Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0066 OLD MILL ROAD - Health
66 OLD MILL ROAD, MARSTONS MILLS A= 064 079 ----- --- - -_- -- - - - - - - - - - i J TOWN WT�t Ql TS'f'1�BLS 3 SC #t VILLAGE " ' "6 f A,"�5FSS®It'S MAP�i IMSTAr�L�Tt'3 Dt &.P��Cf�ME.�iO — SEP:.vl"LC TANK C14PACl.E`Y LEA pe f . . �aiaE} SUt? S i � D¢7llt'.a�i$ra)rL©'WHIZ ...s_.. .,�..--.�:.-�—.�,.,• Cyr � DI ;• FEAT -.w=' PgT `Z'E ,...... w--^--- - aeptaott�jis,t���u Bc't�rrreti tXaa . Fees NtAxlri�uml�c(}usrctit;tpurtclwatet'@'sialeio thcl3nttarrufLet�i;htngl��u;ihty � l lv (�'+l to Sul7pIy 1�1481 �cl eatiB�ite 1?{tcitaty W aiay viells mist Fa el an site,or:within 200 feat pf wic618 frcility) -----�.�:,-.-� ----..---� Eclu� cy�'Wet9 +d quid l.eacit(uly 3F�ciii¢y(YE uny wetlancSti exist sae W1�0311100 feet of leaaliing,Pitcilirya2 �ur�al.�hcclliy C- � o " 130 At TOWN OF BARNSTABLE Vol -30 LOCATION n/Lf, go,, SEWAGE# 67 a 6q ZILLAGE MA&fJ IVS' #n/Z45 ASSESSOR'S MAP&PARCEL © '0 INSTALLERS NAME&PHONE NO. ! 77 �Q�Q SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) bl A 13 NO.OF BEDROOMS OWNER p 4L 1P ,R r PERMIT DATE: ,g-27-07 COMPLIANCE DATE: 2-4,07 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 e 6 • Lon# e09265 LOCATION SEWAGE PERMIT NO. I-oT4 C?C lLc % VILLAGE ALL ER'S NAME i ADDRESS T-0l��y J/©s G B! U 1 D E R OR OWNER DATE PERMIT ISSUED //t,7 DAT E COMPLIANCE ISSUED Z i Et- � ►3 �` t�B6 � 10 No..s= '" �� �`" , Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Z(pp ication for Tigpogal �bpgtem Congtruction Vertu Application for a Permit to Construct( ) Repair(L/Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. G6 044 mk&1W, Owner's Name,Address,and Tel.No. P///LAP— /9j T— Im/t/zwvs fnfa5 6C orol'71ZI_ �D, ��)Q/Z&T" Assessor'sMap/parcel off „clv�r,OIL, Vic/ Installer's Name,Address,and Tel.No. 1�/✓ '�L I� Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ). Other Fixtures 22 / Design Flow(min.required) 7 o gpd Design flow provided 3 L gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil :Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and inWNtenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of nvironm al Aeandn to place the system in operation until a Certificate of Compliance has been issued by this Boar f alth. Signed Date Application Approved by all I AlLtZ Date a j Application Disapproved by: Date for the following reasons Permit No. Date Issued No., fisr -0 Fee `G ..THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION,.,- TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for i pogal, ,pgtem Con2aruction Permit Application-for a Permit to Construct O Repair( 4/Upgrade({ ) Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. 6-6 OW M1UG-1W, Owner's Name,Address,and Tel.No. P1111-4" 49 7— Assessor's Map/Parcel Q o'It Installer's Name,Address;and Tel.No. apll/V/F1�C Designer's Name,Address and Tel.No. c;0,TA6470)0 C(A Type of Building: Dwelling No.of Bedrooms 3: Lot Size sq.ft. Garbage Grinder ( ) Other �..., Pe of Building r-6'.. I 'o.of Persons = i t, Sfioweis( ) Cafeteria( ) Other Fixtures) 22 q Design Flow(min.required) 7''� ;. gpd Design flow provided 3 cl r gpd Plan Date /t Number of sheets Revision Date Title i Size of Septic Tank Type of S.A.S. Description of Soit Nature of Repairs or Alterations(Answer when�applicable) • s x Date last inspected: s 4`Agreement: , --•� The undersignedgrees to ensure the construction and maintentance of the-afore described on-site sewage disposal system in accordance with the'provisions of Title 5 of the-E vironme at� ,e and noko,place the system in operation until a Certificate of Compliance has been issued by this BoardH. ith. r _ Signed '+ DateWAT " Applicatiot'Approved by`_ Date Application Disapproved by: Date for the-following reasons ' Permit No. 3 E `� r Date Issued -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (fertificate of Compliance THIS IS TO CERTI Y,that the f.•�)On-site Sewage Disposal System Constructed ( ) Repaired ( Upgraded ,Q ( ) Abandoned( )by �r/7/U1/VO(7 at ej X &_4 M MAA5WV��)M/Lf Chas been constructed in accordance. with the provisions •f Title 5 and the for Disposal System Construction Permit No. p� 3 dilated Installer /�IA/� ©�rG- Designer - �` #bedrooms Approved desigD flow Cd-� gpd The issuance of this permit shall not be co/�s rued 's a gua ntee that the system 11)furi tion as desi ne-. Date / Inspector s ———No. d T Fee /�Z...�-- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS =t ponl Opgtem, Construction Permit Permission is hereby granted to Construct ( n) Repair (V) . Upgrade ( ) Abandon System located at (1 X- &4 PK4 10, fte5-70 P7/L,1 S .r and as described in the above Application for Disposal Sysfem.Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions'or special.conditions. Provided: Con truction must be completed within three years of the date of this pe f . Date DR— Approved by �1 l AUG.23.2007 12:24PM BARNSTABLE BOARD OF HEALTH N0.688 P.1i1 , Town Of Barnstable Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean;Director 200 Main Street,Hyannis,NIA 02601 Office:.508-862-4644 Fex: 508-790-6304 Installer&Designer Certification For Date: Sewage Permit# �36q Assessor's lVIaplParcel� � -f—�o Designer: Installer: Address: 66 GIL6�OUiLLL- Address: ao i�-��Cl On $-10 - was issued a permit to install a (date) (installer) septic system at 6K cco M/1-1, P®, based on a design drawn by (address) R St/.f _ OZA 1r2 dated Z (designer) - �C_ I certify that the septic system referenced above was installed substantially according to the design, which may include mirror approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major-changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was inspected and the soils were found satisfactory. �,N OF M4SS cy ROBERT A. G (Install afore ZE DRAKE CIVIL v No'41642 O c" A 9F P� F (Designer's Signature) (Affix WAgffe We Stamp Here) PLEASE R>ETU O BARNSTABLE PUB IHEALTH DIVISION, CERTIFICAT OF COMPLIANCE WILL NOT BE I S UNTIL BOTH THIS FORM MD AS- BTHZR UILTA® _ARE RECEIY D,BY TEIR IBARNSTA LE XUBLIC HEALTH DIVISION. Y . Q,15eptioWesiper CerHfiestion Form Rev 03-09.06,doc i NOW TH REF LIP �+- � c;ORE, t A does hereby place the ( I s name) following restriction on his above-n ferenced land in accordance with his agreement Affi-the Town ble-B1oa►rd of 14saM, wMiei, reeMetion sheR run with the land and be binding u;on all successors in title: 1. t�(0 OLD A we 12#Ab AMA rbAd /h ILL!; 1A A may have constructed (address) 02 upon the lot a house containing no;more than (3) bedrooms. 0 l7;AVICA 9 V_A*96M � agrees that this shall be permanent deed fawners name) S fOe/S Al/tLS restriction affecting locat on && cxP**1"--4o MA, and being shown on the.plan recordednplarj Book Paged Or on Land Court Plan 377 12 '6 fl3 For title of se4 the following deed: Book , Page . Or Land Court Certfta of Tide Number PZ Executed as a sealed i rument day of Owner's sign ure «i AZe 7- ` Owner' signature c to C.4"v?7- pees signature COMMONVVE4TH OF MASSACHUSETTS Then personally appeared the a ve•911med st I'r'r, known to me fo be the person v4ho executed the foregoing instrument and acknowled ed the same to be ,4•I fret and eed,before me, i 4 Notary `4®r)W p 4''p My commission expires: BARNSTABL COUNTY o , M.LeBLANC f s? �5 , , = REGISTRY F DEEDS A , A TRUE COP ATTEST (date) Notary Public �' commorwvastth of Mass husetcs ,`, My Commission Expires " (�"y.•�SY June 26,2009 ,ng IOHN F.MEAD=LE R '""' REGISTRY OF DEEDS 1 .- Doc: 1;7.071.s 74S 08-27-2007 1 0=02 BARNSTABLE LAND COURT REGISTRY NOTICE: The own of same"16 lout �"; soak kpa!'ada to propefe a p�rtY word Oaad .. natrlc,tbn d M DEED RESTRICTIONjj f� I WHEREAS, Po.t-up D.•cT.4RQETTanc r'ATRic1A �. 04"! eTT Of (awnNs nan+a) (a oCD m tc.t QoAb. n,*rAsTo" /1'l mLs M4 o24P MA O Is the owner of (oL Oc.D(hu.- &&QD it located (addnaa) at A%A5raA)5 M#US MA (hereinafter referred to is I and tieing-shown on a plan entitled "Subdivision of Land in MA, Property of , et al, duly recorded in Be stable County Registry Of Deeds in Plan Book , Page ; Or on Land Court Flan Number_,_, WHEREAS, A?W,4 bT�/FTi'j(cIA' as a owner of said lot has (owrnrt not"O agreed with the Town of Barnstable Board of Health to k restriction as-to the number of bedrooms which can be included in any hoff 0 built on said lot as a pre-condition to obtaining a disposal works constructiol permit in compliance with 310 CMR 15.000 State Environmental Code, Title. , Minimum Requirements for the Subsurface Disposal of Sanitary , ge; I WHEREAS, the Town of Barnstable Board of Health, a I a pre-condition to granting a disposal works construction permit for a sop ic system in compliance with 310 CMR 15.200, State Environmental Code, Tltl V, Minimum Requirements for the Subsurface Disposal of Sanitary 59wage, and authorizing the issuance of a building permit for the construction 01 a single family home on this property, is requiring.that the agreement for the re triction on the number of bedrooms In any house constructed on the lot be put d 1 record with the Barnstable County Registry of Deeds by recording thisi..document, eeeer A, Commonwealth of Massachusetts —Flo >e_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information its required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information -j" I I 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 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 Evaluatio by the al Approving Authority 8-20-14 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. t5ins•3/13 Title 5 Official Inspection or ubsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 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: System is in good working order with no sign of failure. 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): ' f f t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)'or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °7M 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® 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 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts. usetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for everi Marstons Mills MA 02648 8-20-14 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. ❑ ® An portion of a cesspool or privy is less than 100 feet but greater than 50 feet y P P P vY 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 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 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 .8-20-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: r; Number of current residents: 0 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: , Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 II Commonwealth of Massachusetts w Title 5 Official ,Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments- M 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (coat.