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0058 GOOSEBERRY LANE - Health
58-Gooseberr 4/ Marstons Mills A, R' A4= j 102 —,074 , it r TOWN OF BAR,N/STABLE LOCATION 5 �.;OD��,pjC.��y C.N SEWAGE# c ®t(b 'VILLAGE MAP570W& M f LLB ASSESSOR'S MAP&PARCEL U 2 ' 7 _ INSTALLER'S NAME&PHONE NO.CATt—w,.DC— UJQ SEPTIC TANK CAPACITY I,000 (St4LL&J LEACHING FACILITY: eKol L &A( GdA (size) o (h'p ) ��6�� ) l z.� 9C gQ5 NO.OF BEDROOMS 3 OWNER U Asite c 5AMiDA! PERMIT DATE: 2 "A'-7-0`(O COMPLIANCE DATE: 8—to —gyp( Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /A Feet Private Water Supply Well and Leaching Facility(If any wells exist on r site or within 200 feet of leaching facility) AJ!A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within JJ 300 feet of leaching facility) A1/.4 Feet FURNISHED BYQ A-1 19 ° /A 4e- A-3 = t�•2° I8-3= S't.�ta o u R_�d 5�•3° � p `s 1 ® Town of Barnstable P# 5 f Department of Regulatory Services B ewrwarenrJl ]t Public Health Division Date u la-Wi, KAM A te79� 200 Main Street,Hyannis MA 02601 = • EED►,tK'I A . 11J Date Scheduled Time U LP2 Fee Pd._ co Soil Suitahility Assessment for Se ge • __�tl �� t Pll�l JC . �Po al Performed-By: Witnessed By. . . h LOCATION&•GENERAL INFORMATION Location Address / M M Owner's Name Z3J�I IC L (3AP_Tr 572 �oC7S (�1$ )E Address � Assessor's Map/Parcel:` j�k Engineer's Name a-G NEW CONSTRUCTION REPAIR Telephone# `j 7., 77 job,273 03.77 Land Use•5111 ale. mi� slopes M (0— / Surface Stones Distancea from: Open Water Body —� ft Possible Wet Area — ft Ddnking Water Well ft Dralhagc Wily r ft Property Line 7/D ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pero tests,loeato wetlands In proximity to holes) Ste pkwi i Parent material(geologic) G 1[ e�a I O u4u1r Sin Depth to Bedrock !. Depth to Oroundwater. Standing Water In Hole: '> a. . u S Weeping from Pit PHa — Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONALMIGII WATER TABLE Method Used: Depth Observed standing in obs,hole: In. Depth to soil mottles; In.' Depth to weeping from side of obs.hole: ln, aroundwater Adjustment ft. Index Wall-Y Reading Date: Index Well]oval Adj,dhetor,,,,,r,-„_, Adj.druundwwdr- Leval,,,_, PERCOLATION TEST We- Thns. Observation Hole# Tlme at V; Depth of Pero Time At 6" Start Pro-soak Time® Time VI.6") End Pro-soak See Svc 1 10�s c l ct 1e& LI e 1 -• 8 a Ger- P1 C'n .by L,1 Qkree� �i�c lKeecinc Rate Miu./Inch 42 Site Suitability Assessment: Slto Passed!_/ Sitc Palled: 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. QMEPTIC%PBRCPORM.DOC F DEEROBSERVATION HOLE LOG Hole#J 22— Depth from Soli Horizon Soil Texture Shcl Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stonesr;Boulders. Consistency,96'Uravel) 6-u G LS 1'0 Yr 5/5 Na-i3� c M_ cS 2,sYr6/6 _ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon , Soil Texture Soil Color Soil Other Surface(in:) "' (USDA) (Munsell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders., DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sell Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Scopes;Boulders, t Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No. Yes Within 100 year flood boundary No. Yes Yes Depth of Naturally Occurring Pervious-Material Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorption system? _)ees _ If not,what is the depth of naturally occurring pervious material's .. • 1. Certification I certify that on �a^Z r 9 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection W that the above analysis was performed by me consistent with . the required trainin a tise a d ex 5iccc described in 10 0vM 15.017. Signature v Datb 7-2q 16 , Q:1SflPTlC\PBRCPORM.DOC #4964 P. 001/00l Town ®f Barnstable Regulatory Services i s Richard V. Scali,Interim Direct�. or KAM 6 � Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-.790-6304 Installer & Designer Certification Form Date-, �"��' 1/a � Sewage Per>rnit# vZ0(!r, Assessor's IMap\Parcel ' /b Z 47 y ' Designer: SG En i eectn Sr,c,, Installer: GaQ2.wi�G l:ri��rp�ts� Address:. 295y Graob2ll i (nwa Address: 15-5 C*whmercfo► East wareii1nam M A d Ma On �4 ��--�.f>I � �apewtde, L�� 'se.s (date) was issued a permit to install a (installer) septic system at 5 GGUS �O�rry Lays e, based on a design drawn by (addretss) 5 G EnStn��n c1 'ThG dated �'��y 21 2= ( signer) 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. Strip out (if required) was inspected and the soils were found satisfactory. 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-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ' _._of_the_I\A nnro. (etrers tifmmlicable) e with the terms ti c ti`wo JOHN L U CHURCHILL nst ler s Sig ire) C A PO isr ( esigner is Signature (Affix lies' er amp Herc) P A, E TURN TO I3ARNNSTABLE PUBLIC HEAL.TI DI SION. CERTIFICATE ® COIMPI,IAl�TCE �'Iilal, IV�T BE ISSYJED CTNTIL BCITH TIIIS F®R AND AS- BUILT CARD A C1EI'VEBit BY TILE BARI�STAI3LE PCJI�LXC �l+rALTH DY'Vl'Sl(JRI.THAIVIz Q:1Snptic\De!4ner Certification Form Rev 8-I4-13.doc F THE T°� Town of Barnstable Barnstable Regulatory Services Department U1ftldeaC v + BARNSPABLB, + 9 S. ' Public Health Division A " 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4989 0205 June 28, 2016 Janice Barton 58 Gooseberry Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 58 Gooseberry Lane, Marstons Mills, MA was inspected on 06/20/2016 by James D. Sears, certified Title V Septic,Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below inlet(per Town Code 360-9.1). You are ordered to repair or replace the septic system within Two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE. OARD OF HEALTH s c ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\58 Gooseberry Lane MM.doc e .2. Town of Barnstable • �rrsrnsr.E. • Regulatory Services Department