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HomeMy WebLinkAbout0071 DEER HOLLOW ROAD - Health 1 Deer Hollow Road Marstons Mills A = 030 - 054 J Town of Barnstable P# 13 qq l of IKE Tpr,- o Department of Regulatory Services h� �. snuvsrnsre, : Public Health Division Date �. $ 1639. �� 200 Main Street,Hyannis MA 02601 ATEp�,t a Date Scheduled SLL /I13 Time �y Fee Pd. /0-e Soil Suitability Assessment for Sewage r 'sposal 0 J t Performed By: 1i✓�-C� Witnessed By: o l Lo �7 CATION & GENE INFORMATION _ ` Location Address / /1 e ell�� Owner's Name (v'`� M I f Address Assessor's Map/Parcel: 130 5 / Engineer's Name �(J W e NEW CONSTRUCTION REPAIR Telephone# (sa&) c Land Use Slopes(%) Surface Stones -�` Distances from: Open Water Body Nft Possible Wet Area N/ ft Drinking Water Well ft Drainage Way It Property Line 70 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&per tests,locate wetlands in proximity to holes) -4 z y C) NO �o N� Pic le—, Parent material(geologic) / (� Depth to Bedrock �3V c7 /V Depth to Groundwater: Standing Water in Hole: 7 C_ Weeping from Pit Face Estimated Seasonal High Groundwater No n/e( DETERMINATION FOR SEASONAL HIGH WATER TABLE ` Method Used: Depth Observed standing mobs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION'TEST_ Date Time Observation Hole# Time at 9" Depth of Perc Ali Time at 6" Start Pre-soak Time @ /0J D 0 Time(9"-6") .4;End Pre-soak o,,d, Rate Min./Inch Site Suitability Assessment:' Site Passed 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:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil ther Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency-%Gravel) L Af-S/� DEEP.OBSERVATION HOL E I:OG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell)' Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG - Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel)m DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) I Flood Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No— Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurrine 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? l If not,what is the depth of naturally occurring pervious material? Certification I certify that onig (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,experti a and experience described in 310 CMR 15.017. Signature Date .0 Q:\SEPTIC\PERCFORM.DOC TOWN OF BA,-R�NSTABLE LOCATION "j'i !`'L-1� t� C SEWAGE# i t '� -- VILLAGE S�,IkI ILL kSSESSOR'S MAP.&/PARCEL � INSTALLER'S NAME&PHONE NO. 31C�t_c+' SEPTIC TANK CAPACITY IS^G�J E.At L�•/� LEACHING FACILITY:(type) o aa�.t�-t.t�h4--- (size) qO X JO XJ- ��+ NO.OF BEDROOMS . 3 "`��— JZ- OWNER E 6-tZt`e 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) ;ae Feet ta, Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) K Feet FURNISHED BY JDfsrr J : h irfr�7-P l / yy� yd' 0 No. —2� � s • _ Fee vd THE COMMONWEALTH OF MASSACHUSETTS Entered in co puter: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair w Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. ^ fiD`IcW AO Owner Name,Address,and Te.No.'S'v$'V2$- q61 r�iarst-ons Mitts y mo=rris Assessor's Map/Pazcel,� �j Installer's/Name,Address,and Tel.No. 9 Dce�signer's Name,Address,and Tel.No. 60,4 S O Z O Type of Building: gg Dwelling No.of Bedrooms 41 Lot Size J 0/1 �sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) qqo gpd Design flow provided gi1TB' gpd Plan Date may ld, a�lR.2 Number off sheets Revision Date Titles� ]'1`t�ne Size of Septic Tank Type of S.A.S. };;ejj Description of Soil .5-20 '�ly Nature of Repairs or Alterations(Answer when applicable) &U3b 1-6-06 9,2 910 /D x ' r t 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 Enviro ode and to place the system in operation until a Certificate of Compliance has been issued by this Board of Signed - Date �o/i___1_ Application Approved by Date Application Disapproved by Date for the following reasons Permit No. L 2 �— Date Issued j I`10. 