HomeMy WebLinkAbout0045 EBENEZER ROAD - Health 45 Ebenezer Road, Marstons Mills
A= 123 - 06`1
// TOWN OF BARNSTABLE
LGCATION Ad, SEWAGE # 29,W-2 77
UAGE ASSESSOR'S MAP & LOT r +E� 1
INSTALLER'S NAME&PHONE NO. . 0�"5/20 -l771� J,05 04
SEPTIC TANK CAPACITY 11600
LEACHING FACILITY: (type) _�—S OD //l���i�i/_—%j (size)
NO.OF BEDROOMS 2
BUILDER OR OWNER . EXAP-el AiOO
PERMTTDATE:•,/,27--o 7 COMPLIANCE DATE: 7—17-0 7
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching faci ky) Feet
Furnished by
so. �J
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TOWN
ppOFBARNSTABLE
LO'.'ATION 7S�n�k'�!'«/! Pit, Q-Qtd SEWAGE
W,LAGE ASSESSO 'S MAP& LOT OCa
NAME&PHONE NO. oZ�
SEPTIC TANK CAPACITY /OOO
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS ZL
BUILDER 0 OWNER
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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Town of Barnstable P#
aF�
Department of Regulatory Services
: .,,MM Public Health Division Date ?J y aJ7
t6 200 Main Street,Hyannis MA 02601 Ali]
A
!� ►
Date Scheduled Time Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed By: 12 �' Witnessed By: J*jCd'W ��✓1FR
LOCATION& GENERAL INFORMATION
Location Address LA 5- ig Owner's Name �1CA„may � p�
l �.��ZsG-r �1`�1 ` /
l Address
Assessor's Map/Parcel 2?j C O(� , Engineer's Name�� 1 � 0)
NEW CONSTRUCTION REPAIR Telephone#CS��� —5/3���
Land Use fz-S 1 6" Slopes(%) Surface Stones N��7
Distances from: Open Water Body ft Possible Wet.Area 7l t ft Drinking Water Well �ft
Drainage Way 7 ICY U ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes)
Parent material(geologic) 64Q�`a QUA-tn�u S Depth to Bedrock AVII i �1. �1—
Depth to Groundwater. Standing Water in Hole: /"! Weeping from Pit Face /"
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: _in. Depth to soil mottles:
Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level— Adj,iketor_ Adj.Groundwater Level,
PERCOLATION TEST Bate 'l hoe t(/o
Observation C
Hole# Time at 9"
Depth of Perc �Z/> I Time at V
Start Pre-soak Time @ Gf��� -7�i Time(9"-V) --- A
End Pre-soak
v-1' S`1 I O YtS ` mod,
Rate Min./Inch `7i G�►1�r1�i Vl L S M-n J-L�
Site Suitability Assessments 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
t least one 1 week prior to beginning.
Barnstable Conservation Division a O
Q:\SEPTIC\PERCFORM.DOC
_ I
DEEP.OBSERVATION HOLE LOG Hole# I
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, % ravel
�—CP 5L Z�.�7 3jZ
2 -1 M-><'So,,.-c( Z,.57Y l/
DEEP'OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture
Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure Stones Bould
ers.
Consisten Y.%Grav
^� A S Z&SY 3iz
-3 6-.13 f 3 C r1-�- S�,.-..� 2�S't (0 4
DEEP OBSERVATION HOLE LOG
Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Con iste c G ve
HE]
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency. 1
Flood Insurance Rate Man:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No-4 Yes .
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? Ye-S
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on 11 ;�� S (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 tr ' ing,expertise and experience described in 310 CMR 15.017.
Signature A - Date"
=
QASBPTIC�PERCFORM.DOC
1
No. l/� 7 —,2 `7 Fee D 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
0(ppYication for Migogaf *pgtem Construction Permit
Application for a Permit to Constructt( ) Repair(4)� Qpgrade( ) Abandon( ) ❑Complete System 0-IYf?c vidual Components
Location Address or Lot No.4Jr 16:hfG h e Z e�e- ® Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel �A- 3� w A 'S
"S y2®, 9 y�
Ins s-aller's Name,Address,and Tel.No. O - 738 Designer's Name,Address and Tel.No. J o9'4%��. 7�
wo'%y
1604115 AV
Type of Building: rN® 2 d C
Dwelling No.of Bedrooms j Lot Size o "1 A L1 eI sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 000 C Ih P, /S Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) " n ®O �p —Q O yG
&/ir' toklr vLi
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 ealth.
