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HomeMy WebLinkAbout0193 LAKESIDE DRIVE - Health 193 Lakeside Drive, Marstons Mills I r. TOWN OF BARNSTABLE LOCATION 193 LAKE 5-TpE OR. SEWAGE# e2oo3 - 13q VILLAGE !y, M;/l.S ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. Q i 13 CycA✓AT=o,,7 Sob- y77- OL53 SEPTIC TANK CAPACITY IS00 qcx))o e% .LEACHING FACILITY.(type) (size) 11 X �S NO.OF BEDROOMS ;t OWNER -►c �,c uc an PERMIT DATE: N- y - 0,g COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Lh-*7ff h- s ,P)s-?V h�.sd O O T_-hd s b�-09 � d �.h�• Eb ��-za d ��-IV r ll No. 009 1 Fee 10 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rtl hattion for �DigozaY i§pgtem Conelruction Vermtt Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. I La�_e5 63-e— D Owner's Name,Address,and Tel.No. ✓�1grs+ons MILL - SrEvE "BUGK.t,ANQ Assessor's Map/Parcel _-_F0U.6TD A Le. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �Kol m-T E11LFDy VN4►AjEi_Fi46 U,_O CS B-- B EX T16lN 509.4-I1-0653 1ZW. CZo56'FrEID RO F02_C'SrVA LE Type of Building: Dwelling No.of Bedrooms "' Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 gpd Design flow provided S 14-7- gpd Plan Date Li�21 D Number of sheets 2— Revision Date Title Size of Septic Tank 1500 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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. Signed - Date J 14�0 Application Approved by i Date Lf_Lf�d Application Disapproved by: Date for the following reasons Permit No. P�� l Date Issued 1 �1 No. 00 Fee 1 6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION . TOWN OF BARNSTABLE, MASSACHUSETTS Yes j, aae4v/efAynW� ZippYication for Migogal *pztem Cow5tructton Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. I �-t✓1 C L' I C��- t t�t Owner's Name,Address,and Tel.No. Assessor's Map/Parcel i D'�+ '� OV t6T nA L E Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 5 p S' y 1 l 5 3 I u_��P(Z_"► �11 l.l��t� C ty ter�l f r�I>"I b �.c..C�2.r.5 131 t3 Ex�Av rtvt�l 5v, y�� LioS 12-W• c.&v5sT tt.L_® P-D I`I,Q.CSTI)A LC. TI pe of Building: Dwelling No.of Bedrooms oZ Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 x gpd Design flow provided gpd Plan 'Date L) 06 Number of sheets Revision Date Title Size of Septic Tank 1500 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 lias been issued by this Board of Health. Signed (PxU.PAA Date yI U Application Approved by r / Date t -4-d Application Disapproved by: Date for the following reasons Permit No. a w L Date Issued 1 L1-0 THE COMMONWEALTH OF MASSACHUSETTS r -BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Gonstructed ( ) Repaired (� ) Upgraded ( ) Abandoned( )by '1 T'_� E yLCl\,tn 1 l(it 't 7D_1 (. _ at l q-6 L Ck) e 51 cje_ '"t)�I \,I P_ has been conQs�ructed in accordance ' with the p`r�ovisi{o�nss of Title 5 and the for Disposal System Construction Permit No. �U CI dated L4 Lf-06 Installer 1 S E,-e,1 • (_-1 1 Lf V1j ' 3 t -� t. XC Designer 11CA lf' C' ( i U #bedrooms Approved design flow 33 gpd The issuance of this permit shall not e c nst�rytod as a guarantee that the system ilw� l fu`cot a dest ned. Date �� Inspector 1 0—�i---==--=—='---------'—'—'----- Fee —or) ------ v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION —BARNSTABLE, MASSACHUSETTS =i5po5al �§pgtem Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon75 ( ) System located at V-�- eS Clf r 141 J4 t LL and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this�peit., Date I'� " �� Approved by / /� Town of Barnstable Regulatory Services SL Thomas F.Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: /-s- o g Sewage Permit# goo - 13 9 Assessor's Map/Parcel io a-i.-7a Installer&Designer Certification Form Designer: ,5TJn e.e n n ,% W or`l s Installer: Address: 12 Vy . Cr-0 S S ?