FD NyXI A Public Health Division 200 Main Street, Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from )ollution . p TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) X t(per T Leaching pit <or cesspool with high liquid level, 12 below inlet(p own Code §360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc �0m 22 2016 22:07 Jim The Inspector Man 5085349919 page 1 7—, I 11*)0 ' O� 'Illli \ Commonwealth of Massachusetts i Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments C Z F 58 Gooseburry Lane `AO Property Address Janice Barton Owner Owner's Name f+ information is required for every Marston Mills ik MA 02648 6-20-16 page. Cityrrown State Zip Code Date of Inspection � r 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. T important:when A. General Information filling out forms on the computer, ��� •. '4� use only the lab 1. Inspector: so-'N key to move your DAMES cursor-do not ,lames D.SearS use the return Name of Inspector =cS tSEA r _ y Ca ewide Enterprises, LLC ke :* o Company Name .��i,'��5 T1 `� : 153 Commercial Street ''ra�nrrM....W Company Address Mashpee MA 02649 City/Town Stale Zip Code 508-477-8877 S 1623 " Telephone Number License Number l: B. Certification f 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: } ❑ Passes ❑ Conditionally Passes ® Fails c ❑ Needs Further Evaluation by the Local Approving Authority r is �llte�d� 6-21-16 R pector's Signature Date { The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate I 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. ti C ""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 a the same or different conditions of use. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 c Y • i_ t: 4or# Vs i b Jun 22 2016 22:07 Jim The Inspector Man 5085349919 page 2 3 Commonwealth of Massachusetts Title 5 Official Inspection Form p Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r i 58 Gooseburry Lane Property Address i Janice Barton F Owner Owner's Name information is required for every Marston Mills MA 02648 6-20-16 page. Cityrrown 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 z in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. t Comments: Failed system-leaching The system is a 1000 Gal Tank D Box and pit. t t. r R. 4 B) System Conditionally Passes: E ❑ One or more system components as described in the"Conditional Pass"section need to be f 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. F. ❑ Y ❑ N ❑ ND (Explain below): t { U t5ins.dac•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 G c F t_ Jun 22 2016 22:07 Jim The ,Inspector Man 5085349919 page 3 Commonwealth of Massachusetts ` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r. h 58 Goosebuuy Lane Property Address t: Janice Barton . Owner Owner's Name information is Marston Mills MA 02648 6-20-16 required for every State Zip Code Date of Inspection page. City/Town B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. E B) System Conditionally Passes (cont.): ❑ 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): t ; ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): t • � I r x ❑ 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): z ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below): e P � t• 3 C) Further Evaluation is Required by the Board of Health: t E ❑ 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 e ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh z t5ins.doc-rev 6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 '� k Jun 22 2016 22:07 Jim The Inspector Man 5085349919 page 4 f Commonwealth of Massachusetts is Title.5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments } 58 Goosebuyy Lane Property Address Janice Barton Owner owner's Name information is Marston Mills MA 02648 6-20-16 required for every State Zip Code Date of Inspection =p page Cityrrown e B. Certification (cons.) 2. System will fail unless the Board of Health land 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 I 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, pe rformed 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. r t t` k r D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all Inspections: i Yes No ® � Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in UAUFW is less than 6" below invert or available volume is less ® ❑ than %day flow PjT t5ins.doc•rev.6/16 Title 5 Ofticiai Inspedion Farm:Subsurface;sewage Dispose)system Page 4 of 17 t z Jun 22 2016 22:07 Jim The Inspector Man 5085349919 page 5 r Commonwealth of Massachusetts h' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Goosebuny Lane Property Address Janice Barton Owner Owner's Name information is Marston Mills MA 02648 6-20-16 required for every -!vI State Zip Code Date of Inspection wn page. €' B. Certification (cont.) i° 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. t ❑ ® 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 2000gpd- 10,000gpd. r ❑ 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 16,000 gpd. For large systems, you must indicate either"yes'or"no"to each of the following, in addition to the questions in Section D. i Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ; h ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply `. the system is located in a nitrogen sensliive.area (Interim Wellhead Protection t El El 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, 6 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. Page 5 of 17 tSins.doc•rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposa;System P 6 t. Jun . 