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HomeMy WebLinkAbout0199 LONG POND ROAD - Health 199 Long Pond Road Marstons Mills ` A = 013 51�_ ,.i t� 1 Commonwealth of Massachusetts - Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Long Pond Road Property Address - Lois &John McGreoghegan Owner Owner's Name l information is ' required for every Marstons Mills Ma 02648 12-30-15 page. City/Town State Zip Code Date of Inspection ru-� Inspection results must be submitted on this form. Inspection forms may not be altered in anya(-` way. Please see completeness checklist at the end of the form. Important:When A. General Information 3�Z filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. B&B Excavation � Company Name 14 Teaberry Lane Company Address Sandwich Ma. 02644 City/Town State Zip Code (508)477-0653 S113747- 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 12-30-15 Inspector's atur 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. �� Us t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System e 1 of 17 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ,•'�p 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR.15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating'that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 page. Cityrrown 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): ❑ 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 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 page. Cityfrown 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 T Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 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- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to.15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 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? P 9 ® ❑ 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): 369 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 page. Cityrrown 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d see below 9 ( Y 9 (gp ))� Detail: 2014-49,000gallons 2015-66,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is Marstons Mills Ma 02648 12-30-15 required for everyi page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is Marstons Mills Ma 02648 12-30-15 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2007 tank was replaced/ leaching replaced 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order with no sign of leakage. Septic Tank (locate on site plan): Depth below grade: 1' p g 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: 1500 gallon Sludge depth: 6" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealths of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M ,•''v 199 Long Pond Road Property Address Lois & John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 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 2 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 15" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order with tees present and no sign of back-up. Liquid level equal with outlet invert. Tank should be pumped every 2 years for maintenance. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M SOy`' 199 Long Pond Road Property Address Lois & John McGreoghegan Owner Owner's Name information is Marstons Mills Ma 02648 12-30-15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holdin Tank (tank must be pumped at time of inspection) (locate on site pla n): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•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 M •''V 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 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 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.): At time of inspection d-box appears to be in working order with no sign of carryover. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: infiltrators 11'x38' ❑ 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.): At time of inspection leaching appears to be in working order with no sign of 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 Depth of solids layer 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 Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM ; 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 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.): i Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth,of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments` 199 Long Pond Road Property Address Lois&John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 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. E] drawing attached separately i A i3 I 2O O Ate,, Zo. Q)3� o� i t5ins•3113 / Title 5 Official Inspection Form:Subsurface Sewage Disposal Sysiem:•Page 15 of 17 Commonwealth f Massachusetts� o ss usetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 199 Long Pond Road Property Address Lois &John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 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: No Gw 144" feet Please indicate all methods used to determine the high ground water elevation: ® Ob,ained from system design plans on record If checked, date of design plan reviewed: 6-22-01Date ❑ 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: Plan on file at BOH. 