-' 4'-e c,�f Address: I t-7"Z% rr�s r2lialp On -o �� c�vim ''" was issued a permit to install a N-y 8 (date) ' (installer) �,/ septic system at 193 14 If-eSi^� Pr'. , i"G b� based on a design drawn by (address) Fek v-17 He: K+e-e P. dated S S 08 (designer) I certify that the.septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (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 re f any component of the septic system) but in accordance with State&Local 0tio revision or certified as-built by designer to follow. Stripout(if requ' y d the soils were found satisfactory. _ PETER ER T. o :z McENTEE CIVIL 9�cQL�� No, 35109 (Installer's i ) C/S1 FSS10NAL (Designer's Signature) (Affix Designer's Stamp Here) PLEASE.RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANKYOU. q:\office fonnsWesignemertification form.doc II Town of Barnstable P# S� p� Department of Regulatory Services Public Health Division Date Lwvsrearr. f y ] D puss. l fD M�ag 200 Main Street,Hyannis MA 02601 f fi Date Scheduled WTime Fee Pd. 1 (J o t av Soil Suitability Assessment for Sewage Dis osal Performed By: ?f+C-f_ ��- Witnessed By: �r 1 NVP 74 LOCATION & GENERAL INI+ORI4 TION Location Address �e ; B Owner's Name 1 M6Ar'S>rVV%S. t`t\ t I Address 2 7 1 !Vv r }-Lt fr{c. SLtg t1 -S��T"e too 1)-, aS ,"1-jc ?S2-04 Assessor's Map/Parcel: i V `Z _ -� Z Engineer's Name +fie P L, NEW CONSTRUCTION REPAIR X Telephone# `(-7-7 1 3 Land Use re'e, t (/L �.i Slopes(%) �0�< Surface Stones ��'!-C Distances from: Open Water Body w ft Possible Wet Area �d ft Drinking Water Well LAG ft Drainage Way Z151 A Property Line �j ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 1 `z cy ? D �1 k Ott_. ;t Parent material(geologic) Depth to Bedrock ` � Depth to Groundwater: Standing Water in Hole: 1- d Weeping from Pit Face t" (Jt Estimated Seasonal High Groundwater DETERMINATION FOP.SEASON'ALMGH WATER TOO . 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.Adj.©roundwater bevel c I�E'Peoi ATION BEST 1Dute �'itup. Observation Hole# Time at 9" Depth of Pere Jj� Gj;ft t Gar Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch G v Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- 1P ***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,%Gravel d�l Z A SL- IZ�� 5L to 5 g 3� C- M---C 5,19,Vj DE9P OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel y CA DEEP OBSERVATION HOL LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Moulin Structure t g (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG3ole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) + (Munsell) Mottling (Structure,Stones,Boulders. Consistency, o Gr v 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 LET, area proposed for the soil absorption system? YES If not,what is the depth of naturally occurring pervious material? R Certification I certify that on u (date)I have passed the soil evaluator exatnination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required trai ' ,expertise and experience described in 310 CMR 15.017. L Li c � Signature Date Q:\.SEPTIC\PERCFORM.DOC 1 I COMPLETE •N COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign item 4 if Restricted Delivery is desired. ❑Agent ature ■ Print your name and address on the reverse X -'Ib ❑Addressee so that we can return the card to you. B. i (Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, 2 or on the front if space permits. J & 8, D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I �6 tvtt.G.e•w:�S ���� 1 �(S LO� 3. Service Type ■Certified Mail ❑Express WI ❑Registered 11 ❑Insured Mail (3 C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service?abso 7 0 0'6 215 0 ' 0 0 2 103 8 s 6 9 2 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 CUNITED STATES POSTAL SERVICE First-Class Mail ' Postag LISPSe&Fees Paid Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • I Town of Barnstable a Health Division 200 Main Street Hyannis,MA 02601 T_J ••F}}Fi } i. •i Fi}F}}f •F},t..�}:il ii7}41i -}}F 7lFi.i i _ Town of Barnstable Barnstable l pF THE Tpk �; � �. Regulatory Services Department RINSTABLE, J� ""�639•. a Public Health Division \.v�o a��m \fD MAt 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 22, 2008 Homecomings Financial LLC 2711 North Haskell—Suite 100 Dallas, TX 75204 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 193 Lakeside Drive,Marstons Mills MA was last inspected on February 4, 2008,by Mark Nardone, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool • Liquid depth in cesspool is less than 6"below invert or available volume is less then % day flow. You are ordered to repair or replace the septic system within Sixty (60) days 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 