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0041 LIBERTY LANE - Health
41 LIBERTY LANE, MARSTONS MILLS A= TOWN OF BARNSTABLE Lh' ATION � SEWAGE# �, ,VILLAGE �/ ASSESSOR'S MAP&PARQE1A) l�© � INSTALLER'S NAME&PHONE NO. G/ SEPTIC TANK CAPACITY LEACHING FACILITY.(type)��� (size) NO.OF BEDROOMS OWNER PERMIT DATE:? o� ® COMPLIANCE DATE: 77 Separation Distance etween th 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 - Y Eg:. � • � No. V ' 3 t t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes �'l ftplitation for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair vi upgrade( ) Abandon( ) ❑Complete System ❑Individual Components MLocation AddressA r Lot No. Owner's Name,Address,and Tel.No Assessor's Map/Parcel Installer's Name,Address,and Tel No. `�j � � Lp Hesigner's Name,Address,and Tel.No / Type of Building: Dwelling No.of Bedrooms — Lot Size i�/j"�®�p sq.ft. Garbage Grinder( ) Other Type of Building ,� y� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 1 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank� j C � � Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)_ E /����i d 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 Application Approved by Date 1 Application Disapproved by Date for the following reasons Permit No. d� Date Issued '� ' w e i No. O�-V � © � � � - Fee r THE.�:(9MMONWEALTH OF MASSA54,US TTS Entered in computer. Yes 4 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Wication for Disposall6gotem Constructio-n Permit Application for a Permit to Construct( ) Repair(UY6pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or'Lot No. L//�` : 14 A Owner's Name,Address,and Tel.No Assessor's Map/Parcel Installer's Name;-Address,and Tel.No. �`l�T h Designer's Name,Address,and Tel.No /�� � Type of Building: Dwelling No.of Bedrooms Lot Size 1,45"-oe2 U sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) %®�.S /�� ��r , 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. r .� Signed l r Date Application Approved by Date Application Disapproved by Date for the following reasons ti Permit No. 0,10 16 Q A? Date Issued_ :2 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(!/< Upgraded( ) Abandoned( )by / /. at �_ ,� has been constructed in accordance wiil7 the provisions of Title 5 and the for Disposal System Construction Permit No.,9 Oft dated •/�,0) Installer i "� Designer A v #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system w�f nu ction" as;designed.-� Date '7 /n. Inspector , .. - ------------—- No _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal stern �tConstrUction ermit p � Permission is hereby granted to Construct ) Repair( z4---. Upgrade( ) Abando ( ) System located at J .. and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date� ��� Approved by / , Town of Barnstable �IMME Regulatory Services Thomas F. Geiler, Director BARNMBL& 9�pT & ��®� Public health Division Fo� Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 71301.w Sewage Permit# r 0 'tVAssessor's Map\Parcel lLq Daq D1y Designer: C1�Y / ►`"` yr Installer: Address: O Address: l!G " ��1 e�a��Wtlil✓1 � /�Z �o�� oi-s 3 OnA W I�� �rr\J6t-f- was issued a permit to install a 7 (date (installer) septic system at_41 t qi e based on a design drawn by tom,, (address) VVe� l dated (designer) 670L LZ) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF- MAss9cy �— QAF E G /" XRY �. /41n4stallees5SI__nature) No: 140 � . s£GISIEP� AN I TAR ll I� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARN ABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPLIANCE WILL, NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Heal th/Septic,/Designer Certification Form 3-2674doc v , APPLICANT: _1DGLrf4-✓1 ADDRESS: 41 L t Bl gT,,f L"E , M. mm_o DESIGN FLOW: 3 36> gpd REVIEWED BY: DATE: N/A . OK NO Legal boundaries denoted [310 CMR 15.220(4)(a)] X Street,Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Y 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)] X Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a)for upgrades]- i not, a variance is required [310 CMR 15.412(4)] X Location of impervious surfaces (driveways,parking areas etc.) 1310 CMR 15.220(4)(d)] x Location all buildings existing and proposed 310 CMR 15.220(4)(c)] X Location and dimensions of system components and reserve areas [310 CMR 15.220(4)(e)] X S stem Calculations [310 CMR 15.220(4)(f)] dail flow X . se tic tank capacity (re uired and provided) X soil abso tion s stem {re uired and provided) whether s stem designed for arba e grinder North arrow [310 CMR 15.220(4)( )] Existing and ro osed contours [310 CMR 15.220(4)( )] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] k Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] X Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] k erco a ion test results match loading rate?