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HomeMy WebLinkAbout0055 LONG POND ROAD - Health 55 tong-Pond,Road, --- Marstons Mills P , -- A 014 013. TOWN OF BARNSTABLE LOCATION �j5 (--orc SEWAGE# VILLAGE ��p ps�cs n 5 A; S ASSESSOR'S MAP&PARCEL %LEE C7f �f I R'S NNA&&PHONE NO �` ,r t-6aA SEPTIC TANK CAPACITY \p®® 5,6�,e. y9 LEACHING FACILITY: (type( (size) -©t X iO x NO.OF BEDROOMS OWNER 'e PERMIT DATE: l COMPLIANCE DATE: /I C, ,5'd45 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 5$ 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� �.G�G r�"e• -Y3 Z) d r , Commonwealth of Massachusetts �� D/'I - 013 Title 5 Official Inspecti n Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessmecoo 55 Long Pond Road r71 '4 M on ce Property Address — t 1� Tina & Jason Lilly t s Owner Owners Name / two informations Marstons Mills V/ MA 02648 August 31 2015 required for every g i A page. City/Town State Zip Code Date of Inspection Pt t 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 filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Patrick T. Sullivan use the return Name of Inspector key. Ready Rooter Excavating Company Name P.O. Box 89 Company Address fe= �XForestdale MA 02644 City/Town State Zip Code 508-888-6055 S112843 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 Member 4, 2015 l 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. yya VS t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 55 Long Pond Road Property Address Tina &Jason Lilly Owner Owner's Name information is Marstons Mills MA 02648 August 31, 2015 required for every g page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. /' Check the box for"yes", "no" or"not deter miried" (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 irk pection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that th /tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): i 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 55 Long Pond Road _ Property Address Tina &Jason Lilly Owner Owner's Name information is Marstons Mills MA 02648 August 31, 2015 required for every 9 page. CityfTown 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 ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): r ' ❑ 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.,&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: r' ❑ Cesspool or privy i"within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 55 Long Pond Road Property Address Tina & Jason Lilly Owner Owner's Name information is Marstons Mills MA 02648 required for every August 31, 2015 page. Cityrrown 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". i Method used to determine distance. i *' This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and th > presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no ther 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurfa ce Sewage Disposal System Form -Not for Voluntary Assessments M ,• 55 Long Pond Road Property Address Tina & Jason Lilly Owner Owner's Name information is required for every Marstons Mills _ MA 02648 August 31, 2015 w page. Cityrron 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. El E 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 ❑ ❑1, the system is within 4 04eet of a surface drinking water supply ❑ ❑ the system is within 260 feet of a tributary to a surface drinking water supply ❑ ❑ the syste/ave localed in a nitrogen sensitive area (Interim Wellhead Protection Area—IWmapped Zone II of a public water supply well If you have answered "yes" to on in Section E the system is considered a significant threat, or answered "ves" in Section De large system has failed. The owner or operator of any large system considered a significander Section E or failed under Section D shall upgrade the system in accordance with 310304. 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 r 55 Long Pond Road Property Address Tina & Jason Lilly Owner Owner's Name information is arstons Mills MA 02648 August 31 2015 required for every M g � 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 ® ❑ e ed normal flows in the previous two weekperiod?y P ❑ ® 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): 4 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 GPD t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M �'V 55 Long Pond Road Property Address Tina &Jason Lilly Owner Owners Name information is required for every Marstons Mills MA 02648 August 31, 2015 page. CityrFown State Zip Code Date of Inspection D. System Information Description.- Number of current residents: 5 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 2015= 211 GPD g ( y g (gpd)) 2014= 181 GPD Detail 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/sgfft, etc.).- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste dischargedl to the Title 5 system? ❑ Yes ❑ No Water meter readings, if avaj►Table: t5ins•3/13 / Title 5 Official Inspection Form:Subsurface Sewage Disposal S stem•Page 7 of 17 P Y 9 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Long Pond Road Property Address Tina &Jason Lilfy Owner Owner's Name information is Marstons Mills MA 02648 August 31 2015 required for every _ � , page. Cityrrown 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: Ready Rooter records: pumped Dec. 2013 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volum= pumped: gallons How was quantity pumped determined? Reason for pumping: — Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Long Pond Road Property Address Tina & Jason Lilly Owner Owner's Name information is. required for every Marstons Mills MA 02648 August 31, 2015 page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Tank installed 1981. D-box and Leach Field installed 06/11/2003. Certificates of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 210 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: n/a feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 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: 8.6' x 4.5' x 5' 1000 gallons Sludge depth:: 4 t5ins.3113 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 55 Long Pond Road Property Address Tina & Jason Lilly Owner Owner's Name information is Marstons Mills MA 02648 August 31, 2015 required for every g page. Cityrrown 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 30" Scum thickness 8"at inlet, 3" at outlet. Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Tape measure and dip tube. 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 and outlet PVC tees in place. Liquid level at outlet invert. Risers bring covers within 6"of grade. Tank is scheduled to be pumped by Ready Rooter, Inc. after inspection. 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,Ofoutlet tee or baffle f Distance from bottom of scum k bottom of outlet tee or baffle Date of last pumping: r' Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GMe 55 Long Pond Road Property Address Tina & Jason Lilly Owner Owner's Name information is Marstons Mills _MA 02648 August 31, 2015 required for every _ g page. City(lown 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 ❑ fibergi s ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: r' ❑ Yes ❑ No Alarm level: ;'J Alarm in working order: ❑ Yes ❑ No rl' I Date of last pumping: Date i Comments (condition of alarm and float switches, etc.): 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 Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Long Pond Road Property Address Tina &Jason Lilly Owner Owner's Name information is Marstons Mills MA 02648 August 31, 2015 required for every g page. Citylrown 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 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.): One inlet, two outlets. Speed levelers in place, equal flow. H-10 d-box is 3.5' below grade. Riser brings cover within 6" of grade. No sign of leakage. No sign of high water staining over outlet inverts. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: i ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): i * 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M •' 55 Long Pond Road Property Address Tina &Jason Lilly Owner Owner's Name information is Marstons Mills MA 02648 Au ust 31, 2015 required for every _�__ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-500 gal ea. w/3'of stone. ❑ 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.): Chambers located and inspected w/camera. 4+' below grade. No vent found. Liquid level 1+' below invert at time of inspection. No sign of past hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert r` I Depth of solids layer !` Depth of scum layer r' Dimensions of cesspool Materials of construction i r 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 55 Long Pond Road Property Address Tina &Jason Lilly Owner Owner's Name information s Marstons Mills MA 02648 August 31, 2015 required for every g page. CityfTown 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.)-. i Privy (locate on site plan): Materials of construction: i Dimensions i Depth of solids j Comments(note condition of soil, signs f hydraulic failure, level of ponding, condition of vegetation, etc.)-. 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts luTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Long Pond Road - Property Address Tina&Jason Lilly Owner Owner's Name information iS Marstons Mills MA 02648 August 31, 2015 required for every g page. City1rown State Zip Code Date of Inspection D. System Information (cunt.) 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 !I i I ' I j i i Cc,""C' i 4��� 3 i 13 t5ins•3/13 Title 5 Official Inspection Form:Subaaface Sewage Disposal System Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 55 Long Pond Road Property Address Tina & Jason Lilly Owner Owner's Name information is Marstons Mills MA 02648 August 31, 2015 required for every g page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells �5 I Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed. 07/05/2003 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: maps.massgis.state.ma.us/oliver.php You must describe how you established the high ground water elevation: Test hole in 2003 found no ground water at 12' (elv= 87). Base of SAS at elv= 92 per engineered plans. Accessed local ground water contours and topo mapping. No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Long Pond Road Property Address Tina &Jason Litll Owner Owner's Name information is required for every Marstons Mills MA 02648 August 31, 2015 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION L®Jy� SEWAGE # 7—CX>3 " Z6y VILLAGE • MILLS ASSESSOR'S MAP & LOT Q N"013 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER r 4 C- A7 JA C OL PERMIT DATE: C'�' `�� COMPLIANCE DATE: D� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by f'1 Z4. Zq �z I � s c�L ODS zv C -z V- j- 2Sl FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, i't��TC. 2 , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) - ❑Complete System Xndividual Components Location 55 L Oi-A 136 M, M ,I IsOwner's Name MA pe. ►sou Map/Parcel# M pp P '4 -PCE , l ' 3 Address 65 lon M Q M t 1 Lot# Telephone# Installer's Name S o Designer's Name �h 1 Address - Address Telephone# -9,dO Telephone# —o Type of Building Lot Size O, ��3 sq.ft. Dwelling-No.of Bedrooms Garbage grinder (114 Other-Type of Building 'StAyc) No.of persons Showers (VrCafeteria (Y j Other Fixtures LAi Frm RX �tr�k Design Flow (min.required) gpd Calculated design flow 4-40 esign flow provided 4-SO gpd Plan: Date W03 Number of sheets ( ORevision Date Title 6%P S€pTi Cr u s�l DC':,M& Description of Soils) (3,*\,aCh6A Soil Evaluator Form No. Name of Soil Evaluator CAQAU-t�&Wi'e Date of Evaluation (5 a DESCRIPTION OF REPAIRS OR ALTERATIONS c ` 7b 'CN OCl The undersigned agrees t ' stall the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not<t se td3etem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed i Date 6— ]-� 03 IrlsleV-ovorby: ctions .�.. .. .r - ...... .�. � �.Z fT ,. �_ ...,y,.. .,r..�.ti,.y.._�..sY7ti{"r-� ."R y,•��-r y.,.i#{"(d'-,"'-.. .4�.F"••"+'r ,� ir..,,...�_......,,.1 .-���^..-.-,�1,•,-•^ a l 2M 2s 3 FEE a ♦�I�[MONWEALTH OF MASSACHUSETTS Board of Health, ► 1`��Ci � MA. APPLICATION FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) - ❑Complete System XIndividual Components , I � Location 55 Lcrvaa�, RCI � WM; S Owner's Name Mf)KG CASow Map/Parcel# t' 1 1,4 -PO-CC42.1 ) 3 Address S,5 I-Ons D M A2sTto M►fl Lot# U64 _ Telephone# Installer's Name Designer'sName �s i�l�/�Ul�(r►E'r� �.'atC)C�p XCO.��Oi� Address Address �a� lnnoow\ Telephone# I Telephone# SH8-0-119(0 daS'36 Type,,of Building Lot Size C-90 sq.ft. ,Dwelling-No.of Bedrooms S T I(�Ca �t�l M0� 'gICryC1 Garbage grinder (14 Other-Type of Building SNEn No.of persons Showe's ( Cafeteria (yf Other Fixtures LA n To 2Y 1 L Q:0"C V A Design Flow (min.required) gpd Calculated design flow 44e� Design flow provided gpd ` Plan: Date Number of sheets ! Revision Date Title � »�e� (( �€{�1 C_ o Descrip n of Soil(s) _ — Soil C Evaluator Form No. Name of Soil Evaluator AQ.MENi S"CH Date of Evaluation 5124 I V DESCRIPTION OF REPAIRS OR ALTERATIONS k<gSK rc- The undersigned agrees to install the above described Individual Sewage Disposal S`.i}t m accordance with the provisions of TITLE 5 and � �' � g P Y;s; further agrees to not:to'lacexthe=system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date 6.'/' 03 �PP Insl ections #,... No.,00G 3— 2 S �r FEE COMMONWEALTH OF MASSACHUSETTS Board of Health, A al slcl -� MA. CERTIFICATE OF COMPLIANCE Description of Work: 0 Individual Component(s) ®Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired Ci,Upgraded ( ),Abandoned ( ) by: �� at S5 tc� �� has been installed in a cordance with the pr&isi ns of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application4No. 2o�3-Z574 dated (0( '1 03 Approved Design Flow (gpd) Installer VA156(r Designer:�cso( S/4 i Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. Zoo 2 5 L' FEE •� `� r COMMONWEALT14 ®F MASSAC14USETTS Board of-Health, Ji/7//J �"�� ' MA.DISPOSAL ` SYSTEMtF -.Termission is hereby granted to; Construct( ) Repair( ) Upgrade,(/ Abandon( ) an individual sewage disposal system at s�s C-4rl j�2d. r o as described in the application for �Disposal System Construction Permit No. 2M3— 25�dated 1O1/91 r G3 . t r iiaa�� Provided: Construction shall be completed within three years of the date of this per t. ,loca l, ,nditiop,.must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date (all-9 0 3 Board of Health • t Sep - 20-01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 N • ve s�z ;oi !.XOTICE: This Form Is To Be Used For the Repair Of Failed Sep