BO RD OF HEALTH T 1, as McKean;R.S., CHO Agent of the Board of Health CMS �1DOt, 2�so 000a to3g �,qo2 QASEPTIC\Letters Septic Inspection Failures\193 Lakeside Drive.doc Commonwealth of Massachusetts ONER1. tools Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lei ot PropeNgddreWAKf3lof Owner Owner's ame information is required for every page. CdY to Otftb7�i6flbection _�ns�tlon results must be submitted on this Conn.Inspection forms may not be altered In any Y Important A General Information When filling out � forms on the , computer,use 1. Inspector. only the tab key to move your cursor- not M.4 I y 'L L A.'e /VAI f return use the turn �G►R9 9!J�e Name of llrswaoir key. Company Noma + BfldgE Home & sCj>R1C , Company Address 27 Tiffany clrd. 1_ Cityfrown W.eftowatel, MA 112379 State Zip Code _�� a r Telephone Number uerr ose ��t 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 Sectlon4 5.340.of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes Fails; ❑ Needs Further Evaluation by the Local Approving Authority Inspeao a pnatu Date dr 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. '5insp doc•AJ06 ritte 5 official Inspection Forth Subsurface Sawa D �• is twsal system•Pape 1 of 15 Commonwealth of Massachusetts t,. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Props dre Owner owners information is required for — - t nD' every page. cay T w^ state Zi o Dat I on B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found an information which indicates that any of the failure criteria described in 310 CMR 15.303 o 'n 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditions Passes: ❑ One or more syst components as described in the*Conditional Pass"section need to be replaced or repai .The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not de rmined(Y, N, ND)in the❑for the following statements. If"not determined,"please expl n. ❑ The septic tank is meta and over 20 years old'or the septic tank(whether metal or not)is structurally unsound,ex ibits substantial infiltration or exfiitration or tank failure is imminent System will pass inspect) n if the existing tank is replaced with a complying septic tank as approved by the Board of ealth. •A metal septic tank will pa s inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating the a tank is less than 20 years old is available. ND Explain: ❑ 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 ❑ obstruction is removed t5irspAoc-MOG Title 5 Official Inspection Form:Subsurface Sewage Disposal Sysi•Page 2 of 15 Commonwealth of Massachusetts WHOM Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 19-? rr4 UIX Property Address -qD/t FZ 106 �/i�6 AJGA( Owner Owns elf Name information Is required for every page. cityrrowr fats q)dode DstbofInspection B. Certification (cont.) B) System Conditionally asses(cost): ❑ distribution box i leveled or replaced ND Explain: ❑ The system required pumping re than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if( . approval of the Board of Health): broken pipe(s)are repl ❑ obstruction is removed ND Explain: 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 ublic health, safety or the environment 1. System will pass unless oard of Health determines In accordance with 310 CMR 15.303(1)(b)that the system not functioning In a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is wi 50 feet of a surface water ❑ Cesspool or privy is withi &0 feet of a bordering vegetated wetland or a salt marsh 2. System will fall unless the Boa of Health(and Public Water Supplier, N any) determines that the system is func 'oning In a manner that protect the public health, safety and environment: ,1 ❑ The system has a septic tank an soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply ',r tributary to a surface water supply. ❑ The system has a septic tank and S 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. t5insp.doc•08" Tab 5 Of &Inspection form:Subsurface Sewage Disposal System•Paps 3 of 15 "1 . • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 113 c�KFSfO� DR Property Address h f 42eING /IVIn1CtA( Owner Owner's Name information is required for NkS'orlis M f c O W (94 ye •Z/Y/d� every page, CrryR0M1^ State Zip Code