-[310 CMR 15.242] X Certification statement by Soil Evaluator[316 CMR 15.220(4) ')] X Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] 3( Location of every water supply,public and private,.[310 CMR 15220(4)(k)] �G Address 4 L1 �t 1 LLS Sheet 1 of 7 within 400 feet of the proposed system location in the case of surface water supplies and grayel packed public water supply— within 250 feet of the pioposed system location in the case aC within 150 feet of the proposed system location in the case of private water supply wells X Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] k Water lines-and dtheF=subsurface utilities located [310 CMR 15.220(4)(m) if water line cross see 310 CMR 15.211(1)[1]) X Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(6)] X Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2)] X Stamp of Registered Land Surveyor(required if 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 CMR 15.405(1)(k)] X Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.103(4)] X Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] X Benchmark within 50-75'of system [310 CMR 15.220(4)( )] X Materials specifications noted? [various sections of 310 CMR 15.000] X System components not> 36" deep(unless Local Upgrade Approval or LUA.requested){310 CMR 15.405(1(b) Address 41 u G Evj-;Y Lp�)E Sheet 2 of 7 Size OK? -[310 CMR 15.223(1)] X 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)] x 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)] t Separation between inlet and outlet tees (no less than liquid depth) 310 CMR 15.227(2)) - Inlet/Outlet elevations of 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)] )C 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) - middle access at least 8" (b 7/07) [310 CMR 15.228(2)] �( Access to within 6 "'of grade - one port for systems<I000gpd, two fors stems>1000 gpd 310 CMR 15.228(2)] X 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)] x Setbacks from resources [310 CMR 15.211] Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1)(b)] x First compartment 200%daily flow; Second compartment 100% daily flow 310 CMR 15.224(2) and(3)] X "U"pipe through or over baffle, outlet of each compartment with x as baffle or approved filter[310 CMR 15.224(4)] Address 41 L ac O? L"C_ At. M t U S Sheet 3 of 7 } Located at least ten feet from any water line? [310 CMR 15.222(2)] X Disposal piping at least 18"below water line (when water and sewer cross, see 310 CMR 15.211(1)[1)) x Cleanouts required/provided ? [310 CMR 15.222(8)] X Thrust blocks specified in force mains? 310 CMR 5 22 c 1 1(6) Slopef s oewer line not less than 0.01 (1/8"/ft) 0.02 preferable I[310 CMR 15.222(6)] X 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 um 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) k Stable compacted base [310 CMR 15.221(2) and 310 CMR 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)] x Riser if deeper than 9" [310 CMR 15.232(3)( ] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] X - Minimum sum 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] X 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)] piping,Semice componen;s accessible (not tee deep,with disconnects accessible) 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 4-1 08�> G � /�°�, KQLL5 Sheet 4 of 7 Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] k _ Required separation togroundwater? 310 CMR 15.212)] Aggregate specified 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)] k Breakout requirements met?(No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] . X Each structure with one inspection manhole (if>2000 gpd must be tograde) 310 CMR 15.253(2)] X Aggregate I'minimum-4'maximum. [310 CMR 15.253(1)(b)] X 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 s .ft. [310 CMR 15.253(6)] Kim EM 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 eater(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] minimum 2 distribution lines [310 CMR 15.252(2)(a)] 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)] Separation betweeri-beds 10' minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only 310 CMR 15.252(2)(i)] Address 41 L18GRj-Y tiv, , M WLL9 Sheet 5 of Pressure Dosed System ? Provided pump and piping calculations as re uired. 310 CMR 1 5:220(4)(r)] x Pressure dosing required on all systems>2000gpd or alternative systems undamedial approval [310 CMR 15.254(2) and I%A X Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] X . Inspections once per year(systems<2000 gpd) or quarterly (>2000 d good to note on plan 010 CMR 15.254(2)(d)] x Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? x Im ervious barrier and/or retainingwall ? [Guidance Document] X kEngineer mpervious barrier installation must be supervised by ner [3I0 CMR 15.255(2)(b)] )( etaining wall must be designed by Registered Professional [310 CMR 15.25-5(2)(a)] ide slo e not exceed 3:1 ? 