0�/ err Z Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in co pater: PUBLIC HEALTH DIVISION =TOWN ORBARNSTABLE, MASSACHUSETTS es 4plicatlon for Misposal 6psteln Collstrntt1011 ernlit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 01 Z—Aaex- 140116�0 Owner's§Name,Address,and Tel.No. 5,019-q11 g- q5'1-1 9 A /Parcel ��1Lc�5ionS rl�li ll$ Aa4 Mort-;S. Ma P ,� S MC�f_ �o 1 GaCa4�res t Installer's Name,Address,and Tel.No. -'�7�•- + Designer's Name,Address,and Tel.No. & 3�a-- 13ortrv( �-� Gaon �nx-+%vin,s.,••c .t�Ucur7�� c, i f•�y�¢•%? st- S x a 9 ] ZIA e a o26 _— Type of Building: - Dwelling No.of Bedrooms Lot Size �� 5�-'sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures _ Design Flow(min.required) q q V gpd Design flow provided gpd q Plan Date ?a y /U• apr Number of sheets Revision Date - t s Title—j4p_, 7'l o W "AA '7l fd AQ1 Ver Aq). /lynt(S od a Size of Septic Tank (56jjg4Q Mo Type of S.A.S. 1 ;eO 3- GCc,,mQ 1410< �,wLg�1} Description of Soil � na X69 Nature of Repairs orAlterations(Answer when applicable) Date last inspected: /,.Agreement: r 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 I. - ve, Compli- .Yk. ance has been issued by this Board of Health. Signed Date G a-I/,.3 j Application Approved by / _ Date Application Disapproved by Date I for the following reasons i f Permit No. ) a ( - .2 �— Date Issued ✓ / ------------------------------ --------------------------- - C THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY.�thaat the On-site Sewage Disposal system Constructed( ) Repaired(v,) Upgraded( ) Abandoned( )by it �OG/.0 LG t�i+(�J�1Mn. L,'J C- at 91 Age&c ,�16u) y,"ad;1Is has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. )00�)•dated b= Installer l.� � l' r C ,t ,,..��,cl i� '�� .�� Designer f ' �%, 7T #bedrooms 'y Approved design flow J gpd f O I The issuance of this ermit sh 1 not be construed as a guarantee that the system 11 ,ction as Date Inspector - - - - - - - - -- - - - -- - - ---------- ------------------ No. ° ( � - Fee �W ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposa[ 6pstent Construction i9ermit Permission is hereby grante to Construct( ) Repair,(,/) Upgrade( ) Abandon( ) System located at �� ,� f,�i� /i `VrGC �'S ki'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 permit. (F c 1 Date / / Approved by `!!!i /> t � 1 r - i FROM :clown cape engineering inc FAX NO. :15083629880 Jul. 19 2013 09: 18AN P1 I'MOH MARK- TOP Of BRICK \ s AT aaoiCRM PAD. EL -30' ` PAVED LOT 89 ARIti� 39,7581 S.F. INS PIE QM \ -✓ No J DRIVE ` J + CRA BLAB W ' , SLAB r � FULL RASL q n. 1 8 /bs 84 81 60 an 79 RE-=ATM AND 9LMVFn WATE91LW 78: MILUpelIff Aj/ JOB ##1 3-076 AS S . BUILT SEPTIC SYSTEM PLAN. PREPARED FOR: LOCATION : 71 DEER HOLLOW RD., MARSTONS MILLS BORTOLOTTI CONST./ SCALE : 1" _ 30" DATE : JULY 18, 2013 MORRIS ,y;yy�r�iN OF JNgs �vl OF M off, 508-362-45g1 Sta% 9n� ���� SpC`f DANK fox 506-362-9880 UAN041.A. ,p t, A. OJALA 'A down Cope engineering, inn. " OJA CIVIL N0,40980 CIVIL ENGINEERS LAND SURVEYORS 939 main st. yarmwth, ma 02675 DATE DARNEL A. OJALA P.L.S., P.E. FROM :down cape engineering inc FAX NO. : 15083629880 Jul. 19 2013 09:19AN P2 t -1('P;7i 3 N�`�tt r li[(,-: -f nn11��rr ��f,,�T1 tit c �tI T n, it i�. ,� '�,�teZep•u� 1 �>rcetDr StPS�Ntian.LLE, MASS_ Public _�l[e21tth DIl-lsioi�. : Faas�ai�,y' 1'$noiznz, J �r +:r�im, ll�iuc+en:t�rn�- 0,0 Moln Xree4:,:l lyTaumm is,MAe 01601 Uffi�e: {0&-86'J1 44 Fax: ?()2-`)90-6`104 t<�s Ile A•hiiir tiOM FUDML ),)Late: ! F -- �9u�aTaa�a'1[°e;riv.1 0- A-01.3 vj v� l G/1 r � Yea �i��+aea: + 1 C1 1VinsTt��O.�a o: 6 -D ti0 K Address: �.....-- f� , 1 � r Can. :�a �(J/ � �' �'� :,is:iClEC� fl ��]Tfll't t(1 i7.15t��11 2 (date) tii^taller �j I 'sPPfic�ystcrsa at f 1 _ L�t'r Ho ! 