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 u Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 199 Long Pond Road Property Address Lois&John McGreoghegan Owner Owner's Name information is required for every Marstons Mills Ma 02648 12-30-15 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r TOWN OF BARNSTABLE LOCATION —SEWAGE VL LAOE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (sue) NO.OF BEDROOMS OWNER PERMIT DATE: D -*2 COMPLIANCE DATE: / a '7 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 f ili. Feet FURNISHED BY g r _ �-,,,qoX A .;2/ . , TOWN OF BARNSTABLE LOCATION SEWAGE #! VILLAGE M mr` ASSESSOR'S MAP &LOT b 5 . INSTALLER S NAME &PH ONE NO. SEPTIC TANK CAPACITY LEACHII�IG FACILITY: (type) �e V'r, (size) NO.OF BEDROOMS " BUILDER OR OWNER _ ' PERMTT DATE: I j 03 COMPLIANCE DATE: Separation Distance Between the: =f= 4 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility... Feet Private Water Supply Well and Leaching Facility (If any wells exists . Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist =. peer within 300 feet of leaching facility) Furnished by ! a' i t I tttt� A 28 `" P6 , 8 H 3 Yl ' b two V3<4 `A( t 6 v' � .000777. 3 Ilk "�• x ♦ .y w Y_ d �a! •t s : , t - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es ZppYicatton for Digog pftem Con5tructfon Verna Application for a Permit to Construct( ) Repair dlUpgrade Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. / �O POAAD R L Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 0 Installer's Name,Address,and Tel.No. p("r?� Designer's Name,Address and Tel.No. NONF2- Ty e of Building: Dwelling No.of Bedrooms Lot Size ! 10 F d sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Re airs or Alterations nswer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title,5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o ealth. Sign Date G/ d Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. G�L Date Issued No. "- �`L/L.J� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es Application for �toponj,.6potem Conotruction Permit Application for a Permit to Construct( Repair(W Upgrade Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 77 ZoAJC/` OIUD R Owner's Name,Address,and Tel.No. � 1 1 , , Assessor's Maps arcelcel � Installer's Name,Address,and Tel.No. wiJ_O Am PU/ 1 Designer's Name,Address and Tel.No. �1 11� SS "Typ of Building: Dwelling No.of Bedrooms Lot Size o C7© sq.ft. Garbage Grinder ( ) Other Type of Building —T . No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ; gpd s'j Plan Date Number of sheets Revision Date , Title Size of Septic Tank /:�5-C9 U Type of S.A.S. - c,- Description of Soil +� - itM f �l Nature'Sf Repairs or Alterations(Answer when applicable) Datelast inspected: U� (l IQ �. Agreement: The undersigned agrees to ensure the constructiofi�and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board'o r f Health`s. ; • Signe / '4� Date Application.Approved by �M U Date t, Application.Disapproved by: . Date for the following reasons Permit NJ. Date Issued x - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( t� Upgraded ( ) Abandoned:( )by J ) at )/ hay,been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�} ow r dated v v Installery �yyy� � ��. (�. Designer #bedrooms u Approved design flow gpd The issuance of this permit sh 11 of b cons rued as a gu rantee that the system will fu, designed.' f�iDate IvI c Inspector / ,/ ----L. —— No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Xi5po0al *p5tem Con9truction Permit Permission is hereby granted to Construct ( ) Repair ( t/�Upgrade ( Abandon System located at / ,,,y � ' - r— and as described in the above Application for Disposal`System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. i Provided: Constructio p mqst be completed within three years of the date of t is e it. Date Approved by LAWRENCE ,9,�.ADY MIX SANDWICH CAUTION: Freshly mixed content,mortar,grout or concrete P. O. DC X � t � t may cause skin irritation.Avoid direct contact where possible and wash exposed skin areas promptly with water. If any SANDWICH, MASS. 02563 cementitious material gets into the eye,rinse immediately and 1-800--633=-F3889 repeatedly with water,and get prompt medical attention. LOADING LEAVE PLANT ARRIVE JOB START UNLOADING FINISH UNLOADING LEAVE JOB ARRIVE PLANT TICKET# 9:340M I_ 17233 JOB SITE CYLINDER TEST: ❑ YES ❑ NO Environments!mgulations prohibit the discharge of process water to ground,public sewer, storm drain or to a waterway,it is the responsibility of the Contractor/project Owner to ensure Drivers are not permitted to add water to the mix to exceed the maximum slump. that concrete wash Is contained at the job site. Water added on job at Customer's request: Drivers are prohibited from delivering concrete except under the truck's own power,end where gals to Full Ld.❑YES gals to 2/3 Ld.❑YES gals to 1/3 Ld.❑YES she conditions permit the safe and proper operation of his equipment.The customer accepts full Additional water added to this concrete will reduce its strength.Any water added is at responsibility for damage to sidewalks,curbs,driveways,septic systems or any other property when bucks are required to cross or enter such property. customer's own risk. The customer accepts full responsibility for any loss or damage. AUTHORIZED BY X X Customer's representative SOLD TO CUSTOMER# JOB/PROJ.