Signed Date
Application Approved by Date a
Application Disapproved by: Date
for the following reasons
Permit No. zoo-7 2 77 Date Issued
No. �0 / -77 - ��_ .t ..�;, d �} ss , t Fee
''( + Entered in computer: ✓
THE COMMONWEALTH OF MASSACHUSETTS Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIpprication for Mi5po!gal *pgtemc Con0truction Permit
rade Abandon �-
Application for a Permit to Construct O Repair(G�pg O O Complete System ❑Individual Components
Location Address or Lot No.4✓l` G G e#4 Z Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
as� y -
Installer's Name,Address,and Tel.No. ,f 4 z4- .77 .5~0 8 4/77 s3i Designer's Name,Address and Tel.No. 5r '
Jos-gP4 O--e 6qh-05
F/. d4,w^v eZJ X41 IN4A ')""I S' lWillf cll/ Cra S -i//Gs✓/c�r✓ �i'/esT�l, �� /1�llt,
Type of Building: 0 d L
n � (ALA q g i ( )
Dwelling No.of Bedrooms Lot Size s . ft. Garbage Grinder
Other Type of Building No.of Persons Showers YP g ( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ]. 6 gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank i�0� 1�„ p)f+s Type of S.A.S.
Description of Soil
r
Nature
``of Repairs or Alterations(Answer when applicable) '° 11 2-,5-0 p a-0/, - O
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 ealth.
Signed ,rY Date
Application Approved by Date (pla"7/0'7
Application Disapproved by: - Date
n
for the following reasons
Permit No. 20d 77 Date Issued
———————.———————— .w ——— —————— —— — ——— — — ——
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (4—). Upgraded (G-)_
Abandoned( )by tt5,- 4 P� L s+rt3 /
at y S" 4b ew e Z if e, R�OvCl has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. QV? -? 7 7 dated to .27 0 7.
Installer 'lWo4 Designer
#bedrooms Approved desigryflbIw gpd
The issuance of this perm i'hal not be ins ru as a guarantee that the system wil functio as designed. C e
Date / �� Inspector /A,)/ __� �� �°
--
No. Qv .ra-? / Fee 1 W
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Migog;al *p!5tem Congtruction Permit
4t I /
Permission is hereby granted to Construct ( ) Repair (4. ) Upgrade/(e--)" Abandon ( )
System located at �/.S" '6 1j.0y,e r- e-e nykrcl
i9jrr,_—y///i.
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Const cation must be completed within three years of the date of th perm t.
Date 1 Q Approved by - 12
f
Town of Barnstable
Regulatory Services
_s Thomas F.Geiler,Director
4 9. , '° Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer&Designer Certification Form
Date: r17 Sewage Permit# 2007-110'Y Assessor's MaP\Parcel ,Z 3 061
_
Designer: l;ny ,�o��er.�n lmul�i Installer: J0e)/'5 �J0-)',rC 6t-r1S+-r-,Jc4-ru,1
Address: 2 L`'a C►►�i s��r�j� f Address: i vm me 4 124
M;11S, MIS
02-6 Yg
On 2 (� o&Y s � t n j F was issued a permit to install a
(date) (installer)
septic system at V5 Abe C'2F��r(CIS : based on a design drawn by
(address)� /S� dated e/1 C d 7
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
Of the septic•system)but in accordance with State&Local Regulations. Plan.revision or
certified-as-builtby designer to follow.
OF M4,90
�staller's Signature Z PETER T•
McENTEE Cn
CIVIL
No.35109�Q �¢
ISTEP
vv ON AL LNG
(Designer's Signature) (Affix Des tamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION CERTIFICATE OF
COMPLIANCE WI L NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE.BARNSTABLE.PUBLIC HEALTH4MR71SION. THANK YOU,
Q:Health/SeptidDesigner Certification Form 3-26-04.doc
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Logged In As: Parcel ®eta I I Wednesday,June 27 2007
�0-1 7 Parcel Lookup
Parcellnfo
Parcel ID 123-061 DeveloLoot jLOT 38
Location 45 EBENEZER ROAD Pri Frontage 186
.... . .............. .... . ......... ......... .........