0 u1 XOcce-� based inn a, ciesip drawn.by (adHTe^s) l , /� is dated t.df— �r 1 c.c—it.fy 'Lat fhB ;;ej)tic sys"V m.tef-et'e1►cec? abow was imsLally.d sl2b5t rivally tir:rordiii.F lv flee design, which mg-.y Include. 11'11I.lor qli'proved changes Sllcl1, as hifc.:rs1 relocation of the di s hzb i.1iio:n.hox alullox septic',aDI T. a.rtify thaL Lhc'. sajTtic sysb::iu :uefes.viced abuvc: was iostallud. viidfh ruj r uliang?s (i-e, — F' eatc-r than. 10' 121e-ra.1 Teloc adon of the SAS or any 1>crticaf 3-elun-.t1•dm of arty core poriPnTt of the !;epti('. Symiu) but in accordance witIl;State r Local Remilati.ons- Flan revi-simi of certifin' d.a';-built gncr to fbao-w- - OF MAS UANl6LA. yG;, o O,lAIJ1 C. `' CIVIL `^ No.416SO26 Lr /ONAL EN (M�l;Y1�t1F:r u 1 1'fcttl�rP. (AHr.—Dj�,,aigi7cr's :Stamp He.TE:') G13 li y_, F�i �e TH Fi1d '�:9 }31�J$L�J 1.P1.�� P VJl31i,4��' . D" :.,;._.... --i a u—i, S�Tk3: —4' .`3 k�(D1r�I 1.1 �J!� 1'���T C',�41r�1i1, A a_PD1�7ik'yJA,.Pj4_'.A; �lu_I�To t _._^ 3AIc!:6.D c.! ]C]ECE +3J hS d 4 l�'A B.AF�;N`1➢'AIJLIGh°�Tlf�lf,1�_AflaF '1fI][1�1�fJli,: 151iCt4F --�l6K 6K t3 J'1 ------------- " .7! 7), TOWN/OF BARNS A LE LOCATION SEWAGE # VILLAGE �S�p►v Mi 4I� . ASSESSOR'S MAP & LOT© SYS a INSTALLER'S NAME & PHONE NO, n r SEPTIC TANK CAPACITY 7 LEACHING FACILITY:(type) 4.each,. ` f" (size) NO. OF BEDROOMS ,� PRIVATE WELL OR PUBLIC WATER C� BUILDER OR OWNER ®e�G�� �.1 �h 6.. DATE PERMIT ISSUED: 70. DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Aes4--r V p • Ac" cessfolDl wrov vz"w*, X97 , • fit ' 7/ wN°roF BARNSTABLL LOCATION_ �'� ' SEWAGE IF90. <f7 �pp VILLAGElI" D ASSESSOR'S MAP & LOTOSO -03�. INSTALLER'S NAME & PHONE NO-QX[L a SEPTIC TANK CAPACITY t G LEACHING FACILITY:(type) l,eQc�,. , i (size) ��7 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER_ pNa, , o N OA�V DATE PERMIT ISSUED: —Are 70 A DATE COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No i i RCS�r v� M0. N � �` �SpcK3I L ASSESSORS MAP NO. �}} G PARCEL N0: No.._,1f1.1 ... - Fx THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 4 TO OF BARNSTABLE c�6 �Nvorati anlI* i Vnstt1 Works Tanstrnr#inn rrrmit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Systemat.. .�..._.. ............ ......................... ... ........................................ ation-Addres `� `or Lot \ nor-, v� r I Address Installer Address Type of Building Size Lot........:...................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building .............. No. of persons-----__---------..__-_______ Showers — Cafeteria 04 Other fixtures -------------------------....................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 • 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 arm.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �-4 Percolation Test Results Performed by.......................................................................... Date----------------------------------- aTest Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' --------•---•------------------------------•-----------------------------------•-------------------•--------------•-•---------------- 0 Description of Soil..........._ x ------------------ - - .----------------•----.....---...-------- ----- ----------•-- - ---•-- ---..._...---- U .. . -•------------------------------------------------------------•------..............................................................--. ------ T ....-----•............ U Nature of Repairs or Alterations—Answer w �p livable_________ .__..._____ .l...................N_esti.a-_--_.----___. �.. �.a g �-�-�-•................ t-------•----------------......----------------• ------------------------......._........••............ 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 Co is ce has been issue by the board of h alth. / c� Signed ---�rl/� ----- --------- -C --------- ... Date Application Approved By .................. --- n+?