310 CMR 15.255(2)]reakout requirements met? [310 CMR 15.252(2)and Guidance Document] X At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour'soil interface X 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 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 (4)( )] 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 41 L'1&j -R- LN $4 M N.15 - ) Sheet 6 of 7 r Is the system in a Designated Nitrogen Sensitive Area(Zone II 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)] X Pumping to septic tank? [ 310 CMR 15.229 Shared System [310 CMR 15.290 Address LA 156�N, L Miuc Sheet 7 of 7 Town of Barnstable P# Department of Regulatory Services s ► �, : Public Health Division Date ° 's 19. 200 Main Street,Hyannis MA 02601 Date Scheduled_ Time Fee Pd. D O Soil Suitability Assessment for Sewage Disposal Performed By: ' /�+l',YY\Pib1 IV I � Witnessed By: 04M y j 112�4 LOCATION& GENERAL INFORMATION Location Address JJ/ / t'/ � Owner's Name V v, Address Assessor's Map/Parcel: l/_ o v t1— O Engineer's Name 0°e p- o e g e r NEW CONSTRUCTION 1 REPAIR Telephone# 2 q a.2.. Land Use e4/�( l GLI Slopes(�o) r Surface Stones /u Distances from: Open Water Body 2- 2,06 Possible Wet Area L ft _Drinking Water Well a_oD ft _ Drainage Way > l00ft Property Line Other ft . C1 saoo rt e SKETCH: ._.._._._._.._.._.. 1' L 0 1 ARE.-\ = 11 11 1�000 SF +_\`. 1 It 1 Hro wt �. \ \\ j r-1---3100, t 2 n >I \ \ I I \ p TH-2 Fri TH-1 r- O \ Existing Leach \\� FT] l I ' r\, I (Note 10) t corvC A/ED DRI EWA, It / j 11 Jjt� PAD l/-----------------j I I I I EXIST.I1,00 sHED 6P i SEPTIta TAN G I -.-.._..........-- -I I _ . .. . - . - . . . . . ------ 1� h� C6 64 150.00 It Parent material(geologic) r,S Depth to Bedrock Depth to Groundwater. Standing Water in Hole: /" Weeping from Pit Face Estimated Seasonal High Groundwater �r DETF� mNATION FOR SEASONAL HIGH wATEXTABLE Method Used: A 0 Depth ObserveJ standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment fr. Index Well# Reading Date: Index Well level�. Adj.factor,,,..vo. Adj.drouttdwater Level,,,y PERCOLATION TEST bete , Thne Observation Hole# Time at 9" C t� Depth of Perc J 2" Time at 6" il °-7 Start Pre-soak Time @ I _ Time(9"-6") End Pre-soak ` 1 Rate Min./Inch Site Suitability Assessment: Site Passed X 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:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,% ravel v A LoAM 94,JX9 Ib OV I �► 'tl - � � �o S'a�► l .Q sag �M.uss r-,,� a� � 1 32 G M�^v-S o 2�S?� /WP r4nute-1 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) a LUG, &s%v+-r - t Sa,KA -Z.5-y 71q Cy DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi to c %Gravel DEEP OBSERVATION HOLE LOG NH Ie# Depth from oil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten Flood Insurance Rate Map: Above 500 year flood boundary No— Yes—____ Within 500 year boundary No J+ Yes Within 100 year flood boundary No. Yes Depth of Naturallv Occurring Pervious Material Does at least four feet of naturally occurring pervio s aterial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring per ious material? Certification I certify that on 10 S (date)I have passed the soil evaluator examination approved by the Department of Enviro'mental Protection and that the above analysis was performed by me consistent with . the required n expertise and experience described in 3 10 CMR 15.017. Signature I Date 2L2 L'c? Q:\SEPTlMERCFORM.DOC Town of Barnstable Barnstable o P/ oT Regulatory Services Department �t +nativ.poLE./ , / Public Health Division \�p i� byQ/.�0 s. .c -Eb�a 200 Main Street, Hyannis MA 02601 2007 Office: 508=862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205009885 6/17/2010 Today Real Estate c/o David Holt 1533 Falmouth Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 41 Liberty Lane, Marstons Mills, MA was last inspected on June 2, 2010, by Shawn McElroy, 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. • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. 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 HE BOARD OF HEALTH T PmasMcKean, R.S.; CHO Agent of the Board of Health w Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 41 Liberty Ln Property Address Bank Owned{Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 page. 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. A. General Information I� Coati 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 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 Evalu on by the Local Approving Authority 6-3-10 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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 buyerjf 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. rn t5insp official document•03108 Title 6 Official Inspection Form:Subsurface Sewage Dispot.