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0124 JONES ROAD - Health
124 Jones Road Marstons Mills A= 047- 046 I f r i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e 124 Jones Rd. AM Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 every cage. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When opting out �I �I forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name f� P.O.Box 763 Company Address Centerville Ma. I 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification 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 ❑ Needs Further Evaluatio y the Local Approving Authority evy1/23/2009 Insp is Sign ture 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. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 2 r f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is Marstons Mills Ma. 02648 1/23/2009 required for 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: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the, Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 Commonwealth of Massachusetts ro Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 every page. i City/Town State Zip Code Date of Inspection B. Certification (cont.) 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): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ N.D (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-09/08 Title 5.01[ficial Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 124 Jones Rd. Property Address . (Bank Owned) Debra Schilling Realtor Owner Owner's Name equir. is requiredd on for Marstons Mills Ma. 02648 1/23/2009 r every page. City/Town 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 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•09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °,M e 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 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.] El ® The system is a cesspool serving a facility with a design flow of 2000gpd- 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 CM 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 every page. City/Town 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? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 124 Jones Rd. Property Address E (Bank Owned) Debra Schilling Realtor Owner Owner's'Name information is required for Marstons Mills Ma. 02648 1/23/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon septic tank and a 1000 gallon leaching pit. Number of current residents: 0 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 ears usage d 2007:34,000 g ( y g (gpd) 2008:13,000 Detail: 2007:93 gpd. 2008:36 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: unknownDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7 Commonwealth of Massachusetts _ w Title 5 Official Inspection Form m o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 every page. City/Town 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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•09/C8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1978 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑other(explain): Distance from private water supply well or suction line. 20'+feet Comments (on condition of joints, venting, evidence of leakage, etc.): joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): 8" Depth below grade: 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: 6„ t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 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 26" 6" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10.1 How were dimensions determined? - measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete , ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle. Date of last pumping: Date t5ins•0908 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 10 Commonwealth of Massachusetts IM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 every page. City[Town 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-09:08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 11 Commonwealth of Massachusetts W Title 5 Official Inspection Form Im Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 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 D-Box not present. 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System form - Not for Voluntary Assessments ^M 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gl. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.Leaching pit had 2'of water at time of inspection.Stain line is at top of leaching-pit and in riser with grease build-up indicating leaching pit has been full. 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 13 L i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 every page. City/Town 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•OWN Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 14 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size Zoom Out J J In r-- "111C qj III _ f CY jf L I f i I I• O i � S I V 0 20 Feet Set Scale 1" = 20 I Aerial Photos I . MAP DISCLAIMER (`nnvrinhk 9l1f1F_9MA Tnwn of Rornefohle 6AA All rinh4c roeenn b.ttp://www,town.bAmstable,ma,us/arcim.s/appgeoapp/map,aspx?propertyID=047046&map... 1/23/2009 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of LP 60' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS'database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data. USED:Technical Bulletin 92-000-01 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 124 Jones Rd. Property Address (Bank Owned) Debra Schilling Realtor Owner Owner's Name information is required for Marstons Mills Ma. 02648 1/23/2009 every page. City/Town State Zip Code Date 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 t5ins•09'08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I TOWN.OF BARNSTABLE LOCATION / Z Y ao^Q S Qc SEWAGE# 09 - /Z 7 VILLAGE _ �� ASSESSOR'S MAP&PARCEL 5'7 U tF(o INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /0,00 LEACHING FACILITY:(type) 0 ) /�t Co,2 Q,c, �?)A?size) _12 V Up NO.OF BEDROOMS \ OWNER PERMIT DATE: i LA- -L60ci COMPLIANCE DATE: Separation Distance.Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility IV14 it feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY Lague► Qkyytoy-1..,�] IA i /-►i a4.�1 l31 ��-© R3 3t.0 83 33.0 kq s Z o s-s- �W s3 3b 5-2.s SY o 07 ,F t. c) s-Ec of Town of Barnstable P# Uj gyp' Department of Regulatory Services aenrtSUBL . : Public Health Division Date MASS. 200 Main Street,Hyannis MA 02601 /`� l/ r- r Date Scheduled Time Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: P> i �GI�F'!�-�P Witnessed BXfJ�// LOCATION& GENERAL INFORMATION Location Address Z q :5-0 7e A Owner's Name > f 1 5 /Zm� m425Tz7,i7 /,R))1 S Address 1 2q 517vt j Zed �°`i Assessor's Map/Parcel: 0 (41�O�-((o / Engineer's Name �:�Pz,,,;',(a Ek(!i✓t,r5 zj LL NEW CONSTRUCTION REPAIR y Telephone# qqe� � 1 pa Slopes 9'0 Land Use /�-+�S t u eVi Cf p ( ) Surface Stones - Distances from: Open Water Body ?3 00 ft Possible Wet Area Qrl ft Drinking Water Well 1 ft Drainage Way 7 l ft Property Line 25-+/ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) . BIZ Parent material I ��tN�r(geologic) l-�u�G Depth to Bedrock >13 Depth to Groundwater. Standing Water in Hole: -,-;P l 3 Z 4 Weeping from Pit Race v Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottles: in, Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj,factor— Adj.Groundwater Level-- PERCOLATION TEST Date 0 Thne.._,,._ Observation .17 Hole# ' � o 1 Time ut "4 Depth of Perc 7— Time at 6 1S ant 4 Start Pre-soak Time @ l Time(9"-6") End Pre-soak 29 '2A J��'" 3 Rate MinJlnch 2 '^ t A G Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC " DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,%Gavel O —jZ VL Ia 'Pl2y/2 lo`Cr?-s/y 3$-13Z C- -c'S 6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. . C nsistency,%Gravel) j2=i� A SL to `E�-`BIZ a 36-13Z M-C Stitidl 2,5�'C �/tl DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes . Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas..observed throughout the area proposed for the soil absorption system? -f�— If not,what is the depth of naturally occurring pervious material? Certification 1`IaT I certify that on (date)I have passed the soil evaluator examination approved by the Department of En ironmental Protection and that the above analysis was performed by me consistent with, . the required trai ' ,expertise and experience described in 3 10 CMR 15.017. Signature Date 2 tCl oo( Q:\S.EvnC\PERCFORM.DOC , (tNSttr,'J 3y tlovokc LOCATION SEWAGE PERMIT NO. V I L L A G E ASSESSORS MAP NO; O 4 PARCEL NO.: '7 I N S T A LLER'S NAME & ADDRESS S U I L D E R OR OWNER " ��tt•�� �� -+ fV/�NCv � ►moo NTd 2 i� � DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED r-z N 0 IQ CI T •e r - �,fw 