tic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM �a g — hereby certify that the engineered plan signed by me us:ec ��c�, concerning the property located at lr5 r me.ecs all of the MccS � K S fcl!owma ,^tena • This failed system is connected to a residential dwelling only. There are no :orunztr:.ia! or business uses associated with the dwelling. • -J.e soil is ciass!;ied as CLASS I and the percolation rave is less than or equal to -rr:nUtes per inch. I'he applicant may use histoncal data to conclude th!s fsc- or may :onduct are!trnwary tests at the site without a health agent present • There .s no increase in flow and/or change in use proposed These are no vanances requested or needed. • The bottom of the proposed leaching `aciI ty will not be located less than fourteen l�) i-_e, aonve the maximum adjusted groundwater table elevation. fAdiusc the ;rnundwa.er cable using the Fnmptor method when applicablel Pieose complete the following: Grnunc± Surface E'.evauon (using GIS informauon) r g' G VY' E;cvac.on _ od;uscmtnc for Iv;h G.W. FFFkEIN(-F EETWEEt\[ S (�'►lE D DATE: NOTICE 3asec a,ort tie ado"e :r(or ma(lon, a reoair permit will! be issued for 'oedroom.s Tz .,r^,uTt ` ^ :dd.(i anal bedrooms are authorized to t`ie future without engtncerec I:ept.c system plans. f - 1 Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Lori �D�IC� '�'Rcx'A Mt,lg Lot No. L44 Owner: (`�q�C (_.Q�1� Address: S5S Li ,c A "—Q\• , M M.I,S Contractor: J�o\I �a�y►i�c�cOS1 �Address: C Notes: STEP 1 Measure depth to water table �03 � to nearest 1/10 ft. .............................................................................. .Date month/day/year STEP 2 Using Water-Level Range.Zone and Index Well Map locate site and determine: OAppropriate index well.................•.................................. �vZ53 OB Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to ®� Sn�� water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 26) determine water-level adjustment ..................................................................,......,................. STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ....•...••.......••................•..,•.......... ....,•................,.........................,......... Figure 13.--Reproducible computation form. 15 TOWN OF BARNSTABLE LOCATION �,5 LOP& Pow P SEWAGE# VILLAGE Owl JAIL, -5 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000' I LEACHING FACILITY: (type) (size) 4f NO. OF BEDROOMS---, BUILDER OR OWNER -k C,`-A.�PWj A e— � PERMTTDATE: 6-2-03 COMPLIANCE DATE: a i Separation Distance Between the: , Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility ) Furnished by 1 I Y A 0 Z7 • 6 AL 5® A3 56 A fix. A q 70 A a� 3g 2: 83 Y; ° C� Y odez 9, _ -- , -,It, . 50,-65 LO CATION SEWAGE PERMIT NO. _�o G y — V.IIIAGE �12�iovl mA l�s I N S T A LLER'S NAME & ADDRESS U I L D E R OR OWNER DATE PERMIT ISSUED _„ IS � DATE COMPLIANCE ISSUED_ C \ �� �� � � -� i � ��� �s= �;�� �� � .��:�.� � � . ���� -- �. a Fxx.� N ..._. ............ THE COMMONWEALTH OF MMASSACHUSETTS BOARD OF HEALTH .............t� G Jq.........OF.....tj3/ .r1i. .............................................. OFA� Applira#ion for Ropmaf Works Towitrur#ion Vrr R',3ER G0PD0)!'411 c++ t Application is hereby made for a Permit to Construct (L- oor Repair ( ) an Individual S 15isposa p System at: No. >v •--••---•--•........._............................t .................. ........................... Loeatio Address or Lot N �a Owner Address W L _ a ----. rz�l...---.u.Pl-$.t�.hl.:...-•-•---•............................................. ...... ....... ..................................................... Installer Address UType of Building Size Lot.. d.>.._f .......Sq. feet Dwelling—No. of Bedrooms................. .......................Expansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building .. '.f % =._.... No. of persons..........&.............. Showers ( ) — Cafeteria ( ) Pa Other fixtures .......----••-•-••-••--••-------------•--•---- W Design Flow........................:` ®........gallons per person per day. Total dail flow_...........::?�.0 ................................ WSeptic Tank—Liquid capaclty._/;�ee allons Length......sX-._...... Width.._ ....... Diameter................ Depth... ......... x Disposal Trench—No..................... Width.................... Total Length..._..._...A_...... Total leaching area....................sq. ft. Seepage Pit No..........I........ Diameter....., �_`..... Depth below inlet... ............ Total leaching area...:°.'=.4.4...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) _ '-' Percolation Test Results Performed by. ARIZON/.... ll._kc. �f ............. "f �` f...xa-.... � �--- Date-----•-1--- -------- - a a Test Pit No. 1_.�'�_ ....minutes per inch Depth of Test Pit.....Y 2! Depth to ground water._&OP_:....... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... •.........................•--------...--•- ............r.....................-...................... b =Descri Description of Soil.... �u06l,_ x W -•••--•--•----•••----••-••--•-----•------•-•-•••-•--•-•---•----•--•-•--•---------•................•-•--•-----------•---••••••--•--•----------••-•--••-------•-•--••---•••••-•--•--•-••------.......--•-- UNature of Repairs or Alterations—Answer when applicable....................................................................................•------.---- ---•-----------••------•---•--•••----•-•---------------•---•------.......................--•--.----••--•------••--•-----•-•-----•--••---•-•--•-••-.....•----•-••--•-•••--••-•----•--------.........---•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i ued by theebboard f health. Sied-- _-- !`. ..................... •-•----- 3 —9 D to Application Approved B ' Date Application Disapproved for the following reasons:............................................................................................................. Date PermitNo......................................................... Issued......................................................... Date No............W9 FRic THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7-b W.....A/.........OF...... ........................................ .............. ....... Appliration for Roposal 18orks (npustrurtinn Vrrmitt �\A OF A14S ROBERT Application is hereby made for a,,Permit to Construct (sue or Repair an Individual Sew g D )'VQVN ' - i"s AYR" "H 50M cn System at: R 6,/ ............................ ...... .................... ..................................................................... .. Location-Address or LP nPIL!....12, L6 Lj 04/ -P Ig 4 0 4..................... �k......... ...... ............. ';V ...............................................; Owner Address ......................................................... ..... ...... .............. Installer LdIess Type of Building SiZe Lot...ZR- .J Z.!'......Sq. feet aDwelling—No. of Bedrooms..................Z......................Expansion Attic Garbage Grinder A4 Other—Type of Building ... No. of persons...........ev............. Showers Cafeteria, Other. fixtures .....................................................I.......................................................................;""I',", Design Flow.......................... .......gallons per person per day. Total daily flow....._... .. ..................gallons. Septic Tank—Liquid capacity. Width_._. Diameter________________ Depth---Y'. .