# ORDDq"R# PO# MIKE DEDECO 29999900 29999` 3P Q �.,af� DELIVERY ADDRESS DATE' 199 LONG POND MAR. MIL)_S 1 1)t,t�0l INSTRUCTIONS/DIRECTIONS OFF WAKlmBY MIX SLUMP USE PLANT TRUCK# DRIVER 1 Oft 1 E� I Li_ SAND 1.12.97.1 SOR LOAD SIZE LOAD# CUMULATIVE QUANTITY TOTAL ORDER MAP PAGE TIME DUE RET PLANT 11. 00 it 00 BARN D1J.e : . . , 1.0:00AM QUANTITY PRODUCT NO. PRODUCT DESCRIPTION UNIT PRICE AMOUNT 11. 00 100100 FLOW F=: 1-L DARAFTi-,!_ EXV 71. 00 11. 00 r�+t71t714' WIHTER f'�!h#Ct�f�'f� 5. 00_ . . .. 1; .5 J. 00 11. 00 LOf'00 FUEL SI-)RCFff=iRGE: 1. t" Q1 1: 1'. rA0 1 1. L712 E000 I. I Nt1 I ROMEN T(24L FEE 1. 54 16. 94 REASON FOR DEL AY ❑ JOB NOT READY ❑ SLOW PACING METHOD ❑ JOB DELAY SUB-TOTAL 863. 9- 4 ❑ ARRIVED JOB EARLY ❑ OTHER(EXPLAIN FULLY) The customer accepts full responsibility for suitable truck access to the job site.Unloading time will be TAX 43. 20 charged after 30 minutes. Received subject to above conditions. WAITING TIME RECEIVED BY X TOTAL DUE ` `� xx I � U 111211 L CUSTOMER COPY Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments r` Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 611512000. Inspection forms may not be altered in any way. A. Certification Important: • When filling out 1. Property Information: forms on the computer,use 199 Long Pond Road al,U. only the tab key Property Address to move your Today Real Estate cursor-do not use the return Owner's Name key. 1533 Falmouth Road Owner's Address !! Centerville MA 02632 Cityrrown State Zip Code Date of Inspection: 11/10/07Date 2. Inspector: MR. ROBERT A. DRAKE Name of Inspector KCJ ENGINEERING Company Name 66 GREENVILLE DRIVE Company Address FORESTDALE MA 02644 City/Town State Zip Code 508-477-5048 Telephone Number Certification Statement: I certiTy that I have personally inspected the sewage disposal system at this address and that the info ,ation reported below is true, accurate and complete as of the time of the inspection. The inspection c� 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 pta's—M tion 16.340 of Title 5410 CMR 15.000).The system: OF Mass 0.Tasses ® Conditionally Passes Fails 90 p ROBERTA. yG ( - DRAKE V' [-]Ajee s Further Evaluation by the Local Approving Authority CD CIVIL t-` 1`r/ 1� 1c- IG r •• n � 0 No.4164 2 _= Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the 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 Qwner 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. 199 Long Pond Road-T51NSP[1J.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 1 of 16 t Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments r` Subsurface Sewage Disposal System Form N A. Certification (cont.) 199 Long Pond Road Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the.Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: . Septic Tank is directly beneath the comer of the building. The foundation is on sonatubes according to jeroposed seLbb'c upgrade plan dated 6122/01. Septic tank needs to be relocated. 199 Long Pond Road-T5INSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 199 Long Pond Road Property Address Marstons Mills MA 02648 Cityrrown . State Zip Code Today Real Estate 11/10/07 Owners Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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 16.303(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 199 Long Pond Road-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form, Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 199 Long Pond Road Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health(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. 0 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. 199 Long Pond Road-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments y` Subsurface Sewage Disposal System Form A. Certification (cont.) 199 Long Pond Road Property Address ' Marstons Mills MA 02648 Citylrown State ZipCode Today Real Estate 11/10/07 Owner's Name Date of Inspection 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 Yz day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® 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. ❑ Z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Yes No ❑ ® The system fails. I have determined that one or 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. 199 Long Pond Road-T51NSP[1].doc•11/2004 Title 5 official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 I Commonwealth of Massachusetts Title 5 Official Insp ection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 199 Long Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection 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. 199 Long Pond Road-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 199 Long Pond Road Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection 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(3)(b)] i 199 Long Pond Road-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Fora Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 199 Long Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage(gpd)): 250 gpd 9 ( Y 9 Sump pump? ❑ Yes ® No Last date of occupancy: a couple of months ago Commercial/industrial Flow Conditions: Type of Establishment: N/A 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: Last date of occupancy/use: Date Other(describe): 199 Long Pond Road-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 199 Long Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons How was quantity pumped determined? N/A Reason for pumping: N/A 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) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: House built in 1983. Septic tank is believed to be original tank. Leaching field was upgraded in 2003. Were sewage odors detected when arriving at the site? ❑ Yes ® No 199 Long Pond Road-T51NSP[11.