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A 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 Commonwealth of Massachusetts F Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 30"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 24"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal 12" Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 66 Old Mill Rd Property Address Bank Owned (Contact David.Holt @Today Real Estate 1-800-966-2448), Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" � Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3113 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 ^M 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 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 ts e note if box is level and distribution to outlets equal, f( q a , any evidence o c solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from chambers. 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form ij Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2-500's r ❑ leaching galleries number: ❑ leaching trenches number, length: 4 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure; level of ponding, damp soil, condition of vegetation, etc.): Leach chambers in good condition and empty at inspection with stain line at 4"off bottom of chamber. 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 I I Commonwealth of Massachusetts W Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Qc '4 M 66 Old Mill Rd Property Address P Y Bank Owned Contact David Holt @ Today Real Estate 1-800-966-2448 Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately C' lip' Lo _ Q ; .. ,� � '' { t5ins•3113 Title 5 Official Inspection Form:Subsurface 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 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water a ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. 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 g Title 5 Official Inspection Form lµ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 66 Old Mill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 8-20-14 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 Inspecfion Form:Subsurface Sewage Disposal System•Page 17 of 17 JUN.26.2007 8:05AM BARNSTABLE HOARD OF HEALTH NO.209 P.1i _ Town of Barnstable p Depaetmont of Replatoty Ses V,=V- ,,,, ! Public Health Division Date r�aye«s "0 Maio street.Hymloie 02801 . Date Scheduled ' Pdj'M • i Soil Suits ' 'ty Assessment for Sewage Disposaoe :10—cxq Ptsfhrmeday:' y ter• LOCATION&GRNERAL I NM MATION Loeeliee admeta #k (e 6 O Cd M t C L 2 o Al Owner s Hama P►t-r ?A f e'H- ilZ tZG6E^+cy bu.tve MAJI S'ToNS I,ttCC Add= MAILSTorDS tn�ECS 1Am=WrMap(ftm0 0(4 1a'19 aeginmesName •Room+ 'baAK0- kt:j EN6rw;'e�c«G NEW MNSMUCIMNN • AEPAM TWC13110116 M o —4'17 - I Z S 9 Ind Use• �b�t "7�/ �� abpei(s) wee 9tonea, ��2 Dist nal 9me Open Waxer body R Posible wet Am = n 'Orieft Water Well '—=Je Dwilar wey -_mot Property Line 74 /O R 00 $I{LTt It(SMeot acme,diimeosiaua of lot,easel Ie som of tat Aoki L Pere less,kwto Wdufth?o immindty to holes) ©LI MILL r,aAi� # G G PeseM material(geeloye) DUTL W k) DePu tti aedraek —'~ ��O Deed:to Oroaedwater:Stmnding Weler)n Halt: cS�' weepih®fMom pit PACO Es0imsted Se meal High Gmimdwacer DETU&MATION FOR SEASONAL HIGH WATER TABLE i N Imetal_D"Obiand steedina in obe.Mr. ie. oopth to igll ataataar Ia. e�'� Depth to weeping Dom Bide of abs.hole In. OtmuadwW Adldehaeat,,,,,�,,..,._..,,...,..0. !!! --+ c h"well A Readleg Pak: h:dae Wag IMI Ad).fMNor.,...,.....Adj,OmmWwU&W01 3 c r t= 17— PERCOLATION TEST Dsla.,_...,; 'rl rUU Oburadm � §„ <! U1 hole ar o � Depdt of PM Ststt P+a sosk Timo 6 Ivtd',Prc wak, O CD Rate Mht./Iuen Site Saiteb)flly Aetotetaent Site PM a Additi0d1Il'hieng?1m!d(Y1M oligiml: Peb6e Health Division Observation Hole Data To By Completed on Balk.--------- t *** sated within 100'of wetland,you must first nOM the If etrcolsBon test is to be eotad p n ividon at least one 1)week prior to beginning. Barnstable Con>�fvittfo D f Q-1WE I'IC'MCIPOW DIX JUN.26.2007 8:05AM BARNSTABLE HOARD OF HEALTH NO.209- P.2i3� �OaSER'�V�T�ON8OL•ELOG � • Tbxlaw $Waec ice) ,colary Md. odw C>_ �M b +tea ► emu , S S 1 . DopmfmmDEEP OBBERVAUON$OL LOG FoONaGoe � QMmntol4 Soft . tit0u�111� (86AElute,AEop/e,BgMldelE • +gym✓ DVATIONHOLE LOG Hole# �+a cow UMM) cea WIP O v ATI ON . *M &" sbu Tame HOLE LOG Hn1e# 8oit t]vior ttatt a r a • Elate i1��� • . AboveSoeyesr�focdtro�nd�ry Now yq„f� WiW�SflOyearbore }' HO ;,va Wime Iooywf"db=%fiw Des at tail tbnr fwt ofnatutatty acsumg pawl exist in all areas obauved ghmau*ut the . . area Pro➢�d t�the acg ay�np Itaot,what is dte depth ot'imtna oavr m P���9.. • I �D y date I ham t a? pmIX toe aad that tM I avaluawt examination apta+pved by tho �'d'°d "� described in18Q1�t St .01�7. by comdsteat wig . Sfgaa Pub A 2. LL , Ip—..... .:, •• Hail" � �t` �"� �. -.i. t r�r�,,,'. ` � a��"-' • C a >a,E . w ti fir« ! � � . .. -_..,..