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Home My WebLink About0459 FLINT STREET - Health 1 459'Flint•Street Marstms Mills P A = 101 453 • I TOWN OF BARNSTABLE LOCATION SEWAGE #2OD3-' Off VILLAGE ASSESSOR'S MAP & LOT /Ol—S3 INSTALLE'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) (size) NO.OF BEDROOMS j BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: lJ� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching faci ' ) Feet Furnished by a y7 Ei I No. (((AAd lV//�- S Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplitation for Mizpozal *p$tem Conotruction Permit Application for a Permit to Construct(6,Ygepair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. ' Owner's Name,Address and Tel.No. Assessor's Map/ParcelZjj®� , � Installer's Name,Address,and Tel.No. L�P10— q 7 Designer's Name,Address and Tel.No. Joe.,04 Ae &Povs Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No:of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alt rations(Answer when applicable) :&MZY& 3 3 O00 Th f 11Z-rZ.47V °S Glee Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signetd Date Application Approved by O Date Application Disapproved ollowing reasons Permit No. Date Issued s 13 -• 1 No } Fee THE COMMONWEALTH OF MASSACHUSETTS - Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplitation for Mig;paal bpgtem Congtruction Permit Application for a Permit to Construct((,,)IFepair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. �s q Owner's Name,Address and Tel.No. �itir s� �, Assessor's Map/Parcel rrv,�t �j r 0 Installer's Name,Address,and Tel.No..5-$ Q 75F Designer's Name,Address and Tel.No. .1ase,d� Ur 13,�Nrds c 144-1m_e , �,i/s �1 is 6^4,qc0 Type of Building: t Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. �- Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ' Description of Soil Nature of Repairs or Alterations(Answer when applicable) 2�/ �� 3 D 7 G.�Gi i/ri a•v,k- !� % > Date last inspected: ! Agreement: The undersigned agrees to ensure the construction and maintenance of the�dore 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed Date ., Application Approved by i11� D ' > ` Date Application Disapproved fo a following reasons 09 Permit No. "� Date Issued ------------------------ ------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certifirate of Compliance - THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( �:_)-Repaired ( )Upgraded( ) Abandoned( )by /95 e%4 /),_ at 1-/ i 7 /ti>d?.N71`�s�-s �Yl>��, has been constructed i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '�-p03-QS2 dated_2-! 6 Installer to<,-/GO Designer The issuance o�/this,permit shall not be construed as a guarantee that the system/�`ii °a.asyaesigned. Date �tl YID 3 Inspector ——————— ————————————————————— —— No.�� Fee V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi5po!6ar *p5temc Conotruction Permit Permission is hereby granted to Construct( G)-1 epair( )Upgrade( )Abandon( ) System located at y S�J 111171- _57- G1�I�y' and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be co pletted within three years of the date of this ppr"M/it. / Date:_ Approved by A Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN U cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name VG] P.O. BOX 145 Company Address CENTERVILLE MA 02632 'eQ0! Cityrrown State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification ° I certify that I have personally inspected the sewage disposal system at this address and thet°theme, information reported below is true, accurate and complete as of the time of the inspection. The insp`Pction was performed based on my training and experience in the proper function and m'�intenance`of orfte sewage disposal systems. I am a DEP approved system inspector pursuant to Section 4'5.340-f Title 5(310 CMR 15.000). The system: ,.a - � �r+ ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4/1/13 Inspectifs Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. q Ijq �o t5ins•11/10 Title 5 Official In p ctio Form:Subsurface Sewage Disposal System•Page 1 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 459 FLINT ST Property Address DUSTMAN Owner Owners Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: INLET OF TANK IS UNDER DECK, THERE IS A COVER THAT CAN BE REMOVED TO ACCESS THE INLET COVER OF THE TANK B) System Conditionally Passes: I ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cost.): ❑ 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to'determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 459 FLINT ST M y+ey Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any'portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 2000god- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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? ® El information 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)] D. System Information 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r Commonwealth of Massachusetts w . Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 459 FLINT ST Property Address DUSTMAN Owner Owners Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A 1000 GALLON TANK D-BOX AND 3 3050 INFILTRATORS Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commerciallindustrial 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 459 FLINT ST Property Address DUSTMAN Owner Owners Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: DEBARROS SEPTIC Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000gallons How was quantity pumped determined? TANK TRUCK Reason for pumping: MAINTENANCE 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): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: S.A.S INSTALLED IN 2003 Were.sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 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.): Septic Tank(locate on site plan): Depth below grade: 1.5 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 GALLON Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts - Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK WAS PUMPED RIGHT AFTER INSPECTION FOR MAINTENANCE Grease Trap(Ibcate 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is. MARSTONS MILLS MA 02648 4/1/13 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 I` r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage'Disposal System Form -Not for Voluntary Assessments 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Oil Comments(note if box is level and distribution to outlets equal, any evidence of solids carryov6t, any evidence of leakage into or out of box, etc.): BOX LEVEL NO LEAKAGE SLIGHT SCUM LAYER IN D-BOX AT TIME OF INSPECTION Pump Chamber(locate on site plan): Pumps in workingorder: Yes N❑ ❑ o Alarms in working order: ❑ Yes ❑ No Comments (note condition of.pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NO OBSERVATION PORTS FOUND t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-3050 INFIL ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ iinnovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): D-BOX WAS OPENED AND WATER RUN INTO IT FROM THE SEPTIC TANK WATER COULD BE HEARD DROPPING INTO THE CHAMBERS Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 i Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,.. etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ii Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 459 FLINT ST Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4/1/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells I-Estimated depth to high ground water: GREATER THAN 5 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: bate ❑ 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: 1995 CODE Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM 459 FLINT ST - Property Address DUSTMAN Owner Owner's Name information is required for MARSTONS MILLS MA 02648 4%1/13 every page. CitylTown. State Zip Code bate of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to.high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 4 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I Assessing As-Built Cards Page 1 of 1 TOWN OF BAItNSTABLE �ATION �f.$-9 ��i�% T, SEWAGE#F .2005 OSZ GE 7.IIJ_ ASSESSOR'S MAP&LOT/0/—S3 INSTALLER'S NAME&PHONE NO. �_ a" y20-y/i �o,W-4 Ves9j'r>>� SEPTIC TANK CAPACITY 1,000 LEACHING FACILTIY:(type)-'��Di D�yjF�iajo�S (size) •2 9��'i� //, NO.OF BEDROOMS BUII.DER OR OWNER Orrs7AL0.1-, PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted'Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fact' ) Feet Furnished by yam/ h7i 46 r o Vo 1 http://www.town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=101053&seq=1 4/15/2013 Commonwealth of Massachusetts , Executive Office of Environmental Affairs Department of g `Lri� Environmental ProtectionWilliam F.WeldGovemorTrudy Coxe'EOMSUBSURFACE SEWAGE DISPOSAL SYSTEM INFORMATION FORMDavid S.StruhsCommisaioner PART A CERTIFICATION Property Address: 459 FLINT ST.,MARSTONS MILLS Address of Owner: Date of Inspection:IANUARY 30. 