Date of inspection B. Certification (cunt.) C) Further Evalua on Is Required by the Board of Health(cunt.): ❑ The system h a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a p to water supply well*'. Method used to de rmine distance: This system passes if th well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent a the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided th 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 pi inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ d Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ d Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool dLiquid depth in cesspool is less than 6"below invert or available volume is less than%day flow ❑ u 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. ❑ d Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t!msp.doc•c" Title 5 lrfioal Inspection Form:Subsurface Sews Di P sposal System•Paps 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address imm Frnm i li t, </�lAd lA C Owner Owners Name information is required ford every page. City own State Zip Code Me&of Inspection B. Certification (cunt.) D) System Failure Criteria Applicable to All Systems(cant.): Yes No ❑ 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. ❑ t� 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 H the well water analysis,performed at a DEP certified laboratory,for fecal collform bacteria indicates absent and the presence of ammonia nld an and nitrate nitrogen Is equal to o1 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.] ❑ d The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. Ld ❑ The system f I .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 ❑ LJ the system is within 400 feet of a surface drinking water supply ❑ L� the system is within 200 feet of a tributary to a surface drinking water supply ❑ C� the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5inspAcc-0806 Title 5 Official Inspection fomt Subwrface Sewage Diepoael System•Pape 5 0l 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ►43 [AMUF A Property Address 110HLtoNrob ,�III�ANCIAt Owner Owners Name information is �` required for __ ��SSb9[ k I Uj /�1 OAYt )/y/a4r every page. Cityfrown 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 e ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ d W64 any of the system components pumped out in the previous two weeks? ❑ 91 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? Ll ❑ 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? d ❑ 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 Sall 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)j 15insp.0oc•08106 Title 5 OfNcisl InsWtion Form:Subsurface Sewaps oispoaal System-Pape 6 of 15 r 4 Commonwealth of Massachusetts Title, 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments K3 (AKFSPPf Property Address NGrl f&4 FAG f(tA*AJ(r q Owner Owner's Name information is f H/«S required for /� OJ6W every page. City/town Stab Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?[if yes separate inspection required) ❑ Yes ❑ No Laundry system inspected? ❑ Yes No Seasonal use? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes No Last date of occupancy: Date CommerclaYIndustrial Flow Conditions: Type of Establishmen• Design flow(based on 31 MR 15.203): Gallons per day(gpd) Basis of design flow(seats/pe s/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 syst ? ❑ Yes ❑ No Water meter readings, if available:. Last date of occupancy/use: -.. . _.. bate Other(describe): t5inep.dac•t;8i08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pepe 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address Hor(CW 1N6 rtAMW IA L Owner Owner's Nameinformation 1 required fors Mac�aW I It (S 14A 0)6vf- i/o� every page. Cityfrown Stets Z Code IP Date of Inspection D. System Information (cunt.) 