Sec Road = Sec;:
Frontage}
_.... _...._.- _ _ _...�.._
Village;MARSTONS MILLS Fire District'C-O-MM
Sewer Acct' Road Index!0475
Interactive "
Map g ;
Owner Info
-.... ....
owner'PINA, BARRY A Co-owner
Streetl 145 EBENEZER RD Street2,I
City'OSTERVILLE State 1MA zip!02655 µ Country USA
Land
Acres.0.47 use;Single Fam MDL-01 Zoning IRF Nghbd 0105
Topograp a ow Street Road !Paved
....... ........ ........
utilities Public Water,Gas,Septic Location
Construction Info
......... ... ... ......... _............_.............
Building I of I
___.___ .._ .�_ _ _-..... m _..._._n ..
Year 1981 Roof Gable/Hip Ext Wood Shingle
Built° Struct Wall? .
Effect Roof AC -
Area 1131 Cover Asph�F Gls/Cmp Type,
None
Int Bed
Style!Ranch Drywall 2 Bedrooms y
3_.. .. Wall=. Rooms °+S
Model Residential Int; a 1 Full + 1 H
Floor- Rooms -
Heat Total'
Grade;Average Air 1 Hot =5 Rooms
Type, Rooms
_..,.._ .,... _......... ........ 3 ... ... ...._.....
Heat Found-�
Stones j1 Story Fuel'Gas a ation Poured Conc.
µ Permit History_...._._. ,......__ m_...._....
IIIssue Date I Purpose I Permit# I Amount Insp Date Comments II
Visit History _. ._ ... ...........
Date Who Purpose
1/24/2007 12:00:00 AM Paul Talbot Cyclical Inspection
11/21/1998 12:00:00 AM Frederick Stepanis Meas/Listed
- Sales History
Line Sale Date Owner Book/Page Sale Price
1 7/30/2004 PINA, BARRY A 18881/149 $100
2 5/12/2004 PINA, JOHN ETAL 18578/164 $100
3 5/12/2004 PINA, JOHN &ADELINE 18578/162 $109,000
4 5/19/1997 PINA, JOHN &ADELINE 10755/215 $109,000
5 9/15/1992 PINA, BARRY A 8186/241 $92,000
6 6/15/1992 CAPE COD BANK& TRUST CO 8091/283 $80,000
7 10/15/1990 JAGMINAS PLUMBING & HEATING 7332/337 $90,000
8 8/15/1985 DACEY, WILLIAM E 111 TRS 4691/225 $1
9 GREENBRIER CORP THE 3291/94 $0
- Assessment History__...._____.__.__._...._,__..__ . _ � _. �_._._ . ... .. _....._ ..__......__�
Save# Year Building Value XF Value OB Value Land Value Total Parcel Value
1 2007 $118,100 $2,700 $0 $137,300 $258,100
2 2006 $105,300 $2,700 $0 $142,100 $250,100
3 2005 $100,300 $2,600 $0 $129,100 $232,000
4 2004 $81,400 $2,600 $0 $96,800 $180,800
5 2003 $73,400 $2,600 $0 $43,500 $119,500
6 2002 $73,400 $2,600 $0 $43,500 $119,500
7 2001 $73,400 $2,600 $0 $43,500 $119,500
8 2000 $58,000 $2,600 $0 $26,600 $87,200
9 1999 $56,000 $2,500 $0 $26,600 $85,100
10 1998 $59,500 $2,500 $0 $26,600 $88,600
11 1997 $63,000 $0 $0 $19,900 $82,900
12 1996 $63,000 $0 $0 $19,900 $82,900
13 1995 $63,000 $0 $0 $19,900 $82,900
14 1994 $63,300 $0 $0 $23,900 $87,200
15 1993 $63,300 $0 $0 $23,900 $87,200
16 1992 $72,000 $0 $0 $26,600 $98,600
17 1991 $70,900 $0 $0 $48,000 $118,900
18 1990 $70,900 $0 $0 $48,000 $118,900
19 1989 $70,900 $0 $0 $48,000 $118,900
20 1988 $52,900 $0 $0 $20,400 $73,300
21 1987 $52,900 $0 $0 $20,400 $73,300
22 1986 $52,900 $0 $0 $20,400 $73,300
Photos
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BORT®Li)TTI CONSTRUCTION, INC;. 40, `
765 WAKEBY ROAD,MARSTONS MILLS, ILIA 02648
508-771-9399 508-428-8926 FAX: 508-428 9399
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F
PART A
CERTIFICATION
Property Address:
Date of Inspection: Inspector's 1me: '
Owper's Name and Address: —
AV
CERTIFICATION TATEMENT•
I certify that I have personally inspected the sewage disposal system at this address and that the informa-
tion reported below is true, accurate and complete as of I.lie time of inspection. The inspection was per-
formed based on my training and experience in the proper function and maintenance of on-site sewage
disposal Vstenis. The System:
Passes
Conditionally Passes
Needs Further E aluation B the Local Aproving Authority
Fails
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving authority within thir-
ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional
office of the Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
A)SYST PASSES:
I have not found any informatioii which indicates that the system violates any of the failure
criteria as defined 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 comple-
tion of the replacement or repair, passes inspection.
