HomeMy WebLinkAbout0031 LITTLE POND ROAD - Health LIv3rst1 LITTLE-POND OAD"aOASMills= .065= 023''' ,, �`
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Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 31 Little Pond Road !�
Property Address
Michael Connolly
Owner Owner's Name k
information o r e Marstons Mills MA 02648 02/03/2015 Ma t
required for every }
page. Cityrrown State Zip Code Date of Inspection
I:a
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms
on the computer, I n
use only the tab 1. Inspector: 2sr-W-'
key to rrove your
cursor-do not Fred Swain
use the return Name of Inspector
key. Q
Wind River Environmental t
r� Company Name
1958 R Broadway
Company Address
Raynham MA 02767
City/Town State Zip Code
(508)822-2003 651
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 Evaluation by the Local Approving Authority
02/03/2015
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 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.
z,I �1 ,I 'Ab
t5ins•3/13 Title 5 Official sp on Form:Subsurface Sewage Disposal System•Page 1 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
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:
® 1 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:
Recommend yearly service to tank.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if.it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required-for every Marstons Mills MA 02648 02/03/2015
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N FIND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required-or every Marstons Mills MA 02648 02/03/2015
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
*`This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/z day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
1 0,000g pd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection`
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required fer every Marstons Mills MA 02648 02/03/2015
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 286 gpd
9 ( Y 9 (gpd)):
Detail:
From Water Department: 2014- 107,000 gallons; 2013- 103,000 gallons;Total - 210,000 =286 gpd
Sump pump? ❑ .Yes ® No
Last date of occupancy: Current
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Wind River Environmental 05/10/2013
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1,000 gallons
gallons
How was quantity pumped determined? Tank Size
Reason for pumping: To check the structural integrity of the septic tank.
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
f
Commonwealth of Massachusetts
F W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
^M 31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
requir o t is Marstons Mills MA 02648 02/03/2015
requiredd for every
page. City/rown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
06/08/1987 per Design Plan
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 30"
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 30'
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Good, clean pipes. No evidence of leaking or cracking. Good, clean joints.
Septic Tank (locate on site plan):
Depth below grade: 2'
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:
6'x 8'
Sludge depth:
6"
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
28"
Scum thickness
2"
Distance from top of scum to top of outlet tee or baffle
4"
Distance from bottom of scum to bottom of outlet tee or baffle
11"
How were dimensions determined? Tape Measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Inlet tee intact. Outlet baffle is OK. No evidence of leaking, no visual defects, working properly.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 31 Little Pond load
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments{condition of alarm and float switches, etc.):
Y ,
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Little Pond iRoad
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 18"x 18" 2.5' BG
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence cf leakage into or out of box, etc.):
The box has some carryover from the tank. Box was cleared out at this time. There are signs of slight
deterioration, but there are no leaks in or out of the box and it is working properly.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
" If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
A W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1
❑ 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.):
There is one 6 x 6 pit 3" BG with 2' of stone around it. It has 3'of available space. There are no signs
of failure.
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
tl
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t ,
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
l _
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 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: 04/07/1986
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:
Attached copy of soil log to report.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3/13. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
r Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 31 Little Pond Road
Property Address
Michael Connolly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 02/03/2015
page. CitylTown State Zip Code Date of Inspection
E. Report Completeness Checklist
E Inspection Summary: A, B, C, D, or E checked
E Inspection Summary D (System Failure Criteria Applicable to All Systems)completed
E System Information— Estimated depth to high groundwater
E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
SOIL TEST PlT
_ DATA {
C r INDICATES
PERC. �_ INDICATES
OBSERVED
TP LOT )G TEST GROUND WA TEF'
GRD. EL. ` C�. i TP TP
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DATE: I
DATE: DATE:
TEST By: 'DATE:
SIEVE r TEST BY: TEST BY: 1
WLsa TEST BY: .
WITNESSED BY: WITNESSED BY:
10^'� WITNESSED BY:
WITNESSED BY:
PERC. RATE:
PERC. RATE:
—Z—MIN./INCH PERC. RATE:
MINJINC'H PERC: RATE:
WIN./INCH -----__MINJINCH`
DATUM:
VERTICAL DATUM':
ASSUMED
4
BENCH
MARK USED: SEE PLAN
TOWN OF BARNSTABLE
LOCATION �a �(v " SEWAGE # �f
VILLAGE_ LAN-' f e- ASSESSOR'S MAP & LOT = �
INSTALLER'S NAME & PHONE NO,
SEPTIC TANK CAPACITY L4Z C;
--. LEACHING FACILITY:(type) 4( _:64-4
(size)-
NO. OF BEDROOMS PRIVATE WELL O P�7BLIC WATER
{
BUILDER OR OWNER.