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 199 Long Pond Road Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Today Real Estate 11/10/07 Owners Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: approx. 2' 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.): Joints appear to be structurally sound, no signs of leakage. Septic Tank(locate on site plan): Depth below grade: 1.0 feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) Tank appears to be structurally sound and functioining properly. If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance?(attach a copy of ❑ Yes ❑ No certificate) Dimensions: 1500 Gallon Sludge depth: approx. 5-inches Distance from top of sludge to bottom of outlet tee or baffle approx. 29-inches to pipe invert Scum thickness approx. 1 inch Distance from top of scum to top of outlet tee or baffle approx. 8-inches to pipe invert Distance from bottom of scum to bottom of outlet tee or baffle approx. 13-inches to pipe invert How were dimensions determined? MEASURED IN FIELD 199 Long Pond Road-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form C. System Information (cont.) 199 Long Pond Road Property Address Marstons Mills ' MA 02648 City/Town State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): All components appear to be structurally sound and working properly. The existing outlet concrete baffle(not being used) in septic tank a piece has broken off. However, the PVC outlet tee(being used)appears to be in good working condition. Grease Trap(locate on site plan): Depth below grade: N/A p g 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 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: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): 199 Long Pond Road-T51NSP[1].doc 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 199 Long Pond Road Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: N/A 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.): Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Is slightly below outlet pipe 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.): Appears to be sound and working propoerly. No signs of backups. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 199 Long Pond Road-T51NSP[1].doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 199 Long Pond Road Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A 4 Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leachingits number: p u ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: 5 High Capacity Infiltrators, 11'x38'Trench Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Everything appears to be working properly. No signs of hydraulic failure or ponding. 199 Long Pond Road-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cunt.) 199 Long Pond Road Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 199 Long Pond Road-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 199 Long Pond Road Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. a F K+oaT (ro N 6 Po N D r-n Pt) T?P-r1c Tq,Jr- Cove. OFF cotoek of uoisc, l7 Soy, a`- L i ' 199 Long Pond Road-T51NSP[1].doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 15 of 16 a Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 199 Long Pond Road Property Address Marstons Mills MA 02648 Cityrrown State Zip Code Today Real Estate 11/10/07 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 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: 6/22/01 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: Barnstable GIS Groundwater Maps indicate high groundwater elevation is at approx. = 52', GIS Contour Maps indicate ground elevation is at approx. 102.8', Approximately 50'separation. 199 Long Pond Road-T51NSP[1].doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 Town of Barnstable OF THE Tp� Regulatory Services ,R,,ST" Thomas F. Geiler,Director ib� � Public Health .Division ATED MA'S A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. No. fj v" Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ves PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYicatton for Mtgo9a' petern Construction Permit Application for a Permit to Construct 'Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. / L,oviq 90 nC R Owner's Name,Address and Tel.No. Marsp6vts K;ils K L .