Indicate yes,nor,or not determined(Y,N,OR ND). 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 inuninent. The systeni will pass inspection if the existing sep-
tic tank is replaced with a conforming Septic tank as approved by The Board of Health.
Sewage backkup or breakout or high static water level observed in the distribution box is due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The
system will pass inspection if(with approval of The Board of Health):
- 1 -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPFcT➢ON FORM
PART A
CERTIFICATION (continued)
Broken pipe(s)replaced
Obstruction is removed
Distribution Box is levelled or 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 II EALTH 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.
2)SYSTEM WILL FAIL, UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION-
ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 Feet to a surface
water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is with a Zone I 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.
The system has a septic tank and soil absorption system and is less than 100 Feet but 50
Feet or more from a private water supply well, unless a well water analysis for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from
the facility and-the presence of anunenia_nitrogen and ni(rate_nitrogen is equal to or less
than 5 ppm.
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 into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or ponding of efluent to the surface of the ground or surface waters due to an
overloaded or clogged SAS or cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clog-
ged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2
day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed
pipe(s). Number of times pumped
-2-
s h
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater
elevation.
Any portion of a cesspool or privy:.is within 100 Fect of a surface water supply or tributary to
a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 Feet of a private Avater 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 coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 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
The system is located in a nitrogen sensitive area Interim Wellhead Protection Area
(IWPA)or a mapped Zone 11 of a 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.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:
_Pumping information was requested of the owner, occupant, and Board of Health.
None of the system components have been pumped for atleast two weeks and the system has
been receiving normal flow rates during that period. Large volumes of water have not been
introduced into the system recently or as part of this inspection.
✓ As-built plans have been obtained and examined. Note if they are not available with N/A.
_ The facility or dwelling was inspected for signs of sewage back-up.
�LThe system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout. '
_jZ system components,excluding the Soil Absorption System, have been located on site.
v The septic tank manholes were uncovered,opened, and the interior of the septic tank was in-
spected for condition of baffles or tees, material of construction, dimensions,depth of liquid,
depth of sludge, depth of scum.
✓The size and location of the Soil Absorption System on the site has been determined based on
existing information or approximated by non-intrusive methods.
`-3-
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
v The facility owner(and occupants, if different from owner)were provided with information on
the proper maintenance of Subsurface Disposal System
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C .
SYSTEM INFORMATION
FLOW CONDITIONS
RESIDENTIAL-
Design Flow: 330 gallons Number of Bedrooms: 0 Numbcr of Currcnt Residents:_
Garbage Grinder:_ Laundry Connected To System: Seasonal Use: /iJd
Water Meter Readings, if�ay ailable:
Last Date of Occupancy:(!�.14J}A o,<�j�
COMMERCIAL/INDUSTRIAL
Type of Establishment:
Design Flow: gallons/day Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present:
Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings,If Available: Last Date of Occupancy:
OTHER: Describe)
Last Date of Occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:��G�i _�,L?/)l,J
System Pumped as part of inspection: <)6 if yes,volume pumped: gallons
Reason for pumping:
TYPE
.*OF SYSTEM:
Septic Tank/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System(If yes, attach previous inspection records, if any)
Other(explain):
APPROXIMATE AGE of all com onents,,date installed(if known)and source of information:
Sewage odors detect d when arriving allile site: ,Lard
-4-
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
GENERAL INFORMATION (continued)
SEPTIC TANK: �
Depth below grade: �` Material of Construction: �/concrete metal FRP Other
(explain)
Dimisions:_ Sludge Depth: Scum Thickness:
Distance from top of sludge to bottom of outlet tee or baffle: 35//
Distance from bottom of scum to bottom of outlet tee or baffle: 9//
Comments: (recommendation for pumping,condition of inlet and outlet tees or bathes,depth of liquid
19jel in Wiation to outlet invert, structural integrit , evidence of leakage tc.)