� - _ .. ._ ..�. i _ __.. ,•.�,. ..�.,�.....,. -ore—.. r•w...� ._ -,. � xrt '"t,•r. '���, t'Y„ axdV 1 i {.. - i we..WJ`R'' �e+:W""'?rY ..a,^ym_.--..•,•V..ry ....x< .. e.I.... w.. w .. ..... - .w ..r .._m v... a Y ,. 6 gryR tiAll!2 y� r N6.. 3 -.�✓.... Fizs....T.. .............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .._-VQW.n...............OF.......Z n-.5.V..coo��---------------.-_._._-__-- App iratilan for Uispoii al Works Tontitrurtinn Prrutit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: .................................................... Location-Address r Lot No. Owner Address av�' . _... ---- ..._..s....................•--••---••-- ..................................................................................................�c...�e�aro C �-- Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.._..._.._._...........................Expansion Attic OV-j Garbage Grinder (NO) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures .................................. W Design Flow.............. ! ......................gallons per person per day. Total daily flow...............................____.__..__..gallons. WSeptic Tank—Liquid ca.pacity.PQ...gallons Length................ Width................ Diameter---------------- Depth................ x Disposal TFench—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 ( ) a Percolation Test Results Performed by........ �T._._.ti._ .__ Date........................................ ---- Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ay :............... O Description of Soil ` !Y?�.......---•� 9-------.16 --�? ------------•------------------------- v ....................................... .............................k.Q--C1�.... .......... -cAnn--- .......1.a � 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 TI'i1Z 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. Date Application Approved By ..' ? �B ------ ------------• �`1-3 Date Application Disapprovedsons- ----------------------------------------------------•---•--------------------........._........----•-......•. --------------•-----------•--•-•---•--------•---------------.............-•---------------....------•----.--....--•-----•---------------------------------------•--------------------•••----•------------ Date PermitNo......................................................... Issued.......................................-................. Date e.J No..... .... ..... Fizi3 ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH n..-... ......OF.......; c....... . .. .. 1 i Appliration for Dhipati al Workii Tnnitratrtiun Famit Application is hereby made for a Permit to Construct (V) or Repair ( ) an" Individual Sewage Disposal System at: ................_ .............---.------------=-•---------=--------------•--•-----•-•- -------------------.•-...------------------------------_--------------•-•-•--------•----------- Location-Address, `. � or Lot No. ��� \�...........5.��l a.. ............ 1Ct.1 \r1 `----......-•................................... ----• --- ... Owner Address .. 7 a .......'..... ._' �J_..... . Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................ ............... .Expansion Attic (91.," Garbage Grinder (Nv) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Other fixtures ........................................... _, W Design Flow..............4�.P............._......._gallons per person per day. Total daily flow............2:�....0 ..................... WSeptic Tank—Liquid capacityltl', -_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 ( ) aPercolation Test Results Performed by........ =`� _ f?.................��:?`.1r....................... Date........................................ Test 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........................ --•----------------------- --------••••---•--•••. -•-••--•-•-•--•-•-------••--•----••••-•--•--•----•...............-•-....-•---....-••-••......--•-••••---- Descriprionof Soil-------=-------------------------- -------------- ----------------------•--------------------------- V 1 ,- �'i"" r; , to . ! 'C 4 '.�j�.:----Az� 1. 1, ----------- ----------S7......•........ ._r..x..::. f._ i W ......-----•-------•-•-----•------••---••••-•-••--------------••-...-•••........._..-•-••-••--••-•---1--•-•••••---------•------•....---.....•--••--------••••r--•--•-•-•--•••-•••--•--................. 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 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. SignedZ (=1C Y\ ... V.. . ,l Date Application Approved By. ........._1 Er:. •--------------------••--••----•----•--------•--.....•..... ........................*3..------ Date Application Disapproved t following reasons----------------•-----------------••-------------------------••--------------•--•-------------•----•------..._... ......................................................................................................................................................................................................... Date PermitNo------------------------------......