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HomeMy WebLinkAbout0164 CAMMETT WAY - Health 164 Cammett Way Marstons Mills A= 099-047 J i I Commonwealth of Massachusetts Title 5 Official Inspection Form Flo Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '' 164 Cammett Way ; �V Property Address Andrew Robertson Owner Owner's Name �- �K. information is required for every Marstons Mills ✓ MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. ��uunllnipii Important: llin When goutforms fi A. Inspector Information S/ on the computer, use only the tab James D.Sears JAM ES key to move your Name of Inspector SEARS cursor-do not Capewide Enterprises use the return Company key. P Y Name ��''� R r i 6�•'•0�� 153 Commercial Street ''%�F S i SP G�_11��x\`` Mf l re I I Company Address unmm�m�� Mashpee MA 02649 City/Town State Zip Code faun 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 1-4-19 ;sp__edctor'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. t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal. Tank D Box and two chamber's. Note: Old system -D Box and pit tied into system. 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): �I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts ,lp Title 5 Official Inspection Form Flo Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Cammett Way �V Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational: System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 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 system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ iz Liquid depth in l is less than 6" below invert or available volume is less than '/z day flow/- ❑ Z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinkingwater supply pp Y F1 El the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 118 Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs'of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 I � r Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 '•u 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date'of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 1000 Gal. Tank D Box and two chamber's&. Old system D Box and pit. Number of current residents: 4 Does residence have'a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2016-65,000Gal g ( y g (gpd))' 2017-69,000Gals Detail: Sump pump? ❑ Yes ® No Last date of occupancy: PresentDate t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No I 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: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ 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): Note: Old system ( D Box&pit) still tied into system. Approximate age of all components, date installed (if known)and source of information: New chamber's 2014 permit # 2014 - 158. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 34"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH -40. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 r cam. Commonwealth of Massachusetts Title 5 Official Inspection Form j� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �V 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 28" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast H-10 Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt- Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 27" below grade w/inlet cover at 10" outlet at 18". In tee w/outlet tee &baffle. No sign of leakage or over loading. I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth of Massachusetts x Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 r Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contra ct(required). Is copy attached? El Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Two D Box's. Old Box at 3' below grade w/one line out. New D Box at 35" below grade w/one line out. Both box's are solid. I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 164 Cammett Way Property Address Andrew Robertscn Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 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 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Older system pit w/1'water. Newer system is two 500 Gal. dry well chamber's. Chamber's at 40" below grade w/cover at 22". Chamber's wet bottom w/clean like new wall's. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 O(D O 6 A 3 19 9 3- �`' 40 A5 - 3 �-`' 65- 3a- � b - l� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells iV® Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Auger T.H. 12' no G.W.. Bottom of old pit at 8' below grade and bottom of leaching at 5'-6" below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 i c Commonwealth of Massachusetts p Title 5 Official Inspection Form <� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 164 Cammett Way Property Address Andrew Robertson Owner Owner's Name information is required for every Marstons Mills MA 02648 12-24-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included g 4Tro, C1hWF 1� Pit N� GS t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 I` AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LO' ATION 04 �WiMQ v�ay SEWAGE # Q-5 -_ IOA VILLAGE „ ASSESSOR'S MAP & LOTOW "Qy f INSTALLER'S NAME & PHONE NO.6&r .kt y �r-v)cv"Ly-sb��9 SEPTIC TANK CAPACITY LEACHING FACILITY:(type} `� C ; T (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNEk DATE PERMIT ISSUED: --�- q L DATE COMPLIANCE ISSUED: L�.•-� � , =i" VARIANCE GRANTED: Yes No bpi L10 17' 3: , ]� �•u v T- http://issgl2/intranet/propdata/prebuilt.aspx?mappar=099047&seq=1 7/2/2012 �. TOWN OF BARNSTABLE LOCATION. ( 4-�(d,)xy SEWAGE# a O/til VILLAGE M rsfV ���� ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. 1 mj&C' mmr— SEPTIC TANK CAPACITYY LEACHING FACILITY.(type) _�;- Sc�Oac�(�UnJ f{-1 ( ze) 13• 2.-X t X�— C NO.OF BEDROOMS OWNER D��F I I-oy I If PERMIT DATE: —f /�� COMPLIANCE DATE: n Separation Distance Between the: Nory Nwfbcs*►`&RT) .«_ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility T,rar o4 'PH2 1e5I-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 � � lG camm et+ ,f FIZOOT Al- .11 2Z- -D -32 C) D --:?(5 ® ` ' 38 �- t1m No. �4 " 'J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -`TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(pplitation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(&4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. !G k/ (�,,,,,,,Y� Wbit Owner' e,Address and Tel No. M&j,,5,1V, .a ,1)t. Assessor's Map/Parcel ty Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. %4sA _G(C9'--Jfj V-n+e C;06 -LICO•-7/.S 9 C,a /eUr�dr)u5 ��✓lC5 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 2V4CC)o sq.ft. Garbage Grinder( ) Other Type of Building IACMS e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '3 -jP 0 gpd Design flow provided 3 S 7; gpd Plan Date 9/Y 1/-X Number of sheets Revision Date Title Size of Septic Tank 5a:E'Pi Type of S.A.S. �Z- 5-C.j�:) j 0//"- Ch,d r1/S Description of Soil Nature of Repairs or Alterations(Answer when applicable)T��I�±/� r/L°„J 5,..4, S 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. Signe Date Application Approved by Date Y Application Disapproved by. Date for the following reasons Permit No. C ' Z/ Date Issued f No.�L�//y _ lJ Ct ,+. �,� _ Pt 4 Fee QV THE COMMONWEALTH-OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION =TOW,N4OF BARNSTABLE, MASSACHUSETTS Yes ftplication for -Misposah6p$tenl Construction Permit Application for a Permit to Construct( ) Repair(Vl� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ���/ (a,, ,, �,f t. lt�c Owner's lame,Address and Tel No. /14 a✓y folV4i M,M, �f' hO V `Q Assessor's Map/Parcel oy Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1�04sA -Glow^) Tnu so$-i1b0-7iS C.J /N,[ rdrNf� !tea/leg Type of Building: Dwelling No.of Bedrooms �j Lot Size 9 C2,CCy2 sq.ft. Garbage Grinder( ) Other Type of Building �\pms,e No.of Persons C7 Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) '72 C) a gpd'' D'e ign flow provided '�S`r, gpd g?" Plan Date y/? 