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 cess Poa ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology, Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑ No ;5msp.doc-6&'06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•page a of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments (A► C510f DA. Property Address tp OM�f 4N l�►G �/R1MI C/�� Owner Owner's Name information is required for tydrW Mitts �_ 0)6y/ .11VINK every page. City/rown State Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: dcast 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.): 6009 CcAorrrod Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene Y El other(explain) If tank is metal, list e: years Is age confirmed by a rtificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: Distance from top of sludge to botto of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet a or baffle Distance from bottom of scum to bottom of ou t tee or baffle How were dimensions determined? tsmsp.doc•08106 Tale 5 Ofric0l Inspection Forth:Subsurface sewage omposal system•Pape 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments (a WS1 of pit. Property Address HCNF(WJP6 FnAN(IA L Owner Owner's Name information is 1JS r'l(f N 016 Yr 'l ylo? required for Wpo every page. City own state Zip Code Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Grease Trap(I to on site plan): Depth below grade. feet Material of constructio ❑concrete ❑ etal ❑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 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 b pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal [t fiberglass ❑ polyethylene� Y ❑other(explain): Title 5 Ofltciai Ins pectan Form:SuDeuAece Serape Diepoeal system•P+qe 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments l9.� i',A�S1�• LK, Property Address 40j4((Cp r/JG Owner Owner's Name information bpiJ f M l L(S �„� O.�b yd; y�ol required for every page. Cky/rown State ZIP Code Date of Inspection D. System Information (cunt.) Tight or H Iding Tank(cunt) 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 ala and float switches,etc.): •Attach copy of current pumpi g contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present mu t be opened)(locate on site plan): Depth of liquid level above outlet i vert Comments(note if box is level and tribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): Pump Chamber(locate n site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t!insp.doc-,;8108 Ttle S Official lnspedion Form Subsurface Sewa ge Disposal System•Peps 11 0115 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I'J� Uk 1lfS19F 0�(, Property Address N�MFcvHrN� �tN�INt'rq� Owner Owner's Name information is �Mk)5 t4 f(IS / 0AV .21 Op' required for -- every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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: Type. ❑ leaching pits number: ❑ leaching chambers number. Cl leaching galleries number. Cl leaching trenches number, length: ❑ leaching fields number,dimensions: u 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.): SIWJ OF rAUUI E ,, S10(W4tU AA ? Jth(K S105 0( 54014-S t5.r.sp dot•0fL06 Idle 5 Official Inspection Form Subsurface Sewage Disposal System•Page 12 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 (AOSIM At P pero r Address ib4ftiogiaG 1-INANE/�t t Owner Owners Name information is u NS h s I�t M� O.lby� WIV10d required for �� !�1r` every page. city own State Zip Cods Date of Inspection D. System Information (cunt.) Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): 1 Number and configuration Depth—top of liquid to inlet invert I r Depth of solids layer Depth of scum layer CF X6 �44M. Dimensions of cesspool Materials of construction g to</C Indication of groundwater inflow ❑ Yet ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): S fb+uS of 'ygefe-()6 rAM oufAfic.i SoWf om ouMell" SWFFP NFA!y 5W196¢ /N ci'S•SPW( Privy(loc to on site plan): Materials o nstruction: Dimensions Depth of solids Comments(note ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5mep.doc•08/06 Title 5 OPocW Ine pectnn Form:Subsurface Sewage Disposal System•Pape 13 of 15 y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I fj 01(fSh9f Orl. Property Add Owner Owners N information is �Ns M Il(f Q�6v� v Of' required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. J w AFAR � A 3 A149 ' �FSso 3.�-.fig t5msP doe•08106 Title 5 Official Inspection Form:Subsurface Sewaps Disposal System•Pape 14 of 15 4' r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address —- . .1}--f If hl(#IL Owner Owners Nams information is ft-r b�1 s 11 (((f I — 0 61 y�' required for every page. C State Zip Code Date of Inspection D. System Information cunt. y (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water. 