1996 (if different) Name of Inspector: TAMES A.ORPHANOS Company Name,Address and Telephone number: CERTIFIED INSPECTION ASSOCIATES 47 CAMERON ROAD, N. FALMOUTH,MA. 02556 (508) 564-5653 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the 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 Fa ils Q_011�_Date: Inspector's Sign IANUARY 30, 1996 The system Inspsubmit a copy of this inspection report to the Approving Authority within(30) days of completing this inspection. m is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall subort 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 as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. , I 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 (}', N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. + t, IF 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'8/15/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)SWI049 a Telephone(617)292-SSW Printed on Recycled Paper I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 459 FLINT STREET Owner: DANIEL E. &VIRGINIA M.O'DAY Date of Inspection:,1ANUARY 30. 1996 1., , B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if(with the approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection(with the 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: • S 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 h'A ' 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING 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 within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50' 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 that facility and the presence of ammonia nitrogen and nitrate 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 outlined below. The Board of Health should be contacted to determine what will be necessary to correct the failure.. Backup of sewage into the 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 the surface waters due to an overloaded or clogged SAS or cesspool. (revised.8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 459 FLINT STREET Owner: DANIEL E.&VIRGINIA M.O'DAY Date of Inspection: IANUARY 30. 1996 D] SYSTEM FAIIS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged 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 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 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. 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 large systems in addition to the criteria above: The design flow of 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 H 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. (revised 8/15/95) 3 �e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 459 FLINT STREET Owner: DANIEL E.&VIRGINIA M..O'DAY Date of Inspection: IANUARY 30. 1996 Check if the following have been done: X Pumping information was requested of the owner,occupant,and Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. X 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. X The facility owner(and occupants„if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. (revised 8/15/95) 4 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 459 FLINT STREET Owner: DANIEL E.&VIRGINIA M.O'DAY Date of Inspection: iANUARY 30. 1996 FLOW CONDITIONS RESIDENTIAL: Design flow: 300 gallons Number of bedrooms: 3 Number of current residents:—5 Garbage grinder(yes or no): NO Laundry connected to system (yes or no): YES Seasonal use (yes or no): NO Water meter readings,if available: 1995 IS 53.000 GALLONS AND 1994 IS 47.000 GALLONS ACCORDING TO TANICE AT THE COTUIT/OSTERVILLE/MARSTONS MILLS WATER DEPT. Last date of occupancy: CURRENTLY OCCUPIED. COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no): Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings,if available: Last date of occupancy OTHER: (Describe) Last date of occupancy:: GENERAL INFORMATION PUMPING RECORDS and source of information: PUMPED OCTOBER 18, 1996.ACCORDING TO THE OWNER NO System pumped as part of inspection: (yes or no) If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: 8/2/77 CERTIFICATE OF COMPLIANCE#77 -209 ON FILE AT THE BOARD OF HEALTH Sewage odors detected when arriving at the site: (yes or no) NO revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 459 FLINT DTREET Owner: DANIEL E.