`JJ nk-N .rw d, IkIn-t 1s 4ne- r4`1'Usclr®v-L Assessor's Map/Parcel 3 A2 199 Low Po (Rc(— /`{a rS-fovLs y`l,ol/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Al Z 00 51 50►^t Z� - f/QGV� `�r4�t i✓d -Vk-1-,e 6"V-V - J Type of Building: Dwelling No.of Bedrooms _ Lot Size 711�000 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 130 gallons per day. Calculated,daily flow gallons. Plan Date "�"Z- r > l Number of sheets Z Revision Date Title Size of Septic Tank 16-001 e_>CtS `mg Type of S.A.S. 7-r'e_he-k Description of Soil G Nature of Repairs or Alterations(Answer when applicable) (3®t s Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee issued by this Board of Health. Si ned Date Application Approved b Date 1/ Application Disapproved for the following reasons h Permit No. cQe�0 -s 3 f.8r Date Issued a 1 `i No Fee f3 i Entered in computer: THE COMMONWEALTH OF MASSACHUSET�S Ves f PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS "V }- ZIpprication for Mw oposW 6pztem Congtruct'ion Permit Application for a.Permit to Construct/ Repair( �Upgrade( )Abandon( ) El Complete System 1:1 Individual Components ._Y d �99 GO0g Pond Rd- , Location Address or Lot No. Owner's Name,Address and Tel.No. Mars4ov►s K, ►ls 7iq f1r,- Ae-a LC kht 3�,►+c L, Assessor's Map/Parcel 1 r/'9 4onc� Pon R�. Installer's Name,Address,and TeL No. / Designer's Name,Address and Tel.No. A/ O 2, �. w* ('r� ,d 6- u N 14- v t3 Tndus4ry [�C . C� SO 20- Z arS an *1/11s Type of Budding: ` Dwelling No.of Bedrooms Lot Size 20 000 sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 0 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Z Revision Date Title Y,. Size of Septic Tank JJ 16 00 ek 5yw Type of S.A.S. r'tHC-� -Description of Soil - r R .fir '°� Nature of Repairs or Alterations(Answer when applicable) �GW 1> ter..ti Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. u/ ` S gne Date Application Approved b Date C..) Application Disapproved for the following reasons N • .P G � Permit No. �,3'` ILK—— Date.issued —71 THE COMMONWEALTH OF MASSACHUSETTS 1 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired (Upgraded( ) Abandoned( )by Sa n Sa ti z ' at has been construct in/ccordance with the provisions of tle 5 and the for Disposal System Construction Permit No. Z,06 I- / dated /603 ' Installer Designer The issuance of is pf03 rmit shall not be construed as a guarantee that the syste to/ a .design 'd? Date Inspector { i ---------------------------------------- No. D-00 3 3) 1 Fee / THE COMMONWEALTH OF MASSACHUSETTS - PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 0i5pool bpgtem Conotruction Permit Permission is hereby granted to Construct(t/)Repair( )Upgrade( )Abandon.( ) System located at 1 9C1 LoNr, 1—)6nN f?-L) Q) and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: o stfuu ccttio must be completed within three years of the dat of this p• i Date:_ /!✓ Approved by THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Ta N..................OF........ ?.Iva rs-�'hf�Lc�_...... Ax, iration for Dispati a1 Works Tons rnrtion ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal 4- s t: I��((\///��j�//A' //Ay��� /{�_1 C • I W• e • •IY.I' \ /A • -� . --...--••-----i------------------------ ----------------�T--------------.-2=......---•----•--•-----------..................... .Location-Address or Lot No. ti �M_ �1 c.2.ys tCs------------ -- o��----po N.o .Pry q D------------------------------ Owner Address ._ sTZ�I�IS M l LLS ...... .._ .....---••---- C Installer Address U Type of Building Size Lot...le4.;? 6....Sq. feet �-, Dwelling—No. of Bedrooms.............. _.........................Expansion Attic ( ) Garbage Grinder (u/A) �`4 Other—Type T e of Building � t4 N yp g ___.____._� _____________ No. of persons_._.__...._�!4_...__..___. Showers (ti/r�) — Cafeteria (N/�) dOther fixtures .......N.Un`.................................................................................................................... W Design Flow.............5 ........._._._.......•..gallons per person per day. Total daily flow.......... WSeptic Tank—Liquid capacity.lgQo_.gallons Length__$'G'"____ Width_4�-►0�"_. Diameter__u1_A...... Depth..s�8"._._ x Disposal Trench—No. _._"Jt1 t........ Width....h+.11 ....... Total Length___.t/_A_._..... Total leaching area.... 1A•_---_-•-sq. ft. Seepage Pit No......1-------------- Diameter....... .----------Depth below inlet.......(.:�"_._.._.. Total leaching area.2l;a3:9.._.sq. ft. Z Other Distribution box (✓) Dosing tank (w1A) aPercolation Test Results Performed by.... !� lRs.._ .__�.?t Ct?-!..................... Date........�..:_!o... ........... Test Pit No. .....minutes per inch Depth of Test Pit.....O-.......... Depth to ground water_._4± t+a.......... f=, Test Pit No. 2...4.. -....minutes per inch Depth of Test Pit.....!An_...... Depth to ground water--_��4:W......... ---- --••----- -----------------------•--------•--•--- -------•-----------------------------------•----- 0 Description of Soil................!.-_3 G�n.Y.._... •----�c 5 p�=75 ( o i?d LEs---sa�n .............. U -•-•------......•... -••-•••-----._....-••.--•-3 ...... n=�-SA-`'- "" c'`t!"`A ....' ...' W '1 - i 2 h uE 5r�tir4 --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- V Nature of Repairs or Alterations—Answer when applicable._--.j?"/A---------------------------------------------------------------------•••-_---_.. •---.....................-•-----------•--•---------------•-----...-----------•--------........----------....------------------------------------------------------•--.....--•--•=•-----...........•... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n­iss ed by the board of-ITF-Sa th. Signed-------------..... • ........... -..-.... 2.9--------- D to tc.` .•• . ----- ----• . .... ........... ---- Application Approved By Date Application Disapproved for the following reasons:.........•. . . -- -•--•--•-••-----------•-----•--•----•---•-------•--•-•-------•-•-•---...._ ........