22 2016 22:07 Jim The -Inspector Man 5085349919. page 6 E Commonwealth of Massachusetts Title 5 Official Inspection Form R 6 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f k y 58 Gooseburry Lane Property Address Janice Barton Owner Owner's Name Information is Marston Mills MA 02648 6-20-16 required for every State Zip Code Date of Inspection page. CityfTown C. Checklist , Check if the following have been done. You must indicate"yes" or"no" as to each of the following: - t Yes No r ❑ ® Pumping information was provided by the owner, occupant, or Board of Health E ❑, ® 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? El ® Have large volumes of water been introduced to the system recently or as part of € this inspection? k ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) k ® ❑ Was the facility or dwelling inspected for signs of sewage back up? a ® ❑ Was the site inspected for signs of break out? i. ® ❑ 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, r dimensions, depth of liquid, depth of sludge and depth of scum? F i. ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of.Health. Q ® 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): NA Number of bedrooms (actual): 3 f l: DESIGN flow based on 310 CMR 15.203 (for example:110 gpd x#of bedrooms): 330 i. 4 t5ins.dac•rev.6116 Title 5 Offic al Inspection Form:SubsuAace sewage Disposal System•Page 6 or 17 i; i r F Jun 22 2616 22:07 Jim The Inspector Man 5085349919 page 7 Commonwealth of Massachusetts Alm k Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Goosebuqy Lane Property Address t Janice Barton Owner Owner's Name information is Marston Mills MA 02648 6-20-16 required for every State Zip Code Date of Inspection page. city/town C D. System Information Description: The system is a 1000 Gal. Tank D Box and pit. 1 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) El Yes ® No Laundry system inspected? E Seasonal use? ❑ Yes ® No 2014-36,000Gals " Water meter readings, if available(last 2 years usage(gpd)): 2015-31,000Gal's Detail: Sump pump? ❑ Yes ® No I` Present Last date of occupancy: Date a CommerciaUlndustrial Flow Conditions: € C i Type of Establishment: e Design flow(based on 310 CMR 15.203): Gallons per day(gpd) r Basis of design flow(seats/persons/sq.ft., etc.): F i Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No € c Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No i. Water meter readings, if available: ISins,doc rev.6/16 Title 5 offoial inspection Form:SubsLrface Sewage Disposal System•Page 7 of 17 !; i E l f. Jun 22 2016 22:07 Jim The -Inspector Man 5085349919 page 8 E Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ; 58 Gooseburry Lane r i Property Address i Janice Barton Owner Owner's Name information is MA 02648 6-20-16 required for every Marston Mills page. City/Town State Zip Code Date of Inspection is D. System Information (cont.) Last date of occupancy/use: Date � 6 Other(describe below): E L General Information E Pumping Records: NA I Source of information: Was system pumped as part of the inspection? ❑ Yes ® No F If yes, volume pumped; gallons F i. i. How was quantity pumped determined? t- G Reason for pumping: r r. G Type of System: i ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool L f ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) r ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest E inspection of the l/A system by system operator under contract I F ❑ Tight tank.Attach a copy of the DEP approval. 9, ❑ Other(describe): 6. e. tSins.doc rev.8l16 Title 5 OfBNa Inspection Form:Subsurface Sewepe Disposal System•Page 8 of 17 F Y, f: F Jun 22 2016 22:07 Jim The Inspector Man 5085349919 page 9 F Commonwealth of Massachusetts Title 5 Official Inspection Form E Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Gooseour Lane Property Address Janice Barton owner Owner's Name information is Marston Mills MA 02648 6-20-16, i required for every state Zip Code Date of Inspection page. City[Town 3 D. System Information (cont.) r t r D' Approximate age of all components, date installed (if known) and source of information: 1982 Permit#82 -217. E, Were sewage odors detected when arriving at the site? ❑ Yes ® No . Building Sewer(locate on site plan): 2811 Depth below grade: feet 6' I Material of construction: a C� ❑ 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.). Pi ein is 4" PVC SCH 40. t is E I: z Septic Tank(locate on site plan): L Depth below grade: feet :. r E Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other (explain) E x: E If tank is metal, list age: years , k i Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 1000 Gal. Precast H-10 Dimensions: t is 311 Sludge depth: r l5hs.doc•rev.6/16 Title 5 Official Inspection Form;Subsurlace Sewage Disposal System•Page 9 of 17 is i. l e Jun 22 2016 22:08 Jim The Inspector Man 5085349919 page 10 r , ' F E Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Y 58 Goosebur Lane Property Address 3 Janice Barton Owner Owner's Name information is Marston Mills MA 02648 6-20-16 required for every page. CityrTown Slate Zip Code Date of Inspection f D. System Information (cunt.) i Septic Tank(cont.) 27" Distance from top of sludge to bottom of outlet tee or baffle t 2" Scum thickness 12" ` Distance from top of scum to top of outlet tee or baffle q 16" Distance from bottom of scum to bottom of outlet tee or baffle Asbuilt-Tape How were dimensions determined? Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): _ Tank at working level Tank and covers at 18" below grade in and out let Baffles. F g- h i Raa' Y I; } L Grease Trap(locate on site plan): Depth below grade: feet o. Material of construction: I' i R ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): i Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle 1. Distance from bottom of scum to bottom of outlet tee or baffle s• Date of last pumping: Date t t5ins.doc•rev.6116 Title 5 Offidai Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 3 F�. F. Jun 22 2016 22:08 Jim The Inspector Man 5085349919 page 11 i' Commonwealth of Massachusetts _= fn Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 58 Goosebur Lane Property Address E p' Janice Barton Owner Owner's Name e_ information is Marston Mills MA 02648 6-20-16 4 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) i. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t, k' t G i' F 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: 1. 1. Capacity: gallons i Design Flow: gallons per day Alarm present: ❑ Yes ❑ No : E Alarm level: Alarm in working order: ❑ Yes ❑ No t' Date of last pumping: date f. Comments(condition of alarm and float switches, etc.): t E 4 t I. Y Attach copy of current pumping contract(required). is copy attached? ❑ Yes ❑ No F i t5ins.doc•rev.6116 Title 5 Oifidal Inspection Form:Subs.trface Sewage 01sposd System•Page 11 of 17 g. e Jun 22 2016 22:08 Jim The Inspector Man 5085349919 page 12 . i. • t. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 58 Goosebura Lane Property Address Janice Barton Owner Owner's Name y information is MA 02648 6-20-16 t required for every Marston Mills r page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) z. Distribution Box(if present must be opened) (locate on site plan): 0 t. Depth of liquid level above outlet invert r l: Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any {, evidence of leakage into or out of box, etc.): D Box is 16"x 21"-34" below grade Wall's are gone w/one line out. Need to replace box. _ pD' { I` F i I c r € Pump Chamber(locate on site plan): 1 i. Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes _ ❑ No* is Comments(note condition of pump chamber, condition of pumps and appurtenances, etc,): i 7' r G: * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): r: If SAS not located, explain why: 4 is • i y. t: I' t. 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 12 of 17 Jun 22 2016 22:08 Jim The Inspector Man 5085349919 page 13 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 GooseburTy Lane Property Address Janice Barton owner Owner's Name >: information is Marston Mills MA 02648 6-20-16 required for every tYow page. Ci /Tn State Zip Code Date of Inspection D. System Information (cont.) Type: 1 ® leaching pits number: ❑ leaching chambers number. i ❑ leaching galleries number: ❑ leaching trenches number, length: t i= ❑ leaching fields number, dimensions: r E ❑ overflow cesspool number: ❑ innovative/alternative system f. Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): [r Leaching is a 1000 Gal. Precast pit. Pit and cover at 32" below grade. Pit is full,not leaching. Need €_ to replace leaching t i 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 E t. Depth of scum layer l� Dimensions of cesspool G Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc rev.6l16 Title 5 Official Inspection Form:Subsirface'Sewage Disposal System•Page 13 of 17 e t ' I F r Jun 22 2016 22:08 Jim The Inspector Man 5085349919 page 14 - k'. t: Commonwealth of Massachusetts {{ Title 5 Official Inspection Form f Subsurface Sewage Disposal System Form - Not for Voluntary Assessments o D 58 Gooseburry Lane I z Property Address Janice Barton z. Owner Owner's Name t Information is Marston Mills MA 02648 6-20-16 required for every t' 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, i etc.): z Privy(locate on site plan): t Materials of construction: k i. Dimensions Depth of solids k' Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, i i G L l: q i. t. t 4 • F �6. C t E r t' i i t G' 15ins.dcc•rev.6/16 Title 5 official Inspeclion Fonn:Subsurface Sewage Disposal System•Page 14 of 17 l: I' r. r t. Jun 22 2016 22:08 Jim The Inspector Man 5085349919 page 15 x Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments z 58 Gooseburry Lane 4 Property Address Janice Barton Owner Owner's Name information is required for every Marston Mills MA 02648 6-20-16 page. City/Town 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 ail wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: `' P 7 ® hand-sketch in the area below ❑ drawing attached separately f. 6q_ 3 -v i2 SAP. ;4 `�'�.5`-5'�r p. P -3 = 33 ° ►. / 4 Q: I f c' 1'. i. E' c j Y�Y E 4k. c• i e 15 of 17 t5ins.doc-rev.W18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pag i is Jun 22 2016 22:08 Jim The Inspector Man 5085349919 page 16 ; i Commonwealth of Massachusetts c Title 5 Official Inspection Form h Subsurface Sewage Disposal System Form-Not for Voluntary AssessmentsVj 58 Gooseburry Lane Property Address } Janice Barton Owner Owners Name information is Marston Mills MA 02648 6-20-16 required for every page. City/Town State Zip Code Date of Inspection t D. System Information (cont.) I. Site Exam: r ❑ Check Slope ❑ Surface water ❑ Check cellar i I. ❑ Shallow wells i Iva, 49' Estimated depth to high ground water: feet r- Please indicate all methods used to determine the high ground water elevation: . r ' f ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date P ❑ Observed site (abutting property/observation hole within 150 feet of SAS) I ❑ Checked with local Board of Health- explain: i= C i' ❑ Checked with local excavators, installers-(attach documentation) F ® Accessed USGS database -explain: s: U.S.G.S. WELL SDW 253 -`r You must describe how you established the high ground water elevation: i U,S.G.S. Well SDW 253 at49'. t i r I. is i Before filing this Inspection Report, please see Report Completeness Checklist on next page. r t5ins.doc•rev.6116 Title 5 Official Inspection Form:6ubsuface Sewage Disposal -Page 16 of 17 System is `. Jun 22 2016 22:09 Jim The Inspector Man 5085349919 page 17 ' Commonwealth of Massachusetts s. i Title 5 Official Inspection Form : Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 58 Gooseburry Lane 1= Property Address E Janice Barton Owner Owner's Name �. information is required for every Marston Mills MA 02648 6-20-16 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist t ® inspection Summary: A, B, C, D, or E checked ` ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed I i ® .System Information—Estimated depth to high groundwater r ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file x. z Y. t is F r 1. i t. i t. F 4F[ L% t: C C Y s C i. t5ins.doc-rev_6116 -nue 5 Official inspeetlon Form:Subsurface Sewage Disposal System•Page 17 of 17 t i Y 1 G No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLotion for MispoBAY 6pstrm Const union permit Application for a Permit to Construct( ) Repair(,V Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.j g C—,cw5GLik-_4kQ.k.