&VIRGINIA M.O'DAY Date of Inspection: iANUARY 30. 1996 SEPTIC TANK: (locate on site plan) Depth below grade: 10" Material of construction: X concrete metal FRP other(explain) Dimensions: 4' WIDE X 8' LONG X 4' DEEP Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 14" 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.) TEES IN GOOD CONDITION• LIOUID LEVEL IS 48": NO ADVERSE INDICATORS• NO RECOMMENDATIONS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: concrete metal FRO 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: 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.) (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 459 FLINT STREET Owner: DANIEL E.&VIRGINIA M.O'DAY Date of Inspection: 1ANUARY 30, 1996 TIGHT OR HOLDING TANK: (locate on site plan) 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: X_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) D-BOX WAS NOT UNCOVERED BECAUSE PIT WAS EXPOSED IN ORDER TO OBTAIN A MORE ACCURATE ASSESSMENT AS-BUILT DISTANCES FOR THE D-BOX ARE TAKEN FROM THE SKETCH ON FILE AT THE BOARD OF HEALTH 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.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 459 FLINT STREET Owner: DANIEL E.&VIRGINIA M.O'DAY Date of Inspection: TANUARY 30, 1996 SOIL ABSORPTION SYSTEM (SAS): X (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: X leaching pits,number: ONE: 6' DIAM.X 6' DEEP leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) COVER IS 25" BELOW GRADE: LIOUID LEVEL IS 62"• LIQUID LEVEL TO INLET INVERT IS 10"• BOTTOM OF PIT IS 112"BELOW GRADE: NO ADVERSE INDICATORS. NO RECOMMENDATIONS CESSPOOLS: (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure;level of ponding,condition of vegetation,etc.) (revised 8/15/95) g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 459 FLINT STREET Owner: DANIEL E.&VIRGINIA M.O'DAY Date of Inspection: iANUARY 30. 1996 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 459 FLINT STREET DECK 3 11' 7'611 6'6 24' " 32' 34'411 39'8" NOT TO SCALE DEPTH TO GROUNDWATER Depth to groundwater: >12 feet method of determination or approximation: APPLICATION FOR DISPOSAL WORKS PERMIT#77-209 ON FILE AT THE BOARD OF HEALTH. (revised 8/15/95) 9 TOWN OF BAMSTABLE 1� `.00ATION /��9 SEWAGE # .2003" OS2 VILLAGE ASSESSOR'S MA�P & LOT /0/eS3 INSTALLER'S NAME&PHONE NO. �W- SEPTIC TANK CAPACITY W a LEACHING FACILITY: (type) 3-,9cO-Z�r/ (size) NO. OF BEDROOMS BUILDER OR OWNER Des 7-/-ftaa` PERMITDATE: 2_, 3—p3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin faci ' ) Feet Furnished by .✓ ' h7 Gh r r 3�✓ tit P^C AT ION- S LrWAGE PERMIT NO. VILLAGE INSTA LL R'S AME & ADDRESS 8 URDER 0 , . DATE PERMIT. ISSUED DATE COMPLIANCE ISSUED .._ k3 � �` ,. _:yam--� t i� �� i� id \\� � s� � /` s's ' n �� ., _, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q�d�l�e �► OF................................................. �.Oy_ ........................................ Appliratiun -fur Dbposal Works Tomitrurtiutt Prrutit Application is hereby'made for a Permit to Construct (Z.4`16r Repair ( ) an Individual Sewage Disposal ------------- a fP Ow t ------ �u mi ......0_2 f-e--s-s--- ', 'I-�--�-'------------- Installer Address �- U Type of Building Size Lot.. �� )1 -�___Sq. feet Dwelling�O. of Bedrooms..._....�.........................._-_.Expansion Attic ( � Garbage Grinder aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( — Cafeteria ( ) P4 Other fix res ...................------------ - --------------- -- W Design Flow............... ..d....._....__.._.....gallons per person per day. Total daily flow...._Q gallons. WSeptic Tank—Liquid capacity#40-_gallons Length................ Width................ Diameter-----....------- Depth................ x Seepage Pit No----------- - Total Length.................... Total leaching area--------------------sq. ft. Disposal Trench—No I..._.. Diameter--/----®_ th below`inlet____________________ Total leashing area._......__...___.sq. ft. z Other Distribu i.-,n box ( ) Dosing tank ( ) oh- T• / s ` 77 aPercolation Test Results Performed by--------------------------------------------------------------------------- Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water___-_-._----.--.:-.----- w Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-_.-..---_--_.-_--.-.._. d Description of Soil---- —0 G---- -J.1��r- •��.