• •----- --------•-••-------------•----................................Date PermitNo......................................................... Issued. Date + No. .�:":....... . Fmc.........` . .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................... .................OF..................... -........-._.........._.... Applirattion for Disposal Work, Tontrurttoat Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................__.........................................Location ddr •--•----------- -•._................ ------ ----------•----- ........:...L"o...._......... ------- ....................... Location-Address or Lot No. •.....................__..........---.••-----------•--•---•--................................... ..........--................................... ir............................................... Owner Adress W Installer Address Type of Building Size Lot............................Sq. feet �- Dwelling—No. of Bedrooms........................................h..Expansion Attic ( ) Garbage Grinder ( ) Pk Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ................................................. d •----------------------•-----------------------•-----------------------•-•------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter___________----- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( )' Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •--------------------------------------------............................................................................................................... 0 Description of Soil-----------------------•-•----•-----•--------------...............----.....--------------------•-------.........---- ------ "� W1 4 ... ....._.. VNature 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed....... ---•-- ... ` to Application Approved BY .. !:. "'� -..r .... .. ................. ' '` --------........ Date -- . Application Disapproved for the following reasons:.. _._ ...................................................................... •- -------- -----------------------•------------------------------------ 1 Date PermitNo...............••--- ---- ---------------------- `r Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD^"-OF" HEALTH ..........................................OF..................................................................................... Trrtifiratr of TontpliFanrr THIS ISO CERTIFY That the Individual"Sewage Disposal System constructed ( ) or Repaired00f ( ) bY----------------- -----•--•--•-•--•----------• Installer lww at-........................ •-••---- A .----- ----- ...................................................... ................. .has been installed in accordance with the provisions of TI 71 5 of, The State Sanitary Code as described in the application for Disposal Works Construction Permit No......10- - --_-_--_-. dated................................................ THE ISSUOF THIS CERTIFICATE SHALL NOT BE CONSTR AS A GUARANTEE THAT THE SYSTEM7WILrrFJj11CTION SATISFACTORY. DATE._.. .� � -------------------- Inspector-- -- - - - 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF......................................................................... No..................... FEE ..,.�.............•.... Disposal V rks'Zonstr ion rrotit Permission is hereby granted. ' .--•----- to Constr t og Repair ( ) Individu Sewa e Disposal System atNo............. ... ./----- ------ - ....................................r s . J?c . Street as shown on the application for Disposal Works Construction Permit No.............../.... Dated.......................................... - t' Board of Health DATE...............��,�r .. -- '� a •.... - FORM 1255 .Hoass & WARREN. INC.. PUBLISHERS pCc.:P,E:D ."L1t� rE O.�ioL� l_fl,.rE �EPTc •n _ - 5_G'p l"I G i 1..i Q.LA-L. g .5 e-1'EG�"►' .+'8, Gl. : i:�' (1.1 K••E�p t :E —....t"I E:err-3 f=F 3i�nT ,{ 4 p N12� zt for 99 Lor. �2i Lor i 20 -zo'. 00 SF IAc-A&jT TowN '"AT Er° col r 1c�v�F--- 11 d'K a'I Inc,+wi-vir 1 ,„. DA. 62 ( . Of l,. \ .,a ter. ' ,�.5 � .�I ' ✓!� �. III QQ�'aT N0.29874 p z F Icori:Ln xPrK: ri.r� a ((3Y 47HEts ,. CISTE� J� q A t 4:e 30 ��YP 2 L cf1�s�M�p q7.� I" 99 s t 0 MORSE PQoIECnneJ g: No..10951 p Fr`7ONAL EL 400-0 ry' ..a- i2a 12 43.,.• 125.0c �e LrR�(rY \ �x� ', C vtsa Jrnj o 5 0`. Piz,vArE W v ! ri sca � sI �."1LEGEND FL��,aTt CERTIFIED PLOT PLAN EXI8TIN0B�POT ELEVATION Ox0rEXISTING CONTOUR --- 0 --- V �� µT FINISHED' SPOT ELEVATION (� w' a - L�- 12� f�N� PaNp RagD MARSTowsFINISHED,,.-CONTOUR 0 y IN APPROVED BOARD OF HEALTH DA TE AGENT ° ',1> SCALEt „ =30' DATE1JU1 �83. x DREDGE ENGINEERING CQ IN CLIENT +L u��d• 1. CERTIFY THAT THE PROPOSED EGISTERE REGISTERED SOB 10. µ BUILDING SHOWN ON THIS' PLAN CLVIL 4AND CONFORMS TO THE ZONING, LAWS ENOINEE ,,SURVEYOROR:BY�. -. OF 3ARN7LE, MASS. -ors71.2 MAIN STREET,NY,ANNIS, MASS; L:� OR` 3 DATE0. "LAND SURVEYO R y _ NOTFt /or a/f7lvNE,t 7,We,SEPTIC 7.4N OR .. i • ?Q FT_' pII/M: '_F�gCtli�rG- p!T .4RE- MORE 7NA:•1 /2 BELOt 24-0/A.N'E7-fR CONCR6T�: COa✓ER to P7►.' M/� SSNA L L` $E a A?O U49,q r`'TG G RA L E.77 GOKC/tCTE •¢"PYC PI PC tf ER V y C^S 7" /,eON C J f/E.4 SJ-/A L L C c U S E. k M/N.- PITCt+ lF/N OR/,VE:e/AY i ' EL= lot.o:: CO h'pFT ' - .L� CON C,•c`�'TE E . _5'A IV 401-41 ' JRvv�. , •, o i .'.• . > ''= �fj'P��t PT";_ SEP,��/G.'c T�IV�` 0IST. • i t• ► • • • r• • ��s . • SFD'S7TNE� WASH.PITCX t &aX • t • • � 8r • • • • � • }�, - ,tarc -•L�crh.