( CA) Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 1 0 a ©'-1 58 C bS6IRk / 04P.=US M 1� Installer's Name,Address,and Tel.No.$0%-477-987-1 Designer's Name,Address,and Tel.No.Sdg';L73—0377 C4PC-WidL_ c-njr6:P?.R0Js6-S L(c : 4c =c. iS 3 c o 6611269 ik$ =-V_P-\I Efwy 45,-tv qR at Type of Building: Dwelling No.of Bedrooms Lot Size 10151.5 sq.ft. Garbage Grinder( ) Other Type of Building 90;[ 1T(l�C.� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided .3 T9 o y- gpd Plan Date 7— —ol 01 f Number of sheets Revision Date Title 52 Size of Septic Tank (,U:)o #J Type of S.A.S._(b'F1 Description of Soil ���Gt} _S c� l� /y !nt ) Nature of Repairs or Alterations(Answer when applicable) (�SC (WI L& I,&00 j C_ e OF Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health Si Date Application Approved by Date ri Application Disapproved by Date for the following reasons Permit No. 1�;w/(P oZ / Date Issued IN No. �+" /or� -tE' l — - Fee THE COMMONWEALTHAOF MASSACHUSETTS Entered incomputega w Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for MisposaY 6pstem. Construrtion Permit Application for a Permit to Construct( ) Repair X`Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 's$ aD&5 &/ uJ Owner's Name,Address,and Tel.No. '' C�v4P-TOE/ Assessor's Map/Parcel (Q �-74 S bO:ata�EsTd� (� /i•(!{ '�D1VS MIL ; Installer's Name,Address,and Tel.No., 02—47-1-281"T Designer's Name,Address,and Tel.No..561R 377 153 C o xwiwSuA�L_ 5"r MASfwpeg 6,(.v#V_GqAM Type of Building: Dwelling No.of Bedrooms .3 Lot Size 1 Q t 5 7 sq.ft. Garbage Grinder( ) Other Type of Building P-12,�EMX UTIAC„ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33D gpd Design flow provided - 3149 A gpd Plan Date " a-2 C I(p Number of sheets t Revision Date Title '�`" Gaa.< Size of Septic Tank I,ODti 4.�. Type of S.A.S. Ct � �C.C] C;y�, A fB Description of Soil m ke G�dQ_G J ✓!� ( � s"g _P ax) r Nature of Repairs or Alterations(Answer when applicable) eMs(7-1 LA-,. 1 060 'I.]cam J D-$o)c 7n (_.� t [� t�!l.,f77 4& ux_S 40 IN Date last inspected: 4 , Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of se Compliance has been issued by this Board of Health—, z " Sig#ned-^.•,,'. Date Application Approved by \ "� Date`'�/ M Application Disapproved by Date Jt for the following reasons Permit No. Date Issued ' 1 c - (0 . x THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of CompliaHce THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired()) Upgraded( ) Abandoned( )by CAP66i l DC 6P-rg9U.0j5&yr C.C.. ,. at L j$ [fit!;60 :MV 4.406 --M.M i has been constructed in accordance j with the provisions of Title 5 and the for Disposal System Construction Permit NoG�r<G (0 ) dated Installer(2AP&LA)1 p, 6e�nn���� �..(.�, Designer._34. #bedrooms Approved design flow., gpd The issuance of this Y,� / �r ape' it shall not be construed as a guarantee that the system wil fixnetion as designed. ,/ Date p Inspector ,��l rJ AA 11,Q le 1 , ----:-------------------------------------------------------------------------- ----------------------------------------------------- No. D�� (A / Fee / 0 C-) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal *pstrm ConfitCULtioll Vermit Permission is hereby granted to Construct( ) Repair()() Upgrade'( ) Abandon( ) System located at OILS 5 js' a ,L/ LA r Jiq /L AfL=X) M t(.4_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 ermit. Date ' / // i'� Approved b�y�, � � 1 AsBuilt Page 1 of 2. LOCATION SEWAGE PERMIT NO. LaT ti 2 e.c, b..m m,, iZ4 2-1.7 VILLAGE M�.2�TM�, N , ►tis INSTA LLER'S NAME & ADDRESS 793 M9ovy sr S BUILDER OR OWNER it�koIAs nma.* DATE PERMIT. ISSUED DATE COMPLIANCE ISSUED ed I+o T y'2 'ram 0 �j.o o S r►'-��R iL� )� http://issgl2/intranet/propdata/prebuilt.aspx?mappar-102074&seq=1 6/17/2016 LOCATION SEWAGE PERMIT NO. LeT 5 2 -Z4 ?X- }17 VILLAGE �d� — 07 1"10'rt sr-oki M I L1 s 'INSTA LLER'S NAME & ADDRESS 793 �4,41,0 S r- S' !yA m-me vt4- GUILDER OR OWNER acku1ks 410mLT3p DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� ��� ��'` � for "g2 d ~�+ o �,r :�. A e�` (?©o s��-b a R�� �Z�l No... Fimic.............................. .................. THE COMMONWEALTH OF MASSACHUSETTS OARD OF HEALTH 1'7 1 ............ ---------------------- -----OF.... ......................... .................. Appliration for Bhnpoiial Vorkg Tomitrurtion ramit 4A16 Application is hereby made. for a Permit to Construct or Repair (k-) an Individual Sewage Disposal System at: ......... .................................................................................................. ddros r Lot No. ,/ocatior� A 0................................. .................................................................................................. ;W"O"wner Address ... .................... . ...........b.4... ....... .................................................................................................. Installer Address Size Lot............................Sq. feet U Dwelling—No. of Bedrooms....._...