� ,stem•Page/1of t . J r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 41 Liberty Ln Property Address P Y Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 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. Answer yes, no or not determined (Y, N, ND) in the ❑ 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. 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 t5insp official document•03/08 Tltle 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) i B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ 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 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 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 aseptic 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. t5insp official document•03/08 Title 5 Official Inspecbon Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has aseptic 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 0 ❑ 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 1/ day flow Required pumping more than 4 times in the last year NOT due to clogged or ❑ ® obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the 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. t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): 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. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ 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 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. t5insp official document-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 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 j . ❑ ® 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 CM 15.302 5 p ) [ Ol t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 page. City/Town State Zip Code Date of Inspection 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 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 years usage (gpd)): Sump pump? ❑ Yes ® No 4-2010 Last date of occupancy: Date . Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 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: Last date of occupancy/use: Date Other(describe): t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: N/A 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): Approximate age of all components, date installed (if known) and source of information: 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp official document•03/08. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 page City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18"tee" Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): 12" 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 gal Sludge depth: 16 Distance from top of sludge to bottom of outlet tee or baffle 16" Scum thickness. 3" Distance from top of scum to top of outlet tee or baffle 5 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape t5insp official document•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 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.): Tank is in good condition with bafies installed and no sign of leakage. r Grease Trap (locate on site plan): Depth below grade: feet j 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 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): t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box had clear signs of failure with stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp official document•03/08 TrUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: 1-1000 gal ❑ 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.): Leach pit had clear signs of failure with stain lines above inlet invert. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 16 e Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 i page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.): t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Marstons Mills MA 02648 6-2-10 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. (�u4 k A _ _ 6 b .. C� t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Liberty Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1=800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 6-2-10 page. City/Town State Zip Code Date of Inspection D. System Information (coot.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12' 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: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 �[ TOWN OlF/BARNSTABL.E LOCATION T l L i �ij 2�TTl/ L SEWAGE VIULAC"sE �r3 s ,��s ASSESSOR'S MAP&JLOT INSTA,LLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LACHrrc I"AcI.IlTx: (type) (size) ., + U® NO.OF BEDROOMS � BUILDER OR OWNER, PERMITDA.TE: COMIIT.It�WCE DATE:— Separadon Distance Betweep tbe: Maximum A.djuste-4 Oroundwater Table to the Bottom of Leaching Facility 'Feel Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ' Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet ZOPO., lcaching.facilig� y-... I^ee Furnished by c� `/_'!