00 °Q M. O' �110 o 0 No. Fee 2ooq - 12 '� /DO ,— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Mtgpogar 6P.5tem C0115truction permit Application for a Permit to Construct( ) Repair Q Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 12 y J pnkS 1 Owner's Name,Address,and Tel.No. �4,-4 Assessor's Map/Parcel L4—7 lib IY`Q mon W 11I S 5 L4 Q y gty w Installer's Name,Address,and Tel.No. ee1/JC.w:61( 67-1 �0�Jt) Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size `� �y 3 sq.ft. Garbage Grinder ( ) Other Type of Building W No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) : gpd Design flow provided gpd Plan Date 2. ^�j—2-0 Cf j Number of sheets 22— Revision Date Title 1't�I 5cv-+e S Size of Septic Tank woo ersA ,,. Type of S.A.S. `Jl A-ke-a5 Description of Soil P P 3(, 3�' Nature of Repairs or Alteratla swer when applicable) &31 t`�h '� +'VL '� rw- . Sf?J►�-a�e.i-) Date last inspected: -2,0 o�( 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-11calth. Signed Date �(I q 20 0 Application Approved by Date S /Y '100 Application Disapproved by: Date for the following reasons Permit No. �L O� 2 �"' Date Issued Iy 200 r _ r No. 2 d U r( 2 r b Fee THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer: v/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS "Yes 47 ZIppYication for Th5pogal 6r5tem Cowaructiou f Permit Application for a Permit to Construct( ) Repair Q Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (�t l J� S ,J Owner's Name,Address,and Tel.No. . - > II f-�7 �• 0 -�3 a r- •z�t Assessor's Map/Parcel —'] Q c(( t1' r' 1 c ' (' S { �' Y 807 GrA.,,, t aJ F Installer's Name,Address,and Tel.No. (�L1� ;�i �r''1 ��'i C) Designer's Name,Address and Tel.No. ��YLC.e n�� t,/ott(,•S FL --c r � Type of Building: Dwelling No.of Bedrooms Lot Size `5 1 3 sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures _-. Design Flow(min.required) 3 3 l.) gpd Design flow provided gpd Plan Date "Z -\7 -ZO c1 Number of sheets -71 Revision Date Title Sow Q) u Size of Septic Tank 1000 �C�I�,ti Type of S.A.S. '5TZ�-���5 ► �A Description of Soil P (,� 3(, 1 Nature of Repairs �or Alteratiioons( swer when applicable) &,� I I' a i Si u►�-�uci.e.)� L�i.� F' Date last inspected: o�( Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealth. ; Signed A Date 2Up Application Approved by e. p . $ , Date S 1 Y 20U Application Disapproved by: Date .�,.for the following reasons ;r g , Permit No. 2.CCU ` 2 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER FY,that the On-site Sewage Disposal System Constructed ( ) Repaired X) Upgraded ( ) Abandoned( )by LL ` at 12`( TOn e S (?-a ►ll 4dr rAn5> has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 e>O� - ( 2-• 4 dated K 200, Installer 6W4"! J-s- Designer iR X( . %A,, L #bedrooms Approved design flow 2>36 gpd The issuance of this+permit shall be the system will fun t to n.as designed. Date 4 1 f v� not e construe as a guarantee that Inspector �G 12c No. Zoo Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Th5p0al *pgtem Construction Permit Permission is hereby granted to Construct ( ) Repair (X) Upgrade ( ) Abandon ( ) System located at 12-( Sosn e 1 G v-,. M �� s V1n`► t and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. I Provided: Const ction must be completed within three years of the date of this permi Date 15" Approved by _ - f TRANS. NO:: . CITY/TOWN: APPLICANT: .ADDRESS: DESIGN FLOW: gpd T REVIEWED BY; DATE: Z- 01 a , N/A OK NO r Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] L/ Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] {/ daily flow septic tank capacity(required and provided) soil absorption system (required andprovided) .� whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] .� Existing and ro osed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR ,I 5.220(4)(n)] Address —.6re ,s ( Sheet 1 of 7 r N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins V- located within.50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system ✓ components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] ✓ Stamp of Registered Land Surveyor (required_f construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as ✓ approved for an upgrade under LUA at 310 Cl` R 15.405 1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] f Test Holes adequate to confirm adequate groundwater separation? q q bn P [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)O] Materials specifications noted? [various sections of 310 CMR 15.0.00] � System components not> 36" deep (unless Local Upgrade ,Approval or LUA requested).