%.3............................Expansion Attic Garbage Grinder (P4 Other—Type of Building ............................ No. of persons............`'......... Showers Cafeteria ( Otherfixtures ........................................................................................ --------------------------------- Design Flow............................................gallons per person per day. Total daily flow..33D----Ga. 4_601. - • gallons. 04 Septic Tank—Liquid capacity/0jYX4...gallons Length..S......... Width..0........... Diameter________________ Depth....._......._.. Disposal Trench—No. .................... Width............._...... Total Length.........__....._... Total leaching area....................sq. f t. Seepage Pit No......../ ---- Diameter......./e;........ Depth below inlet.........A....... Total leaching area..Z.6.6....sq. f t. Z Other Distribution box Dosing tank 14 Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. Ljg�-.?-----minutes per inch Depth of Test Pit-_____!..._........'.1 ....... Depth to ground water..-.—C------------- Test Pit No. 2................minutes per inch Depth of Test Pit..____......__.._... Depth to ground water--------0........... --------------- ------------------------------*...... -------------"...... ----------------**--------------- 0 Description of Soil---.%k"(1. _._.Z.10.. ....... &.0 ve-/........................................................................................................... x U ........................................................................................................................................................................................................ ......................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .................................................................................................................................................................a...................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I Ti LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben issued by the board of health. iggn,,y.... ..... .... OX ignc ........... ..... ..................................... .te ApplicationApproved By.......... . ... ........................................................................ ............ . Date e following r ,Application Disapproved r e following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date No... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r 1, OF......rlZ... ............... ............---------- Appliration for Diipoiial orks Tomitrortiott ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at 60—.. .P.... .......... ...-- ..... .S.............. ..------------------.._....._...------------------........----------------------......------------ �y Lc�ation Address or Lot No. •-................. 'f.......... ... ......... ................. ..........--...................................................................................... net Address - � Installer Address VType of �ar �«s�' �,� Size Lot............................Sq. feet .-� Dwelling—No. of Bedrooms_________-...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons___._____.____-_____ Showers (/ ) — Cafeteria ( ) a' Other fixtures ____________________________ W Design Flow............................................gallons per person pe day. Total daily flow........33Q___ �/Wgr__gallons. WSeptic Tank—Liquid'capacity/Ga<._gallons Length------- ..... Width_.(..__.____ Diameter________________ Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./----------- Diameter__________ _______ Depth below inlet.........0....... Total leaching area....1&._6....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I._..1$A....minutes per inch Depth of Test Pit....... _Z-__.__. Depth to ground water......... __'____- 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x - . ........................................................Soil x se 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 TIT1Z 5 of the State Sanitary Code— The undersigned further agrees not to place the system-in operation until a Certificate of Compliance hWbeenued by the board of health. igne ----------------------- -- ..... . .. t Application Approved BIre ` ---------•-•-•---------------------•--•------------------------------•- ' � ............. A Nate Application Disapprovedlowing reasons: �;k--------------------------------------- ......................:.........•---.._....--•-••----•--•--...------------------•-------...._..-•--------------------•-----i--•----•----•-•............................................................ Date PermitNo......................................................... + Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD,/f F HEAL. ..........................' ......OF....;...... -?:. ...�* : ........................... /� Trrtifiratr of Tootpliattrr 0 C 2ZTIFY, That the Individual Sewa e Disposal Systew constructed ( _<or Repaired ( ) by ................ ... ••- w Installer has been installed in accordance with f ___ the pr visions of TI,T� 5'of The State Sanitary Code s ried in the application for Disposal Works Cons C—-on Permit No._ _�__'` l7................ dated--------- - d THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFA TORY. �j DATE............................. � --- Inspector......AZ_A �-�-----•--------------••----•----•---.....---......-•-•-•--- HE-"COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH ........................OF..........-CVL/1-•.a. .• f -- FEE No....•---•----•-"-L 't ........................ �. �.� . ot��tr�rtion rrotit Permission is ereby granted � - ---•--_........... to Construct or Reba r ( ) an dual S age i�Jogystem at No + Street as shown on the application for Disposal Works Construc ion Permit No_____________________ Dated_.