� � � ``l z i rl IV 1- may' -D- 3c' { J. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS > DEPA T.RTMENOF ENVIRONMENTAL PROTECTION. . � I V V♦ TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM ..;PART-A- , CERTIFICATION Property Address: _ ��jjss�gg�� Owner's Name Q NQ I QQ Owner's Address: / 0 2Q Date of Inspection: Name of Inspector: lease printaf Company Name Mailing Address: A,1A Telephone Number: ' CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to ection 15.340 of Title 5(310 CMR 15.000).:The system: V Passes Conditionally Passes . eeds urt r Evaluation by the Local Approving Authority ails Inspector's Signature: llate: � P g The,system inspector shal 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. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 page 1 } Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A /(� CERTIFICATION(continued) Property Address:� Owner: Date of Inspection: Inspection Summary: 'Check A;B,C,D or E/ALWAYS complete all of Section D A. /System Passes: YYYYVYY 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: . CL 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. Answer yes,no or not determined(Y,N,ND)in the 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. 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 distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: 2 Pa e3ofll I g OFFICIAL INSPECTION.FORM.- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued).., Property Address: A,969AL-ea� C Owner Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health ri order to determine if the system . is failing to protect public health,safety or the environment. L System will pass unless Boa rd.of.Health determines in accordance with 310.CMR 15.303(l)(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 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.aseptic tank and.soil,absorption system(SAS)andthe 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no.other failure criteria are triggered.,A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of l I OFFICIAL INSPECTION FORM_NOT FOR,VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner. J Date of Inspection: C(1 D. System Failure Criteria=applicable to all systems:. You must indicate"yes"or"no"to each of the following for all inspections: Yes N _ Backup of sewage into facility or system component dueto overloaded orclogged 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 t/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool P V V2._ Liquid depth in cesspool is less than 6 below invert or available volume is less than day flow Required pumping more than 4 limes 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 f water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or legs than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) (Yes/No)The system fails.-I have determined that one or mote 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 109000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a.surface drinking water supply the system is within 200 feet of a tributary,to a surface drinking water supply _.the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the.Department. 4 Page 5 of l 1 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM`INSPECTION.FORM PART B CHECKLIST Property Address: -"Z' '�v Owner: Date of Inspection: Check if the following have been done You must indicate"yes"or"no"as to each-.of the following: Yes o 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 ram_. Has the system received normal flows in the previous two week period.? t/_ 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 V— . 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 the o 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 o!'the.Soil Absorption System.(SAS)on the site has been determined based on: Yes no t/ 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(3)(b)] 5 Page 6 of I I : OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: / ? 