[310 CMR 15.405(1(b)] Address Sheet 2 of 7 r `I r N/A OK . NO__. . 40 Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] ✓ Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] ✓ gx� T � Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(0] Three access covers (inlet and outlet must be 20" or greater) - r middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] ✓ r Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet..37of 7 P w N/A OK NO .r Located at least ten feet from any water line? [310 CMR j 15.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR�15.21l(1)[1]) Cleahouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/ (leachfield below pump chamber) Endca s or vent manifoldspecified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) ^� Stable compacted base [310 CMR 15.221(2) and 310 CNM 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency storage above working—design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) /U//U Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and 8 ] Stable Compacted Base [310 CMR 15.221(2)] ,Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] Address Sheet 4 of 7 f II N/A OK NO �r > > ✓. „_... Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregatespecified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation / within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and ✓ Guidance Document] 3_ , A Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must `" _ J be to grade) [310 CMR 15.253(2)] Aggregate 1'minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)J Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever J greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211 1)[4] and Guidance Document] -E �y minimum 2 distribution lines [310 CMR 15.252(2)(a)] fim Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" / maximum. [310 CMR 15.252(2)(g)] c/ Separation between beds 10'minimum. [310 CMR 15.252(2)(0] Bottom area used in calculations only [310 CMR 15.252(2)(i)] _/ Address Sheet 5 of 7 '3, .. h N/A OK NO Pressure Dosed System ? Provided-pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems >2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year (systems<2000 gpd) or quarterly (>2000 d) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] 'F a , Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for J� perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan? [310 CMR'15 220 RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address' Sheet;6 of 7 N/A OK NO Is the system in a Designated Nitrogen Sensitive Area(Zone H for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address Sheet 7 of 7 r 05/23/2009 05: 10 50&'4775313 ENGINEERING WORKS PAGE 01 Town of testable Regulatory S.rvi.ces Thomas F. (seder,Dkwtor Public Renu-b UvW931 Tbomas McKean,.DhW- Wr 200 Moon.street,Hyannis,MA,.0201 Office:. �,QB+B G�F4 Fax: 50$-790-6304 sJ Z2I0'� Ike:. sewage Perxtttt# 401-12 7 Assassor's.MOWRAMA nr:Cf-ea i°c �ktl l2 .(�.. Address: laX- �O� 7(�.3 ✓ - �T f�'! 1� d 21.E y�J C'c� fc���11� M4q d Z(9 7 on. l`�-200 W`Ckt en k,_,o r`was Issued,a,permit to install a 1 � (instaner)'— ;�$ Tames t2d M 01 i based on a desip dmavu.by (address) dated f rood above was ir*Wed sub�;t aC the septic system raM-i4qQQW., tv u¢e unor.appr ve . &e-whichtnay inC d cha se a;;bcax am�/br septic tank, I.r�o ..ttrat the septic system referenced above was insta with Uvd r cb gas (i,e, lb 10ty*relocation of the SAS or any va ical relocation of any 0c l3ppnent o r system) but in accordance with State & Local R�,g ations. Pl" re vision or �bt t by designer to follow. PETER T, Mc:ENTEE CIVIL ,fl No.$5109 O Q /ONAL (Affix I?esigner s 4imp Hm. ) Q:HadWkptidD899M Certification Fom 3-25-04.dw No Finc THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . Tovm._.. ...OF......Barnstable Applira#ion for Dhipoii al Works Tomitrurtion Prrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal syM7. t Jones Road y, Lot 2 ..........................•-•--•..................... . !.l- ._..!`a-----. ............--------......-------------- 3 7 • ................_.............. Location-Address or Lot No. O ner Address n W ................... ... u. •-•----.................................... -•--•--•-•-----•--------- �--�5 -----------------------•--•---•--•-•-•---- Installer Address 44 0 d Type of Building RIAhbC 14 Size Lot................7.