DATE PERMIT ISSUED:_
DATE COlipLIANCE ISSUEDz
VARIANCE GRANTED: Yes No/L
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TOWN OF BARNSTABLE t�
LOCATION torp7o t;ml e -MMASEWAGE #
VILLAGE X1djfb ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. e�,���✓✓✓�Lf�e �� �
SEPTIC TANK CAPACITY f( � Z a-gj
LEACHING FACILITY:(type) /cno 6'�ivvj (size)
NO. OF BEDROOMS-PRIVATE WELL O PUBLIC WATER
BUILDER OR OWNER Flhoxd
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No,>
1\�
Fps..
No3a.—.344 47
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
T ..W ..............OF.....BA�RNS`t'PrF3LE
Alip irFation for Biiivuiia1 i Dorki (to u s tru rt i o i t Famit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
S stem at: �f/l
yste at: Pbr.�D RD• wr S - RP LOT-) to LTITLE 'POKID Es-rATES.......-•- .. y ---------------------------a----•...•-•--•---••-••----------..•---- ------........ ......
Location-Address or Lot No.
CAPRt- } EA LT '1R1AST'.............: L OTLE POMP.. PtA_..........._...-•-----._.....
.. ..; .............
OW r
Address
w ...... A.R�45- !-E.�rv�flRs-r,p�ls
Installer Address
U Type of Building Size Lot 45} ±_Sq. feet
Dwelling—No. of Bedrooms.............. ..........................Expansion Attic 40) Garbage Grinder (Nd)
a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ...
W Design Flow___55-5..........................gallons per person per day. Total daily flow......3.aQ......................__gallons.
WSeptic Tank—Liquid capacityl,PQQgallons Length-6...(Q..... Width4.-.1-0 . Diameter................ Depth.51.8.'..
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No----- -------------- Diameter...1.0.__........ Depth below inlet._-F,.&.7....... Total leaching area.2 7-..sq. ft.
Z Other Distribution box (X ) Dosing tank ( ) -�
Percolation Test Results Performed by P .5:a .-`�.49VU4 CONSGtLT;9N7 Date...4 --__/..-'8
�7 ��
Test Pit No. 1.....�......minutes per Inch Depth of Test Pit-144.._._.__ Depth to ground water. ... __
��di L�jd j� A
fz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wat . . ....... . �
------------•--•----------•---•----------------•-----------•--------•---------.......__.....-----•................•............
O Description of Soi1.TIF10_LOT 1.6 O'=3!0'�-�'OPsdlL. Sub Solt. &��Pr+�..
v -••--• •--• `-�I�--.... -S ND•--- �"IFtE. WILSO`! i
-SIRiJ A_-¢R`-FINE No�E........................................................................................................ o. ......N
U Nature of Repairs or Alterations—Answer when applicable--------------------------------------
U 4
S/
ONAI
Agreement: co,
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in cordance with
the provisions of iITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
o tion until a Certi- of Compliance een is ed the bo of health.
Sig -- =' .�---- .......
Appl• atio Approved By...........• .•-- •......••• • •................................................. ........................G'
Date
Application Disapproved for the f ollowin reasons:
-•--••-•-••--••-•---•--•......••--.........•-•----•------•-•-----•••-•-----•�-•-...--•--•-••--••....•.-----•--...-••-•••--•---••----••---••--•-•••-•-••-----••---•-••-•-----•••--••••••--•-•••-•-•-•-
3 o j Date
PermitNo........................................................ Issued........................................................
Date
t
l f
` T • � t
No.._............_.....- � � � � —Z- •� � RiB... 7 ..�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
- . ....----..._OF......1 ............ .....
ApplirFaiilan for Disposal Marks Toustrurtinaa Prrmit
Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal
System at:
l.jTt'trE _PbND RD..,. Rl�l �i /1 t.. Wig'-- -1,O r 1�....�-1. .rOhILI� ���"�T��.
-- ...------ -
Location-Address
- or Lot No
APR1 ,►� RL,T4...rRsUST- .... . .1°T.rA.9... ±4p..1.2D...&! -•-------------------------------
Owner Address
W ...................................