+b .A r .� � � •F�FFCT/YC • e • 3 4 - I �2 4 - We • • G • • • : WA5,YE0 STONE ..B>=�c�i • • APT • • cr.lr+ use•-.,Pe.- Fso aF ` 84 *- - 7 ,z . . • . •. • o PRECAST SA.As Wa£ • , • • • • • • �. • P/T DR FQU/V. INY�R'T &ARVAT/CW� i 5o a x 'L s r 3��;r, /D F—L= �1,G f _Y 9 - �� t X= } p 1 f 3'! ! 0 »` 3' j�Fr �/A�'J. e r IXYfRT �6T QWLD/NQr R g- r'k i F7 ®/141�5.. C e�F Ts�dUl�{TION� _ 9B 4 6LD ET .SEpTC. .. ' g vz 0J37J�/Al/TI�IIIBF SrEGTl4N OF GROuNO iTE.'e TitDL£ //✓LEA ; Y • r - p�/TIETDJ3TR1®tITJOIV sewASAM A S. rsT. %`Sffirt l�iPtlf tfatCXtx�r PJT ,955 / _ 7Ad4VCAT140#A '� t EACffI/Y� �Z' AV DFSl611E .C�tITF1�lI� '. D1AFA f/SIOA0 lvuareER of��ov�s - _ oIM�TrsiaN WRGl�•D/SPOSAL U/1llr Now E SOIL LOG SOlL TEST 7 'A L E37/M4T!'D J=LAaV 330 Y SOl L TEST/R/< „SO/L 7FS770Z417 :• i VUA.fBER GF 4rACx1nrG O/73 oal fte&Y. 98,5 s EiCffV, �19.8 Lk4TE OF SOIL. TgST t o 83 F S/DF L EAGH/NG oE/t PIT I o: I•T.. ar i RFSt/tTS yvlTISIFSSED dY T,G . hcaPs�, asurl�`�OT GO7TOM Ltr�C/I/NG PER P1T 113. , � F.T __ . / PERCOLATIO.A AA 7-0 rA4.'j.Z4C,4hYa AREA. 263.9 S41f77 t �, cLA-( T/GN R.ATE MII�JINGlf I 1y1N.�/NGN 4ESERtiEGE.{CNtX6AREI� 203:9 Sp. AT_ _ Tg•ST k�F p- 2 t l Co ti . n �NGr=Ar,c 3-� '/ SR�L? _ LoT I�I - L lL� Yar�D �Q I1,J may`. i.r or - HN lll4 S L : OBERT = _ _ - fL rr,, N V7 R 4L,S MORSE Y No ies�e o A 9 No.10951.E�Q EL DREDGE EivG/IV R/h�G CO,/NC. .� i FG� R�_Q• � 40 �C/sTE EL- C>-7. 9 7!2 )bIAIYV ST. , f/Y4N.viS. NlASJ. ST6 v F V Fss/ONAL�`� �O6,T0iV, t7 + Y47L&M 1•'NCOUNTI�R�O CL/ENT: ` a DATE -3 GROU. O -,PVATE.P AT ELEV• NO• 2 —✓Od 3144 SHEET 2 OF 3 � % zl y2' S8 N s pA' , •'' ` AC-Awrwi- a9�k� 23820' o 46� Vie. o p 2 b �• �`r�,� ��' G d°° °off•y'� - y� °�A /16 7O 4 20 n Q. . Z0000 / a �'� �► ZS.000 p06 0 0 3 0 0 4 2 /08 a • 6 .y ' \' R-52.sv. ,)� oo ass �yQ 0 9 ZO 3 DO�f �. - . -� «%I DE S.a►a: '� 37 �• VAeI\�T �' 1� e•Lss . .4:35.22 2 c37:J ,t Q 0( �, �` , I Q•2s,00 Anyren'� 110 zo 3n S bi �� vnc nNT- , 100 31 735 S p ;e•52:50 o :'O't ti�o D C SAG .co /4 \ti �� 6 6 5�! O�r .• / :.AvJT" , /03 If/YAA �� Q� Y.I \ V�N�W 1 {/ V AQITtL 0 25 340 t z>�•r 0► �0 H ,; c co �. \�O (/'d6 `xuA. a' y J _ h, v 20 � Ij /5/O t ,,1 ,v8on6ob•' b �J`o s.:.•��.`�6,I��,�g �'�� � QN � 4 �b Nil 41 vA AN o►�2 v,� ;y ti 140. ba hV'` ' �►•35'.�7 k 'yb•.\ 1 0 \b 60 24130 r- Q 'f A ;� �•tS Ofd� `,, � . �tic�ec;;AeC' , �6''�-3 ry �' �V .�►E. ,K/A y`' 06., -_� ,,: " 711M/wP•�S \� V. ^".I.wqT W 4: ¢ iiie 06 DO�/G'���� .$A7•89 __ O`ti� 7-,.3,5.96 •. O -. 1 OV $• / / ti b /7� } a. � 9 ►moo � .. . r . 2s.o / � •..jio.3� �ls 44) i25,o• � , y �� a r06" ,/ Op ✓V eS5,3; �2 �of3 mac' 8 i 44 10 .O,! �-T WELL 5WE I_cC-A_'nOW% 1 f I CDC T � :5�� 1 H L _ MARSTONS MILLS A.M. 13/49 (TOWN WATER) - A.M. 13/50 `M. (TO WN WA TER) �' z CB/OH LOC-101 US 101 UPOLE ;' r?� WAKEBY ROAD 116 •• 2yt O, r~` �Y#2 Y1�'gs i p •'••`..• � c�O 9.��ems,?, ti 15' 8 IO a l 1 T� .01 � r Q � •G� . 1 � 1. . O �o a �' ; �'► �'� o LOCUS MAP , o ► ONA TUBE(FND) ——— , f�4 J — a o EXIST. ---+' j -o _ �� _ a", ;� w D-BOX o >. 284191 A.M. 13131 �` 8 , PLAN REF 28 f! (TO WN WATER) c'~ y� DECK HOUSE ��� O ZONING: RF „ 199 O VERLA Y DIST.. GP � �� c� � GROUNDWATER 24 P�NE 10 0,% , ,�� `ti i; ASSESSORS MAP 13 o . ' T. O.F EL. =:6102.2 - - - - - - - - W APPROX LO TION i' GARAGE �' I42 Iw Q� SOF EXIST YSTEM PER L_ ;; SEPTIC UPGRADE' PLAN INSTALLERS CARD ' PUMP & FILL 2z� / , 4 10O -} / ,� ; PROJECT L OCA T/ON 199 LONG POND ROAD oc� MARSTONS MILLS, MA. \\ A. M. 1 3-/51 . O AREA=20,000f S.F. APPLICANT.• t\ (TOWN- WIT TER) SOMA TTHEW & KHRISTINE \ q MOSGRO VE YA AIKEE SURVEY CONSUL TAN TS CB/DH \ i P.O. BOX 265 0 -O IF'p \ UNIT .5, 40H INDUSTRY ROAD " �� MARSTONS MILLS, MA. 02648 1�I o) 4 ' PH.(508)428-0055 - FAX(508)420-5553 i SCALE: 1 "=20' DA TE.• 6 22 Ol J N 32 A.M. 13/29 �'mmmmv �� 614 E \ U pLE , z (TOWN WATER) 3 Mu+ar , �At u►��g NO. 749 `�° i REV. REV. JOB NO, 52764 SHEET 1 OF 2 a r. EL. = 102.2' TOP OF FOUNDATION (EXIST.) ` 20' MIN. i 10' MIN. CONCRETE,COVERS 4" SCHEDULE 40 P. V.C. MIN. PITCH 1/8 PER FT. 2"LA YER OF EL=100.8 CONCRETE COVER WASHED S719NE lool 6' MAX EL=100. 7 4" CAST IRON PIPE 6" (OR EQUAL MINIMUM CLEAN SAND 9 PITCH 1/4 PER FT ray MIN. FLOW LINE � EL=97. 7 1 10" INVERT MIN. 14" EL.= 99 4 ADD GAS INVERT �6 SUMLE VEL o o°°° °oo° (EXISTING) INVERT BAFFLE EL = 98.9 INVERT INVERT c o o°o °°oo° EL.= 99T EL.= 98.5 _ EL.= 98.25 o° o =96.2 (EXISTING) NEW DISTRIBUTION 1500 —_GALLONS BOX 5 HIGH CAPACITY INFILTRATORS EXISTING SEPTIC TANK TO BE WATER TESTED 11' X 38' TRENCH FORMATION IF MORE THAN ONE OUTLET PLACE ON 6" STONE 3/4" TO 1-1/2" SOIL ABSORPTION PROFILE OF DOUBLE WASHED STONE SYSTEM (SAS) SEWAGE DISPOSAL SYSTEM BOTTOM OF TEST HOLE OR VSGS PROBABLE WATER TABLE ELEV.=_88.9_ NOT TO SCALE NO OBSERVED WATER TABLE (6110183) ELEV..=_ 88.9 OBSERVATION HOLE 1 EL"V.=_ 100.9' PERCOLATION RATE _!!�2___ MINI INCH OBSERVATION HOLE 2 ELEV.=_ 100.9' DEPTH TEXTURE DEPTH TEXTURE 0-12" LOAM & SUBSOIL 0-12" ORGANIC 12-36" CLAY 12-36" SANDY LOAM GENERAL NO TES 36-84" MEDIUM SAND— 36—84" MEDIUM SAND 84"-144" FINE SAND 84"-144' FINE SAND 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. ' TITLE 5 AND THE TOWN OF _$ARff.F ABLE--__ RULES AND NO WATER ENCOUNTERED NO WATER ENCOUNTERED REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO SOIL TEST P# 2116 WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" DATE OF SOIL TEST 6110183 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITNESSED BY: T.C./JACORI WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN DESIGN CALCULA TIONS.' 