- ....... ............... -----------------...--------••----_...- DATE......................................� Board of Health ,,r/'� '... ,.... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS --� PL P6 'Z5 — -- S ° O D xw. S-rATic q o la T 512 N /o,S75 S,F. a t-o oc o 0 '-�v 44� ) `a OFF + 3U- N rq 3 , No sun`+ /05,7 S —N 30 oo ' ao " �t ,�/ NAIL SET, Ti3N ('4o' wAYJ Zoti, P F: ---- ----- 43,slap s. F I FQ_c�.,rAG 15 p�reC1 I o►�J u+.�DES q(�ncL� 3a' F 5 B air , c�APT-E2 TEI- LEGEND �z9��� CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION OAO EXISTING CONTOUR --- 0 --- so`' ALBERT �� LOTSz- �oosel3ER L/+/✓F FINISHED SPOT ELEVATION m NJ 2 s77-o S Al / L L S FINISHED CONTOUR 0------- ,pNo.109 1�0 IN APPROVED BOARD OF HEALTH 9s �� SAJI S tASLjla WAS * SCALE, I"=30 DATE 14/2-/ DATE AGENT LDREDGE ENGINEERING CQ /N N/cI<V4,A s CLIENT I CERTIFY THAT THE PROPOSED EGISTERE REGISTE-RED JOB NO. 8�S BUILDING SHOWN ON THIS PLAN CIVIL LAND ��,�M CONFORMS TO THE ZONING LAWS ENGINEER URV DR.BY OF ►BARNSTA8 E , ASS.,EFxc�Pr CH. BY E s� R AS I:DTE: 712 MAIN STREET, 4-13-:3� NYANN I S,. MASS. SHEET— OF Z DATE REG. LAND SURVEYOR 20 FT. M//V. N07-,- /F E/TNER THE S�PT/C TAB/f� OR ?'E�4Ct//ivG PIT .4RE ' /O FT. .M/N. _ MORE 1,?AOE� �4 24`O/AM ETER ['ONCRETE COfiER SWALL B.E BROUGHT TO GRADE, �.;;'✓ EXTRA coNCRCTd 9'PYC P/P�M/N. P/TCN t,,E,4Vy C-1 ST /RO/Y COVE,4 Sy�gLL dE USED EGC-l/, O Z,O COYERS /B'PF,Q FT. IF/N DR/VEJw.4 y . CL E.4N .SANG - LQ[J/D LEYELY17 Z $' 4"CAST Z'LAYER M/N.P cEN 0.4L.- • •o o P • of //B"-J18" %"PER -r. SEPTIC TA/VEC D/sT, 0 o • . . • • e . `:-7 • s I • • • • • • • � • e 1& WA SHFO STONE a':, . BOX o .+ • • • B • • • • • • .•• ,•• • • • e I • IEFFECT/VC r ' , 3�4'- �2" r:,a;. - • • r • • pEPThI • • • • • y✓,43//ED STONE /88 x Z • S' = 470 • a. . r • . • • • • • . �P PREG4STSEEPAGE /NYER'T CLEYAT/ONS 7 x o = 7B ►• • • • • • • • • a o P/T OR EQL//V. I/VYERT AT QlJ/LD/IVG 9 9,o FT T Tit S�$ G�o 6 Fr D/AM. • E L Z INLET SEPTIC TANK g�.8 FT F'T O/fiJ�. C SEE TABU4A77)ON> Ot/TLET SEPTIC TANH 6 FT, �• '' j /NLET OISTR/13!/T/ON BOX 98 FT. SECT/O/V OF GROuNO WATER TABLE O!/TLETD/STR/B�1T/ON BOX 9Br2- /NLET LEACH/NG PIT 98 Q FT SELVAGE O/SPO�S'A L .SYST,EM L EACH//VG PIT 7ABULAT/6/V DES/GN CR/TER/�l .YCALE %�" _ /= o" D/MENS/ON A 3 FT. 01N.E/Y5/0N $-7-FT. NUMQER Of 9EDROOMS 3 D/MENS/ON C 4 FT n1/A/ G.�RQ.46E0/SPOSAL UNIT SO/L. LOG TOTAL E?T/MATEO FLOW 3 3 o G"4L./0AY SO/L TEST */ SOIL 7-_=S7_**2 SD/4 TEST /1(UMBER QP LEACNlIVG PITS �ELEK /00,0 LEY, PATE aF SOIL, TEST �/ �d Z- . S/OE LCACH/NG PER P/T _/ 819 S! '-;r r /cg 0- 2 z- RESULTS h//TNESSEp BY BOTTO/►hF 4A4 C/&//NG PER P/T $Q, AT. LOA PCRCOLAT/ON /IgTE L E S S M e� LA77o y RA Ik2 TOT.4C LEACHING AREA 26� SQ FT At/ 7iJA r� M/N•//NCH FWleCO RESERI�EGEAG'HlN6AREA ��'� SQ FT. TnS�/� 2- A., I Or _ M yo - t{ OF /lq �--/� ! U j ) �oT 5 z G'do.sE/sen/zy ��►�� C2J0 Lcf g F� BECl, l��S 7J n/S /�/L 2-S I E S " ``MORSE v,, 74�0 ,o ,p No. 10951�0 � EL DREDGE ENG/VEER/NG CO /NG. s 9pGlS.7 `-Y;S ,Q 712 Ml SU /N ST. , HYA:Viv/S, M,gSS. NO GROLlNo 1-v,QTCR ENCOUIVTLEREp , A GROUND 1-vTER AT ELE�! CL/ENT:/(/CKUG.fi 5 DRTE : ...._. .IQB NO,• �s'ZC7 4S SHEET?OF 2 FINISH GRADE OVER D-BOX= 84.81+ PROP.VENT VMTH CHARCOAL FILTER TO ABOVE GRADE GENERAL NOTES T.O.F. EL.= 85.9'+- FINISH GRADE OVER CHAMBERS 84.4' - 85.1' 3/4"TO 1-1/2" DOUBLE WASHED PROVIDE EXTENSION RISER REMOVABLE WATER-TIGHT COVER OVER SLOPE @ 2% MIN.OVER SYSTEM STONE TO CROWN OF PIPE WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION OUTLET TO WITHIN 6"OF F.G. 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS 2"OF 1/8"TO 1/2"DOUBLE WASHED METHODS SHALL BE IN ACCORDANCE WITHTITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE F.G.OVER TANK EL.= 84.7± 5-DIA. OUTLET(S) MIN SLOPE 1% BOX TO F.G. (SEE NOTE 21) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. 85-53: i AND. R. ...... ------------------ 1 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE PLACE RISERS ON ALL DESIGN ENGINEER. 9"MIN. TOP OF SAS= 81.60' CHAMBERS WITH PROPOSED4" 35MAX 3. 4"SCHEDULE 40 PVC,PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL 3T MAX. SCH.40 PVC 80.60' SEE NOTF-22 INLET PIPES TO 6"OF BREAKOUT EL 8 1.101 SYSTEM UNLESS OTHERWISE NOTED. FINIS;HED GRADE SEWER PIPE 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 1i 6" 3" 3"DROP MAX 3' 9"' L=271'+ 2"DROP MIN W I I PROVIDE WATERTIGHT ELEVATION=81.10' FOR A DISTANCE OF IVAROUND THE PERIMETER OF THE SAS. UNLESS A MIN-SLOPE 4"PVC IN FROM JOINTS(TYP) 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF a 00 S NOT LESS THAN THE BREAKOUT ELEVATION. 4"PVC OUT TO 0 0 THE LINER I SEPTIC T 14" LEACHING FACILITY C:) 5. SLOPE ALL SOLID PIPE AT 1.0%MINIMUM. CONTRACTOR TO PROVIDE 00 C:>- 00 SPECIFIED DROP BETWEEN 6, THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL 81.30' M N. 81.130 2' 00 OUTLET TEE SHALL VERIFY SIZE 48" VERIFY CONDITION OF 7. LOCAL BOARD OF HEALTH AND.DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 00 CP AND CONDITION OF EXISTING TEES GAS BAFFLE FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION.SYSTEM IS 6"CRUSHED STONE 4::> = = = = <:) 00 C> AND REPLACE AS OVER MECHANICALLY I I NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH EXISTING SEPTIC TANK NECESSARY COMPACTED BASE 4.9 1 AND DESIGN ENGINEER. 8.5,(TYP) 4.0', -4.0'- 4.83' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L DATUM. BENCHMARK ELEVATION OF 85.00' 5 0 UTLET DISTRIBUTION BOX (TYP-) 25.0' TO BE INSTALLED ON A LEVEL STABLE ESTABLISHED ON THE CORNER OF THE BULKHEAD,AS SHOWN ON PLAN. ------ BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 73.40 12.83' -nuTy LOCATIONS PRIOR TO CONSTRUCTION 1 78.60' -7- 9. CONTRACTOR SHALL VERIFY ALL u PIPES TO BE LAID LEVEL. 