Installer Address
U Type of Building Size LA_`-6___Z.Qt.Sq. feet
Dwelling—No. of Bedrooms-------------- ________________________Expansion Attic (gip) Garbage Grinder (NO)
�`-4 Other—Type T e of Building No. of persons............................ Showers
� OYP g ------------------------•-•- ----•--(----)--- Cafeteria-(----)-
ther fixtures -----------•.•---------------•---•------------....--•--------•------------------------...---••••••+�•. ►
WDesign Flow.........5..>_.5..........................gallons per person per day. Total daily flow..... Q........................gallons.
WSeptic Tank—Liquid capacity)+C�Mgallons Length .�6..... Widthlvlo... Diameter................ Depth. ".8.'_.
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No._._.I--------------- Diameter...l.0........... Depth below inletO.4?X-..... Total leaching area..257_..sq. tt.
Z Other Distribution box (X4 Dosing tank ( )
W Percolation Test Results Performed bye Date.. ..7:7 g .......
Test Pit No. I.....a......minutes per inch Depth of Teq-Pit.144._11....... Depth to ground wat
40 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground w : z�W _..._ .
Description of Soill --- L„c�X'..I�1�p9 "�1�._.T4?.��I/t��..�er�•aCU�$\��""�'�'-.--•-•.............• y A`LY� ?"➢
W .....1a. it �" 7� ,+,+��"1 LI....-4.0.�� !- :I,.. I"'1 , ��Jam!5e'!!._.....--•.....................•......-_ -��IL Cn
W .................. _F'tAl .. _! t1�Ft�-r�.............. � .A -- J�'Jo 3
Natrre of Repairs or Alterations=Answer when applicable._..._____________________________________________:__........._...
U P .......
----------------------------------------------------------------------------------------------------------------------------------------- IaL
Agreement: Ge viC 3 i
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with/A,
the rovisions of TT:'I.i�
F 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
gper tion until a Certi e of Compliance has been issued by the board of health. _
/// App'14ication
Signed------------------•---.----------------••----------------------•--------------------•- ----•-••...............--•--•••.
DatApproved BY---------- ----- . 6---
Date
Disapproved for the f ollowi reasons:----•--------------------------•----•------•---•-------------•----------------••---------------•••---•---.._...
..................................•--......-•------•--------•--..........---------•-----•--•-••----------------•----------•--•••-•-------------•---•--•-•--------------•------••------••---••------•----
Date
PermitNo......................---...............----...._... Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF �H�E�ALTH
.. ......OF.....S) 1.�l ..................................................
At
Qpwr#ifiratr ,af Tampliattrr
TITS CERTI Y, Tl}at the Individual Sewage Disposal System constructed (X) or Repaired ( )
by ....................
---t---..............................
....a......•--
.......................---------•---
......................................................................................................
.
at•---Lai------......1.(9---••--•----�1 :_ t' -� -•----•-- =- ------ _.J—t 11.3
has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit ................ dated------6..... ------�2--_---_-__...__-.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................... . 7.'.. ..................... Inspector..................----'--
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
v: ') .OF.._.......!.,�
No�. z _ 1 ..:............................................. FEE........................
Disposal Marks-,fanstrlutw- tl rnmit
Permission is hereby granted.... --•-•-------------------------------------------•...............------
to Construct (X) or Repair ( ) an Individual Sewa a Disposal ystem
I
at No.----- . ...........1-t------------- ---•---- J... _..`f� i._�/
......... --•................••--
Street ?"36�-
as shown on the application for Disposal Works Construction P rmit NJ.................. Dated.._.._.L.__�_-. �.......___....
' --------------------•---
J Board of Health
DATE...............--- -- ----- ...............