9/T/9- Nu r of mmbe sheets 7 Revision Date Title t Size of Septic Tank° Type of S.A.S.— S"� n `Z"i �`li��ir✓S Description of Soil c Nature of Repairs or Alterations(Answer when applicable) �q/G/ i✓r�,,! _. Date last inspected: Agreement: 9 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. Signe Date � N— N Application Approved by Date <� Application Disapproved by Date for the following reasons o Permit No. Date Issued �- ' 6 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( L� Upgraded( ) Abandoned( )�by a,,j n)c at /421- � If ,, 4, A- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Ne:�0141 / S( dated -S Installer J-Dw �)G4,A j to,.,N C Designer � #bedrooms "tij Approved design flow `►,-ti/7 ,gpd The issuance of this permit sh 1 not be cbnst "ed as a guarantee that the system ill function as desi//g. e d. Date Inspector ! !, ---------------------------- -------------------------------------------------------------------------------.------------------------ No. / - Fee ��d Y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Voposal 6pstem onstrUction Permit Permission is hereby granted to Construct( ) Repair( ( {Upgrade( ) Abandon( ) System located at f G �/ �urwle �°!/ (.4.Ju-i ./��,%� /i�.✓s �(i/.//s 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 pe Date "� ����� Approved by 4. J/1 ~1 TOWN OF BARNSTABLE ' i✓ LQ ` .:fION �'� CLZVy�Yy�e Q�l SEWAGE # 95 VILLAGE „ N� ASSESSOR'S MAP & LOTOW 6117 INSTALLER'S NAME & PHONE NO.4fq,romt.4 SEPTIC TANK CAPACITY ,LEACHING FACILITYAtype) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER c,%� DATE PERMIT ISSUED: i DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r yO d64 9 it '.. ASSESSORS MAP N0- D q q � ��ff / PARCEL NO: `n No.10i ...1 - Fr 3.©................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di-tipm3al Worlai Tomitru"anIndividual rrmit Application is hereby made for a �-i to Construct ( ) or Repair ( Sewage Disposal System at !t �: . ........Ca rn. m1 t �{ oration-Address or Lo o. . w 1----....••• wn^ X'`-C -?----------- 1 5— �5 ._Ades = o'K1K •n {- �'►'1 Installer Address 1 Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms.......3.............__._____-._._.Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ................................ . W Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length................ Width-----.---------- Diameter---.------------ Depth___--_____------ W Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area-------_.............sq. ft. x Seepage Pit No.---_---__.. _-.-.- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. _ Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (Z Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a -----------•-------------------------•----•--•-•--------------•--•-•--••-•-•----•------------------•......................................................... 0 Description of Soil----------- ----------------------------------------- V ....-•--------•---••---••-•------------•-•-•---••--•-------------•------- -- ......-------------------•----...-•---•---•---------•-•-------------•------...... ...................................... ----------------------------------------------------------------------------- ----------------------------------------------------(---- t ---------- ---------- --•- U Nature of Repairs,.Pr Altera Ions—Answer en plicable--.-.-.--_=k2 T�... \.............Nf-y........... �.... ...`_6- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environ Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli ce has be Issued by he board of health. Signed . ..... � .�"vw-�C. ^...L. Dare .. of .�....`.. �. n-- Application.Approved By ............... �7. ^..