-P gpd
Plan Date Number of sheets Revision Date
Title /
Size of Septic Tank ( Type of S.A.S. a6l x 12=-5, 52,00 n&( DQKa �
Description of Soil rN.e (_eary
Nature of Repairs or Alterations(Answer when applicable) t/15T/41/ /r00 [�/
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 aDate I—(2
Application Approved by Date �(�--
Application Disapproved by Date
for the following reasons
Permit No. Lip Date Issued 1 Z oZ.l 1 Z
r
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No. aC I Z _ 1 I E� ,,•� Fee (fin
Enured in computer:
THE COMMONWEALTH OF MASSACHUSETTS
k PUBLIC HEALTH DIVISION -TOWN'�OF BARNSTABLE, MASSACHUSETTS Yes
2pplicatioll for Disposal Opstem Construction Permit
Application for a Permit to Construct( ) •Repair`(�grade( ) Abandon( ) / omplete System ❑Individual Components
Location Address or Lot No. /a/ C kJ 01M/=1T �� Owner's Name,Address,and Tel.No.
"ne"STO)I-S W-//6- Johh Ra,S/4R/O
Assessor's Map/Parcel p qq
Installer's Name,Address,and Tel.No.S 0 8-yz d= 173$ Designer's Name,Address,and Tel.No. _''00-_,?6 2_ 2 cf2-2
Ar
Type of Building:
Dwelling No.of Bedrooms _3, Lot Size 6 7 a p sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ?2(2 gpd Design flow provided 'l L 1 2-5 f h n gpd
Plan Date Number of sheets Revision Date
t
Title -
' Size of Septic Tank ! Type of S.A.S. ..� (j' X 12 .� C-,nO T� l(&4 �
Description of Soil (,n L,►'!!� n n d /
- 1 F
i
Nature of Repairs or Alterations(Answer when applicable) Z,�5 j411 /500 �pl rr za
i` Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
4 E .
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. 4
Signed Date -
Application Approved by ot _ Date
Application Disapproved by Date
for the following reasons
w
Permit No. k 611 2 Date Issued
---------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
t Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(`11� Upgraded(�).
Abandoned( )by D
at 1,21
4VL lls- has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit Non 0 datedf�
Installer, 0,4 Designer v
#bedrooms ? Approved desi flow I_�0 gpd
The issuance of this permit shall not be construed as a guarantee that the systemwill fun -as designed.
Date 1�,� ( � Inspector l`--`,< � -
---------------------------------------------------------------------------------------------------------------------------------------
'JE Fee (p 6
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS --
)DisposaY 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade(v}— Abandon( )
System located at f'O~ /22
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit. i
n
Date Approved by f dT\!
Town of Barnstable
�p'ME nj,. Regulatory Services
Thomas F.,Geiler, Director
HARNSTABLE. '
Public Health Division
Thomas NlcKean, Director
200 plain Street,Hyannis,MA 02601
Office: 503-362-4644 Fax: 503-790-6304
Installer & Designer Certification Form
Date: `6 3 Sewage Permit# Ig- Assessor's itilap\Parcel �� D
Designer: V" ` S Installer;
Address: (10 6�x I,s' Address: & J/,,,,,27
On was issued a permit to install a
(date) (installer)
septic system at based on a design drawn by
(address)
Y& dated
(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 o �.h:.
distribution box andb'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 an, 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.
OF MgssV_
_ y
A E M.
-� R
(Installer's Signature) N 1140 C°
'F£G/STEM
SOITA��a� /
(Designer's Signatt ) (Affix Designer's Stamp Here)
PLEASE RETURN TO ARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COiNIPLIANCE 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 3-26-41doc
I t G
:.. ' COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Grad
DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector
ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119
TeaTicket,Ma.