� � --�--- •�� -la/��--�� V ............ .......... .....------. ...: =' " 1�-_� �,t-- ,�.-----•- x -----------•---------------------------------- -•---------------------------•---------------------------------•-------------••-----••-•-------------•------.-------------------------------------.------ U Nature of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------------------------. --------------------•--•----.__----------------......-•---------------------•--...-----•------..-------•--••---•---•.._...-•----...---------........---------------•- -•------------------------..--..-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of CompliancAreasonns: d bo d Aw�th Si --••--- ----- -•- ----------------- Date Application Approved By..-- . ��A,----------- �� Application Disapproved for the followin ........................................................ .............------------ Date.............. -----•------------------------------------••-•--------------•-•-•-------•--•-----•-------•--•--•-•---•--------•-•-••-------------•--••--•-----•-••-•--------••-----------_.._..------.......--------••-- Date Permit No. Issued �-- `r----- - , Date .. THE COMMONWEALTH OF MASSACHUSETTS BOARD' OF HEALTH ...... .. . ... ............OF..................................... - .-.-.....-.. Appliratiun -for Ri ipoiittl Works Towitrurtintt Prrutit Application is hereby'made for a Permit to Construct ( "Sr Repair ( ) an Individual Sewage Disposal System.at o ` �? t ess Installer Address + Q Type of Building Size Lot_- d� ___Sq. feet U Dwellin M o. of Bedrooms___. Expansion Attic i Garbage Grinder a g • .------ P ( , g a Other—Type of Building ____________________________ No. of persons_______._.._...__._._..: Showers ( = Cafeteria ( ) Other fix res _ -------------------- Design =__ ........... Flow------- t _ Mons per pet-son per day. Total flail flow . ______-_--_ -_ _gallons. W g P P P Y• Y g P4 Septic Tank—Liquid carncity �� _�.gailons Length________________ Width................ Diameter-----.---------- Depth --____-__. xDisposal Trench No_ _________________ Widtl . . '.,.�_�11Total Length _____._____.--- Total leaching area--___ _,_____sq. ft. Seepage Pit No `...L�------- Diameter �__�I7 th below inlet ____ __:____ Total leaching area _______sq. it. 77 Z Other Distribution box ( ) Dosing tank.( ) �` aPercolation Test Results Performed bY--------------------------- ---------------------------------------------- Date-------_------------------ -------.... Test Pit No. i................minutes per inch Depth of "Pest Pit_.-_______.________- Depth to ground water.----------------------- (� Test Pit`No. 2................minutes per inch Depth of Test Pit--._________________ Depth to ground water........................ a /r t� -iF / D Description of Soil..-- `'! ' '"' Tr"'Gt/ . x ' ' jo W --------------------------- U Nature of Repairs or Alterations—Answer when applicable----------------------------------_--------------------------------------___ _________________ . •----------------------------••-----•-------------------------------------------------•------•--____-----------•----•.—"----------•--------- ---------------------------------------------•------•--- Agreement: The undersigned agrees to install the aforedescribed Individual.Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until-.-a` Certificate,of''Compliance has iss d'b bo d of th 10 Sig d.. - --- F" Date r Application Approved By..... t '� ---jlo �........... ..` -- ---- Date Application Disapproved for the f ollowin reasons: ------ ••------ - --------------------------........................................................ -:•--•----=--==•--•---•---•............................................................................................................................------------------------------------------------- Date PermitNo-------------_=............... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ...... . ....... .. ................................................ O F..... .. .. 0.rrtifiratr of Tulnphaurr TIIS LS TO C RTIH, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) - --•---•--- --•-••• --------•-----•------------------ w sal y at �� a � '� �"` .