�q --------------------- ------ - ................................................ Date Application Disapproved for the following reasons: ----------------------------------------- --------------------------------------------------. .............................. - ---------------------------------------------------------------..._...---...------------------------------------ ---------------............. .... .........................-------------- , Dte 14 ..7--------------- ---- Issued ------------------------------------------....---------. .--.Permit No. I Date =- 020 THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH TOWN OF BARNSTABLE op,fir ttau for Djspusttl Works Tnnstrnrtinn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair t( an Individual Sewage Disposal System at:................_..... . ��� :'r ... ,�::�����............ .................. ..... -----------....•...-..........----------• ,-- ation-Add or Lot No.} Owner aa _ Address (_•��� � ..\ LJ v�kV C� o! S_...__n'1 Ct.i?�_ L(1,{ Q S VI. C ------. - •---•------------- --•- -----.... --.. ..---•--. --- � Installer Address d Type of Building Size Lot----------------------------Sq. feet V Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( ) J, Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ---------------------------•-••• . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) - �" Percolation Test Results Performed by•-•-------------•---••-•--•........----••------•-----........----•••---- Date-----.....- ---------------------------- a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water--___---___-________---. f3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .-- ODescription of Soil........... ^ ►�j -•...................•-----•----------------------------------------------------------------------------------•-•----_-•... U -•..._..•••••-•---••-•••-••--•--••-•••-...•--••---------...--------- — .=--•-------------••.._._......-•-••---------•----------•----•--•------•-•-•---....----•--•--•---..............•---•----- W ....1 -� UNature of Repairs or Alterations—Answer whe ap licable_........`�T_�?_. ................... -. `-. . .:..-----•-------------------- ------------------------------------------------------------------------.. ----------------------------------------- ......�_a••-•-•-••••. =--•-•-- Agreement: _ J 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 Com iannce has been issued \by,the board of*health. ' / q Signed(`��/�- o ..- - `Cl-( 1� .. '7�..'"c9......./- ' Date Application Approved By - ^. J ----------------�.,,,�NJ----- - /-� . Application Disapproved for the following reasons: -------------------------------------------------------...------------------------------------------...--------------------------------- --------------------------------------------------------- ------------------- ------------------------------------------------ --------------------------------------------------------------------- ---------------------------------------- ..............--'-'--.. ................-----.........--......—......—.......Date......Permit No. ......... /1... /.?..� Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�ex ttfirate of Compliance � Ty al IS TO CE TIFY, That the Individual --wage Disposal System constructed ( ) or Repaired �--- t by--------- ..cam--v- �.... , ..w--....---.....�..�...--S.k_st.. 1 Installer at ..... Ll�..�9�?--h---------_ C�� v.,-q,�, .. ....... .. . � ---------- ------- -------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...... ..—..,/.9,?--.... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTITIIOON SATISFACTORY. DATE----------�..---�----" --^......---�............................ -------------- Inspec r...:.,..,���� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No...