__._..._Sq. feet Dwelling—No. of Bedrooms.........._.3.............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons_-_..._6.__.____......... Showers ( ) — Cafeteria ( ) Q' Other fixtures ---------------------------------- Design Flow..................... 5..................gallons per per so per day. Total daily flow....................33Q...............gallons. W Septic Tank—Liquid'capacity.l000gallons Length... .._.. Width �.__l�n Diameter---------------- Deptl �.- .. x Disposal Trench—No. .................... Width-------------------- Total Length..................-_ Total leaching area....................sq. ft. Seepage Pit No..-_..1....-_-..... Diameter......1q 1....... Depth below inlet....6............ Total leaching area... 67.......sq. ft. Z Other Distribution box (X) Dosing tank ( ) '-' Percolation Test Results Performed by..Cape...C.O.d-...Surmey..Consul-tont Mate------June...B,....3,97B `-la Test Pit No. 1......2........minutes per inch Depth of Test Pit------12.!------- Depth to ground water-------none-_,--- w Test Pit No. 2................minutes per inch Depth of Test Pit-_.---_---.._-_--_•- Depth.to ground water........................ a O Description of Soil.....-...__0-0.7 wood loam .0.•7-5.0 subsoil 3.0-12-.0 coa .. qs�9 U ............-•••••......--- gravel----•••••. •-••-••• •••...... ...................• •--••-•• ----•-•• •-•••---•-•••----- --ROsF-RT--- cy� W ----•--------------------- ---------------------------------------------•------------------------------------------------------...--------------------------•-•------•.... UNature of Repairs or Alterations—Answer when applicable.-....................._._.-___....-___--.--.---_----.-----_------ b.......DAYtOR__. ai No 23741 .••--•--------------------------------------------------------------------------------•-------------------------------••-••--••...•--•--•-•---••-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac the provisions of L I':LE 5 of the State Sanitary Code—The undersigned further agrees not to place the sy in operation until a Certificate of Compliance has been issued by the board of health. S ne Date Application Approved By...... --• •• . • • . -Ak.. Date Application Disapproved for the following reasons--------------------•--------------•-----------•------------------------------------------.....-••-----•--------- ---------------------------------------------------•----------------•-----------------......----....................................................................................................... Date PermitNo......................................................... Issued........................................................ Date T / --s No......- �[...->.... Fps.....2.s..�............... THE COMMONWEALTH OF MASSACHUSETTS �., BOARD OF HEALTH TOVA OF Barnstable Application for Disposal Works Tonstrurtion rruti# Application is hereby made for a Permit to Construct ( xj or Repair ( ) an Individual Sewage Disposal System at o3 ARE?_. d Lot 32.7............................................. ......_•-•-......................... •- --.................................. .............•-•••....._..._....... ......_. Location-A/d�dress or Lot No. -A� 1� .................................................. ----•__'rC• �jlj .....................•-•- -•--------=�'J. : u ._........ • t Owner Address a ............................. .--..... A_N........................................... .....------------------- _°?. .......................................................... Installer Address �t 1 :.- d Type of Building /<;4 t,I C r14 Size Lot............. .........Sq. feet __________________Expansion Attic Dwelling—No. of Bedrooms.......................... ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons......_�_..__......_____.. Showers ( ) — Cafeteria ( ) a' Other fixtures . Design Flow.....................55.... gallons per pers per day Total dail flow....................3-3 ...............gallons. Liquid pacityIQQalons Leng 4*-lo- DWSeptic Tank h iameter...... ......... Depth.. x Disposal Trench—No. .................... Width............... Total Length......... ........ Total leaching area.... ._......_....sq. ft. Seepage Pit No._..._�-..____---- Diameter.._._.;k91....... Depth below inlet......