`1.5 ... .......... -- . ................... Dare Application Disapproved for the following reasons- ------------------------------------------------------------------ ------------------------------- .. .......................... . .................. ........... . . ...................... .......................................... - .. c� Dare Permit No. .......��ej..... 1.- .. ..... Issued ....... ate ..'^ D q - F�s .v.'..T THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , pphratiott for Divi-Vaii tl Work.6 C outitrnrtion Prrmit Application is hereby made for a Pejniit to Construct ( ) or Repair ( an Individual Sewage Disposal System at. t1t f �. y n ----------------------`- .....----------------------------------...------------------------. l `Location-Address , / n,� Z- ..... ...!c 'F (�2�_ �lI!..__(�...... //^u/+ Owncr `n ` r Adder\cs a ` -�'e�-.�'r.�.____...._.� N _f��.� _ �_ __,rt'� ....!-`^.......t2..._._:.._._H V�INJ�� T;_•!_/I••Z..........__. ........ ...... ........... ............... ..... ._.. Installer ),\) Address Type of Building , ,` `% Size Lot.................... q.__.___..S feet t t Dwelling— No. of Bedrooms........ _.-------------------'___._2Expansion Attii,,C (t,�) Garbage Grinder ( ) Other—Type of Building No. of persons __,_:__ _ _ _ Showers — Cafeteria A4 YP g ------------••--- P ------- ( ) ( ) r f! Other fixtures = ----------------------`------i----------------------------------- ------------------------------------------------ -••---------- W Design Flow............................................gallons per person ' ay. Total daily flow s__-----_--_______--_--_____-__----__-----gallons. WSeptic Tank—Liquid capacity------------gallons Length_.__t:---.s h_ Width--------- �.._.tl iameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length..--__-_-_ ..1.1Total leaching area....................sq. ft. Seepage Pit No---------.-_--._.-- Diameter-------------------- Depth below inlet.........�.E_._ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) •-' Percolation Test Results Performed by-------- ------------------- ............................................. Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit___--.____________ Depth to ground water..................... GX4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 04 •-••--•-•----------------------•---•-------••-•--•••--•••---••---•---•--......-•-•••----•--•._....--......................................................... 0 Description of Soil.............Q�.�p) _ ------------------------------------------------------------------------------------------------------------------------------ U -•-•--•-------------------•------------••-•----••---••••---•.........••. ... ................................................................. W Nature of Repairs-Dr Alterations—Answer -. when applicable �5�-�=-�-�------------��------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compiia(nce has beet 'ssued by-the board of health. Signed ..._..\.:._--- � -------- ................................. Date Application,Approved By ........... E ... -—- —-- . cj- Application Disapproved for the following reasons- ---------------------- -------------- --- --------..................._.......-------------�.--.............................—... ....... ----- -- -- ------------------------------ `� QDate Permit No. ....... +.... J Issued ........ ---- - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C e rtif rate of Compliance THIS IY'T0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired _..�....� S ---------------------------------------------------------------------------------------- by ................... -- --------------- , at .. .._y........0 ---- ... ------ has been installed in t provisions ToLE 5 of The State En-vironmental Code as described in he application ionforDisPosalWorksCon on PermitN dated --------..... ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIONSATISFACTORY. DATE _.----�......... - ...... - Inspector ------------------------------------------------------- ------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �` o No...Z5..