-A llons Length.......4V...... Wid Disposal Trench—No..................... Width.....-A......._.... Total Length................... Total leaching area....................sq. ft. Seepage Pit No..........j........ Diameter......42"!.... Depth below inlet....,,�;LA...... Total leaching area-.....?_..z 6-..Sq. ft. ... Other Distribution box Dosing tank Percolation Test Results Performed by..PA.Rjh1Pd....6.56 Z N!e t le- D.7......................Date._.__ Test Pit No. L.A�.-&...minutes per inch Depth of Test Pit_-----A k......... Depth to ground wateri,.-eA&A/4�' PL4 Test Pit No. 2................minutes per inch Depth of Test Pit..__............._.. Depth to ground water.............._.._.._.__ . .....................................................................I................................. -------------------- ----------- 0 Description of Soil..... C 4A V 4­ Z_ 10 tF P ly A-4 5 A 11/0 ............... ------ -------------------------------------g--------- -- ........... U .........................................?.............................................................................................................................................................. ..................................................................................................................... ......... .................................................................... U Nature of Repairs or Alterations—Answer when applicable.................................................................. ............................. ............................... .........................77....*..................... ---------------1*11,11111-1----------------------1-1-1*--------- --------------1*1-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is tied by the board f health. 0 " OP ed. ------------------------------ D el Application Approved Bye..: .... ............. ............................................Or------------ .............. ........ ...... ...... Date Application Disapproved for the following'r-edsons:.............................................................................................................. J .............................................................7-------------------------------------------------------------------------------------------------------------7............................ Date ,e I/ ,.I I - Permit No.................................. ....................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD,3 HEAL ....... . .............OF........ . ............... At THXIIS,(TO ER FY, That the Individual Sewage Disposal System constructed (41,0'Or Repaired by..... P47ki, ... ........... V.................. /---------------------- ..... ....... ........ Installer at... I - V I I W �� 'd dr - ­ A� , .aw--:x,--- .. ......!4� , / .. ....00.. ............. has been installed in accord'. ce with the provisions of Ar I of The. State Sanitary Cods described in the application for Disposal Works Construction Permit No.. .-r......-7.......... dated..., ' .. ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE':� SYSTEM,,-WILL FUNCTION SATISFACTORY. , .... .... . ... DATE;..................................... ......... ................................. Inspector---........ ................. ...... .......................... ....... THE,.COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ................... NC) . . ........OF............ FEE... Permission is hereby granted- ................................... to Construct 0)/Repair ( �(al�I idi Dis osa I Sysu, at No....... !!�. u . ..... .............. ... .. .................. .. T. ........ ... Street 7. ..... as shown on the application for Disposal Works'Construction Pert o.. D�)j ............ .................. ............... ......... ....... ..... ................. .......... DATE........... ............... Board of Health —. . V................................ FORM 1255 Hosss & WARREN, INC.. PUBLMHERS:__ _ f t� ATLANTIC ENVIRONMENTAL Y"D.BOX 2384 MASHPEE,MA 02649 b/y v'3 Attn: Commonwealth of Massachusetts Date: 06/16/96 Town of Barnstable Board of Health 367 Main Street s Barnstable, MA 02601 f k From : Mr Michael DeDecko J U N 2 .1 1996 Po Box 2384 ",It ' Mashpee MA 02630 ,�e ! � c�a.r Dear Board of Health Official; I certify that I have personnally inspected the sewage disposal systems at the following address : 55 Long Pond Road. Marstons Mills, Ma. The informations reported are true, accurate and complete as of the time of the inspection. If you have any questions regarding this inspection,please contact me at this number: (508)477-14-20. Thank you. Sincerely, chael D D ko phone 508 477-1420 a , t Commonwealth of Massachusetts Executive of Environmental Affairs D apartment of Environmental Protection SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 55 Long Pond Rd. Marston Mills, Ma. Address of Owner: Jason& Barbara Stockman (if different) Date of Inspection: 06/08/96 Name of Inspector: Michael D eD ecko Company Name, Address and Telephone number: Atlantic Environmental P.o Box 2384 - M ashpee Ma 02649. Tel : (508) 4771420 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 inspection . The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. The system X- Passes ---- Conditionally Passes ---- Needs further evaluation by the local Approving Authority ---- Fails Inspector ' s Signature Date: 06109l96 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer,if applicable and the approving authority. SUBSURFACE SEWAGE DISPOSALLT YASTEM INSPECTION FORM PARCERTIFICATION (continued) Property Address: 55 Long Pond D rive. M arston M ills, M a. Owners : Jason&Barbara Stockman Date of Inspection: 06/08/96 INSPECTION SUMMARY: Check A,B,C,or D A)SYSTEMPASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 15.303. Any failure criteria not evaluated are indicated below B)SYSTEM CONDITIONALLY PASSES: ---- One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes,n0, or not determinate(Y,N, or ND). Describe basis of determination in all instances. If"not determinated", explain why not. ---- The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfilkration ,or tank failure is imminent. The system will pass inspection if the existing septic tank is re-31aced with a conforming septic tank as approved by the Board of Health. ---- Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven pass ins distribution box. The system will pa inspection if approval of the Board of (with Healkh). ----- broken pipe(s) are replaced ----- obstruction is removed --- distribution box is levelled or replaced -- The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ----- broken pipe(s) are replaced ----- obstruction is removed SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address : 55 Long Pond D rive. M arston M ills, M a. 0 wner : J anon&B arbara S tockman. Date of Inspection : 06/08/96 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ---- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health , safety and the environ- ment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ---- Cesspool or privy is within 50 feet of a surface of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING INAMANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ---- The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. ---- The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. ---- The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. ---- The system has a septic tank and sail absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analy- sis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that at facility and the presence of ammonia nitrogen and nitrate notrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: -- I have determined that the system violates one or more of the following failure criteria as defined in 310 CM 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. --- Backup of sewage into facility or system component due to an overloaded or or clogged SAS or cesspool. SUBSURFACE SEWAOE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Ad g Address: 55 Lon Pond Drive. Marston Mills,Ma Owner: Jason & Barbara Stockman Date of Inspection: 06108/96 D) SYSTEM FAILS (continued) -- 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 over- loaded or clogged SAS or cesspool. --- Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. --- Any portion of cesspool or privy is within 100 feet of a surface water supply ortributary to a surface 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 ana- lysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen. H • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION (continued) Property Address: 55 Long Pond D rive. M arston M ills M a. 0 wner: J ason & B arbara S tockman Date of Inspection: 06108/96 E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater Large System and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist -- the system is within 400 feet of a surface drinking water supply --- the system is within 200 feet of a tributary to a surface drinking water supply --- the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area -IPA) or a mapped Zone I I of a public water supply well. The owner or.operator of any such system shall bring the system and facility into full compli- ance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please, consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 55 Long Pond Drive. Marston Mills Ma. O wner: J ason& B ar bar a S tockman. Date of Inspection: 06/08/96 Check if the following have been done : -x Pumping information was requested of the owner , occupant and Board of Health. --x None of the system components have been pumped far at least two weeks and the system has been receiving normal flow rakes during the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. --x As built plans have been obtained and examined. Note if they are not available with N 1A. --x The facility or dwelling was inspected for signs of sewage back-up. --x The system does not receive non-sanitary or industrial waste flow. --x The site was inspected for signs of breakout. --x All system components, excluding the Soil Absorption System,have been located on the site. ---x The septic tank manholes were uncovered, opened and the interior of the sep- tic tank was inspected for conditions of baffles or tees, material of construc- tion, dimensions, depth oaf liquid,depth of sludge, depth of scum. ---x T he size and location of the S oil Absorption System on the site has been deter- K _ or a non intrusive methods based on existing mined b g approximated b information pp y ---K The facility owners and occupants if different from owner Were provided with information on the proper maintenance of Subsurface Disposal System. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 55 Long Pond D rive. M arston M ills M a. 0 wner: J ason&B arbara S tockman Date of Inspection: 06/08/96 RESIDENTIAL: D esign flows : gallons Number of bedrooms Number of current residents: Q Garbage grinder (yes or no) : t 3 c Laundry connected to system (yes or no): Seasonal use (yes or no) : . Water meter readings, if available: Last date of occupancy : 4} COMMERCIALIINDUSTRIAL : Type of establishment: Design flow : gallons/day 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 : Other: (Describe) ............................................................................................................ Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information : er..�V................. System pumped as part of inspection(yes or no) :.....�'7-.t3........ if yes, volume pomped : .................... gallons Reasonfor pumping:............................................................................................................ I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 55 Long Pond Drive. Marston Mills, Ma. O wner: J ason&B arbara S tockman. Date of inspection: C6}08/96 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) --'-�Dther (explain). : �. .'-..::�;r .. �...t .�? v ��.:.. ................... APPROXIMATE AGE of all components, date installed (if known) and source of information . .........:. .....�............... ............................................................... ...................................... ..................................................................................................................... ................................ Sewage odors detected when arriving at the site : (yes or no)........:::?. SEPTIC TANK: ...... (locate on site plan) Depth below grade: ...f...... Material of construction: ..� concrete ......... metal ........ FR P ........ other(explain) .............................................................................................................................. Dimensions: `''. Sludge depth :....3�t...... Distance from top of sludge to bottom of outlet tee or baffle:.....3 .................... Scum thickness :.../0.`'............ Distance from top of scum to top of outlet tee or baffle: ........1.6........................... Distance from bottom of scum to bottom of outlet tee or baffle:....1.-.................... Comments : (recommendation for pumping , condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.)...................... ! n� Lc�s ....ti. .��r. c._ :1! 5a. ::.'. ../..!: a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 55 Long Pond Drive. Marston Mills, Ma. O wner: J ason&B arbara S tockman. Date of inspection: 06/08/96 GREASE TRAP : ......NO..... (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FRP........other(explain).... . ............................................................................................................................. Dimensions:............................... Scum thickness:........................ Distance from top of scum to tap of outlet tee or baffle:....................................... Distance from bottom scum to bottom of outlet tee or baffle:................................ Comments: (Recommendation for pumping condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.)........................ ................................................................................................................................................ TIGHT OR HOLDING TANKS:...pt?�... (locate on site plan) Depth below grade:............... Material of construction:........concrete........metal.........FRP..........other (explain).......... ................................................................................................................................... Dimensions:............................ Capacity:....................gallons Design flow:...............gallons/day Alarm level:............................. Comments: (condition of inlet tee alarm and float switches, etc.,, condition of ) ................................................................................................................................... ...................................................................................................................................... SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Short Way. West Yarmouth Ma. Owner: Charles Dickson Date of inspection: 06/01/96 DISTRIBUTION BOX:..1)cj. (locate on site plan) Depth of liquid level above outlet invert:................... Comment: (note if level and distribution equal evidence of solids carryover, evidence of leakage into orout of box, etc.).................................................................................................................. ................................................................................................................................................ ..................................................................................................................;............................. PUMP CHAMBER:...N .... (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.).................... SOIL ABSORPTION SYSTEM (SAS):......t��,5... (locate on site plan,if possible; excavation not required, but may be approximated by non- intrusive methods) lj if not determined to be present, explain: ................................................................................................................................................ ..................................................... .......................................................................................... Type: leaching pits, number: ..�.. .6.k.`1 .-- leaching chambers,number:........ leaching galleries, number:........... leaching trenches,number ,length:..................... leaching fields, number, dimensions:................... overflow cesspool,number:.......... Comments: (note r ondition of soil signs of h drauli failure, level of ponding, condition of vegetation, .... . ... .. rya, �� ..11 ,e _r... .. ! (Y� .... _ 1 �O f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR T C SYSTEM INFORMATION (continued) Property address: 50 Short Way. West Yarmouth M a. Owner: Charles Dickson Date of inspection: 06/01/96 CESSPOOLS:....& (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: ..................... Indicator of ground water: .................... inflow (cesspool must be pumped as part of inspection) ) ................................................................................................. ................................................................................................. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ................................................................................................................................................ ................................................................................................................................................ PRIVY (locate on the site) Material of construction: ................................... Dimensions: ...................... Depth of solids: ................ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ................................................................................................................................................ ................................................................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address : 50 Shark Way. West-Yarmouth, Ma. Owner: Charles Dickson Date of inspection: 06/01/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100'. Oki O � DEPTH TO GROUNDWATER: Depth to groundwater: �.`. D..feet Method of determination or approximative: it.c�,.... :�......... ...... •. .... L.... ..�................ �. �-.E-O' t ��'. �. C•7'1 CT\ Q tF naG .l "A.+[ds �^—�. �.._r� �.. ........4..vc? ........... .... ......................................1.:... ...��.5�.............................. ................................................................................................................................................ LOCATION SEWAGE PERMIT NO. ,far'/aa o•�, ,�O•y� �'� VILLAGE AMs7.rr (l,at INSTALLER'S NAME. i ADDRESS l7i4?l�iie�i B UI'LDE R OR OWNER ,SOU/,s SGdmwim DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� 1 ��A o �� a q`t � � r _ b N N 4 m m. P6 WA V4• 10'-9 I?' 4'-I 9/4' ■MuV1 � m IX4 MANOR.OCOK'b _--- ON P.T.FI[AFl. X iTJ U 8 � 'X LL TUe YLA p 11 R. fA `---`---� MSTR. " . x rr BATH MOP x SINK \J�� �� LAyy �j Ory�O ' S ` 0'-0• P 0 _--____-0,-r Svx � 8 a x o a HALL `�Q- - ------------- ' - KITCHEN i11 ____ UC1~4".DEOK r '6 2v 5-IO C.O. ON P.T.FRAPM. n x rr rr '' N j ANm. f22M ---__----- rY � Ys s 1 x h G �40vYbr MSTR.BEDROOM ----- rr - S Q`zkE 6 UP �f-OOLLArt nE9 1 c ADOVE AO X m ------ ------ J---------_ M m f o V b`°SEOOLv FL it a iu Z O � ope X X PO H X X W K N A n Q J Z T T - T N Z n 11 � ON Ix OLOCKws. Z O.. -- X OEILON OHNN"OAGC. A-6 Z 0 LL ON 1x4 MAN06.DEGK'O P.T.FRAF! T 4.O l7 Td 4'-0' S'-0' S'-0• OlO' 0'-S VY 540 V4' 0 U '/�'-I 9/4• y/ ` m 02OY ! AmW Seer 21.2002 9Md ^ . baY . V4.1.0 1_ 1 p.,m nr. FIRST FLOOR PLAN SOALE, 1/4' 1-0- ry ' I e A-2 f O o0 Q � L 2T-e ..r v 0 U S E �L L 8 X X X f/ h LIN b r R BATH O BEDROOM 2 � 9 NLROOa� TO ATrIC. s w•-s• ' f� z-r iw yr a vr§ p 8[3 lit y IeALINS f l,3 3 1 `�fi ' •SALLLNY J yp II eb• h e I ax 1 TO ac a A -exa-e H o-n IR' F r-2• IO.4• a v7 e U b Y T r'1'O 56,TALL h RAILIN9 � BEDROOM 3 LOFT ilj A � i s � 0 ___________________________ ____________ Z B MM O Z U4. X —1 z ( C) p z U s < csi J*M : In0, e'-0• e•-0• 5�212' sW t�Ia 5C►:,21,2002 :ra .yr oc* : Va.r•o• 2T-6 V2' RV. I :wr. t ew•. 5EGOND FLOOR PLAN A - h 17-- + I l / � \.. / `per �� +• Za,o7a a F - I f V / .L Oar•� r G f.. ��� ..��� 1'/ X 'f ) PROJ SCALE: DATE: SOIL LOG MOTES L SEWAGE FLOW= 2. LEACHI,'JG AREA= �.z_G ;t - y7 7 SU(j $! fL 4 f' ,.,L 3.SEPTIC TANK= /oao c.r,l'c,n-� 4. ALL WORK MUST COMPLY WITH MASS. ENVIRONMENTAL CODE TITLE 5 AND TOWN BOARD OF HEALTH REGULATIONS ' 5.BRICK TANK a PIT COVERS TO WITHIN 17-"OF GRADE 6.THERE ARE NO WELLS WITHIN Ia OF THIS LEACHING PIT, AND THERE IS NO SEWAGE LEACHING WITHIN [001 OF THIS WELL. SAP., � p,,,� I � �''�'��,. T. SEWAGE SYSTEM IS MORE THAN 25' FROM STREET DRAINS M v• 'i PERC RATE= DATE 1- / y-�s! /�ft '`� `� + r � •I FINISH GRADE l 93,o 'z f �? S c f t.io e ° 4" i'.�� P I PE I �� 2 3"-� G Z `l '' F u G /i.�/fl + PIPE 2+ I/8+�I/2+�WAS'11ED Q' PITCH 1/4/FT.MIN. `� I Lqo 0o _96 r -10+s 14° / �D PITCH I/8 /FT. fVIIN. '+ PEASTONE „o 86.,;�fc 3/4 -11/2_ WASHED -y Cl 'FEE �} 4+TEE PVpJ4 STONE FREE OF� FINES DUST 9 IRON ny 6� DIAMETER,PRECAST FOUNDATION SENGTHTA$K _ OR BLOCK PIT c.b. WIDTH - 5+ LEACHING PIT t SEWERAGE SYSTEM PROFILE WATER ( NOT TO SCALE) TABLE HARRISON SCALE � .� . SEWERAGE PLOT PLAN WITH AT �cr G �{ �oNG foil: �a ENGINEERING ATE SYSTEM FLINT LOCKE DRIVE Z-2- 81 PLYMOUTH,MASS. 02360 PROD. 7IIS FOR f �_6T'+rfr Cv� c.l��' ,//�r• =, L ��1]/��vE IZ I'_'= 2000 +/- 1, .ALL.. PIPE" OUTLET S FROM THE PIPES T 4 H 4 P.V C.NOTE.. ALL I ES ARE 0 BE SCHEDULE 0 SECTION A A DISTRIBUTION eox SMALL BE 10 min. from ,Y 'SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER 0•d �se to septic tank - O Existing Foundation n G PROFILE VIEW OF'ZEACXINC SYSTEM R Septic took covers must tM! ,•r '•: 2- within / P ,.. ..