__. _tY. - - --- lids been installed in accordance with the provisions of,rtc1e FYI of The State Sanitary Code as described in the application for Disposal Works Construction Pgrriiit No"" __"---:_ __ _______________ dated-_- __:�+'_ _-_:_, __ .............. THE ISSUANCE OF'THIS CERTIRCIATE SHALL- NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATFSFA(:TORY.;,' ,x DATE....................................................---..........---• ----- Inspector f THE,C:OMMONWEALTH OF MASSACHUSETTS BOARD O. HEALTH ` ./.y ..... ............ .. .. ...O F........... ..�."",a�g.".?we'3,.; .-�Ls..........$........................ No.....-•-'•----- FEE_._: U rtiott Wrntit Permission is hereby granted...... I to Construjct ( of Repair ( ) an aid vi�l -ewage isp s r stem ,X r at stree as shown on the application for Disposal Works Construction Pm�it No. Dat '____ __ _- -. ..... ....,,� oaraf o -�-- 71", a I�alfli` DATE................. Z_. ----------- ---- = FORM 1255 HOSES & WARREN. INCg;!...UBLISHERS .. I - v` \�U k.� t �T. 'Ntt1, CW %N OF Ai,Q,•s •r r WILLIA"A cN 4 C. NYE y ,pNo. lQn4 su t Cr-sz-rtF-( T"Ar TNT ' cx�►.}pl�i�Ut lSuawu P1..aN 'R FctZc�.IGE v162 E aN TWIZ-- . 51 VE-LI W AWt:> SETPeACK $?GQUIIiZGAAE .Tc, O1= THE Z'oww PL&Ki 00ay Z Z PAGt:. IZ. DATE S'is-T7 Uj c tV - REGtS•r�Z�D LA�-ID SU�vcYot,ZS TV41.5 PLAW I'S WOT Ba.'SE� oSTERv L.I.E Q Mass. tN c�MEiJT SU2�/EY TNT t�Fr~SSTS S�tas+,�LD APPL_tCA."-T- CSt�IJ 1 hbT 6L u5c0 To ue:rezM'Wt�= LoT L l► aS s SHUBAEL ASSESSORS MAP: 101 TEST HOLE LOGS NOTES.- POND PARCEL: 53,. N FLOOD ZONE: C ENGI�11, A�EER: THOMAS McLELLAN, P.E. 1. VERTICAL DATUM: ASSUMED FROM QUAD (NGVD +f-) DATE: 11-15-01 2. MUNICAPAL WATER IS AVAILABLE. PERCOLATION RATE: < 2 MIN/IN 3. SCHEDULE 40 - 4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. T 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO H-10 N TH-1 TH-2 LOADING SPECIFICATIONS. $ ELEV 5. PIPE PITCH = 114„ PER FOOT, (UNLESS NOTED OTHERWISE). VNA HORIZON 6. FIRST 2' OF PIPE OUT OF D-BOX TO BE SET LEVEL. DY 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE 5- foYR s/z USE OF A GARBAGE DISPOSAL. B HORIZON SANDY LOAM 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE ss" fOYR 618 734 STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL LOCATION MAP c NORrzox HEALTH REGULATIONS. ND LOT 5 TH cR VEL 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR 20,081 t S.F. TO CONSTRUCTION. (0.46 + AC.) 10. GROUND COVER OVER ALL .SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3.0'. 132` 165D 11. EXISTING LEACH PIT TO BE PUMPED AND FILLED WITH SAND OR REMOVED. NO GROUND WATER ENCOUNTERED .FLIArT ST R-E 7EDGE or PAVE _ J _ _ �75. 0 ._ SEPTIC SYSTEM DESIGN 74- - - - � ..y_74. 6 75- - - A�qg. �9• - --- s- - . . - - -75 FLAW ESTIMATE. 75 tt I'ENca - - -7s BEDROOMS AT 110 GAL/DAY/BEDROOM =_332 GAL/DAY - _ i - - • SEPTIC TANK. ' • - - _ - - 330 GAL/DAY x 2 DAYS = 660 GAL USE 1000 GALLON SEPTIC TANK (EXISTING) 74 r LEACHING AREA: ` . rxrsTrNc DRnrA+ BEDROOAf D►rrLLINc USE 3 INFILTRATOR CHAMBERS (MODEL 3050) WITH far- 784 3.5' OF STONE ALL AROUND (29.5' x i1.2' x 2' DEEP) 1VY.- 74.6 _ t t 73 ` 5YDE AREA.- (29.5 + 112)2 x 2 = 163 (.74) = 121 GAL/DAY t , IOTTOM AREA: 29.5' x 11.2' = 330 SF (74)' s 244 GAL/DAY r r CAPACITY = 365 GAL/DAY i SEPTIC; SYSTEM SECTION 2" PEASTONE i i r COVERS WITHIN 12" OF r - ' TH-1 .FINISHED GRADE 314" - 1 112" 78.6 oNE INSPECTION COVER --�� WASHED STONE i r r i 1st FLOOR ELEV. fro BE WITHIN MOT of GRADE) BENCHMARK AT r r r r _ _ - 3' MAX. ys.4 ELEVATION �r rr . r COVER ELEV.= 73.5 � ► r � i 74.0 r - ELEV. . . r , 100. o EXIST,) 7s j 74,25 1 00 GAL ( »BOX 73. 3 ,F�. �-.> ELEV. 74 75 78 77 ELEV. SEPTIC TANK 73.6I(D 6 OF ELEV. 3.5' 3.5' Z74.6 (EXISTING) ELEV. STONE 29.5' ELEV, UNDER) 3 INFILTRATOR CHAMBERS (MODEL 3050) (EXIST.) TEE SIZES; (TO BE CONFIRMED) GAS BAFFLE 73.l� WITH 3.5' OF STONE ALL AROUND INLET: 6" UP, 13" DOWN AT OUTLET TEE ELEV. (29.5 x 11,2 x 2' DEEP) OUTLET: 6" UP, 14" DOWN SITE AND SEWAGE PLAN KEY: EXISTING CONTOUR: ,APPROVED BY; DATE: PROPOSED CONTOUR: L0 'AT'1014 , EXISTING SPOT ELEVATION: 25.5 , _ 459 FLINT STREET PROPOSED SPOT ELEVATION: 25 OF r�M. MARSTONS MILLS, MA TEST HOLE:- � J" UTILITY POLE: -a- � a. �' Z. JR. PREPARED FOR. FENCE LINE: HYDRANT: -6- � � � �o� e A �c .� CANG'D / DUSTMAN RETAINING WALL: z-nzzza DM TREE: DEMAREST-McLELLAN ENGINEERING, ' ! � SCALE: 1" = 30' DATE: 12-6-01 24 SCHooL STREET P.O. Box 463 .- WEST DENNIS, MASSACHUSETTS 02670 REFERENCE: PLAN BOOK 263 PAGE 42 DM # 01-63 PHONE & FAX : (608) 398-7710 THOMAS McLE LAN, P.E. JOHN Z. DEMAREST JR., P.L.S,