•5 -- �.7 TOWN OF BARNSTABLE FEE.. !... Disposal)Works 0unstrurt�io�n Y rutit Permission is hereby granted------- ---- -- ... .?..........._..... S'.. .................� �. ��s>.._._---•_-........................ to Construct ( ) or Repair (l.-)anIr 'victual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No..,?4._1,97.. Dated....._ ............................... . --------•-----------------------------•---••-.. DATE...................................................................••-_....:-•• •/Board of Health FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) A- DATA v >�; r � 3 ._� - - �17P Tale Sties P Oox��1 - De�sartnten�o� - - - ._ _ - Teaticket-NIA 0253C� _ 1ll�Il_@i1to �r�tdiet S08 564-68-1� _ — _ SUBSURFACE SEWAGE ptSPOSAL SYSTEM INSPECTION FORME C�EftTIFICATION OAT: ` -Property Address: 15 Wood Dua Rd.Marston Mills- Address of Owner: Date of Inspection:10l10f96 (If different) Name of Inspector:'John Graci Donahue:13ox 702 Marston Mills -- i Company Name,Address and Telephone Number:` " CERTIFICATION STATEMENT I'certify-that-'I have - —"nally'inspected the sewage disposal system-,at:this;address:and.that the mformation 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 _ Conditionally Passes Needs Further Evaluation.By.the Local Approving Authority Fails . Inspector's Signature: �l Date: 1011o196 The System Inspector shall submit a copy of this inspection report to the Approving Authority.within thirty(30)days of completing this nspections. 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. INSPECTION SUMMARY: Check A, B,C, or D: A] SYSTEM PASSES: X' I have not found any information which indicates that the system violates any of:the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.- B].SYSTEM CONDITIONALLY PASSES:. One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection Indicate yes, no,or not determined(Y, N, or NO). Describe basis of determination in all instances. If "not determined", explain why not.) _ The septic tank is metal, 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 conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500: • -_:_"S.lJBSURFACESEWAGE DISPOSAL SYSTEM INSPECTION:FORM x r r .....,,.,.... r - - - _ - - _ Property Address 35Wood DuckR&Marston Mllts; awller _ oonafiue Box:702 MarstorrMllls- -= 196 x9pH0 - - _ - ='s du�to _ TrT -tiro keRprpets)are-replaeed ig Ve distribution'box is leveled`o replaced __- ~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 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 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 a surface water Cesspool.or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. OF HEALTHSUPPLIER, IF APPROPRIAT ER Z) SYSTEM WILL FAIL UNLESS THE ONINGBOARD A MANNER T;HATDPROTECT THPUBLICT A E PUBLIC HEALTH AND SAFETY AND THE.DETERMINES THAT THE SYSTEM IS FUNCTI ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a,surface water supply. The system has a septic tank and,soil absorption system and is within a Zone of a public water. supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ em and is Jess than IOO feet but 50 feet or more from a private The system has a septic tank and soil absorption syst analysis for coliform bacteria volatile organic compounds indicates that the well is water supply well, unless a well water ence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm• free from pollution for that facility and the pres 3) OTHER D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined 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. Backup of.sewage in facility or system component due to an 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 cesspool. SAS is in hydraulic failure. (revised 11115195).. 2 ..a..e,..�mr,=. �`.:sue —.�'—• •-.- --a... -sue+'°`.—"-.,�_""�' : � "�.