(508)564-6813
TRUDY COXE
Secretary
AROEO P AI IL CELLUCCI DAVID B.STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION t s
Property Address: 101 CAMMETT WAY MARSTONS MILLS MAP 099 PAR 010
Name of Owner HOMER ASHBY h�
Address of Owner: 6219 SOUTH DORCHESTER AV.CHICAGO ILL 60615 II
a EVLIVEO a
Date of Inspection: 8/9/99
Name of Inspector:(Please Print)JOHN GRACI tD A U G 1 0 1999
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
TOWNOFWNSTAB�
Company Name: n/a S 14EALT11DEpr
Mailing Address: n/a r
Telephone Number: n/a ��
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.The system:
X Passes The Inpection is based on criteria defined in Title V
Conditionally Passes code 310 CMR 15.303.My findings are of how the system is
Needs Furtheiubmit
ati n By the Local Approving Authority performing at the time of the inspection.My Inspection does
Fails not imply any warranty or guarantee of the longgevity of the
septic system and any of its components useful life.
Inspector's Signature: Date:8/9/99
The System Inspector shall a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the
system owner and copies sent to the buyer,if applicable,and the approving authority.
NOTES AND COMMENTS
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING NOW AND THEN MAINTAINING EVERY ONE TO TWO YEARS.
revised 9/2/98 Page 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 101 CAMMETT WAY MARSTONS MILLS MAP 099 PAR 010
Owner: HOMER ASHBY
Date of Inspection:8/9/99
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
I have not found any information;which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated
are indicated below.
COMMENTS:
System passes Title V inspection
B. SYSTEM CONDITIONALLY PASSES:
nLa One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the
replacement or repair,as approved by the Board of Health,will pass.
Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances. If"not determined",explain why not.
nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or
the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank
failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
nLa Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health).
_ broken pipe(s)are replaced
_ obstruction is removed
distribution box is levelled or replaced
nLa The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
revised 9/2/98 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 101 CAMMETT WAY MARSTONS MILLS MAP 099 PAR 010
Owner: HOMER ASHBY
Date of Inspection:819/99
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 the public health,safety
and 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well,
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm.Method used to determine distance n/a- (approximation not valid).
3) OTHER
n/H
revised 9/2/98 Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 101 CAMMETT WAY MARSTONS MILLS MAP 099 PAR 010
Owner: HOMER ASHBY
Date of Inspection:8/9199
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is
identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow,
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped n1a.
X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone I of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well,
X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality
analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds,
ammonia nitrogen and nitrate nitrogen.
X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and
safety and the environment because one or more of the following conditions exist:
Yes No
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the
Department for further information.
revised 9/2/98 Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 101 CAMMETT WAY MARSTONS MILLS MAP 099 PAR 010
Owner: HOMER ASHBY
Date of Inspection:8/9/99
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
Yes No
X Pumping information was provided by the owner,occupant,or Board of Health.
X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates
during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection.
X As built plans have been obtained and examined.Note if they are not available with N/A,
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout,
X All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles
or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption
System on the site has been determined based on:
X Existing information,For example,Plan at B4O,H,
X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
[1 5.302(3)(b))
X The facility owner(ar•d occupants,if different from owner)were provided with information on the proper maintenance of
SubSurface Disposal Systems.
revised 9/2/98 Page 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 101 CAMMETT WAY MARSTONS MILLS MAP 099 PAR 010
Owner: HOMER ASHBY
Date of Inspection:819/99
FLOW CONDITIONS
RESIDFN7IAL:
Design flow:-Q g.p.d./bedroom
Number of bedrooms(design): 3 Number of bedrooms(actual):31
Total DESIGN flow: 1Q
Number of current residents:Q
Garbage grinder(yes or no):NQ
Laundry(separate system)(yes or no): NQ If yes,separate inspection required
Laundry system inspected(yes or no):-W
Seasonal use(yes or no):AQ
Water meter readings,if available(last two year's usage(gpd): Wa
Sump Pump(yes or no): NQ
Last date of occupancy: 3/1/99
CQM M ERCIAL/INDUSTRIAL
Type of establishment: Wa
Design flow: nLa gpd(Based on 15.203)
Basis of design flow: nLa
Grease trap present:(yes or no):M
Industrial Waste Holding Tank present:(yes or no): NO
Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ
Water meter readings.if available:Wa
Last date of occupancy: Wa
OTHER: (Describe)
0La
Last date of occupancy: DLa
GENERAL INFORMATION
PUMPING RECORDS and source of information:
n1a
System pumped as part of inspection:(yes or no):NO
If yes,volume pumped nLa- gallons
Reason for pumping: nLa
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no)(if yes.attach previous inspection records,if any)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other: nLa
APPROXIMATE AGE of all components,date installed(if known)and source of information:
m
Sewage odors detected when arriving at the site:(yes or no) NQ
revised 9/2/98 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 101 CAMMETT WAY MARSTONS MILLS MAP 099 PAR 010
Owner: HOMER ASHBY
Date of Inspection:8/9/99
BUILDING SEWER:
(Locate on site plan)
Depth below grade: 1_6"
Material of construction:_ cast iron _ 40 PVC X other(explain)
Distance from private water supply well or suction line: TOWN
Diameter: nLa
Comments: (condition of joints,venting,evidence of leakage,etc.)