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: Cl Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: _- cq wtoys bf .4uF"t -r Lix - i5msp dw-011106 T,Ik 5 official Inspection Form:Subsurface Sewage Disposal System-Pape 15 of 15 �J r V COmmOnweWh of MOSSOChUSetts .lolm Grad Executive Office of Er'Monmental AffcArS D.E.P. Title V Septic Inspector Department of P.O. Box 2119 Environmental Protection Teaticket,MA02536 (508)564-6813 � 8 e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR 10 PART A tt` CERTIFICATION v+ Property Address: 193 Lakeside Dr. Marstons Mills Address of Owner: ►!� TdWq, ¢ 19 Date of Inspection:7109197 (If different) yr��B,qt�� 9J Name of Inspector:John Grad Higgins pE�Tgp,_ a Company Name,Address and Telephone Number: 1 Z CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes This inspection Is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Fu r aluation By the Local Approving Authority performing atthe tlme ofthe Inspection.My Inspection does not Imply any warranty or guarantee of the longevity of the Fails septic system and any of its components useful rife. Inspector's Signature: Date: 7110197 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: Al SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. Ell SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined",explain why riot.) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 193 Lakeslde Or.Marstons Mills Owner: Higgins Date of Inspection:7109197 _ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: I I have determined that the system violates one or more of the following failure crileria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 11115195) 2 ,r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 193 Lakeside Dr.Marstons Mills Owner: Higgins Date of Inspection:7109197 D]SYSTEM FAILS(continued) Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11115195) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 193 Lakeside Dr.Marstons Mills Owner: Higgins Date of Inspection:71o9197 Check if the following have been done: x Pumping information was requested of the owner,occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. nfaAs built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the Interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115193) 4 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 193 Lakeside Dr.Marstons Mills Owner: Higgins Date of Inspection:7109197 FLOW CONDITIONS RESIDENTIAL: Design flow: 0 gallons Number of bedrooms: 2 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): Yes Water meter readings,if available: nla Last date of occupancy: used 6 months ayear COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings,if available: nla Last date of occupancy: rea OTHER:(Describe) nla Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of iinformation: System has not been pumped in the last year. System pumped as part of inspection: (yes or no)Yes If yes,volume pumped: 1000 gallons Reason for pumping: Maintenance TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system X Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) X Other(explain) 1,000 gallon leach pit APPROXIMATE AGE of all components,date installed(if known)and source information: 1078 Sewage odors detected when arriving at the site: (yes or no) No (revised 11115195) . 5 f, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 193 Lakeside Dr.Marstons Mills Owner: Higgins Date of Inspection:7109197 SEPTIC TANK:_ (locate on site plan) Depth below grade:Na Material of construction:X concreate_metal_FRP_other(explain) Dimensions: nla Sludge depth:n1a Distance from top of sludge to bottom of outlet tee or baffle:nla Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n/a Distance form bottom of scum to bottom of outlet tee or baffle:n1a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) nla GREASE TRAP:_ (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_other(explain) Dimensions: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n1a Distance from