�+-�_--'�` �--xr :� � -, Y SUBSURFACE SEWECGE-DtSPOSAIL:SYSTEM I�kSeE�TION FORM _ � - �. _-Pro6ertyAddress 35WoodDuck_Rd MamonMiils> _ Donahue-Box-702Marstort M1ils - _ _�""`�� D�S`fS EM FAILS(oor�iinue .. ; u. Staiicaiquidaevelinth`e:distributronbox"=above-outletiinvert"due_to an over _� _ _ Liquid depth m cesspool is less than;6"below invert or available°volume-is less than 1/2 day flow Required pumping more than A times in the last year MOT due_to clogged or obstructed,pipe(s).` Numbers:of times pumped _ Any portion of the Soil Absorption System, cesspool orprivy is below the high groundwater elevation.: Any portion of a 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 t of a public well _ Any portion of a.cesspool or PdVyr 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for y coliform bacteria,:volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: . 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: 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 _ rim Wellhead Protection Area(IWPA)or a mapped Zone ll of a the system is located in a nitrogen sensitive area(Inte public water.supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11115195) 3 - # TaT gUB3CtRFEkCE SEWAGE DtSPO ALS_YSTEM7N�PECUON FORM arm _ ���,..�'�-..` � - = b ', , ---r---°�� �•� '~ - - _. -Property Address 35-w odDuckAd MarstortMllls _ r _:OWnef-= - Dorfahue Box`G2MarstortMllis _- :� Check if the f'ollowmgrtave been-dane - _ _ X Pumping information was requested of the owner.occupant, and Board of Health r stem has been receiving normal ,. X. None of the system components have been pumped for.at least two weeks and the and the system flow rates during that period: Large volumes of water have not been introduced into the system recently or as part of this inspection. _ v been ob tained me d and examined. Note if they are not available with N/A x built plan hav e As b P _ X The facility,or dwelling was inspected for signs of.sewage.bacl. 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. S ystem on the site has been determined based on existing information or X The size and location of.the Soil Absorption approximated by non-intrusive methods: X The facility owner(and occupants, if different from owner)'were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/15195) GL p'-+" �s .� ,� 'n,..,x.-f'�- -..> �-''"".,�v 'w' ..� 'F �� •�:�,�"�-. r a .:✓",�`s•3��5-'�x'*s..•c,'�`.".�'�r�G_ ..vim .._.. .�,- •... .,_v..y.,.� ;-... :... -. , ... �, - _ .. .i.. "`.'"_"�- r- ..-.- , - � SUSS_ 0 FACE'SEWAGE DISPOSAL SYST.EVIANSPECTION FORM- _ - O odProperyAddrass 35WDuckRdMarst6n-NI iDnaue: ownsr x702MarstonMls r - f _ f a L Design fhrw--44o - _... NUmtier of:current:residents 'Z' - :Garbage grinder{:yes or no).;. No y -Laundry-connected-to:system(yes or no) Yes _ Seasonal.use(yes.or noj No - - Water meter readings, if available: nta Last date of occupancy: n1a : COMMERCIAL/INDUSTRIAL: Type of establishment: nta Design flow:0 gallons/day Grease trap present:(yes or no) Nn Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no)'No Water meter readings, if available: n1a Last date of occupancy: nta OTHER: (Describe)-nla Last date of occupancy: GENERAL INFORMATION , PUMPING RECORDS and source of information: System was last pumped on Oct 1995 System pumped as part of inspection: (yes or no)Yes If yes,volume pumped: 1200 gallons Reason for pumping: Main(enance.' TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: 1972:New pit installed in 1990. Sewage odors detected when arriving at the site: (yes or no) Yes (revised 11115195) T x- -.