}t........... Total leaching area..267.......sq. ft. z Other Distribution box ( ) Dosing tank ( ) ''' Percolation Test Results Performed by. d3 .4 0 ...il t30 3 17; 1 vate.._.._c l __ _ aTest Pit No. 1......'';"........minutes per inch Depth of Test Pit..... �...... Depth to ground water. _--_$fllaa.,_.. lT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' .. O Description of Soil Q•" i00G �O f�.T r 3133 , �' p P F-Mgss v ............... .... • --•-.•. ........._ ---••--• •-•••-•• ------•. ---------• --•-••--••- '............ 9°y o ROSERT G Zr U Nature of Repairs or Alterations—Answer when applicable........................................................................ �. ._____ y --•---•..............................•-------•-•--•-•--•-•-•------•-•-----•---------------------•----•.....-----......-------• ,p--Na 23741 Agreement: The undersigned agrees to install' the aforedescribed Individual Sewage Disposal System in acc the provisions of TIT1E 5 of the State Sanitary Code— The undersigned further agrees not to place the sy. '" V operation until a Certificate of Compliance has been issued by the board of health. ne t° `' ..rl... •-•- • •----••............................... ...............•••••-_.. ...._�.._. ..._ . .. ! Date Application Approved By...... ---------------- - - - --� ---•---••--------------------- --------7.`---/-��=-�� - Date Application Disapproved for the following reasons:.....................................----•--------•------•................................ ----•------•-• ........•----...----•-----•---------•---......---•-------------------------------------•--•-•- ....------•-•-------------•--•-••---••......---••-•-••---••••-•. Date PermitNo......................................................... Issued.....=................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ....................O F. ....... ................................................... Trr#ifiratr of Tompliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (- or Repaired ( ) by------------------- .................................f_. 3rJ..fir'_./...................................................................................................................... y Installer f has been installed in accordance with the provisions of 5 o,/The State Sanitary Code as desuib d in the Le application for Disposal Works Construction Permit No ..----- {--• ._....... d . ............ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS.A GUARANTEE THAT THE SYSTEIA ILL FUNCTION SATISFACTORY. ! nn DATE..... :-)....•_..r_..J. ...................................... Inspector. - ! ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD JaF HEALTH No......_. ..[........... FEE... ............ Disposal Works Tralustrurtion rrrmit Permissionis hereby granted------------•-1�•...... ! ` ..................--•------••-----------------------------------------------------•-..................-- to Construct ,(k,) or Repair ( ) an Individual Sewage Disposal System atNo., '. _.- .l.......__: / .`.......:z" /: ...... .'......- ..-------------•-••-----.......................................................... Dated-- '. //+ Street ,`- i as shown on the application for Disposal Works Construction Per No.___.� � � .. "` L. Board of Health DATE ..--•--•��••••-••-•••...---•••...................•-- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS J 63 TOWN OF BARNSTABLE — UNDERGROUND FUEL ANDCHE CAL STORAGE REGISTRATION OWNER AND INSTA LER INFORMATION J ADDRESS: I � 0� '-� /I�/ ' ...MAP.—NO. `7` ` % PARCEL NOP '` �� G OWNER NAME: /0/1 /1) C. -1 Iv'A1Vr" A P t/,/? �� ��/�� VILLAGE: r ���/�s�`�A�`� r •- INSTALLATION DATE: �� wr:�r, I , BY: .7N r!+ r t , • ADDRESS:„ CERT.-NO. � ..�-.w..��a_� - •.� ] ..: . .. ,.. .'i: ��.. _. _..�-'` --ya..._. A .;-••e^_`.,,,,=••�'."e---:— ...4 TANK- NFORMAT ZON OVA AN' ION`{OF j•.9�,jCAF'A I TYr � '( 6.1 i,)/ PE+ 3 - AGE � q� FUEL/CHEMICAL t W.