`/O.�.' FEE........ .!.......•- Dtspant, Workii Taamitrurtiaan Vrrmit Permission is hereby granted. _ .................. ..'--------•-----------•---•--------------- to Construct ( ) or ,Repai (t-')n Individual Sewage Disposal�S stem 1� r C j "', 1,— .w.___V .....--J-"`.------�y4 5 =•---. .. Street f©a� a� as shown on the application for Disposal Works Construction Permit No------ ---------- Dated____...___.___._.__._l......._..�....... ^� ( ,1�....................•-----•------•• V Board of Health DATE----------------•••---•....................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS D. Town of Barnstable Regulatory Services ' Richard V. Scab,Interim Director i g Public Health Division 1 9. ° Thomas McKean, Director 200 Main Street,Hyaanis,MA 02601 Fax: 5o8-790-6304 Office: 508-862-4644 Installer & Desl er Certification Form f t`� 1Ma 1P arcel Date: � Sewage�ermft# aowffAssessor3sp - Designer: ���t..�J�•,wo �•+,. E_ r� C_ Installer: T 9 0 - 1t Address: t 2 w.as lol Address. �Le. Z4 32 On was issued a permit to install a (date) (installer) septic system at �b� M K( rased on a design drawn by (addrest) tt dated (designer; �L I certify that the septic system referenced above was installed substantially acw ordirg to the design, which may include minor approved changes such as _ateral relocation o= he distribution box and/or septic tank. Strip out (if _equired) was inspected and the soils were found satisfactory. 1 certify that the septic system referenced above was installed wirh 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 oy certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory _ I certify that the system referenced above was constructed in complia s ith the terms of the 11A approval letters (if applicable) ��+a PETER T. WENTLt staller's Signature) c(4�lt, � i ISO.35100 esigner's Signature) ix Designer's PLEASE RETURN TO BARNSTABLE PUBLIC ACTH DIVISION. CERTIFICATE b1j T CARD ARE PCECEI YED BY TT� BARI�STABLE UBL C REALTR DDNiSXON, TTIAi X YOU, Q-!Scptic\Dcsigner Ccitifieation Form Re7v 8-14-13,doc TQ �o d tr.',� 1-1 1 � e, P;# Deparent�of:Regulttitoty r�ervices sIy11 ZL 1 9 200 Mam 3trCet,Iiyannis MA 02601 "Date Scheduled / c mime Fee Pd (GS,CO� dam` N Soil Suiabty Assessment for Sewa e Dzsposal Performed;By /� / / 'C` .e�¢{v' Witnessed By: LOCATION&:GENERAL-INFORMATN Location Address' pIO Owner's Name �C7 ce.,,,2 0JkQ v.. C C9^ /3a is 9 J Adders z e.�.F c�►��I k, 1q O.Z63 Assessor's Map/Parcel:, .y: _ Engineer's Name Cl =, NEW CONSTRUCTION • REPAIR Telephone# ' SQ " 7 3 -5/?:..(¢.. " Land Use O ` ) S.lopes O V J Surface Stones Distances from: Open Water Body w / ft Po Bible.Wet Area"ft Drinking Water Well L:-/, ft Drainage Way / ft Property Line -�_�ft .-Other SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests;locate wetlands fn proximity to holes) ^s _ (:PC Parent material(geologic) Depth to Bedrock n' n •�,r.....� Depth to Groundwater. Standing Water in Hole:_ �r Weeping t9om Pit FAee /�-- ° Estimated Seasonal High Groundwater �/"( 3 Z t ., a DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: __..Depth Obsewed-standing inobi hole: — id, Depth to soil mottles itf Depth to weeping from side of obs.hole: " in, t3roundwater:AdJustment th.'" Index Well.# Reading Date. index Well level Act;thctor. drnutidwatetLevel,,,,e PERCOLATION TEST Dote�, Time Observation Hole# _— Time at 9" Depth of-Pere . 'A 2� A T1ment6" Start Pre-soak Time® L Time(g"•6") _ _lj'r► End Pre-soak Rate Min6lnch Site Suitability Assessment: Site Passed p�_ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on.Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning, Q:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE'LOG Hole# 1 Depth from Soil Horizon Soil TCxwre Shcl Color Soil: Other 'Suiface'(in.)' (USDA) (Munsell) Mottling (Structure,Stoues;.Boulders:. veft- U 2 � 3T2 �5 DEEP OBSERVATION HOLE`I,OG Hole# - ?i Depth from Soil Horizon Soil Texture SOII"COIOr Soil Other Surface^^(in.) (USDA) (Munsell), Mottling (Structure,Stones,Boulders. DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. m.. I - _ DEEP OBSERVATION HE LOG Hole# OL Depthfrom . Soil Horizon. Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Struewre,:Stones,Boulders. Consistency.wailnil— Flaod Instarance Rate Man: Above S00 year flood boundary' No;_ Yes.; ... _ . Within S00:_year'boundary No Yes.... - Within too year flood boundary No mzYes De0th of Naturally Occurnne Pervious Materl$1 Does ataetist four firet:of naturally>occurring pervious material:exist in all.arees;`dbserved throughout the;area proposed for the soil absorption system? ...._ If not,'wiiaE is the depth of`naturally occurring per maCoriai Certi£i_. cation I certify that on (date)I have passed the sotl evaluator examtnatton approved by the Departme�?tof Environmental Prot�etlon and that the above analysts was performed by me consistent vrtth . ru, k . the retjutred training,t;xperttse an, experience described in10 CMR 15017. ' Day a 17 /-z Srgnature , . . t . f ... r�N Q�S:13p'1'IC►PBRCFORIVt DOC' a 'F x' By jw £ ?� `� L— lot S L lilt, y ► a ' �) ^ G � CAD '� y v �x��� ��� 3�s�,M�� a_=—� f c��- i /�/ i � 7 v N 4 -- ,._�-ma's= i TOWN OF BARNSTABLE LO%'--JTION 1�94 w. TT uj EWAGE # VILLAGE ga(Z6&,)S Al l 1,s ASSESSOR'S MAP & LOT O`A9 6 INSTALLER'S NAME & PHONE NO. i SEPTIC TANK CAPACITY LEACHING FACILITYAtype) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER (--jn l &'Lk7 -4 fz f-W 2Qfji to t DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes No I n , MI, I►q J 9 Z l�lduS E SrLeT c. i b C!�m TT W+4 - ——102—— EXISTING CONTOUR Old Falmouth Rd y x 100.98 EXISTING SPOT GRADE N G EXISTING GAS SERVICE .H.-W.—OVERHEAD WIRES W EXISTING WATER SERVICE TEST PIT ass c BENCHMARK ° z ^o, 0 ° LEGEND w� Comme}t Ln Locus 9�00 40�e//s p°� Cammett WY 2 <o �. Ma. St LOCUS MAP —y NOT TO SCALE N 36*32:43" E 0,33 + 125.00' 101.01 + 8 - 100.99 J x 100.02 0 `1, �O 100.03 / 01,03 + (` SWIMMING x1199,87 POOL x 00.53 � 1 1 100.9 + 100.36 101.00 1 (LOT 72) ��,, ,,� 1 0.7 ( 9931 APN 099-047 101.03 SHED I 20,000 S.F.t 100.66 1 0, 100.26 X i 100.47 x x � 100.52 PA TIO DECK i z / z 0,68 CI � 100,10�' ^j 0 100.48 x m rno N o J _ _. 100,12 - --�T - - ' x /EXIST/ G GARAGE �- - HOUSE (#2) ' x 99.921 TOF=101.13' x 1 100,51 100,210./ 100.381:.:. ?00,2 x 100.10 EXIS77NG SEPTIC TANK (TO REMAIN) x 100.57 - TOP OF TANK, EL.=98.62 . .r' 0 x 100.47 INV.(OUT)=97.29E 50' 1 p 10 0,19 " EXISTING LEACH PIT I D +N 6. TO BE PUMPED & FILLED W/SAND AND ABANDONED 1 TP-h9. •mt 00 100.24 —-� TP-2 r o 100 — 125.00' 9933, x 00,4 WS❑ ----N 36'32' 8--- HYDRANT L. P_-------- 99.44 Edge of Pavement 99,84 PK SET 100,00 100.00 CIA �/�� E T T �/j A Y Benchmark Set v, I y I I r MAGNETIC NAIL SET L 0100 EL.=100.00 (Assumed) �P��� OF Mgssq�ti PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN. . McE N 164 CAMMM WAY, MARSTONS MILLS, MA OWNER OF RECORD CIVIL\AL BROWN, JEAN C No. 35109 Prepared for: John Zapalla, P.O. Box 921, Centerville, MA 02632, P.O. BOX 921 °y RE6/SZE`��� �� Engineering by: SCALE DRAWN JOB. NO. CENTERVILLE, MA 02632 FS Engineering Works, Inc. 1"=20' P.T.M. 241-12 %ZAPPALA, JOHN 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.1 �' (508) 477-5313 9/23/12 P.T.M. 1 Of 2 4„r 3 " NOTE: TO PREVENT BREAKOUT, THE PROPOSED * FINISH GRADE SHALL NOT BE < EL..97.4 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F. COVER SET TO 6" OF GRADE OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & WATERTIGHT SET TO 3' OF F.G. TO SERVE AS INSPECTION PORT EXISTING F.G. EL.=100.7(MAX.) F.G. EL.=100.5t F.G. EL.=100.4f MAINTAIN 2% GRADE (MIN.) / . OVER S.A.S. L = 10' L=5' 2" LAYER OF 1/8" TO 1/2" ® S=1% (MIN.) ® S=1% (MIN.) DOUBLE WASHED STONE 4"SCH40 PVC 4"SCH40 PVC (OR APPROVED FILTER FABRIC) ris" 10"I " 6 aaaeaaa WOOMMOM EXISTING 48" LIQUID aaaaaaa --3/4" TO 1-1/2" DOUBLE LEVEL WASHED STONE ADD INV.