- .v •,' 3- 5-OUTLET r-v within 6 m. of finished rode / G� L 0 KNOCIc0UT5 pover SAS ELEV� 98.00Code aver Septic Tonle 9800 Grade over D-Bo< 98.00 O /A/I M I l/>! IMA•!C1'u/Ae/llOw• q/!/>f - t/1! I••bt/ti••1wv - � -156 -�....: 12" INLET �-.T'` '1 OUTLET , 1 \,� a- SITE S 0.02 3 HOLE H-10 DIST. BOX 3' Maximum Cover �/�Top of SAS-EIeA95.00 :" ` O EXIST. S-0.10 S- 0-010, toot A- �✓ ,S S s, fo I / , SCH. ao T EXIST. PIPE ` ' x 1.000 GAL. 36.s" OR ATER O C3 O l� FROM FOUNDATIOI W PLAN SECTION CROSS-SECTION a SEPTIC TANK 8 ' Elfective Depth • O CI O O O O L A H-10 w TO o 0 0 0 C3 C3 ,� � 0 3 Uni w . '♦ taro in et.e - 29.5' CONCRETE FULL rotnlw m ; 1I °' a, N 2.7 2s.5 2.75 3 HOLE H-10 DISTRIBUTION BOX r n u 3. M-5 3.5 � o 6 in-of 3/4--1 1/2- y i > a NOT TO SCALE SYSTEM PROFILE u 12 11 35' Q campoefed stone LOCUS M A P c d a _ .n Effective Length �P Not to Scale - ST IFPOUT�ALL AROUND m c c ?0 ELEVATION 92.00 J d SOIL ABSORPTION SYSTEM (SAS) 6 in.ot 3/4'-1 1/2' 0 00 - C N- 0 LEACHIN UNITS / N N PRECAST compacted stone m 5 2 GUI IGGI S Note: Remove soil down to med sand layer $ replace with GENERAL NOTES Not to Scale ' elev. 92.00 6 replace with clean coarse sand w erC: Note. Certification of Fill Material Required. QQttum_9!-Isftll4s_1_Elatir�L99 ( ) p �p 1. Contractor Is responsible for Digsofe notification rate less than or equal to 2 min./in. before dt after placement Before and After Placement by Seive Analyses and protection of all underground utilities: and pipes. 2. The septic"tank and distribution box shall be set ' 9$ level ,on 6 of 3/4"-1 1/2",stone. 2-18' olAM. ACCESS MANHOLES ,'� - 3` Bockfill-should be clean sand or gravel with no -,,� stones over 3" in size. 8• _ 4. This system is subject to inspection during installation ., ---- . _. , . ,� may,• •; �,__ ,� by Carmen. E.,Shay Environmental Services;. Inc 5. The contractor' shall instoll this system in accordance o t with Title V of the Massachusetts state code, the approved plan � .� � • .I \ / and Local Regulations. .. / / s THE ACCESS COVERS FOR THE SEPTIC TANK. \ 1 DISTRIBUTION BOX AND LEACHING COMPONENT \ 6. If, during installation the contractor encounters any \ / OU ET SET DEEPER THAN 6 INCHES BELOW FINISHED 1 O N �-/ �� O� soil conditions or site Conditions that are different GRADE SHALL BE RAISED To WITHIN 6 OF i from those shown on the soil to or in our design '•'I �,` FINISHED GRADE. �/ g g (40 FIOOT RIGHT OF WAY) installation must 'halt & immediate notification be INSTALL TUF-11TE GAS BAFFLES OR EOUALS t I made to Carmen E Shay - Environmental Services, Inc, . \ `� 7. No vehicle or heavy machinery shall drive over the STEEL REINFORCED PRECAST CONCRETE septic ,system unless noted as H-20 septic components. PLAN VIEW ����� --- i I--------------------���------ '- -- -- 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends: 3-24" REMOVABLE COVERS ` I 28d ,06 33 1'�' 9. All Distribution Lines shall be 4 diameter Schedule 40 NSF PVC pipes. i 10. All solid piping, _tees & fittings shall be 4" diameter `. H 125.00 I X Y. . X d I Schedule 40 NSF PVC pipes with water tight joints. 3' min. Neoronce %' l ,'I- ` 5 11. Municipal Water is ,Connected to The Residence and Abutting . -. -- - ... •. t3 INLET � h �,��� ,_ '�� '��--- ,T 8-mul_�-�2 min. inlet to outlet 6• min. 98.b3 I •� . Properties Within 200 Feet. Liqu 0 level OUTLET r T _ t0" m T ' H } 1 `- \` ' 5 -7 ---- �- 5 -7 fE 4'-0' min: 41 THE PROPERTY 'LINES ARE APPROXIMATE AND Ga IMs• Liquid depth r l W \ COMPILED FROM THE SURVEY PLAN GENERATED BY �' os o i _ `\ LOT 64 = �\ e r I # M \ YANKEE SURVEY CONSULTANTS OF MARSTONS MILLS, MA 20,073 Square Feet +/ 1 ENTITILED "CERTIFIED PLOT PLAN OF LAND" 1 _ c. ; ..., ,... ;•:, • , '.:, ... . .. ;:r W d r a l \i _ u 55 LONG POND ROAD MARSTONS MILLS MA" DATED SEPT. 20 2002 4' -i0- 4 i t ( 'O ii AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN M •• r N 1 t1. O u CROSS SECTION END-SECTION M 1 Q 1 PORCH IT SHOULD BE USED FOR NO PURPOSE OTHER THAN I l 1` THE SEPTIC SYSTEM INSTALLATION, l I O O r t i t L _J USE EXISTING 1000 GALLON H 10 SEPTIC TANK ExIsrlNc _ � �. � . _-.�. _. _ _ LOT- ss 3 BEDROOM NOT TO SCALE co i HOUSE LEGEND PERCOLATION TEST #55 , \ DENOTES PROPOSED MAY 4 PROJECT BENCH MARK DE 0 ES 0 OSED Dote of Percolation Test. A 2 2003 1 104X 1 Test Performed By. CARMEN E. SHAY, R.S., C.S.E. X , TOP OF FOUNDATION SPOT GRADE Results Witnessed By. WAIVER( Per BARNSTABLE B.O.H.) ELEV. = 100.00 (Assumed) DENOTES EXISTING . EXCAVATOR.. Shay Environmental Services. Inc. Deck 98.00 �J X 104.46 Percolation Rate: Less Than 2 MPI LOT #�31 SPOT GRADE Test Hole --- ,. PL PROPERTY LINE No. 1 1 1 X EXIST. 1000 gal. � v. i i Septic Tank,,,/ 96P PROPOSED CONTOUR DEPTH SOILS ELE DOG 98.05 PEN 0 98.00 I I Sandy 54- - - -97 EXISTING CONTOUR Loom L----J �' X 10 YR 3/2 / 0*-7- A, 97.40 - 97.11 DEEP TEST HOLE & Sandy O� PERCOLATION TEST LOCATION Loam TEST HOLE to rR '' _ t>- SHED ELEV.- 9g.tOp . . (.. 36' B. 9s.00 6 FOOT STOCKADE FENCE Medium Sand g. 2-5 Y 6/6 � l 36'- 60' 93.00 .. . . , slit ��� I` • ` • • i1z'i Loom ' t r 1 7 C' 92.00 Perc 1 f6' H \� 35' j PLOT PLAN 60 2 L-�--�� ---=��---------- Depth to Perc: 72" to 90" X Medium Perc Rote= Less Tho 2 MPI F SEPTIC Y RA Sand Groundwater Not Observed Failed , 97.63 0 PROPOSED S E C SYSTEM'E M UPGRADE G D E 2s Y 7/4 Leach PIti No Observed ESHWT \� / 26.5' PREPARED FOR 72 - 132 87.00 ADJUSTED H2O Elev. = None X MARL 8c CYNTHIS CASOL1 8.25 AT i 124.50 Design Calculation s # 55 LONG POND ROAD • ' S' 28d ,06' 33" E PERMIT REQUESTED FOR THREE BEDROOM ONLY - SEPTIC OVERZIZED AT CLIENTS REQUEST. , MARSTONS MILLS MA LOT #32 �0 i; Number of Bedrooms: 3 Bedroom Permitted due to Property is Within a Zone II. LOT #ss b®� Garbage Grinder. No PREPARED BY: g Leaching Capacity Required: 330 Gal./Doy (MIN. PER TITLE V) Note: Remove soil down to el. 92.00 & replace With W 1 A i Tank V Septic ;Tank 2 X `330 Gall./Day 660 USE NEW ,000 GAL. Septic clean coarse sand w/perc. rate less than or (��� li 1 Y Li . �� 1 SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch or equal to 2 min. in. before & after placement I VSERVICES, INC. q p EN ENVIRONMENTAL Bottom Area: 0.74 gal/sq. ft. x 400 sq. ft. = 420 gallons THERE ARE NO WETLANDS WITHIN 200 OF THE PROPERTY. f . Sidewotl Area: 0.74 al./sq. ft- x 200_ sq. ft. = 188 gallons (5 FOOT STRIPOUT ALL AROUND AS SHOWN) g P.O. BOX 627 Providing: _ 450 gallons 9 S 4EXISTING` PrT T P MP FILLED IN PLACE EAST FALMOUTH MA 02536 O 20 0 50 LEACH 0 BE PUMPED & LED r4�y T btu , _ fi Use. 3 PRECAST 500 C UNITS, HAVING A 2 EFFECTIVE DEPTH, INSTALL NEW O = OR'REMOVED 1F FaJND TO BE NECESSARY.TO S ALL E SAS AX - 4 - TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND 4, {' TEL/F 508 5 8 0796 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE •� • =r = , 0E S = z - 2.75 of WASHED STONE ON THE ENDS., SCALE. 