•.i 1 ; t c'+' . . TEST I NG� .CERTIFICATION C • ]''*PASS 11- 3]� AIL , DATE LEA KA-TECTION C ] CHECK IF N/A TY E/BRAND ,. ZONE OF CONTRIBUTION C ] YES C NO e: DATE TO BE REMOVED .. FIRE DEPT. PERMIT ISSUED C ] YES C ] NO I ATE�. W.. -+ .'3N?QNS RV�A N� C ] CHECK IF N/A ATE' T p _ BOARD OF HEALTH':. TAG NO.C/'/]C I[ ]C ]C ] DATE PLEASE PROV I DE •SKET H OWING THE._TANK LOCATION ON THE BACK OF THIS CARD 47- -r. c. lI% w st\ TOWN OF BARNSTABLE ypf 7NE Tp� OFFICE OF MAN STADL BOARD OF HEALTH �p0 1639. �' 367 MAIN STREET �o NAY M� HYANNIS, MASS. 02601 r I s Nc>j 1988 Dear Enclosed is brass valve tag # 1 . Please attach to the fill pipe of your underground tank . You must do the following as indicated . ---- Remove your tank . I have enclosed information for you, regarding tank removal . -}CS i rz1 aV 'aS IDh^ ` ��a� 13* I :St- ��, l7 f' ZW fir• an's a�a [(� dreaW < e�( ;n C -, O11 ---- Have your tank tested starting now. You must test during the 10th, 13th, 15th, 17th and 19th year and annually thereafter. Removal in the year I have enclosed information regarding tank testing . ** In order to have your tank tested you must first contact an engineering company (see attached) to have a monitoring well installed-. Once the monitoring well has been installed you can then call 362-2511 , Ext. 334 and ask for Charlotte Stiefel or George Heufelder at the Barnstable County Health Department, to have your tank tested via the Soil Vapor Analysis Test. Currently, the test is done free of charge under the auspices of an EPA grant. Due to the unknown 'age of your tank we must presume it is twenty (20) years of age. You must have it tested every year and remove it by the year 1993 . To have it tested please follow the procedure as . indicated above from the ** (asterisk) on . If you have any questions please feel free to call me at 775- 1120, Extension 183 . Thank you, Donna Miorandi Health Inspector -99 -- - --EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE ~ 0 C Fqj-771 PROPOSED CONTOUR N o 'a W EXISTING WATER SERVICE LOCUS �s --+JGVV--UNDERGROUND WIRES et h� Slockthorn o �a TEST PIT oy�C Pebble Po BENCHMARK (`l s. LEGEND 401h Ge S d 3 V LOCUS MAP ,o ' s1`7 "X 911.30 x NOT TO SCALE 496' � EXISTING LEACH PIT TO BE PUMPED, FILLED WITH SAND AND ABANDONED �, 3 s 3.16 x i W 100.75 47.61 X f 6 N Lil 94.17 i 2 IN GROUNDI l 1 46 s SHEDS POOL c§ I� Ql r-T 17' E M 1 -4-Q die Garden INSPECTION PORT PF 1 t 101.40_1t gal z c 5 I` `y PATIO may-'::I1 x E j L 1 i �';_` EXISTING SEPTIC TANK TOP OF TANK, EL.=97.66+ 6'9 INV(OUTI', EL.=96.331p C NC _ :a x C)y 100.175 x F , 1 :� DOG ro '"" DECK 4 ` �,. PEN Benchmark Set iv ORANGE PAINT MARK ON . BLOCK `sf,'1RI` 1�- 9� TOP OF CONC ` EL.=98.30 (Assumed) 7 4.r x 98.4aS 46 ` f GARAGE I r EX/STIIVG 59.73 x /HOUSE (/124) TOF=100.29E t 99.63x • s � 10 00 4 x 99 33 ' k I x 99.00 99 �` t W 3 101.27 1 in§ v I LOT J27 �o 45,643E S.F. Map 4 7 Parcel 046 � 3 1C' 105A \ Q5.00' /V k GENERAL NOTES: ° I CB/dh 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL e�y9e of povene Q' 41 of BOARD OF HEALTH AND THE DESIGN ENGINEER. ` 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS N CB/dh OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE \r/�� LOCAL RULES AND REGULATIONS. JQ 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR ROAD TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ��P� 9��G ENGINEER BEFORE CONSTRUCTION CONTINUES. o PETER T. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. CENTEE 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF CIVIL THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 0. 35109 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. ( p OWNER OF RECORD 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. Ppf Sf DURNFORD, DAVID C & DARYL C 8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. %HEARTLAND BUSINESS BANK 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS P.O. BOX 291 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE l �� SHEYBOYGAN, WI 530S2—G291 DIRECTED BY THE APPROVING AUTHORITIES. 10, IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE PROPOSED SEPTIC SYSTEM UPGRADE PLAN THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 124 JONES ROAD, MARSTONS MILLS, MA ' 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS Prepared for: Ca ewide Enterprises., P.O. Box 763, Centerville, MA 02632 IN THE AREA BENEATH AND FOR ON ALL SIDES OF THE Q.A.S. AND P P P REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). Engineering by: SCALE DRAWN JOB. NO. 12. ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC SYSTEM 1"=20' P.T.M. 110-09 COMPONENTS NOT SHOWN ON THE PLAN. E119111Ci9 Works, Inc. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY, (508) 477-5313 2/15/09 P.T.M. 1 Of 2 � NOTE: PREVENTTO BREAKOUT,F NISHGRADE S ALLNOT BE < EL94.33 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT OVER END UNIT T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE EXISTING wa1��C.