.I FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS "';�
1i SOIL TEST PIT: DATA: SEPTIC TANK DETAIL: 11000 Gi ?4, L DISTRIBUTION BOX DETAIL: LEACHINC-1 PIT DETAIL: REVISIONS-
INDICATES INDICATES
PERC. OBSERVED NOT TO SCALE NOT TO SCALE NOT TO SCALE NO DAT E
P -5550 TEST GROUNDWATER LOAM 5 SEED
NOTES: 1. SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES'TO BECAST IRON, NO. OF OUTLETS: 3 MANHOLE COVER OR PAVEMENT
TP LOT ')ro TP TIP TP REINFORCED CONCRETE. SCHED,* 40 PVC OR CAST-IN-PLAICIE CONCRETE. TEES BROUGHT, TO FINISH GRADEi
_R 1-11V I( -
TO BE CENTERED UNDER MANHOLE COVER. NOTES! iffi III
GRD. EL. 901(1� GRD. EL. GRD. EL. GRD. EL. 2. SEPTIC TANK TO WITHSTAND H-10 LOADING 1. DIST BOX TO WITHSTAND H-10 LOADING 2"MIN OF 1/8"
UNLESS UNDER PAVEMENT, DRIVES OR
G W. E L. GW. EL. GW. EL. GW. EL. UNLESS UNDER PAVEMENT, DRIVES OR TO 1/2" 12"MIN. F I LL-,�
TRAVELED WAYS.WHEREIN H-20 LOADING TRAVELED WAYS WHEREIN H-20 LOADING WASHED
SHALL'APPLY. PRECAST I STONE
11--_ SHALLAPPLY.
DIST I
3. ALL PIPE CONNECTIONS AND CONCRETE MANHOLE COVER I I-_ 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF
CONSTRUCTION TO BE WATERTIGHT. BROUGHT TO FINISH GRJADE BOX I
INLET PIPE EXCEEDS 0.08 FT./FT OR IN PVC INLET PIPE C= =3 C=3 C3 In
S UE S0 k L PUMPED SYSTEM.
'MI __j
I 9='C= cm r= t= C= C3 a NOTE� GENERAL NOTES:
12 N. __1 I I
ER 3. FIRST TWO FEET OF PIPE OUT OF DIST
COV
r_1 4 0� LEACHING PIT TO
80% TO BE LAID LEVEL. WITHSTAND H-10 LOADING 1. TEIS PLAN IS FOR DESIGN AND
I L-rLj PLAN VIEW C3 C3 CM C3
c:I M a CONSTRUCTION OF THE SEWAGE
tk
UNLESS UNDER
WATER LEVEL ' 'RE,MOVEABLE 'PRECAST PAVEMENT,DRIVE OR DISPOSAL FACILITY ONLY.
NORMAL COVER 3/4'�'TO 1-1/2" 13 M�'cf, rn I= CD 00 - -!�TRAVELED WAY WHEREIN
- -- - - - 0 2. ALL CONSTRUCTION METHODS AND
DOUBLE H- 0 LOADING SHALL
117-711 . I _&71�_ 1. ",;�LEACHING PIT APPLY. MATERIALS SHALL CONFORM TO MASS.
P40 U -1 WASHED - C=3 C= C=T I= C3 13 -
VIDE Uj 10 D.E.Q.E. TITLE 5 AND LOCAL BOARD
f INLE T TEE WATERTIGHT STONE OF- HEALTH REGULATIONS.
JOINTS(typ) (no fines$
PRECAST �5 i Bit IAj
a C3 C3 EM C_-3 C3 C= 0 3, ALL PIPES LOCATED UNDER PAVEMENT
4'-0" MIN. OU1rLET
SEPTIC it LIQUID DEPTH TEIE
L., - 4" INLET ,r NOTE 2
TANK 4!-10 -4 tj 1 1 r= OR TRAVELED SHALL BE SCHEDULE
C3 tn' CM C" CM C3 13
STP_/\-nFIED L_ 40 OR EQUAL.
-5 A�w Z)
----------
L J
1�2
11 DIAI
-------- BOTTOM ON LEVEL STABLE BXSE 0.4_9,�*c ---BOTTOM ON
LEVEL STABLE'
CROSS-SECTION ------7T_3,,1_d_e BASE DIA,
PLAN VIEW '17 1
CROSS-SECTION VIEW
144 Mo VVA-rcP_ 78.e, CR SS SECTLQIL
CONSTRUCTION NOTES:
INVERT ELEVATIONS:
SUITABLE $10IL
D -7- EG
ATE: DATE: DATE: DATE:
-4
IF ENCOUNTEPED,� ALL 'UN
O�
TEST BY: TEST BY: TEST BY: TEST BY: SMALL BE REMOVED WITHIN A WID-
�0
4" INVERT AT BUILDING ZONE AROUND THE LEACHING FACILITY
-7
AND SHALL BE REPLACED WITH CLEAN
WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: 4" INVERT AT SEPTIC TANK(in)
i�t.J SAND AND GRAVEL IN ACCORDANCE WIT�,
TITLE, 7.