1 20 DRAWN BY: CES DATE. MAY 2$ 200� N A H`PIT P T E I POSED• FROM THE EXIS I G LE G S/CESS OOLS 0 B D S NIT TO BE SEPARATELY PIPED AND TO BE,SEPARATED-2 APART. UNITS T 4 FILENAME: 4 PP_ W SHEET 1 F 1 x 1 _ OF AS PER f3oAR0 OF HEALTH SPECIFICATIONS. PROJEC LSD 28 FILE E. SD 28 D G SEE 0 I SCALE- 20 1' = 2000' +/- " ALL OUTLET PIPES FROM THE • T 4 SCHEDULE 40 P.v.C, SECTION A -A DISTRIBUTION BOX SNALL BE , d 10' min. from NOTE. ALL PIPES ARE 0 BE S _ 2" CONCRETE COVER o0 • SET LEVEL FOR AT LEAST 2 FL ' - _ R f house to septic tank PROFILE 'VIER'-OF LEACHING SYSTEM ..._.. .. : : y Existing Foundation Septic tank covers must De p ti: .v` K- S" OUTLET Iry p s,a, Z OL�� within 6 in. of finished prole _ , Hopcou S ' Geode over Septic Tw* - 98.00 Grade over D-Box - 98.00 ode over SAS ELEV� 9800 /�•I. r 1/t 'V.A d C►4aw sea.. 'of r/11'-r/ * �..A.a r...e.... - 15.5, ,2 se ET OUTLET ¢ ' SITE 5 . O.OY 3 HOLE H-10 DIST. BOx 3' Moximum Cover Top of SAS-Etev.®95.00 s-o.to s< o.o,o / pq" 10' EXIST. Per foot 4" - SCH. 40 Te / ¢ EXIST. PIPE x 1,000 GAL S, A7ER / C3 C3 C3 C3 3 o PLAN SECTION CROSS-SECTION o� FRON FOl1NDATtaN w SEPTIC TANK a I h o C3 C3 S r3 r3 o H-10 a:s.re. '^ OD 20 0 o Effective a Dept 3 Unit o o !� o 0 /1 m 1 r. _ ♦ tone in etwe = 29.5' v�•yG��'��i, BETE FULL FOVNOATION-�. - CoNc > s rn a+ N � 29.5' 3 ' 5; 3.5' � o ! 2. � 3 HOLE H-10 DISTRIBUTION BOX • SYSTE ' PROFILE 6 in.a, 3/4•-1 ,/r v ;; h ii _ 35 NOT To SCALE 5 �� L❑C U S M A P M 2 compacted stone y y - t i n Effective Length Not to ScaleEffective Vldth > > LT'13 STRIPOUT ALL AROUND S 5 c ELEVATION 92A0 d SDIL ABSORPTION SYSTEM (SAS) 6 in.of 3/4'-1 1/2' m 500 C H-20 LEACHING UNITS / WIGGINS PRECAST p j Note Remove sod down to med sand foyer do replace with compocted stone GENERAL NOTES Not to Scale elev. 92.00 ) do replace with clean coarse sond w/pert. Note: Certification of Fill Material Required. Lts:<n_9S_Iett!±21s_]_E!4Y.��L99 1. Contractor is responsible for Digsafe notification rate less than w equal to 2 min./in before &.otter placement Before and After Placement by Seine Analyses and protection of all underground utilities and pipes. Y 2. The septic tank and distribution box shall be set level on 6" of 3/4"-1 1/2' stone. �-9$ - ---_ 3. Backfill should be clean sand or grovel with no 2-18- DIAM. ACCESS MANHOLES stones over 3" to size. s' 4. This system Is subject to inspection during installation . ,.•i ,; r•.`; ,,, -_____ ,�' by Carmen E Shay Environmental Services, Inc. 5. The contractor shall install this system in accordance • �` o - ---- with Title V of the Massachusetts state code, the approved plan ' and Local Regulations. THE ACCESS COVERS FOR THE SEPTIC TANK, \ 6. If, during installation the contractor encounters any IT _-.1 - DISTRIBUTION BOX.AND LEACHING COMPONENT \ T o J�T/ O ND 4? O-A - ou ET SET DEEPER THAN 6 INCHES BELOW FINISHED 1 _L_/ 1 �' v �c SOiI conditions OI Site conditions that are different GRADE SHALL BE RAISED TO WITHIN 6' OF ( from those shown on the soil log or in our design FINISHED GRADE. /�' 40 LOOT RIGHT OF WAY installation must halt & immediate notification be INSTALL TUF-nrE GAS BAFFLES OR EouALs mode to Cormen E. Shay Environmental Services, Inc. T a ;? T:,:• ^.�T; t 7 N vehicle r heavy machine shall drive over the o e e o vy machinery STEEL REINFORCED PRECAST CONCRETE �� \�� z septic system unless noted as H-20 septic components. -----� ----- ------------------------- ------ ---------=--- -------- PLAN VIEW r 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. \\�- 28d 06' 33" Kr 9. All Distribution Lines sholl be 4" diameter Schedule 40 NSF PVC pipes.` 3-24' REMOVABLE COVERS x 10. All solid piping, tees & fittings shall be 4" diameter d `�t 125.00 Schedule 40 NSF PVC pipes with water tight joints. 4t, 4' I 11, Municipal Water is Connected to The Residence and Abutting __3" min. Clearance t3' s+IET C h T 8' mi-T 2" min. inlet to outl °' 9$.b3 "� l \� J \� �� 1� ` PE ----�__-_-- ounETPro ernes Within 200 Feet. LiQVid70" min.s 7 THE PROPERTY LINES ARE APPROXIMATE AND 4'-0' met. r I �� �� N RAT Y • co.Hors• :- Liquid depth :,: f � ► � � � COMPILED FROM THE SURVEY PLAN GENERATED B �s I o I LOT #64 = YANKEE SURVEY CONSULTANTS OF MARSTONS MILLS, MA • f I t 20,073 S uare Feet + M ENTITILED "CERTIFIED PLOT PLAN OF LAND" o f I L) 1 9 �_ co t W f _Q I c \ I 55 LONG POND ROAD, MARSTONS MILLS, MA", DATED SEPT. 20, 2002, B_o" 4' -10" = f a 1 , l AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN M f Q , 1 \ O I IT SHOULD BE USED FOR NO PURPOSE OTHER THAN END-SECTION M PORCH ,� r• � ; CROSS -SECTION f i � THE SEPTIC SYSTEM INSTALLATION. if I CO O owt 1 t N I f I I t -J L ---- --- 1 L _ N _ H 10 SEPT{C TANK # USE ' EXISTING 1000 GALLO � I � 3 BEDROOM NOT TO SCALE LEGEND HOUSE �\ PERCOLATION TEST ,�Ss PERCO _ j PROJECT BENCH MARK 104X1 DENOTES PROPOSED Dote of Percolation Test: MAY 24, 2003 Test Performed By. CARMEN E. SHAY, R.S.. C.S.E. x ; TOP OF FOUNDATION' SPOT GRADE I Results Witnessed By. WAIVER( Per BARNSTABLE B.O.H.) ELEV. 100.00 (Assumed) DENOTES EXISTING EXCAVATOR: Shay Environmental Services, Inc. Deck 9$.00 �� X 104.46 Percolation Rate: Less Than 2 MPI LOT #31 SPOT GRADE i Test Hole r-----, i PL PROPERTY LINE No. 1 I 1 X EXIST. 1000 gol.�,' of--I DE PTH salts ELEV. i DOG i 98.05' Septic Tank, 9_6 PROPOSED CONTOUR 0 98 00 i PEN - EXISTING CONTOUR 97 EX S G GO OU Sandy 1 1 Loom L----� ��� a X ,o YR 3/2 �. �-' DEEP TEST HOLE & O--T A, 97-40 97.11 - l PERCOLATION TEST LOCATION Sandy o� Loom ���' TEST HOLE j,L HE `O 10 rR 5/6 ELEV. '9g.6D' SHED co 6 FOOT STOCKADE FENCE 7'- 36' B. 95.00 O Medium l Sand E silt Loam .. _ P LOT P IAAN 5 Y 6/t 1 \ •�_..�-ate• . a ..: 60'- 72 C' 92.00 Perc #1 Depth to Perc: 72" to 90" �.-^- ---- >------------ X , Medium Perpc Rate= Less Tho 2 MPIOF PROPOSED SEPTIC SYSTEM UPGRADE Sand Groundwater Not Observed f Failed t 97.63' z-s v �/, I`Leoch Pity PREPARED FOR Y No Observed ESHWT \ �� t 26.5 72 - 132 87.00 ADJUSTED H2O Elev. _ None X i MARC 8c CYNTHIS CASOLI 8.25 124.50' ,`f AT i nCalculations ; S z8c os' 33" E # 55 LONG POND ROAD Design PERMIT REQUESTED FOR THREE BEDROOM ONLY - SEPTIC OVERZIZED AT.CLIENT'S REQUEST: MARSTONS MILLS MA LOT #32 ' 0 � 'r LOT #66 -\NOF q\ Number of Bedrooms: 3 Bedroom Permitted due to Property Is Within a Zone=;11- , � �`�'� .� PREPARED BY: Garbage Grinder: No r� Leaching Capacity Required 330 G01, o MIN, PER TITLE V) - ,;: Note: Remove soil down to el. 92.00 & replace with r/� /�/��/ �j E. SHAY Leac g P Y q /D Y ( / , a C R L 1 ►' .L� . AJ f i ll Y t Septic Tank 2-x 330 Gol,/Day'= 660 USE NEW 1,000 GAL. Septic flank. clean coarse sand w/perc. rate less than or P SH SOIL ABSORPTION AREA: Usingpercolation rate of <2 min./inch or equal to 2 min./in. before & after placement � � ENVIRONMENTAL SERVICES, INC. € Bottom Area: 0.74 qal/sq. ft. x 400 sq. ft. = 420 gallons : HOWN THERE ARE NO WETLANDS WITHIN 200 OF sTHE PROPERTY. ft. 188 aeons (5 FOOT STRIPOUT ALL AROUND AS S � �° P.O. BOX ' 627 Sidewoll Area: 0.74 gal./sq. ft. x 200 sq. g �fSTIE Providing: 450 ollons S 9 g EXISTING LEACH PIT TO BE PUMPED & FILLED IN PLACE N1TAIR\ EAST FALMOUTH, MA 02536 ...,. 0 20 40 50 - T NECESSARY TO INSTALL NEW SAS. Use. (3) PRECAST-500-C UNITS, HAVING A 2 EFFECTIVE DEPTH, ,- OR REMOVED IF FOUND 0 BE E TEL/FAX 508-548-0796 b WITH 3.5' OF WASHED STONE ON THE SIDES AND CONTAINING LEACHATE TO BE USED NOTE: ANY STRIPPED .OUT SOIL CON G SCALE: ' 1 "=20'_ -DRAWN BY: CES DATE: MAY 28, 200� 2.75 OF WASHED STONE ON THE ENDS. " IT T E SEPARATELY PIPED AND TO BE SEPARATED 2 APART. FROM THE EXISTING LEACH PITS/CESSPOOLS TO BE DISPOSED UNITS O B S `F As PER BOARD OF'HEALTH<SPECIFICATIONS. -PROJECT#SD42$ FILENAME: SD42$PP.DWG SHEET 1 OF 1 SCALE. 1 =20' o