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` . Trdifiratr oaf ToutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (e,-j or Repaired ( ) by -t?.1_�_ - -'•`---•-•••---••------------------•--............•---_..... Installer at--------- .... has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code s d. r•bed in the .---•-----•-.._. da.ted_...� _. ... ---------------------------- THE application for Disposal Works Construction Permit No .___.�._�_.... .. ISSU NC OF THIS CERTIFICATE SHALT. NOT BE CONSTRU A GUARANTEE THAT THE SYSTEM I F CTION SATISFACTORY. DATE-•��v '� ----------•-•........------------ Inspector. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............k\ u).''..........OF..............: 41.: n:.?.. ....t:L �-......_.-.. �'✓ No......................... FEE.!... ...- Disposal Iforkii Tonotrurtion ramit Permission is hereby granted.......... _ .`_1 .......... �` � to Construct ( .ror Repair( ) an Individual Sewage Disposal System at No.----... �.�........`:� -----..... �._.��...-.1��....---- 1�_' ut_ ...-............ .....................'-- Street as shown on the application for Disposal Works Construction Permit No�!�!. Da _..........7.... DATE--. ...................................................... Board of Health�✓' FORM 1255 HOBBS & WARREN, INC., PUBLISHERS it Z o i 5►►.rG�.E�FAM+�Y - � B�ORooM ,�—�a�.l�..' /! �8 Dom++-Y FLOW : 110 x 3 = 33oG.Pv, 33.IZ SE.PTIG 'rA%JIC = a3Ox15o'/• =a956.P. Q- + /// •� !!/. �- ' UsE 1000. GAL. Ct5P05nL P►'T WSE l000 &At.. 5+DG.'�ALL AR1rA. = 15d 5.� � ttkZ 15o 5.►; X z•5 -a 3'l5 G.Pq �,/ T.N. /!o•Z R • BOTTOM AEA= . YO -'iF. Q" So 5.1= x I, o A. 0*0 G.P o 10 'TOTAL. DESIGN o irz5 (:P.PR / -ToTA%- DA 1 LY FLDv4 = 330 6Po EXP, D.�oX ' PE2GOLATION GZATEj MIN 2•M+N Dt�LeSS o�oAoG^L� �' I' I _ z CST / / I o uN"i> /o �S' of ��. M��N Of MRS v RICHARO, �'v s` ssc 1) A ALAN 2i BAXTER u No 24048 I JOW. S v / �QisTtiR�pQ' 4 4 .� ' . z>loo a 9l.7 QL� �k0 SUlN� ?6ST To P FND=1°to.Z. /er �c lad' �Y LOAM loco lNv. p15T i CO",* 6V8. .So%L BOK IaG 7 Sr.PTIL tU7. 1000 G I IJY. TANK . 04S INV. IN c.�. 1oe},5 ►.Ea,cu . PIT V, t.T Gtfi�N WITH Io�,Z 1oG.b' Q Net- WAS AGI) ' — g4�S GwAYEL �1.� -I.� C.awrIPIEO pl-®T PLAN PROFILE LoCA-TION MAP,STotLS MILLS 44•S No 5c?_IIN. 40irr.VA'Tr-_- /ze/83 o IU�ITt"n-- p�A r•� REF SIREN GE 1 GER•rtPY -fNAT ?N�F4c�1��A'T�G�ySNOVifN •• i NERE=a►J COMPL'*?!S yJITN'THE S1oE %Wr �o-T c� AND 56Tp,p.GK R.6Qu+2fcME.NT'� DF'fl�lE -ro W N o F a�eN sT�8�>�►N� I S K oT' . c , 3-7 71 Z.-I3 LOGp.TED •WITNIIJ 'r .E Too .PLAIN D A'T E BA*cTEIZe NYE INC. REG I SZ f�Q6V'LAW S u EN ra -r%AIS PL&W 1 f2 N&P atvjl=aD Old AN OSTEiZVILLE • MA55• •IN5T?-uMEN'A' SV2VC-Y 4'TVAS 0F�-'SE'T5 Suout� � NoT i3C- Val" {iTL`r DC.TI:.t'�I►�C L��' i4PPl. IGAiJ"r WARD TITLE 5 P.O. BOX 1934, MANOMET, MA 02345 508-224-5749 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM plo`I PART A G` CERTIFICATION PROPERTY ADDRESS: 66 OLD MILL RD c _40 BARNSTABLE, MA. MARSTONS MILLS m +psi 2 5 139 NAME OF OWNER: MARSILIA HOBAN N ADDRESS OF OWNER: PLMOUTH MATMF DATE OF INSP'ECTION:11/23/98 NAME OF INSPECTOR: DAVID M. WARD I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) COMPANY NAME: WARD TITLE 5 MAILING ADDRESS: P.O. BOX 1934, MANOMET, MA 02345 TELEPHONE NUMBER: 508-224-5749 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: ® Passes ❑ Conditionally Passes ❑ Needs Further Evaluation by the Local Approving Authority ❑ Fails INSPECTOR'S SIGNATURE: DATE:11/23/98 The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) 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 of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS: revised 9/2/98 Page 1 of 11 WARD TITLE 5 P- O- BOX 19341 MANOMET, MA 02345 508-224-5749 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PROPERTY ADDRESS: 66 OLD MILL RD OWNER: HOBAN DATE OF INSPECTION:11/23/98 INSPECTION SUMMARY: (Check A, d, C, or D) A-SYSTEM PASSES: ® I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. Indicate yes, no, or not determined (Y, N, or ND) - Describe basis of determination in all instances- If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection, or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent- The system will pass inspection if the existing septic tank is replaced with a complying 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 distribution box- The system will pass inspection if (with approval of the Board of Health) . El 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 revised 9/2/98 Page 2 of 11 WARD TITLE 5 P. O. BOX 19341 MANOMET, MA 02345 508-224-5749 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PROPERTY ADDRESS: 66 OLD MILL RD OWNER: HOBAN DATE OF INSPECTION:11/23/98 C•FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 (1) (b) 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 surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh• 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF ANY) DETUMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 aseptic