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE i USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. TOP LOAD NUMBER OF BEDROOMS . 3 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL 5 HIGH CAPACITY INFILTRATORS WITH GARBAGE DISPOSAL NO BE MORTERED IN PLACE. 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 4' STONE SIDES AND ENDS TOTAL ESTIMATED FLOW DA3' x 3___ BR) 330 GAL/D.4Y DEFDF,D RJR ZONING REGULATIONS. O WNERIAPPLICANT IS TO 11' X 38' ( 110__GAL 1'BR 1 OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. y REQUIRED SEPTIC TANK CAPACITY 1500 GAL 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCA VA TION CONTRACTOR SOIL f CLASSIFICA TION . . . . . . . . 1 ` IS TO CALL "DIG— SAFE" AT 1—800—322—4844 AT LEAST 72 HO URS ' DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN. PRIOR TD COMMENCING WORK ON SITE. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS ' EFFLUENT LOADING RATE . • 74 GAL/DAY/S.F LEACHING CAPACITY (AREA X RATE) 369 GAL/DAY SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. � RESERVE LEACHING CAPACITY . 369 GAL/DAY 8) PARCEL IS IN FLOOD ZONE __ 9) LOT IS SHOWN ON ASSESSORS MAP __13 AS PARCEL __51 ___, (38X11X. 74)+(38+38+11+11X .83 X • 74)SHEET 2 OF 2 JOB NUMBER 52764 _ r . MARSTONS MILLS A.M. 13/49 (TOWN WATER) - A.M. 13/50 (TOWN WATERS CB/DHlea LOCUS Cp ,�� Tr�, p fOl - — UPOLE �� �9 WAKEBY ROAD 1,00 a� LOCUS MAP SONA TUBE -- o EXIST. oti,,` %� �; 3�6• %' �co A.M. 13/31 11, o D-BOX g o" ►'� HOUSE" ;' It/ REF ,284191 (TOWN WATER) i DECK O U 1 ZONING.- RF 24 NE `'? c� CRO UND WA TER 0 VERLA Y DIST.: "GP" •� Zoo, � '� ASSESSORS MAP 13 fo T. D.F EL.102.2 ,� APPROX LOOC,t TION i GARAGE OF EXIST. SEP lC SYSTEM PER \ �_` - SEPTIC UPGRADE' PLAN INSTALLERS CARD '-_, '� / l � PUMP & FILL � �2,�� ' / �Q �- — - 100 _ / ; PRO✓EC T L OCA T/ON 199 LONG POND ROAD MARSTONS MILLS, MA. \ CI) A. M. �13151 O � t� AREA=20,000E S.F. APPL/CANT. (TOWN WA TER) W i MA TTHEW & KHRISTINE q MUSGRO VE 1 1/CB/DH IQ YANKEE SURVEY CONSULTANTS P.O. BOX 265 0 IF 16'Q \ UNIT 5, 40B INDUSTRY ROAD MARSTONS MILLS, MA. 02648 'Alm PH.(508)428-0055 - FAX(508)420-5553 3A. MERrTHeW �_ ; z; �` SCALE. 1 "=20 M. ' DA TE 6 22 A. 13/29 r `' UPOLE % O 01 , ` (719 WN WA TER) REV. IV. ;-- ✓OB NO. 52764 SHEET 1 OF ,2 EL. = 102 2' YOP OF fV UNDATION (EXIST,) 20' MIN. 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. VC. j MIN. PITCH 1/8 PER FT. 2"14YER OF Fy . EL=100.8 WASHED MONE —T , , CONCRETE COVER 6' MAX " � � � , � . , , . . EL=100. 7 4" CAST IRON PIPE (OR EQUAL1 MINIMUM 6 CLEAN SAND 9 PI?CH 1/4 PER FT. w MIN. FLOW LINE EL=97. 7 /NVERT 1 N 14" --2.0' EL.= 99.4' _ ADD CAS INVERT LEVEL u c °° °0 00 (EXISTING) INVERT BAFFLE EL.= 98.9 INVERT s SUM INVERT o ° °o° o 0000 0 EL.= 9_9.15' i EL. 98.5 _ EL.= 9_8.25 °°oo° 0 =96.2' (EXISTING) NEW DISTRIBUTION GALLONS BOX 5 HIGH CAPACITY INFILTRATORS EXISTING SEPTIC TANK F 7v HE WATER TESTED 11' X 38' TRENCH MRMATION IF MORE THAN ONE OUTLET PLACE ON 6" SMNE 3/4" To 1-1/2" SOIL ABSORPTION t` PROFILE OF DOUBLE WASHED STONE SYSTEM (SAS) SEWAGE DISPOSAL SYSTEM ` BOTTOM OF TEST HOLE OR USCS PROBABLE WATER TABLE ELEV.=_8B 9_ NOT TO SCALE NO OBSERVED WATER TABLE (6110183) ELEV. __ 88.9 OBSERVATION HOLE 1 ELEV.=_ 100.9' PERCOLATION RATE _S�__ MIN./ INCH OBSERVATION HOLE 2 ELEV.__ 1--- DEPTH TEXTURE DEPTH TEXTURE 0-12" LOAM &.SUBSOIL 0-12" ORGANIC 12-36" CLAY 12-36" SANDY LOAM GENERAL NOTES 36-84" MEDIUM SAND 36-84" MEDIUM SAND 84"-144" FINE SAND 84"-144 FINE SAND i 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. , TITLE 5 AND THE TOWN OF _EARNBTABLE____ RULES AND NO WATER ENCOUNTERED NO WATER ENCOUNTERED REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE CO VER ON SEPTIC TANK SHALL BE BROUGHT TO SOIL TEST p ,2116 WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12"H-20 LOADING SHALL BE DATE 0 F SOIL TEST 6/10/83 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITNESSED T.611018 BI 10 FT. OF DRIVES WITHSTANDING TT DI0 LOADING UNLESS OR PARKING AREAS. THEY UNDER WITHIN DESIGN CALCULATIONS.' USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 3 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL TOP LOAD NUMBER OF BEDROOMS . . . . . . . BE MORTERED IN PLACE. 5 HIGH CAPACITY. INFILTRATORS WITH GARBAGE DISPOSAL . . . . . . . . . NO f 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WI7YJ 4' STONE SIDE'S AND ENDS TOTAL ESTIMATED FLOW DEEDED OR ZONING REC ULA TIONS. OWNER/APPLICANT IS TO 11' X:38' ( HO-_CAL/BR/DAY x 3-__ BR) .__ 330 CAL/DA Y OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. REQUIRED SEPTIC TANK CAPACITY 1500 GAL 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR IS 719 CALL "DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS SOIL CLASSIFICATION . 1 3 PRIOR TO COMMENCING WORK ON SITE. DESIGN PERCOLATION RATE < '4 MIN.AN EFFLUENT LOADING RATE . CAL/DA Y/S.F. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS , LEACHING CAPACITY (AREA X RATE) 369 CAL/DAY SITE CONDITIONS PRIOR 719 COMMENCING WORK ON SITE.9) PARCEL IS IN FLOOD ZONE___=C"___ RESERVE LEACHING CAPACITY . . . 369 CAL/DA Y toT IS SHOWN ON ASSESSORS MAP __13 AS PARCEL ------- (38X11X 74)+(38+38+11+11X .83 X . 74) JOB NUMBER 52764