/i
GREASE TRAP: �
Depth Below Grade: Material of Construction: concrete metal FRP Other'
(explain)
Dimensions: Scum Thickness:
Distance from top of scwu to top of outlet tee or baffle:
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,cte.)_
TIGHT OR HOLDING TANK:
Depth Below Grade: Material of Construction:_concrete_metal_FRP_Other(explain)
Dimensions: Capacity: gallons Design Flow: gallons/day
Alarm Level:
Comments: (condition of inlet tee,condition of alarm.and float switches,etc.) _
DISTRIBUTION BOX: v
Depth of liquid level above outlet invert:
Comments: (note if! el and cis ribu ion Is eq l evidence of solids carryove evidence of leakqge into
0 out Qf box,etc.)
PUMP CHAMBER:__,d),/)
Pump is in working order:
Comments: (note condition of pump chamber,condition of ptnnps and appurtenances, etc.)
-5-
r u
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.
PART C
SYSTEM INFORMATION (continued)
SOIL ABSORPTION SYSTEM(SAS):
(Locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive
methods) If not determined to be present,explain:
Type:
Leaching pits, number: Leaching chambers, number: Leaching galleries,number:
Leaching trenches, number, length:
Leaching fields, number,dimensions:
Overflow cesspool, number: .
Comments: (note condition of soil, signs of.lrydraulic failure level f ponding, onditionof vegetation;:..
et ) O _1 ` 11
ii n
CESSPOOLS:
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(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
PRIVY:
Materials of construction: Dimensions:
Depth of Solids:
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.)
-6 -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INF011MATION (conlimied)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to atleast two permanent references, landmarks or benchmarks.
Locate all wells within 100 Feet.
a
LP
g ,
<< 3
DEPTH TO GROUNDWATER:
Depth to groundwater: A/ Feet '
Methoo of Determination or Approximation: �1
O YP1'9U/'
- 7-
��, .E.. is w �,+ .!r•�.;'4: g
1
e
�� / O
5 TJ b r
a �
AD
R 0 oa '
�. �,._�,.t ;;� � LOCUS � 6
A \PONDS
ENEZER �_
-v EB
1 r, ,, _ ,". :�R,; 1 EXISTING S.A.S. �/ °
f1�1'def�'berr. =�,�. y 7 i '" I TO BE REMOVED N �o
^, _- - G }r k. q�w SEE NOTE 11) �b
G G O• i0 ' 1.' i `..l�' 1 0 Reba (ur"bery
� E ? SSS cca Ln Mid RV 2
w 72°16'50 ,€, s R�450.6�0 0 ; 1 r. "` t PROPOSED S.A.S. g Zoromoc Rd
7tv a r r
53 � � g P*�c 96 c 0 TP- s so v
Route 28, _
.� ;�,,�y x"'� ,:{eaOV'LN T
/ram 1
/
9� L '- o�z LOCUS MAP N.T.S.