tank and soil absorption system and the SAS is within a Zone I of a public water supply well• ❑ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well• ❑ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid) • 3) OTHER revised 9/2/98 Page 3 of 11 WARD TITLE 5 P. O. BOX 19341 MANOMET, MA 02345 508-224-5749 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PROPERTY ADDRESS: 66 OLD MILL RD OWNER: HOBAN DATE OF INSPECTION:11/23/98 D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 31 0 CMR 1 5.303• The basis for this determination is identified below• The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No ❑ ❑ Backup of sewage into facility or system 'Component due to an overloaded or clogged SAS or cesspool. ❑ ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged 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 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 a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply ❑ ❑ Any portion of a cesspool or privy is within a Zone 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 1 00 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis• If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen• E• LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No ❑ ❑ The system is within 400 feet of a surface drinking water supply ❑ ❑ The system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ The system is located in a nitrogen sensitive area (Interim Wellhead Protection Area -: IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 31 0 CMR 1 5.304(2) • Please consult the local regional office of the Department for further information• revised 9/2/98 Page 4 of 11 WARD TITLE 5 P.O. BOX 1934, MANOMET, MA 02345 508-224-5749 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PROPERTY ADDRESS: LL OLD MILL RD OWNER: HOBAN DATE OF INSPECTION:11/23/98 Check if the following have been done: You must indicate either "Yes' or "No" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health. ® ❑ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ® ❑ As built plans have been obtained and examined. Note if the are not available p Y with N/A. ® ❑ The facility or dwelling was inspected for signs of sewage back-up ® ❑ The system does not receive non-sanitary or industrial waste flow, ® ❑ The site was inspected for signs of breakout. ® ❑ All system components, excluding the Soil Absorption System, have been located on the site. ® ❑ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or toes, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: ® ❑ Existing information. For example, Plan at B-O-H ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) EI 5.3O2(3) (b)]I ® ❑ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Subsurface Disposal Systems. Revised 9/2!98 III Page 5 of 11 __ I WARD TITLE 5 P• 0. BOX 19341 MANOMET, MA 02345 508-224-5749 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PROPERTY ADDRESS: 66 OLD MILL RD OWNER: HOBAN DATE OF INSPECTION:11/23/98 FLOW CONDITIONS RESIDENTIAL: Design flow:110g•p•d•/bedroom• Number of bedrooms (design) :4 Number of bedrooms (actual) :4 Total DESIGN flow:44O Number of current residents:O Garbage grinder (yes or no) :NO Laundry (separate system) (yes or no) :NO If yes, separate inspection required Laundry system inspected (yes or no) :NA Seasonal use (yes or no) :NO Water meter readings, if available (last two year's usage (gpd) :NA Sump Pump (yes or no) :NO Last date of occupancy:11/15/98 COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gpd (Based on 15.203) Basis of design flow: 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: NA System pumped as part of inspection (yes or no) :NO If yes, volume pumped: gallons 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) ❑ I/A Technology etc• Attach copy of up to date operation and maintenance contract ❑ Tight Tank Copy of DEP Approval Other: APPROXIMATE AGE of all components, date installed if known and source of information:2/10/83 PER BOH Sewage odors detected when arriving at the site (yes or no) :NO revised 9/2/98 Page 6 of 11 f WARD TITLE 5 P.O. BOX 1934, MANOMET, MA 02345 508-224-5749 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PROPERTY ADDRESS: 66 OLD MILL OWNER: HOBAN DATE OF INSPECTION:11/23/98 BUILDING SEWER: (Locate on site plan) Depth below grade:22IN Material of construction: ❑ cast iron ® 40 PVC ❑ other (explain) Distance from private water supply well or suction line: Diameter:4IN Comments: (condition of joints, venting, evidence of leakage, etc• ) GOOD CONDITION SEPTIC TANK:® (locate on site plan) Depth below grade:4IN Material of construction: ® concrete ❑ metal ❑ Fiberglass ❑ Polyethylene ❑ other(explain) If tank is metal, list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions:1000 GAL Sludge depth:3-5 IN Distance from top of sludge to bottom of outlet tee or baffle:22 IN Scum thickness:6 IN Distance from top of scum to top of outlet tee or baffle:? IN Distance from bottom of scum to bottom of outlet tee or baffle:8 IN How dimensions were determined:ROD Comments: ( recommendation for pumping, condition of inlet and outlet toes or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc•) TANK