4' INVERT AT SEPTIC TANK(out)
PERC. RATE: PERC. RATE: PERC. RATE: PERC. RATE: LOT 8 4N INVERT AT DIST. BOX(in)
MIN./INCH MIN./INCH WIN./INCH —MIN./INCH 4f
I I I I I 1 1 4 INVERT AT DIST. BOX(out)
NIF
0-
I T CAPRICORN .1 1
INVERTS AT LEACHING FACILITY:
DATUM. 101c) < REALTY TRUST
0
J ,
VERTICAL DATUM: ASSUIVED 0
�p
vIV4-K 'r A-r z er�c_t_j 6s . 2_7
BENCH MARK USED: SEE IOLM
0 Z_
NY -T-
fi"l OF P 1 8 71. GO
rid
% OBSERVED GROUNDWATER
ELEVATION
CL
LOT 5
(n NIF
CL 0
�0
CAPRICORN
REALTY TRUST LOT 9
t
ZONE.-RF NIF J
SETBACKS;'
V�
CALCUL/�Tj
e v CAPRICORN
B 9-
-DESIG ERA:'
REALTY TRUSTI
FRONT 39,
-��SIDE 15' ":� N CRIT
REAR 15'
1 4 T V\ A DESIGN FLOW:
I � "I -",_—7 1 . \% ck5 / I I / r ". %
5�_O P6_ BEDROOMS AT//O G.P.B./D 3,?0 G.P.D.
8 -7
J 0
vv.
fqv Im 4 /t/0
F_L I 6e _7
It r�ll
JUN The BSC Group
/J
REQUIRED SEPTIC TANK:
j
_T/E;5' C_� 20 495 G
x -i So X, x I AL.
(b
f GAL.
NOTES: SEPTIC TANK PROVIDED: / 000
(0 ;;
PROPERTY LINES SHOWN HEREON WERE COMPILED Cape Cod Survey Consultants
j
C09 SIZE OF LEACHING FACILITY REQUIRED:
h
FROM A PLAN RECORDED AT THE BARNSTABLE A4 DESIGN PERC. RATE: MINJINCH
REGISTRY OF DEEDS IN PLAN BOOK 429 PAGE 58 ?J 261 Main Street
A
AND DOES NOT REPRESENT AN ACTUAL SUWEY ON Route 6A
--rA
THE GROUND. I Barnstable Village MA
------ 02630
617 362 8133
THIS TOPOGRAPHIC. SUWEY WAS MADE ON j 11
IV
THE GROUND BY TRANSIT AND STADIA METHOD
ON MAY, 1970 SIZE OF LEACHING FACILITY PROVIDED: PROJECT TITLE:
j
)X
v F 7
-il_ro'All 6-
SEWAGE DISPOSAL
SYSTEM DESIGN
C-BIID.� I 7>6-L'i e-L. j-) P, �-,F x 2. 4 4
I
FND.
f 01r71-1-k1A -7 j
j FOR
-5,F >
LOT 16
'Q
L
LITTLE IDOND
CALE: I"=2083"+ ESTATES
S
LOCUS PLAN.
45
NIF I
B.,V.EL-100.0(Y - C.8,1D.H. AT N.W. BARNSTABLE, /VA
CHRISTOPHER F. K�Op '14 1 1 COR.OF LOT 7.
(MARSTONS MILLS)
PREPARED FOR:
CA11L CAPRICORN REA1
DATE PROPIESSIONAL ENGINEER I LOCUS _Ty
TRUST........._I
cj
=LE PON10
RACE
OF j- LANE
213.03
FrA 53 E FEBRUAf?y 27)987
21 wmrm'
J_ N
I AJ 76 24' Wi I LOT 115 1 NIF
IG DAT
No. CAPRICORN REALTY TR' USTI 1 0 f COMP/DESIGN, __� . A, ,
MYSTIC LAKE
Qt CHECK.
PLAN VIEW DRAWN RfH TAW. /L . H.
7
DATE PROFESSIONAL LAND SURV5YOR SCALE: 1" FIELD: W.B.
C.BID.�Y. AT N.W.
FILE NO� 3138606SS2D
COR. OF PLISKIN LOT.
DWG. NO 1247 /,q- SHEET
10 40 (00 FEET
JOB NO� 3j386.06 I OF I
34HT
,yp) .1
C
0
Ilw� __j