Wa
SEPTIC TANK: X
(locate on site plan)
Depth below grade: V
Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain)
Wa
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NQ
nLa
Dimensions: 6'X6'BLOCK CESSPOOL
Sludge depth: 3_"
Distance from top of sludge to bottom of outlet tee or baffle: .3r
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: ]Z
How dimensions were determined: MEASURED
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
MAIN CESSPOOL AND ALL COMPONENT ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM NOW AND THEN MAINTAINED
EVERY ONE TO TWO YEARS.
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain)
nLa
Dimensions: Wa
Scum thickness: nLa
Distance from lop of scum to top of outlet tee or baffle:jiLa
Distance from bottom of scum to bottom of outlet tee or baffle n1a
Date of last pumping: nLa
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,
etc.)
nLa
revised 9/2/98 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 101 CAMMETT WAY MARSTONS MILLS MAP 099 PAR 010
Owner: HOMER ASHBY
Date of Inspection:8/9199
TIGHT OR HOLDING TANK: MQ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: nla
Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain)
nLa
Dimensions: nLa
Capacity: n/a gallons
Design flow: nLa gallons/day
Alarm present: NQ
Alarm level:jVa_ Alarm in working order:Yes—No—: NQ
Date of previous pumping: nLa
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
nta
DISTRIBUTION BOX: _
(locate on site plan)
Depth of liquid level above outlet invert:nLa
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
nLa
PUMP CHAMBER: NQ
(locate on site plan)
Pumps in working order:(Yes or No): 11LQ
Alarms in working order(Yes or No): NO
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
nLa
revised 9/2/98 Page 8 of 11
1 . ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 101 CAMMETT WAY MARSTONS MILLS MAP 099 PAR 010
Owner: HOMER ASHBY
Date of Inspection:8/9/99
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
nta
Type:
leaching pits,number: 1000 GALLON LEACH PIT
leaching chambers,number: j3&
leaching galleries,number: _nta
leaching trenches,number,length: n&
leaching fields,number,dimensions: n&
overflow cesspool,number: nLa
Alternative system: nLa
Name of Technology: -nLa
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONING PROPER Y THE PIT HAS NOT HAD MORE THAN 2'OF WATER IN JL
CESSPOOLS:
(locate on site plan)
Number and configuration: nLa
Depth-top of liquid to inlet invert: nLa
Depth of solids layer: n&
Depth of scum layer. n&
Dimensions of cesspool: n&
Materials of construction: nLa
Indication of groundwater: nLa inflow(cesspool must be pumped as part of inspection)Wa
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
nta
PRIVY:
(locate on site plan)
Materials of construction:nLa Dimensions:nLa
Depth of solids: n&
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
nLa
revised 9/2/98 Page 9 of 11
1 _
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 101 CAMMETT WAY MARSTONS MILLS MAP 099 PAR 010
Owner: HOMER ASHBY
Date of Inspection:8/9199
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
n/a
6ac
revised 9/2/98 Page 10 of 11
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 101 CAMMETT WAY MARSTONS MILLS MAP 099 PAR 010
Owner: HOMER ASHBY
Date of Inspection:8/9/99
NRCS Report name: n&
Soil Type: nLa
Typical depth to groundwater: nJA
USGS Date website visited: n&
Observation Wells checked: UQ
Groundwater depth:Shallow _ Moderate _ Deep _
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
Shallow wells
Estimated Depth to Groundwater 12 Feet
Please indicate all the methods used to determine High Groundwater Elevation:
_ Obtained from Design Plans on record
_ Observed Site(Abutting property,observation hole,basement sump etc.)
_ Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators,installers
X Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
USGS MAPS AND CHARTS
revised 9/2/98 Page 11 of 11
MARSTONS MILLS
LEGEND
PROPOSED CONTOUR / 63 oPp
98 PROPOSED SPOT GRADE - Q'
;' ,' OLD FALMOU
EXISTING CONTOUR '
+ 96.52 EXISTING SPOT GRADE
W— EXISTING WATER SERVICE
t9 TEST PIT / Ss�2,' PARCEL ID: N a� � LOCUS
f 00 A)
/ 099/40
ItK o ROU04
T $
' rn
PARCEL ID:
099/10 --
AREA=20,000 t S.F. LOCUS MAP
Qj
LOCUS INFORMATION
PROP. 1 ., 5,00 GAL PLAN REF: LCP 29500C SH.2
TITLE REF: CTF# 183133
SEPTIC TANK PARCEL ID: MAP 099 PAR. 10
120
/_` _ .,\` / ZONING: "RF"
r ��
FLOOD ZONE: "C"
! 57 --— COMMUNITY PANEL: 250001-0015-C DATED:08/19/85
------
%� -- SEPTIC SYSTEM
(�. REPAIR PLAN
� -' 0"P LOCATED AT:
101 CAMMETT WAY
UPOLE -`—�= —_ -_, #101 �IQo MARSTONS MILLS, MA.
TOF=57.22 PREPARED FOR
0
" TUB JOHN J. ROSARIO JR. TR.
(Si R'9(� TBM: �`�s. 12"0 NOVEMBER 30, 2012
,q F COR CONC.
6 ) _- BJ EL=55.0' ` 00
TH-1 24"0\ Q �`�' ���� Of ,y9sf�
DRYWELLI
e O \hod TWIN/0 M T(ER v
ul \ No. 1140
c
�E6/ M`
12"Pi " S STEgNiTARTa�
\ 10"0 \X vent 240
PARCEL ID: ;
099/11 i llx/
'60
Q 8..0 CO`�' 8"P MEYER & SONS, INC.
P.O. BOX 981
EAST SANDWICH, MA. 02537
PARCEL ID:
099/028-002
(508)362-2922
SCALE: 1" = 20'
SHEET 1 OF 2 J#1491
4
ELEV. TOP
FOUNDATION NOTE: METAL RINGS AND COVERS TO GRADE OVER ALL COMPONENTS
t• (Existing) FINISHED GRADE (55.0-56.40)
57.22 F.G.EL: 56.0 F.G.EL: 56.0 F.G. EL: 55.5
17-71
n MAINTAIN 2% MIN SLOPE OVER LEACHING AREA VENT
� a•
a 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2"
,. STONE OR FILTER FABRIC DOUBLE WASHED STONE
A 6.. 4" SCH 40 PVC
a
10"I ®®®® p ®®®®
A 14,. e 0 S= 1% (MIN. ®®®®E313I=®
4EE SCHR40 PVC
INV.51 .50 )
2 EFF. DEPTH ®®®®®®®®®®®
INV.52.42
INV.51 .30 4' 2 X 8.5' 4'
GAS PROPOSED DB-3
EXISTING OUTLET BAFFLE _ DISTRIBUTION BOX EFFECTIVE LENGTH = 25'
- _
"
INV. 52.67 INV. ELEV.= 49.40
PROPOSED 1,500 GALLON SEPTIC TANK
OF
GAS BAFFLE TO BE INSTALLED ON ���` M9PIP BREAKOUT
OUTLET TEE AS MANUFACTURED BY o� D �� TOP CONC. ELEV.- 50.40 ELEV.= 50.40
TUF-TITE, ZABEL, OR EQUAL eE -
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING N 11 INV. ELEV.= 49.40 ®®
®®®fiza®®®r
PIPE INVERTS PRIOR TO CONSTRUCTION ®®®®®®®
2) TANK AND D-BOX SHALL BE SET LEVEL AND ®®®®®®®
TRUE TO GRADE ON A MECHANICALL COMPACTED SANIiAR�a� BOTTOM EL.= 47.40 ®®�®®®®
SIX INCH CRUSHED STONE BASE, AS SPECIFIED 1 3.75' 5 FT.