,�9• Op
EXIS `— ...., '• .,.1.. "�- ' c' � � `;'i,.,��Ir,,,, , , •� i
TING SEPTIC TANK I I
TOP OF TANK, EL.=94.77 .� `1 r , � � �1 ' L' LEGEND
INV.(OUT)=93.44t S N
i-'T� - i _' �--• 99 PROPOSED CONTOUR
Benchmark set 99 PROPOSED SPOT GRADE
� -
Righ t cor. top step
�'�. 11C EXISTING CONTOUR
r 7;
EL.=97.01 Assumed . .. a i ��, .; ,/ / s
r,
,EXISTING',!/ // ! �_ .1 �6, O- 1 t I EXISTING SPOT GRADE
ir7C7PC7. a y
";HOUSE 45 '
i
'O PIT
•'` // (# �i TEST
TOF=96.86 ,✓ i, j'
Lot 38 ' "(Assumed) /p', /' BENCHMARK
art ' / / /,/%
20 350f S.F. i j"; % ; W EXISTING WATER SERVICE
MaIU 23 I i �� ^--.,� G EXISTING GAS SERVICE
Parcel 61 I
���,��' "�• Y wits j � ,'' ��,I �t;s
- O.H.W. D WIRES
_ . . _ EXISTING OVERHEAD E
740 ..
• �o9co /3 6V 00
FFER
119.00' ---
GENERAL NOTES _--
N 65 00'00" W
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
BOARD OF HEALTH AND THE DESIGN ENGINEER.
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS FLOWING POND
••
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 7. WATER SUPPLY PROVIDED BY TOWN WATER. ••,�,••'
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: g THERE ARE NO ABUTTING WELLS LOCATED WITHIN 150' OF THE S.A.S.
J 1) 310 CMR 15.405(1)(b) CONTENTS OF LOCAL--UPGRADE APPROVAL: �� 4S,
9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
A 2' variance to maximum cover requirement of 3', for 5' of P� 9�
moximurn cover. S.A.S. sholl move H-20 units and be vented. TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. yaw �G
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY ate' PETER T•
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING v M CIVILEE N PROPOSED SEPTIC SYSTEM UPGRADE
DESIGN ENGINEER. CONSTRUCTION. No. 35109
4, ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 11, WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 45 EBENEZER ROAD, OSTERVILLE, MA
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN IN THE AREA AND REPLACE BENEATH
NEA H ANDFILORAS FT. O IEDLL S DE COF THE S.A.S /S1�F� �``�
ENGINEER BEFORE CONSTRUCTION CONTINUES. F I /SA Prepared for: Barry Pina, 45 Ebenezer Rd, Osterville, MA 02655
5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 12. CONTRACTOR SHALL EVALUATE STUCTURAL INTEGRITY OF EXISTING, Surveying b
NA
SEPTIC TANK PRIOR TO CONSTRUCTION. Engineering by: y; SCALE DRAWN JOB. NO.
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF SYSTEM POSES ONLY Enginewing Works Terry A. Warner PLS 1"=20' P.T.M. 140-07
13. THIS PLAN IS TO BE USED FOR SEPTICSTEMURP
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF �Q
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 12 West Crossfield Road 22 Long Road
Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO.
(508) 477-5313 (508) 432-8309 6/1//07 P.T.M. 1 Of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
T.O.F F.G. EL: 98.�6(MAX. FINISH GRADE SHALL NOT BE < EL.93.5
(EXISTING) EXISTING VENT FOR A DISTANCE OF 15' AROUND THE
F.G. EL: 96.Ot(EXISTING) F.G. EL: 96.2t PERIMETER OF THE S.A.S.
1;�� MAINTAIN 2% MIN SLOPE OVER S.A.S. 4 SCH 40 PVC PERFORATED PIPE WITH
SCREW CAP SET TO WITHIN 3" OF FINISH
INSTALL RISERS OVER INLET & OUTLET I INSTALL RISER OVER D-BOX TO 3-500 GALLON LEACHING CHAMBERS GRADE TO SERVE AS INSPECTION PORT.
TO WITHIN 6" OF FINISH GRADE { WITHIN 6" OF FINISH GRADE SURROUNDED WITH STONE AS SHOWN
INSTALL RISER OVER CHAMBER
L =3' L=22'(MAX.) WI TOW 6 N PLAN
F FINISH GRADE
COVER
4" SCH 40 PVC 4" SCH 40 PVC 2" LAYER OF 1/8" TO 1/2"
10 EXISTING 14" ® S= 1% MIN. 7s' $ DOUBLE WASHED STONE
_'. (MIN.) =INV.=93
= 1% (MIN.) ®® ®®
1000 GALLON ®®� ®B®
n SEPTIC TANK INV.=93.40 .23 2' EFF. DEPTH ®®®���� (OR APPROVED FILTER FABRIC)
•.' '•'•'; (SEE NOTE 12 -SHEET 1) , 3/4"-1 1/2"
EXISTING PT, INV.=93.44t D-�BOX 2 5 2 2 STONE
WASHED
.. EFFECTIVE WIDTH = 9.2'
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING
INV.=93.00
PIPE INVERTS PRIOR TO CONSTRUCTION.