- _ � •Sk)-BSU�FAC�SEINAGE 6TSPOS/fiL SYSTEM INSPECTIOFI FORM' _ _ _f-reperty,Address 35 Wood DUCK Rd MarstonMllls Dortahue.Bo702 MarstonMllis x y _ (.oca a on si e_P an),z T Depfli below grade: M:aterial;.of-_construction_concreaie_metal�FR.P_other(explain) Dimensions:.Na Sludge depth:Na Distance from top of sludge to bottom of.outlet tee or baffle: Na Scum thickness:nla,. Distance from top of scum to top of'outlet tee or baffle.Na Distance form bottom of scum to bottom of outlet tee or baffle: 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.) Na GREASE TRAP: (locate on site plan) Depth below grade: n/a Material of construction: _concrete_metal_FRP_other(explain), Na Dimensions: Scum thickness:n/a Distance from top of scum to top of outlet tee or baffle:Na Distance from bottom of scum to bottom of outlet tee or baffle: n/a 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.) Na (revised 11115/95) 6 x� - 77z- '-��--- �_ �,-�.-- =-�U6.5llRF-�kC�SE11�4�E�I�POSAL.SYSTEMINSPECTtON FORM- 4. P1q ert Address 35Wo6dDuckRd MarstonMllls:� - �.--�. -=.=Dormhui.-EkiWimarstoaMills_: .. - t TTIGHT OR HOLDING TANI<i-'— - (locate on-si e plan): Depth below grade: We _ _ - Material-of construction:_concrete metal_FRP other(explain) Dimensions: nla Capacity: - We gallons_ Design flow: n1a gallons/day Alarm level: rda Comments: (condition of inlettee..condition of alarm and float swtches,.etc.)` Na- DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.) n1a PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) n1a (revised 11115195) 7 , ri ,- - _ T`-.._ � •.-s^^m _ mod- .- - —- - - �- -��-.�-�� ems,=• ��,._ r r T — - T 4 = properly Address�35:WaodOuekd 6narsfonMnls a _ -- - - - " '5ClttBSOftPflO#SSA€-Afl[SA��X_ - - r s of re.'uired but may.b_e approxlma e ` y non-mtrusrre ;�f not determined.to be present eitpialn _ _ _ `s_ _ � r � } Type - - leaching pits;number. 1_00o gallon leach ptt leaching chambers;number:_ELL leaching-galleries, number: n1a leaching trenches,number.length: n1a leaching fields, number, dimensions:n1a overflow cesspool,.number:6x8 block pit Comments:(note condition of soil. signs of hydraulic failure,level of ponding, ectionl Both are sgtructurall sound and ell functioning properly: Y The overflow cesspool was empty and the leach pit had 2112'of water at the time of the inspection. y CESSPOOLS:X (locate on site plan) Number and configuration: none Depth-top of liquid to inlet invert: 6' Depth of solids layer: 4 f r 0 Dept h o scum layer: Dimensions of cesspool: Materials of construction: block Indication of groundwater: none 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.) Main cesspool is structurally sound and functioning properly.Recommend pumping system every year for maintenance. PRIVY:_ (locate on site plan) . Dimensions: nla Materials of construction: n1a Depth of solids: n1a Comments:(note condition of soil, signs of hydraulic failure, level,of ponding; condition of vegetation, etc.) PrivyComments (revised 11115195) } 711 M R 'C t=. yy _ _ - �.w _ .._, ._. .. T _ :PART SYSTEM INFORMATION(continued) s; Date of=thspec-lon "!?0196 ...:�� r-benctimackst _ 1 . 1 DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts h11Ta�^T�. id1 111 W �,„�.-_ ��—...+..—.ems `'Cis _ :mho—.` v v i'+35.a'> �L ,is'yf• _ ui.--+.�' . — ALL SHALL TE SYSTEM PROFILE MARK DS WITHC MAGNETIC TTAPE OR BE NOTES PROVIDE MIN. 20" WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD ACCESS COVERS TO WITHIN 6" OF FIN. GRADE „ CONCRETE COVERS TO WITHIN 3" GRADE 2 PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS EXISTING FILTER FABRIC OVER STONE As me, s °I \ TOP FOUND. EL. 85.7' Sc ° EllMINIMUM SLOPE PER FOOT. MINIMUM .75' OF COVER OVER SOPE REQUIRED OVER SYSTEM780' - 790' 3. MINIMUM PIPE PITCH TO BE 1/8'PRECAST � BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST cu 3 RISERS (TPRECAST YP.jo PRECAST RISERS UNITS TO BE AASHO H-ZQ 3 2'rt 4"0SCH40 PVC MORTAR ALL "'er Rd COMPONENTS H-10 " 2 PROP. TEE PIPES LEVEL 1S 2' (}YP•) INV' . 