-� � � F.G. EL: 96.0-97.3(MAX.) F.G. EL F.G. EL: 97.2t MAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 11' L = 10'(MAX) INSPECTION PORT S=1% (MIN.) 0 S=1%% (MIN.) • 4'SCH40 PVC 4'SCH40 PVC 6" • TOP LOAD UNITS lo' 14" 8 1.6 4' TO EXISTING 48" LIQUID INVERT - LEVEL GAS BAFFLE INV.=95.87 PROPOSED INV.=95.70 4 ROWS W/4 UNITS AT 6.25'/UNIT = 25.0' ,.. . INV.=96.33t D-BOX INV.=94.64 EXISTING 4 OUTLETS (MIN.) EXISTING SEPTIC TANK SOIL ABSORPTION SYSTEM (PROFILE) RESTORE VEGETATIVE COVER BACKFILL WITH CLEAN PERC SAND TO TOP OF CHAMBERS INV. ELEV.=94.64 NOTES: BREAKOUT=TOP ELEV.=94.33 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.= 93.00 EXISTING SUITABLE 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 2.83 MATERIAL ON A MECHANICALLY COMPACTED SIX INCH CRUSHED 5' MIN. ABOVE BOTTOM OF STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). T.P. EXCAVATION OR G.W. 3) INSTALL INLET & OUTLET TEES AS REQUIRED. ADJUSTED GROUNDWATER EL.=85.0 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 4 ROWS OF 16 (H-20) ADS BIODIFFUSER UNITS WITH NO SEPARATION BETWEEN EACH ROW & NO STONE TYPICAL SECTION SEPTIC SYSTEM PROFILE N.T.S. SOIL LOG 21" 6-V POLY*INLETS DATE: FEBRAURY 10, 2009 (REF#12,469) 2" 2" 1-4' PO SOIL EVALUATOR: PETER Mc ENTEE PE CSE WITNESS: DONNA MIORANDI R.S. - - - - HEALTH.AGENT- -- _ _ r.N- ' 0ELEV. TP-1- DEPTH ELEV. TP-2 DEPTHo 11 03 96.4 0.. 96.0 0 FILL FILL 95.4 .A 12" 95.0 A 12" N Top View Section SANDY LOAM SANDY LOAM D-BOX 95.1 10YR 4/2 1OYR 4/2 16" 94.7 16.. B B SANDY LOAM SANDY LOAM 10YR 5/4 10YR 5/4 j 93.2 38" 93.0 36" 75 - C 18" C PERC 50" MED. SAND MED. SAND 2.5Y 6/4 2.5Y 6/4 >20% GRAVEL >20% GRAVEL 85.4 132" 85.0 132" PERC RATE <2 MIN/IN. ("C" HORIZON) 76" -I NO GROUNDWATER ENCOUNTERED PROFILE 16" •. 11.2" �--34" � SECTION END CAP DESIGN CRITERIA 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT NUMBER OF BEDROOMS: 3 BEDROOMS MODEL 16" HICAP CLASS I SOIL TEXTURAL CLASS: LENGTH 76" _ NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT DESIGN PERCOLATION RATE: <2 MIN/IN EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. DAILY FLOW: 330 G.P.D. SIDE WALL HEIGHT 11.2" DESIGN FLOW: 330 G.P.D. OVERALL HEIGHT 16" GARBAGE GRINDER: NO OVERALL WIDTH 34" �r 4640 TRUEMAN BLVD LEACHING AREA REQUIRED: (330) = 445.9 S.F. 13.6 CF ® HILLIARD, OHIO 43026 .74 CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 4 ROWS OF 4 - 16" (H-20) ADS BIODIFFUSER UNITS 124 JONES ROAD, MARSTONS MILLS, MA W/ NO STONE FOR AN S.A.S. WITH DIMENSIONS 11.3' x 25.0 Prepared for: Capewide Enterprises., P.O. Box 763, Centerville, MA 02632 (HIGH CAPACITY INFILTRATORS MAY BE SUBSTITUTED) SIDEWALL AREA: NOT APPLICABLE Engineering by: SCALE DRAWN JOB. N0. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) Engineering Works, Inc. NTS P.T.M. 110-09 I 16 UNITS x 6.26 LF x 4.7 SF/LF = 470.0 SF 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. DESIGN FLOW PROVIDED: 0.74 x 470.0 = 347.8 GPD (508) 477-5313 2/15/09 P.T.M. 2 Of 2 SOIL LOS r?14 12'PEAS-ONE _OAM 9 A. ✓JOb.D�..OrLM?I 4 C. I. IDISTo. 1 • A BOX I { iz/ j ' , � II,N 1000 -i �z< e,� r I 1000- GAL. • o ' / IGAL. PRECAST OR Go/sALSE SEPTIC 6 ; BLOCK TANK ,�> •: SEEPAGE PIT o E 1 i -- 20• MINIMUM FOUNDATION 1 1/2„ WASHED STONE - i �t9x� r.�o W,4•t'�'•�' ELEVATION SKETCH )-. -- 10' —"1 't It C. R A Tv � TEST B Y SCALE 1 - 4 TOWN INSPECTOR r-�3rG BACKHOE OPERATOR cc /33CZZ Jc 114AIS TEST MADE ON --,.lam!✓ 3._f 7 2 :_ ' `--�� l S �-!> V �o I l3'Z \ l I Se.Pn4 Tip W K 3 12 { `IV ,z .41 134 1f ' t s' '�' ti a 157, > Ito r/e r 00 _L. �%.e���."y! ��'J4`�'./,�.� T'Jfir�+�"�` �tr�`�'.^ _�7.r':.:G 9f•/.�N., � � � +L' S �,h�ca L..e..•eL..+ ..�-/c:ilk 4 o v� Ge.7F1.� /�.o c.K'�-f.<-.C� �a.Y �•� 's-iic.:a.,rs3 �.... >.. N eo _J41-Ft 78 .�� Go��""s'i '.+� - ' lm Ate. . SCrT = 79 ► K \ t aBvA�/ 7 CMG e,mg ELEVATION SCHEDULE OBERT \� PROPOSED SITE PLAN I. IN AT FOUNDATION = °I DAYL' J, V. SEWAGE SYSTEM DESIGN F. 2. 1 NV. INTO SEPTIC TANK I N v C�AYLOR y 3. INV. OUT O F SEPTIC A N K 1150`1�, S .�aca �' 3� e..�c�^/r�'Sa•4 a� NU �3741 Q 4. INV ;NTO DISTRIBUTION BOX = 13A' C3 ! SCALE I"-2o' ,j%-o , 1978 JNRL�F� 5 INV OUT OF DISTRIBUTION BOX 2"1- 1 C-s-G 7 6. INV INTO SEEPAGE PIT _ I�3 CAPE COD SURVEY CONSULTANTS • ROUTE 132 + 7BOTTOM OF PIT (t t ' 00 - 4 HYANNIS,MASS. DIVISION BOSTON SUOVIY CONSULTANTS, INC- B. BOTTOM OF STONE LAYER = 117'c7t3 r