IN 310 CMR 1& OUTLET
L) SEPARATION 6.00 FT. EFFECTIVE WIDTH =
3) INSTALL INLET & OUTLET TEES W/
GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE
BOTTOM OF TESTHOLE EL: 42.40 SOIL ABSORPTION SYSTEM (SECTION)
(500 GALLON (H20) LEACH CHAMBER)
GENERAL NOTES: SOIL LOGS DESIGN CRITERIA
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL P#: 13812 NUMBER OF BEDROOMS: 3 BEDROOOM
BOARD OF HEALTH AND THE DESIGN ENGINEER.
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: DECEMBER 3, 2012 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF)
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN
LOCAL RULES AND REGULATIONS, EXCEPT AS NOTED BELOW: SOIL EVALUATOR: DARKEN .MEYER, R.S., CSE #1614-310cMR15.405(1)(b): WITNESS: DONALD DESMARAIS, BARNSTABLE B.O.H. DAILY FLOW: 110 G.P.D. X 3 BR -- DESIGN FLOW: 330 G.P.D.
1) A 3.00 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW GARBAGE GRINDER: NO (not designed for garbage grinder)
LEACHING TO BE 6.00 FT. BELOW GRADE VS. REQ'D 3 FT. (H20/VENT PROVIDED) Elegy. TP-1 Depth Elev. TP-2 Depth
SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE NEW 1,500 GAL. SEPTIC TANK
,
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 54.40 0"
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE A LOAMY SAND 54.20 A 0" LEACHING AREA REQUIRED: (330) = 445.94 S.F.
DESIGN ENGINEER. LOAMY SAND
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 53.65 10YR 4/2 9. 53.45 10YR 4/2 9' .74
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN B
ENGINEER BEFORE CONSTRUCTION CONTINUES. LOAMY SAND B ` USE TWO (2) 500 GALLON (H20) PRECAST LEACH CHAMBERS W/ 4'
5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 49.90
IOYR 5/8 54" 49.70 10YRT 5/8 54" STONE ON SIDES & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF C C BOTTOM AREA: 25 x 12.5= 312.5 SF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. MEDIUM SIDE AREA: ) X 2 X 2 = 150 SF
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. MEDIUM- (25 + 12.5
COARSE COARSE
8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED PERC ® EL. 48.40 SAND 1 SAND DESIGN
SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D
TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd
9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 2.SY 7/4 , 2.SY 7/4
CONSTRUCTION. PROPOSED SEPTIC SYSTEM UPGRADE PLAN
10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5.
REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5 SPECIFICATIONS. 42.40 144" 43.20 132" 101 CAM M ETT WAY, M. MILLS, MA
11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
APERC RATE <2 MIN/IN. ('Cl' HORIZON) Prepared for: Rosario
12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY NO GROUNDWATER OBSERVED
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY IEngineering by: Surveying by: SCALE DRAWN
13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 1, Darren M. Meyer, R.S., CSE, hereby certify that I am .currently approved by MADEP pursuant to 310 CMR 15.017 PO BOXYER 8 SONS, INC. Alaepougan Survey N.T.S. DMM
14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. to conduct soil evaluations and that the above analysis has been performed by me consistent with the PO BOX ( )508 419-1086 DATE CHECKED SHEET N0.
requirements of 310 CMR 15.017. 1 further certify that have passed the Soil Evol. Exam in October, 1999. EASTSANOWICH,MA02537
15. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPECIFIED) Ilt 508-362_2922 12/17/12 DMM 2 Of 2
l