5'MIN.- THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT EXISTING 1,000 GALLON CONCRETE SEPTIC TANK 2 - 500 H-20 GALLON CHAMBERS CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CROSS SECTION VIEW _r\/n!r%AL CHAMBER PROF11E I L T TO THE DESIGN ENGINEER. SEPTIC T ANK PROFILE H-20 CHAMBER DE [ AILS DISTRIBUTION BOX DETAIL 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATI A REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM /A airgroun 5,-� v APPROPRIATE AUTHORITY. PERC NO. 15103 < 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED %4� ,A 1- 1 1 - �:� I J INSPECTOR: David W.Stanton,R.S. UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES,OR 'Y 40 EVALUATOR: Michael Pimentel, EIT,C E TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. .......... C.S.E.APPROVAL DATE: Oct. 1999 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. Jul, 12,2016 14* WHERE REQUIRED,CONTRACTOR SHALL REMOVE ALL LOAM,SUBSOIL AND UNSUITABLE DATE: oil, MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. TEST PIT#: REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ELEV TOP 84.40' 0 W 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN ELEV WATER <73.40' SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. MAP 102 MAP 102 PERC RATE 2 min./inch LOT 73 16. PROPOSED PROJECT IS LOCATED WITHIN: -A C14 j ASSESSOR'S MAP 102 LOT 74 LOT 84 DEPTH OF PERC 42"-60" ZONE U,P_#5824 a. OWNER OF RECORD:, JANICE L. BARTON 00 40 TEXTURAL CLASS:. I .100.00, EXISTIN,- A ADDRESS: 58 GOOSEBERRY LANE N870 Oo, SHED 00-W k' 4� (L MARSTONS MILLS,MA 02648 011 0 84. *OF ki e FEMA FLOOD ZONE X C14 .; - 85xl' Fill h 6 10 31 1 40' COMMUNITYPANEL# 25001CO542J, 6" 83.90! PROPOSED (4) (3) 24" 17. DEED REFERENCE: DEED BOOK 9303,PAGE 269 INSPECTION PORT LOCU%S 4- 3 PROPOSED 21500 GALLON 18. PLAN REFERENCE: PLAN BOOK 138, PAGE 25 > 0.30 Loamy Sand H-20 LEACHING CHAMBERS mblin B 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. I OYr 5/6 PROPOSED WITH AGGREGATE APPROX. LOCATION OF DISTRIBUTION BOX 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY 6"WATER 1\4AIN 0 ond MA� i _ / f C3 WIN 4"/2 < FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 4T 180.90, Ij V, \T I vlz� Perc 21. A 4"PERFORATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A 7 C14 TP2 Wo 60" 79.40' DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A ;r ?V1 PROPOSED 4"PVC VENT PIPE; i - J�k I I - I I A REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. x LSA 0 1< PER OWNER 84�4� -Coarse Sand EXACT LOCATION if, 1�1-, Med POOL C 22, IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE 2.5Y 6/6 APPROVAL IS REQUESTED FROM 310 CMR 15.221(7): WAIVER(3.50--3.00)FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. < (I.)A 0.50 A� Benchmark Bulkhead Comer 23. OWNER/APPLICANT CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL 2.8' - PLAN W LOCUS z REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT. 7, Elev.=85.00 < TP 1 Approx.M.S.L. SCALE: 1"= i000. 137 73.40' 0 BC-1 84x6' 844' No Mottling, Standing or Weeping Observed Lu W APPROX. LOCAT ION OF C0 a BH 84xT Uj to EXISTING WATERLINE DESIGN DATA ' PER SOIL LOGS DATED APRIL 1, 1982 LEGEND 0 0 W (per plan by Eldredge Engineering Co,Inc.) MAP 102 NUMBER OF BEDROOMS(DESIGN) 3 0 soxy EXJSTING SPOT GRADE z C-1 LOT83 Ck U') 0 1 DESIGN FLOW 110 _.PAUDAY/BEDROOM 50 - - - EXISTING CONTOUR CO T- C) TEST PIT DATA #58 a- TOTAL DESIGN FLOW 330 GALIDAY 50 PROPOSED CONTOUR >_ PERC NO. EXISTING 660 GALJDAY 15103 DESIGN FLOW x 200 % = INSPECTOR: David W. Stanton,R.S. 3-BEDROOM 175-01 PROPOSED SPOT GRADE DWELLING USE EXISTING 1,000 GALLON SEPTIC TANK TOF=85.9± r EVALUATOR: Michael Pimentel, EIT,CSE LL EXISTING GAS LINE 0 C.S.E.APPROVAL DATE: Oct. 1999 C9 July 12,2016 0/H1W EXISTING OVERHEAD UTLITIES a C DATE: ul C INSTALL 2 - 500 GALLON H-20 CHAMBERS TEST PIT#: 2 _W__W_ EXISTING WATER LINE 14" W/ AGGREGATE ELEV TOP 84.40' SIDEWALL CAPACITY ELEV WATER <7314V TEST PIT LOCATION r? (LENGTH + WIDTH) (2 SIDES) (2'HIGH) (0.74 GPD/S.F.) GAUDAY PERC RATE EXISTING 1,000 GALLON SEPTIC TANK \--STOOP (25.0+ 12.83) (2) (7) (0.74 GPD/S.F.) 112ff GAL0AY DEPTH OF PERC BOTTOM CAPACITY TEXTURAL CLASS: I MAP 102 <; (LENGTH x WIDTH) (0.74 GPD/S.F.) GAUDAY 1 0 PROPOSED DISTRIBUTION BOX LOT 74 84- (25.0'x 12.83) (0.74 GPD/S.F.) 237.4 GAUDAY 10,575 S.F. 00 1 EE PROPOSED 500 GALLON H-20 LEACHING CHAMBER 8it.40' I Fill 1 TOTALS: 6" 83.99 TOTAL NUMBER OF CHAMBE RS 2 < I TOTAL LEACHING AREA 472.2 SQ.FT. PROPOSED SEPTIC SYSTEM UPGRADE TOTAL LEACHING CAPACITY 349.4 GAL./DAY FEINICE (TYP) td4, '10- PREPARED FOR: Loamy Sand X B S870 00'00"E I OYr 5/6 JOH 100.00, CAPEWIDE ENTERPRISES CHURC R. C IL 42" 80.90, NO 807 LOCATED AT MAP 102 T,F 58 GOOSEBERRY LANE MAP 102 LOT 82 - MARSTONS MILLS, MA 02648 LOT 75 C Med-Coarse Sand SCALE: I INCH 1 OFT. DATE: JULY 29,2016 NOTES: SWING-TIES 2.5Y 6/6 0 10 20 40 FEET 1.) CONTRACTOR SHALLVERIFY SOIL CONDITIONS IN THE LOCATION OF DESCRIPTION HC-1 BC-1 R E�k- k ffi iY. SED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST P THEPROPO CORNER OF STONE(1) 20.1' 23.9' PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL RESERVED FOR BOARD OF HEALTH USE JC ENGINEERING, INC. BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. CORNER OF STONE(2) 29.6' 36.1* 2854 CRANBERRY HIGHWAY 13Z' 73.40' 2.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2 AND CORNER OF STONE(3) 48.1' 48.91 EAST WAREHAM, MA 02538 No Mottling, Standing or Weeping Observed THE GROUNDWATER PROTECTION OVERLAY DISTRICT. 508.273.0377 SITE PLAN CORNER OF STONE(4) 42.8' 40.6' 1 Drawn By: BJW Designed By:BJW JOB No. I Checked By: JLC 3544 SCALE: I"= 10' --------- 0= "'"r" ur 0\1 4"PVC SEPTIC <=> 2 LL I 4OF 0 C:)l r aL d __7r_ T