=97.17 _PROPOSED INV.=97.00 4' 5.2' 4' GAS BAFFLE INV.=97.29t D-BOX - EFFECTIVE WIDTH = 13.2' EXISTING INV.=96.90 ELtEXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP CONIC. ELEV.=97.7 NOTES: BREAKOUT ELEV.=97.40 Iff 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=96.90 aaaa INVERTS, PRIOR TO INSTALLATION. ease eases 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=95.90 GRADE ON A MECHANICALLY COMPACTED SIX 4' 2 X 8.5'=17.0' 4' INCH CRUSHED STONE BASE, AS SPECIFIED 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' IN 310 CMR 15.221(2). PERVIOUS MATERIAL 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' (MIN.) ABOVE G.W. I 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO G.W., EL.=89.5 4 AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. LEACHING SYSTEM SECTION SEPTIC SYSTEM PROFILE • N.T.S. GENERAL NOTES: SOIL LOG 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. DATE: SEPTEMBER 17, 2012 (REF 13,740) .2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL EVALUATOR: PETER McENTEE �SE#1542) OF THE STATE ENVIRONMENTAL CODE, TITLE V,- AND ANY APPLICABLE WITNESS: DONALD DESMARAIS RS HEALTH AGENT LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 100.5 A 0 100.5 A 0" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LOAMY SAND LOAMY qSANDFROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 1000 10YR 4/2 6" 100.0 10YR ENGINEER BEFORE CONSTRUCTION CONTINUES. B.5. ALL ELEVATIONS BASED ON ASSUMED DATUM. LOAMY SAND LOAMY 6..THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10YR 5/4 10YR 5/4 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 97.5 C1 36 97•5 C1 36" HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. PERC 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. LOAMY SAND 42"/54" LOAMY SAND 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 10YR 6/4 10YR 6/4 ,9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 94.0 2 66" 94•0 C2 66" AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY MED. SAND MED. SAND THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 2.5Y 6/4 2.5Y 6/4 CONSTRUCTION. 89.5 132" 89.5 132" 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS PERC RATE <2 MIN/IN. ("C1&C2" HORIZONS) IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND NO GROUNDWATER ENCOUNTERED REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL - 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND ®®®® ®®® IS NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 0 14. THE CONTRACTOR SHALL BE RESPONSIBLE FOR OBTAINING A TRENCH ERI ®®®®®®®®®® 3 33" PERMIT FROM THE LOCAL MUNICIPALITY IN WHICH THE WORK IS BEING d w ®® PERFORMED. N z ®�U 15. THE ENGINEER 1S NOT RESPONSIBLE FOR ANY UNDOCUMENTED OR _ UNPERMITTED SEPTIC SYSTEM COMPONENTS THAT MAY EXIST ON THE PROPERTY. 102" , 16. CONTRACTOR SHALL VERIFY THAT ALL SEWAGE EXITING THE HOUSE IS CONNECTED TO THE PROPOSED SEPTIC SYSTEM. DESIGN CRITERIA 4" KNOCKOUT • 20" DIA. COVER NUMBER OF BEDROOMS: 3 BEDROOMS 0 SOIL TEXTURAL CLASS: CLASS 1 4" KNOCKOUT 4" KNOCKOUT 62" DESIGN PERCOLATION RATE: <2 MIN/IN DAILY FLOW: 330 GPD 4" KNOCKOUT DESIGN FLOW: 330 GPD GARBAGE GRINDER: NO 500 GALLON CAPACITY, H-10 LOADING LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF CHAMBERS .74 GPD/SF EXISTING SEPTIC TANK: 1000 GALLON CAPACITY, H-10 RATED N.LS. PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 2-500 GALLON LEACHING CHAMBERS IN SERIES SURROUNDED BY DOUBLE WASHED STONE-ALL SIDES 164 CAMMM WAY, MARSTONS MILLS, MA SIDEWALL AREA: 2(13.2' + 25.0') X 2 = 152.8 S.F. Prepared for: John Zapalla, P.O. Box 921, Centerville, MA 02632 BOTTOM AREA: 13.2' x 25.0' = 330.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:..............................................................482.8 S.F. Engineering Works, Inc. N.T.S. P.T.M. 241-12 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.' DESIGN FLOW PROVIDED: 0.74(482.8) = 357.3 G.P.D. (508) 477-5313 9/23/12 P.T.M. 2 of- 2