75.2' 76, 5. PIPE JOINTS TO BE. MADE WATERTIGHT. a�Q *82.50' PROPOSED 14" °°°°°°° o o o 0 0 �0 o 70.. . FT 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE " 10" WITH 310 CMR 15.000 TITLE V. ^� 79.85 TEE 1500 SEPTIC TANKTEE ®��� ���� ®® -���� ( ) 79.60 >oo °o ®��0�����0® a �oaoaaoao a>°o°o°o°o �eononoono Long .. o 0 0 0 ° ° I�o®®�a�a®�� D o°000°o °GAS BAFFLE °09°°°°° Do Ond ° ° °° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 000 ° °°°o o _0 73.2' o 75.51 75.34 NOT TO BE USED FOR LOT LINE STAKING OR ANY o 09 a 6' MIN. SUMP OTHER PURPOSE. ::.. .. S ..:.:..:•:.:..•,• •• .• .... ,•..• 12" MIN. INT. DIM. •o"o"o"o"o"o"(.3°o°o°o°o°o°o° 'o"o"o"o"o"o"c H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. $, PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. �okeb o '°°o °o°° °O °°°O°O°'O°O°°O°°O000 o° 3 4"-1-1 2" DOUBLE WASHED STONE o a ° ° ° ° -° ° ° ° °- ° ° ° / / (3) UNITS REQUIRED y7ood OVERALL DIMENSIONS TO OUTSIDE OF STONE: 40' X 10' 9. COMPONENTS NOT TO BE BACKFILLED OR �Q w°keby Rood '* 6" CRUSHED STONE OR MECHANICAL COMPACTION. (15.221 [2]) CONCEALED WITHOUT INSPECTION BY BOARD OF EL. 81 .Ot 5.2' HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. SLOPE) ( 1 6% SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP CALLING DIGSAFE (1-888-344-7233) AND NOT TO SCALE 68.0' BOTTOM TH-2 VERIFYING THE LOCATION OF ALL UNDERGROUND & FOUNDATION 37' \ NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF LEACHING ASSESSORS MAP 30 PARCEL 54 SEPTIC TANK 25' D' BOX 16' FACILITY 11. ANY UNSUITABLE MATERIAL ENCOUNTERED FOUNDATION 36 SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL 12. EXISTING LEACHING FACILITIES SHALL BE PUMPED UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS AND REMOVED OR PUMPED AND FILLED WITH CLEAN PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM SAND. cp \ = SYSTEM DESIGN: c GARBAGE DISPOSER IS NOT ALLOWED O N \ DESIGN FLOW: 4 BEDROOMS @ 110 GPD = 440 GPD USE A 440 GPD DESIGN FLOW SEPTIC TANK: 440 GPD (2) = 880 BENCH MARK --TOP OF BRICK \ _.._ - _ _ m.. -_\ ..:._USE _-A':1500 GAL. SEPTIC TANK AT CONCRETE i'AD. EL. = 85.7' \ \ - 1 \ LEACHING: PAVED 1 1 SIDES: 2 (40 + 10) 2 (.74) = 148 GPD TEST HOLE LOGS DRIVE / BOTTOM 40 x 10 (.74) = 296 GPD RNE H. OJALA SE PLS 39,7058f S.F. INTO GOES ' J TOTAL: 600 S.F. 444 GPD ENGINEER: A 1 ' ' GROUND 1 GRAVEL WITNESS: DONNA MIORANDI, RS r 3' DRIVE I GAR. USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) DATE: 5/3/13 CRAWLSP \ SLAB WITH 2.25' STONE AT ENDS 5' BETWEEN UNITS AND 2.6' PERC. RATE _ < 2 MIN/INCH /� I AT SIDES CLASS I SOILS P# 13991 FULL SHED ^ / / BASE. ELEV. ELEV. p„ 79.5 78.0� 85 4 4 o� MA p„ _ 0�2 0/A 0/A �, ��� % APPROVED DATE BOARD OF HEALTH LS LS �S' /i' CHRISTMAS TREE 6» 10YR 4/2 6„ 10YR 4/2 g 70 � r g� `SAS) � • � / TITLE 5 SITE PLAN E E \8 ` g_ CP �� OF -79 Q' MS MS PROP. CLEAN-OUTS „ 1OYR 5/2 „ 1OYR 5/2 - 87 _• �� �o _ �S� 71 DEER HOLLOW ROAD 10 12 G �° 0 �� ���� / MARSTONS MILLS Bw Bw 06, 80 � / � LS LS s2' 80 J TH 1 I1\ID/ /OQ PREPARED FOR 10YR 5/8 10YR 5/8 30" 77.0 3p 75.5' WATERLINE MUST BE RE-ROUTED AND/OR SLEEVED ^� 7g ao �6 Q BORTOLOTTI CONSTRUCTION/ WHERE WITHIN 10' OF SEPTIC COMPONENTS/LINES. C C SLEEVE SEWER LINE FOR 10' EITHER SIDE OF CROSSING \ �� <0 �� O� MORRIS WITH WATERLINE �B TH 2 C' PERC MCS MCS AS PER 15.211(1)[11, BOTH LINES SHALL BE �� lr. 0 / MAY 10, 2013 CONSTRUCTED OF CLASS 150 PRESSURE PIPE AND SHLL ;' G BE PRESSURE-TESTD FOR WATERTIGHTNESS h / / .tea ��-�� � off 508-362-4541 2.5Y 6 6 2.5Y 6 6 � � / / fax 508-362-9880 120 69.5 120 68.0 a �� r �����' �c 'o E cy'` downcope.com y DAiJI-L WATER ENCOUNTERED ACTUAL WATERLINE , \ o L 0,!F.:_Ay NO GROUND LOCATION / �� OJA!A down cape e/lghdeer�/!8' �nc• (TO BE RE-LOCATED) / �l CIVIL 140.409100 o.4Gb02 F 1. C/V/l engineers �o ° SS;° z land surveyors Scale. 1 - 20 PROVIDE APPROX. 38' OF 40 MIL LINER \ 0 / T GIST EFi y AT 5' OFF SAS IN AREA SHOWN. TOP 939 Main Street ( R to 6A) AT EL. 76', BOTTOM AT EL. 72' DATE DANIELA �OJALA, P./E., P.L. YARMOUTHPORT MA 02675 3-0 7 c 0 0 20 30 40 50 FEET / i I