4 n ma r-31 /t1r4 Owner��e A2 > Date of Inspection: C FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): . DESIGN flow based on 310 CMR 15.203(for example: 1.10 gpd x#of bedrooms):330 Number of current residents: Does residence have a garbage grinder(yes or no): ` Is laundry on a separate sewage system (yes or no%%Y,O-[if yes separate.inspection required] Laundry system inspected(yes or no):,f!:2 T_ Seasonal use: (yes or no)"--,w Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no)• Last date of occupancy:: - G%� 2 A&ULd COMMERCIAL/INDUSTRI,k A/� �r� Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap,present(yes or no):— Industrial waste holding tank present(yes or no):_ Non-sanitary waste-discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection—(yes or If yes,volume pumped:._`gallons--How was quAtitiy pumped determined? „ Reason for pumping: TYPE OF SYSTEM __V,<eptic 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) _Tight tank _Attach a copy of the DEP approval Other(describe): roximate an of components,date installed(if kn wn)and source of information: Were sewage odors detected when arriving at the site(yes or no --- 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7� Owner: i Date of Inspection: co BUILDING BUILDING SEWER(locate on site plan) /1�1� Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain).- Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC.TANK: r/(locate on site plan) 1l • Depth below grade: c� Material of construction;t, concrete_metal_fiberglass_polyethylene _other(explain). If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: '�S� )( � X Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: , Scum thickness:(?2 r �! Distance from top of scum to top of outlet tee or baffle: 2. Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensionsdetermined:'4A46C2Zd LA J Comments(on pumping recomineiTffati6tis,linlet and outlet tee w baffle condition,structural integrity, liquid levels (4 related to outleinvert,evidence ofleakaoe, etc.):6L 0 007 GREASE TRA oc�site plan} Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):. 7 Page 8 of 11 OFFICIAL INSPECTION FORM.7 NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: q� Owne . Date of Inspection: D/OC) TIGHT or HOLDING TANK nk 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: gallonsIday Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and'float switches, etc.): DISTRIBUTION BOX: /i (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:Zz� Aw/ Comments(note if box is level and distribution to outlets equal;any evidence of solids carryover,any evidence of age into or out of box,etc.): / p/, PUMP CHAMBE ocate on site plan) Pumps in working order(yes or no): Alarms in working-order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 . t u5b/ Va al' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART.C. SYSTEM INFORMATION(continued) Property Address: Ownerj&4 Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type _jefleaching pits,number: 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, et CESSPOOL,% esspool 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 or no): 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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: (�, Owner: Date of Inspection: 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. (Ao- ., r 15 10 last/ 11 V1 l 1 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM P ART C SYSTEM INFORMATION(continued) Property dress: Owner• Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked7with local excavators, installers-(attach documentation) ✓Accessed USGS database-explain: You must describe how you established the high ground water elevation: , i 11 . V i' +�1 f� TOWN OF BARNSTABLE LOCATION L6+'# SEWAGE # 4/ --52,6 VILLAGE WtArS{otis 11s ASSESSOR'S MAP & LOT INSTALLER'S NAME 6t PHONE NO. Oc�Sca\� 7►-1 o`id SEPTIC TANK CAPACITY 110d0 LEACHING FACILITY:(type) (size) f,dvv tiM��ows NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC W TE BUILDER OR OWNER �y s 9-)0`14.uS (o. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: J 'oZ 3 VARIANCE GRANTED: Yes No 1�1 �71 7 Zy, Z9' La � � 1 j ,, SURVEY REFERENCE: LEGEND PLAN OF LAND BY: BATES &•CHELLMAN, ENGS. DATED: July 1, 1926 PROPOSED CONTOUR ROUND M: ® PROPOSED SPOT GRADE SITE POND — — —— 98 —— EXISTING CONTOUR -- + 96.52 EXISTING SPOT GRADE 3 'Q ,50.00 ft 6 �— — — N W— EXISTING WATER SERVICE s� J 64 — — —* — — \\\ !j1 TEST PIT i AREA = 15000 Sf + — F� CD !! I \ �32.00' � O� 0 II ��\ Zo �` \ ►I , TH-2 j1 LOCUS MAP N.T.S. ➢ I :I ��\ \\ m TH-1 ��\ i 0 GENERAL NOTES: r 0 0 m o 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS O OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 0)1 1 } LOCAL RULES AND REGULATIONS. !! _ 00 Existing Leach t I. 62 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 1 I:I -w�TER �i>�E o z z (Note 10) ! TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE _ 0 Z \ I DESIGN ENGINEER. Z O I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. !I 11 I I I 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. rn I O C O N C !! 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF PAD ! HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED j DRIVEWAY ! \ I I j TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. ,I �AVED II I I SHED j 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING !I ----- —_—J i EXIST. i I ,OO G I; CONSTRUCTION. --� __ � 10. EXISTING LEACH PIT TO BE PUMPED, CRUSHED AND FILLED PER TIME V. SEPTIO TAN _;_-- 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY __ I! 68 !! _--�--- — 66 64 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING ! _ _ —"-- 68 14. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPEC. OTHERWISE) 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW !� FOR THE USE OF A GARBAGE GRINDER 16. NO WETLANDS WITHIN 100 .FT. OF PROPOSED LEACHING B E N C H MARK 17. PROPERTY IS WITHIN A ZONE OF CONTRIBUTION PAINT SPOT ON CONIC TAD CORNER �E rn ELEVATIbN = 62. 8Q OF Mqs� BARN STABLE CIS DATUM o DA Efjll M yG f ACGIEIR PROPOSED SEPTIC SYSTEM UPGRADE PLAN No. 1140 41 LIBERTY LANE, M. MILLS, MA RfG/ E � MAP.-124 Prepared for: Mike Dedecko �NITAR\p� LOT. 0041014• I i Engineering by: Surveying by: SCALE DRAWN� . LCP.•C160457 DARREN M.MEYER,R.S. Soo—Tech Environmental 1"-20' DM M P0 Box gal (508) 364-0894 EASTSANDWICH,MA 02537 DATE: CHECKED SHEET N0. 508-3622922 07/26/10 DMM 1 of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:59.39 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. T.O.F. EL.=68.80 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER ���` OF 44,p OUTLET AND SET TO 6 OF FINISH GRADE SET TO 6 OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. F.G. EL.=68.0-66.Of F.G. EL.=63.50t F.G. EL: 62.75t F.G. EL: 62.0-61.50(MAX.) I DAR N M. ✓+ M XWONFARIM o. 114 L a 1O't 9" MIN COVER/ , 36" MAX COVER L 30 L a 10'(MAX INSTALL TWO INSPECTION PORTS (MIN.) ® S-t9G (MIN.) ® So1fb (MIN.) ® Sa1� (MIN.) NITAR�P� 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 10 14 6 11.3" TO 7 ?6 INV.= 61.36 48"uquiD INVERT cEVQ INV.=61.11 GAS BAFFLE PROPOSED INV.=59.80 D-BOX 3 ROWS OF 5 UNITS AT 6.25'/UNIT + 0.75 WEDGE m 32.0'/ROW DB-3(14-20) INV.-59.0 INV.=60.0 - SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1,000 GALLON SEPTIC TANK RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND 75"- TO TOP OF CHAMBERS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ;. • .•::;;, .: ,• ;;, :...•.. ... PIPE INVERTS PRIOR TO CONSTRUCTION -16 BREAKOUT=TOP ELEV.=59.39 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 59.0 GRADE ON A MECHANICALLY COMPACTED SIX ;.' INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 58.06 EXISTING SUITABLE 310 CMR 15.221(2) 2.83 MATERIAL 3) INSTALL INLET & OUTLET TEES AS REQUIRED 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH = 3 x 2.83' = 8.49' 76" I T.P. EXCAVATION OR G.W. (7.31' PROVIDED) USE 3 ROWS OF 5-HIGH CAPACITY PROFILE BOTTOM OF TESTHOLE EL.=50.75-=- ADS 16008D BIODIFFUSER UNITS-NO STONE W/ CONTOURED WEDGE SEPTIC SYSTEM PROFILE TYPICAL SECTION 16" N.T.S. e•Ts• 11.2" DESIGN CRITERIA SOIL LOG P#; 13006 NUMBER OF BEDROOMS: EXIST. 38R DWELLING DATE: JULY 26, 2010 34" � SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 SECTION END CAP WITNESS: DAVE STANTON, BARNS. BOH DESIGN PERCOLATION RATE: <2 MIN/IN Elev. TP- 1 Depth Elev. TP-2 Depth 16"" HIGH CAPACITY 16008D (H-20) BIODIFFUSER UNIT DAILY FLOW: 110 G.P.D/BR. 62.0 A 0" 61.75 A - oil DESIGN FLOW: 330 G.P.D. LOAMY SAND LOAMY SAND MODEL 16" HICAP GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 10YR 4/2 10YR 4/2 LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT PROPOSED SEPTIC TANK: 200% X 330gpd = 660GPD (USE EXISTING 1,000 GAL CAPACITY) 61.50 6" 40.20 7" EFFECTIVE LENGTH 75„ TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: 330 = 445.94 S.F. LOAMY SAND LOAMY SAND „ DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. ( ) IOYR 5/8 10YR 5/8 SIDE WALL HEIGHT 11.2 74 OVERALL HEIGHT 16" DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) 59.42 C1 31° 59.08 C1 32" OVERALL WIDTH 34" 4640 TRUEMAN BLVD PRIMARY S.A.S. 13.6 CF E&M. HILLIARD, OHIO 43026 USE 3 ROWS OF 5 - 16" ADS 16008D BIODIFFUSER H-20 UNITS-NO STONE MED. SAND MED. sAND CAPACITY 101.7 GAL ADVANCED DRAINAGE SYSTEMS, INC. 2.SY 7/4 PERC ®57.62 2.5Y 7/4 ( ) AND EXTENDED 0.75' W/ CONTOURED WEDGES PROPOSED SEPTIC SYSTEM SITE PLAN BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) (BIODIFFUSERS) 15 UNITS x 6.25 LF x 4.7 F = 440.63 SF o sF/L 41 LIBERTY LANE M. MILLS MA (CONTOURED WEDGE) 3 ROWS x 0.75' x 4.70 SF/LF = 10.58 SF C 51.0 132" 50.75 132" TOTAL AREA = 451.21 SF PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Mike Dedecko DESIGN FLOW PROVIDED: 0.74GPD/SF(451.21 SF) = 333.89 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN DARRENM.MEYER,R.S R'oo-Teoh BsnvimamenW NTS D.M.M. • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pO BOX 981 (508) 364-0894 to conduct soil evaluations and that the above analysis has been performed by me consistent with the DATE: CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. EAST SANDWICH,MA 02537 50&362--2922 07/26/10 D.M.M. 2 Of 2