2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE TOP CONIC. ELEV.=94.1 -BREAKOUT 'ELEV.=93.50
ON A MECHANICALLY COMPACTED SIX INCH CRUSHED INV. ELEV.=93.00 a®®®a
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2).
3) INSTALL INLET & OUTLET TEES AS NEEDED. BOTTOM ELEV.=91.00
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE. ��ECTIVE
3 X 8.5'=25.5' 3'
5' MIN. ABOVE BOTTOM OF LENGTH = 31.5'
T.P. EXCAVATION OR G.W.
SEPTIC SYSTEM PROFILE NO G.W. ENCOUNTERED LEACHING SYSTEM SECTION
BOTTOM OF TP EL: 86.00
N.T.S.
DESIGN CRITERIA
(3) 5" DIA.OUTLETS
I• 5.5" ' 2" NUMBER OF BEDROOMS: 2 BEDROOMS
" SOIL TYPE: CLASS I(
15.5' r, 9„ 31.5' SOIL LOG DESIGN PERCOLATION RATE: 2 MIN./IN.
s' �__ - 1 DAILY FLOW: 220 G.P.D.
- -A. ; DESIGN FLOW: 330 G.P.D.
H-10 LOADING 2° 13.
_--R0P S. DATE: JUNE 1, 2007SOIL EVALUATOR: PETER T. MCENTEE P.f . GARBAGE GRINDER: NO
D-BOX ' - - � WITNESS: DONNA
MAGENT)IORANDI LEACHING AREA REQUIRED: (330) = 445.9 S.F.
NLS
N, REFERENCE NO. P-11,746 .74
g8' �d PROPOSED SEPTIC TANK: 1500 GALLON
®0®® 0 ®®®®
O �i 8 'P.. Elev. TP�-- 1 Depth Elev, TP=ee2 pgth
®�®®®®®EA®®® 37" N 98.2 A 0" 975 A D USE 3-500 GALLON LEACHING CHAMBERS IN SERIES
N W ®2®®®®S EM®®® SANDY LOAM SANDY LOAM
?z ®�7�®®®®�®®® _.k 2.5Y 3/2 2,SY 3/2
---~ SIDEWALL AREA: 2 9.2' + 31.5' X 2 = 162.8 S.F.
1 97:7 B 6' 97.0 R 6"
102" / % f LOAMY SAND LOAMY SAND
BOTTOM AREA: 9.2' x 31.5 = 289.8 S.F.
/,! /� // + 2.5Y S/6 2.5Y 5/6
TOTAL AREA: 452.6 S.F.
/ / EXtSTING 96.2 C 0 24" 94.0 36"
r i / / {.i~1t t E r
♦" KNOCKOUT /
HOUSE (#45),1 DESIGN FLOW PROVIDED: 0.74(452.6) = 334.9 G.P.D.
20" °IA. COVER / / / /
4." KNOCKOUT O/4" KNOCKOUT es" //(Assumed)/ !%' ///:. t PERC 54" PROPOSED SEPTIC SYSTEM UPGRADE
M-FSAND M•-FSANb 4" KNOCKOUT 2.5Y 6/4 2.5Y 6/4 45 EBENEZER ROAD, OSTERVILLE, MA
/
Prepared for: Barry Pina, 45 Ebenezer Rd, Osterville, MA 02655
500 GALLON CAPACI -20 LOADING 86.7 138" 86,0 i 38" Engineering by: Surveying by: SCALE DRAWN JOB. NO.
NO GROUNDWATER OBSERVED
Engineering Ineetin Works Terry A. Warner PLS NTS P.T.M. 140-07
CHAMBER PERC RATE <2 MIN/IN. ("C" HORIZON) 12 West Crossfield Road 22 Long Road
nTs S.A.S. LAYOUT Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO.
(508) 477-5313 (508) 432-8309 6/1//07 P.T.M. 2 Of 2