bottom of scum to bottom of outlet tee or baffle:n1a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Iva (revised 11115195) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 193 Lakeside Dr.Marstons Mills Owner: Higgins Date of Inspection:7109197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n1a Material of construction:_concrete_metal_FRP_other(explain) Dimensions: nia Capacity: n1a gallons Design flow: n1a gallons/day Alarm level: n1a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Na DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) n1a PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)_ Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) nla (revised 11115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 193 Lakeside Dr.Marstons Mills Owner: Higgins Date of Inspection:7109/97 SOIL ABSORPTION SYSTEM(SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: Na Type: leaching pits,number: 1_000 gallon leach pit leaching chambers,number:n/a leaching galleries,number: n1a leaching trenches,number,length: n1a leaching fields, number,dimensions:n1a overflow cesspool,number:nfa Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) The leach pit Is structurally sound and functioning properly,it had 1'of water in It CESSPOOLS:x (locate on site plan) Number and configuration: one c Depth-top of liquid to inlet invert:level Depth of solids layer: 3' Depth of scum layer: 0 Dimensions of cesspool: 5'x5' Materials of construction: block Indication of groundwater: n1a Na inflow(cesspool must be pumped as part of inspection) Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Main cesspool and all components are structurally sound Recommend pumping system every year for maintenance PRIVY:_ (locate on site plan) Materials of construction: n1a Depth of solids: nra Dimensions: Na Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) Na (revised 11115/95) 0 C! SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 193 Lakeside Dr.Mars(ons Mills Owner: Higgins Date of Inspection:7109197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' h B 3y 0 g LM DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 -, TOWN OF BARNSTABLE LOCATION 2 1 Ak V SEWAGE # VILLAGE � � ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.,-( SEPTIC TANK CAPACITY LEACHING FACILITY:(type) w (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER t DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �/" .. r, � [ aF� �/ `� r �� O II II I I LO-CATION SEWAGE PERMIT NO. . 13 Lza-d 0� * Gam. VILLAGE W—,A INSTA LLER'S NAME A ADDRESS e LDER NER DATE PERMIT ISSUED /F7J-- DATE COMPLIANCE ISSUED zs � L,�K�` 4 N LOCUS _ PB 138 PG 50 c� G O W F P lb s Cr Cr m 509°29r0/yM r. Shubael I09.0(y Pond Lakeside Or Colvin Hamblin Flint St - Rood o.F LOCUS MAP " NOT TO SCALE GARAGE\ ```` 99.25 x ti 1 99.57 Pik PROPOSED SEPTIC TANK 1 TBM: LT. OUT5IDE CORNER BOTTOM CONCRETE STEP EL. = 92.13 (A55UMED) IHE r 9b �x 55.-5 95.77 TPt�, =,o t 91.70 x -2 -�� MS' ILI� EXISTING CESSPOOL(APPROX.) REMOVE—SEE NOTE 11 NOTE: ADDITIONAL CESSPOOLS 01 MAY EXIST ON PROPERTY EXISTING SEWER :FULL CELLAR �' o0.86 INV.=89.00f � z 'CRAWL SPACE z' 'TOF = 91 .58 z � Cb Q 90.11 O� APN 1 02 - 172 15,820± 5F � 86.90 Q - SS GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 80ARD OF HEALTH AND THE DESIGN ENGINEER. s6\ y 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS /D $3 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND..ANY APPLICABLE LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: 310 CMR 15.405(1)(b): It I © 84.2 1) A 2' variance to the 3' maximum cover requirement, for no greater than 5' of cover. S.A.S. shall be vented and H-20 Rated. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 8103 DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6, THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION, t 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO PRIVATE WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE OWNER OF RECORD DIRECTED BY THE APPROVING AUTHORITIES. A 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE HOMECOMING FINANCIAL LLC THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 2711 NORTH HASKELL—SUITE 100 CONSTRUCTION. DALLAS, TX 75204 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND ON ALL SIDES OF THE S.A.S. AND REPLACE LEGEND WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REOUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. —;04 -- EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE �`` ti� PROPOSED SEPTIC SYSTEM UPGRADE PLAN o PETER T. 94 PROPOSED CONTOUR o McENTEE CIVIL ,N 193 LAKESIDE DRIVE, MARSTONS MILLS, MA U yy EXISTING WATER SERVICE No. 35109 Prepared for. Stephen Buckland, P.O. Box 414, Forestdale, MA 02644 —flHyt�-- OVERHEAD WIRES E�/ST� �� Engineering by: Surveying by: SCALE DRAWN JOB. No. Engineering Works HOOD 5URM GROUP 1"=20' P.T.M. 136-08 TEST PIT 12 West Crossfield Rood 18 Route 6A BENCHMARK ' � Forestdale, MA 02644 Sandwich, MA 02563 2 08 CHECKED SHEET P.T.M. i Of 2 (508) 477-5313 (508) 888-1090 2 } NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:88.57 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. PROPOSED 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 F.G. EL: 93.5(MAX.) VENT F.G. EL.=92.0t F.G. EL: 93.Ot MAINTAIN 2% GRADE (MIN.) OVER S.A.S. �Sa' INSPECTION L = 11' L = 12' L = 7'(MAX) PORT @ S=1% (MIN.) ® S=1% (MIN.) @ 5=17. (MIN.) 4"SCH40 PVC 4'SCH40 PVC 4"SCH40 .PVC 6" jV 70'} S 11.3" TO t a" INVERT wwwwwo INV.=88.80 48" LIQUID I _I LEVEL ADD BAFFLEGAS INV.=88.42 INV.=88.25 r4 ROWS OF 4 UNITS AT 625'/UNIT = 25.0 PROPOSED D-BOX INV.=88.18 4 OUTLETS (MIN.) SOIL ABSORPTION SYSTEM (PROFILE) INV.=88.55 PROPOSED 1500 GALLON SEPTIC TANK ESTABLISH VEGETATIVE COVER BACKFILL WITH CLEAN NATIVE OR TIE IN TO EXISTING PERC SAND TO TOP OF CHAMBERS 4" PVC SEWER AT HOUSE, INV.=89.02t BREAKOUT=TOP TOP ELEV.=88.57 NOTES: 1) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=88.18 GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED BOTTOM ELEV.=87.24 II ifl�llln�l f STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 2.8' 2) INSTALL INLET & OUTLET TEES AS REQUIRED, 5' MIN. ABOVE BOTTOM OF 3 GAS BAFFLE TO BE INSTALLED ON OUTLET TEE T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=11.3' r� EXISTING SUITABLE �? AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL, NO GROUNDWATER, EL=82.0 - MATERIAL 4) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE 4 ROWS OF 4 - 16" (H-20) ADS BIODIFFUSER UNITS INVERTS PRIOR TO CONSTRUCTION, SEPTIC SYSTEM PROFILE WITH NO SEPARATION BETWEEN EACH ROW & NO STONE TYPICAL SECTION N.T.S. KT.S. RAWLyST'Ac ~. ~ ~• ~� 21" 5-4POLYSEAL'INLETS " 2" 20 1/� d,• ��F� P P. S.A.S. ____________ S.A.S. LAYOUT E-F-25.0 N Top View Section SOIL LOG D-BOX DATE: MARCH 28, 2008 (REF#12,151) SOIL EVALUATOR: PETER McENTEE PE WITNESS: DONNA MIORANDI R.S. HEALTH AGENT ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH �- 7s" 94.0 A 0" 92.5 A 0" SANDY LOAM SANDY LOAM tOYR 4/2 10YR 4/2 93.fl 12" 92.0 6„ B B SANDY LOAM SANDY LOAM 10YR 5/8 10YR 5/8 91.0 C1 36" 9fl.5 Cl 24" SILT LOAM SILT LOAM fi 76" 5Y 5/3 5Y 5/3 89.0 60" 89.5 36" PROFILE C2 C2 PERC IfE 48" M-C SAND M-C SAND 16" ` 2.5Y 6/4 2.5Y 6/4 11 82.0 144" 82.5 120" PERC RATE <2 MIN/IN. ("C2" HORIZON) 34 NO GROUNDWATER OBSERVED SECTION END CAP DESIGN CRITERIA 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT NUMBER OF BEDROOMS: 2 BEDROOMS MODEL 16" HICAP SOIL TEXTURAL CLASS: CLASS I 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: 220 G.P,D. SIDE WALL HEIGHT 11,2" DESIGN FLOW: 330 G.P.D. OVERALL HEIGHT 16" GARBAGE GRINDER: NO OVERALL WIDTH 34" 4640 TRUEMAN BLVD LEACHING AREA REQUIRED: (330) = 445.9 S.F. 13.6 CF HIWARD, OHIO 43026 74 CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS. INC. PROPOSED SEPTIC TANK: 1500 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 193 LAKESIDE DRIVE, MARSTONS MILLS, MA W/ NO STONE FOR AN S.A.S. WITH DIMENSIONS 11.3' x 25' Prepared for: Stephen Buckland, P.O. Box 414, Forestdole, MA 02644 SIDEWALL AREA: NOT APPLICABLE Engineering by: Surveying by: SCALE DRAWN JOB. NO. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) Engines IngW6rkr HOOD SURVEY GROUP NTS P.T.M. 136-08 16 UNITS r. 6.33 LF x 4.7 SF/LF = 470.0 SF 12 West Crossfield Rood 18 Route 6A Forestdole, MA 02644 Sondwich, MA 02563 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 x 470.0 = 347.8 GPD (508) 477-5313 (508) 888-1090 4/2/08 P.T.M. 2 Of 2