AND BAFFLES ARE GOOD TANK SHOULD BE PUMPED GREASE TRAP:❑ (locate on site plan) Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ Fiberglass ❑ Polyethylene ❑ other (explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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•) revised 9/2/98 Page 7 of 11 WARD TITLE 5 P. O. BOX 19341 MANOMET, MA 02345 508-224-5749 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PROPERTY ADDRESS: 66 OLD MILL RD OWNER: HOBAN DATE OF INSPECTION:11/23/98 TIGHT OR HOLDING TANK:❑ (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ Fiberglass ❑ Polyethylene ❑ other(explain) Capacity: gallons Design flow: gallons/day Alarm present: Alarm level: Alarm in working order: Yes❑ No ❑ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc• ) DISTRIBUTION BOX:® (locate on site plan) Depth of liquid level above outlet invert:0 IN Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc. ) BOX IS LEVEL AND HAS NO SOL'IDS CARRYOVER PUMP CHAMBER: ❑ (locate an site plan) Pumps in working order(Yes or No) : Alarms in working order (Yes or No) : Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc• ) revised 9/2/98 Page 8 of 11 WARD TITLE 5 P• 0. BOX 1934, MANOMET, MA 02345 508-224-5749 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PROPERTY' ADDRESS: 66 OLD MALL RD OWNER: HOBAN DATE OF INSPECTION:11/23/98 SOIL ABSORPTION SYSTEM (SAS) :® (locate on :site plan, if possible excavation not required, location may be approximated by non-intrusive methods) If not located, explain: DID NOT DIG UP ON ASBUILT PLAN FROM BOH Type: leaching pits, number:1 leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of pending, damp soil, condition of vegetation, etc•) NO SIGNS OF FAILURE RAN WARTER FLOW WAS GOOD 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: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of pending, damp soil, condition of vegetation, etc• ) PRIVY:❑ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc•) revised 9/2/98 Page 9 of 11 WARD TITLE 5 P• 0• BOX 19341 MANOMET, MA 02345 508-224-5749 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PROPERTY ADDRESS: 66 OLD MILL RD OWNER: HOBAN DATE OF INSPECTION:11/23/98 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) \ j revised 9/2/98 Page 10 of 11 f ' WARD TITLE 5 P• 0. BOX 14341 MANOMET, MA 02345 508-224-5749 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PROPERTY ADDRESS: 66 OLD MILL RD OWNER: HOBAN DATE OF INSPECTION:11/23/98 NRCS Report name: Soil type: Typical depth to groundwater: USGS Date website visited: Observation Wells checked: Groundwater depth: Shallow Moderate ❑ Deep ❑ SITE EXAM Slope.: YES Surface water:YES Check Cellars:YES Shallow wells:YES Estimated Depth to Groundwater:10 feet Please indicate all the methods used to determine High Groundwater Elevation: ❑ Obtained from Design Plans on record ® Observed Site (Abutting property, observation hole, basement sump etc. ) ❑ Determined from local conditions ❑ Checked with local Board of health ❑ Checked FEMA Maps ❑ Checked pumping records ❑ Checked local excavators, installers ❑ Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) BASEMENT WAS DRY AND NO WARTER IN ABUTTING PROPERTY revised 9/2/98 Page 11 of '11 .. t Nov-17-98 15:33 BARNSTABLE HEALTH PEPT 5087906304 P.Ol 1 rk� Y LOCATION + . 13 /—a 'r1p SEWAGE PERMIT NQ. V L/ VILLAGE Ow INSTA LLER'S NAME 1. ADDRESS al S uILDER on owNER A//?.. DATE ' E—It'MI T —IS SYED SAT E COMPLIANCE SSUED �O J LEACHING FIELD INLET + OUTLET ACCESS COVER TO BE BROUGHT WITHIN 6" OF FINISHED GRADE GENERAL NOTES 1.) THE PROPOSED LEACHING FIELD SHALL CONSIST OF 2 500 9"MIN., 36"M 10'-0" FINISHED GRADE OVER STONE AS SHOWN ON THE DETAIL SECTIONS ON THIS PLAN. AX. GALLON LEACHING TANKS WITH 4 FT. OF 3/4" - 1/2" DOUBLE WASHED DISTRIBUTION BOX = 109.5' 1.) UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND 9. 24" DIA. MANHOLE REMOVABLE COVER 36" 5" DIA. OUTLET(S) 2.) THE GROUND ELEVTION AT THE LEACHING FIELD IS AT EL. = 109.50' O CONSTRUCTION METHODS SHALL BE IN ACCORDANCE MAX. WITHTITLE THE ELEV. AT THE TOP OF THE LEACHING FIELD IS AT EL. = 106.83' I ��11.:_,., �11 I- I I I I 1 1 11 1 1 � '' - I - ll� 11 1 x, 19" THE ELEV. OF THE 4" PVC SERVICE PIPES ARE AT EL. = 106.00' C11 APPLICABLE LOCAL RULES. PROVIDE WATERTIGHT A JOINTS(TYP.) THE ELEV. AT THE BOTTOM OF THE LEACHING FIELD IS AT EL.= 104.00' -4, FROM 4' LIQUID LEVEL 2.) ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD SEPTIC TANK G PVC OUT FROM LEACHIN OUTLET TE z4 FACILITY. MINIMUM SLOPE* 1% OF HEALTH AND THE DESIGN ENGINEER. 12* -25'-0" 06.18'± 106.35'± / _MIN 6" CRUSHED STONE SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL 3.) 4 BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. 3�,,l OVER MECHANICALLY r . COMPACTED BASE LEVEL BASE 5 OUTLET DISTRIBUTION BOX (H-10) h- 6" CRUSHED STONE PLAN VIEW 4.) 4" SCHEDULE 40 PVC PERFORATED PVC PIPE SHALL BE USED CROSS SECTION VIEW TO BE RESET ON A LEVEL STABLE OVER MECHANICALLY BASE. FIRST TWO FEET OF OUTLET PIPES --------- INSIDE LEACHING TRENCHES OR LEACHING FIELDS. TO BE LAID LEVEL. COMPACTED BASE 'x 7 5.) SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. tV EXISTING 1,000 GALLON CONCRETE SEPTIC TANK(H-10) CROSS SECTION VIEW 12' 10" LENGTH 10.50' WIDTH 5.67' DEPTH 5.33' DISTRIBUTION BOX DETAIL 6.) THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. ........ N.T.S. \\-EL.= 106.00' SEPTIC TANK PROFILE EL.= 106.00'-/ CL ii &11 0- k, Rp 7.) LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED -'fx Rd N.T.S. PRIOR TO BACKFILLING WHEN SYSTEM IS NEARLY COMPLETE AND XA READY FOR INSPECTION. SYSTEM IS NOT TO BE BACKFILLED CL l xir 4� I. 04 WITHOUT FIRST OBTAINING APPROVAL FROM THE BOARD OF HEALTH 00 0 /A AND DESIGN ENGINEER. TOP OF FOUNDATION FINISHED GRADE OVER PLAN VIEW 0.) 20' MIN. ACCESS COVER (ASSUMED EL=I 10.2 TYPICAL OF 3) DISTRIBUTION BOX =109.5' IODDh FINISHED GRADE OVER F 8.) ELEVATIONS BASED ON AN ASSUMED FOUNDATION ELEVATION FINISHED GRADE 364AX. EXISTING 4" PIPE -/-DISTRIBUTION BOX =109.5' ± OVER TANK EL. 109.0 ± - OF 107.2' AS SHOWN ON PLAN. SCHEDULE 40 PVC 9" MIN. 36" MAX. 6.1 5" DIA. OUTLET(S) MIN. SLOPE 0 2% 9.MINJ 36'MAX. REMOVABLE COVER MAX. TOP OF TRENCH 9 Awl LOCUS MAP z�d ,"\,, 'r-1 � L LEACHING FACILITY. F3 T 4" PVC IN FROM 4" PVC OUT FROM 0 0 106.83*± 9.) CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO SEPTIC TANK = = + U = j �)\__ CONSTRUCTION THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR L_/ rh 3.- 9. MINIMUM SLOPE 0 1% k� ': " _,", -888-DIG-SAFE AND ANY r� vi�j iT L, Q __I!� TO COMMENCING WORK ON SITE AT 1 107.0 F TEST PIT DATA A � -_j �,\_ I " OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES TO \�,07.28'± 106 75'± 106.35*± , _ \/ 1 099 29 1091 12" 106.1 8'± TLET TEE THE DESIGN ENGINEER. Ou E :1 L_J 4' LIQUID LEVEL ILL PERC. NO.: TP 01 + #2 BOTTOM OF TRENCH 10'-0" TRENCH TO BOTTOM OF TRE 104.00'± MINIMUM BE LEVEL EL. = 104.00,±, BASE. FIRST TWO FEET OF OUTLET PIPES 17 TO BE RESET ON A LEVEL STABLE 10.) NON-SHRINK GROUT TO BE USED AT ALL POINTS WHERE PIPES SLAB FOUNDATION TO BE LAID LEVEL 11 �? WITNESSED BY: DONNA, _MIORANDI ENTER OR LEAVE ALL CONCRETE STRUCTURES IN ORDER TO PROVIDE -25 _W� 0" K$_0** PERFORMED BY: DAVIlD MASON, C.S.E. WATER TIGHT SEALS. CROSS SECTION VIEW 01-1019 DATE: AUGUST 17, 2007 11.) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED END VIEW OR ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH SEPTIC SYSTEM PROFILE GROUND ELEV.: 109.5' DETERMINATION FROM APPROPRIATE AUTHORITY. N.T.S. LEACHING DETAIL ELEV. WATER: NO GW OBSERVED 12.) ALL SEPTIC SYSTEM COMPONENTS ARE BEING INSTALLED TO N.T.S. WITHSTAND H-10 LOADING UNLESS UNDER PAVEMENT, DRIVES OR PERC. RATE: < 2 MIN./IN. TRAVEL WAYS WHEREIN H-20 LOADING SHALL APPLY. DEPTH OF PERC: 37" 13.) DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. TP #1 TP #2 14.) WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL 00$9 1 .5"± 0021 IA: LOAMY SAND IA: LOAMY SAND' 109 5± AND UNSUITABLE MATERIAL BELOW AND FOR AN AREA 5 FT. ON ALL SIDES OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL 10 YR 5/2 1 10 YR 5/2 WITH CLEAN COARSE SAND FREE FROM CLAY, FINES OR OTHER O 1B. LOAMY SAND B: LOAMY SAND! UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). In vo rz /0 37$p 106.4 ± 37" ,�77 106.4'± 15.) CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATON OF WORK. z 104.0"± 16.) PROPOSED PROJECT IS 'LOCATED WITHIN: BOTTOM OF ASSESSORS MAP #E4 PARCEL JZ9 104.0'± PROPOSED 1 2.83'x 261LEACHING FIELD LEACHI. FIELD li 2- H20, 500 GALLON LEACHING TANKS BATH 17.) THIS PLAN IS TO BE USED ONLY FOR SEPTIC SYSTEM UPGRADE. KCJ ENGINEERING WILL NOT ASSUME ANY LIABILITY FOR THE WITH 4'OF STONE Cl: MEDIUM Cl: MEDIUM ROOM USE OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. Kj PIPE INV. 106.00' COARSE SAND COARSE SAND 10 YR 7/4 10 YR 7/4 5% GRAVEL 5% GRAVEL BEDROOM BEDROOM EXISTING LEACHING PIT 144" 97.5' 144" 97.5' TO B UMPED AND ABANDONED TP #2 NO GROUNDWATER NO GROUNDWATER 110.73 X OBSERVED OBSERVED REVISIONS: EXISTING D-1130)1( TO BE ABANDONED 2-24-07: ADDED WATER SERVICE, TP #2 10 #1 SECOND FLOOR INFORMATION 109.84 109.89 X W D-BOX (NOT TO SCALE) DESIGN DATA: 109 3 BEDROOM DWELLING 109.11 DESIGN FLOW: 110 GPD PER BEDROOM 00, N\ 15' 110 x 3.0 = 330 GPD PROPOSED SEPTIC SYSTEM UPGRADE SEPTIC TANK: 0 PREPARED FOR: 0 330 GAL X 200% 660 GALS. DESIGN CAPACITY CD USE PROPOSED 1,500 GALLON SEPTIC TANK 1109. PHILLIP + PAT JARREW EXISTING 000 GALLON O REQUIRED LEACHIING AREA: SEPTIC TAN 0 REMAIN 101v KITCHEN BATH (330 GAL/DAY) / (0.74�) 446 SQ. FT. ROOM DEN LOCATED AT: SIDEWALL CAPACITY: 5p, Q� �k , x� O 25.0' (LENGTH) X 2.0' (HEIGHT) X 2 100.0 SQ. FT. 66 OLD MILL ROAD P N 12.83' (WIDTH) X 2.0' (HEIGHT) X 2 51.32 SQ. FT. 95 Q TOTAL SIDEWALL CAPACITY 151.32 SQ. FT. MARSTONS MILLS, MA. 4QZ LIVINGROOM BEDROOM BOTTOM CAPACITY: SCALE: AS SHOWN 4.0 DATE:8-21-07 80 FEET 25.0' (LENGTH) X 12.83" (WIDTH) = 320.75 SQ. FT. Q 34/ PROPOSED EFFECTIVE LEACHING AREA: OF AjW44 PREPARED BY: SIDEWALL AREA + BOTTOM AREA ROBERTA. KCJ ENGINEERING T 0 151.32 SO. FT. + 320.75 SQ. FT. = 472 SQ. FT. DRAKE C14VIL FIRST FLOOR (472 SQ. FT.) x (0.74) := 349.3 GAL/DAY Mo. 1642 Co ROBERT A. DRAKE 349.3 GALS./DAY > 330 GAL/DAY O.K. (NOT TO SCALE) 66 GREENVILLE DRIVE FORESTDALE, MA. 02644 TEL. NO. 508 287 1253 Drawn By. Designed By. Checked By. JOB No. 0712 RR 11 1- dplx� -�7 99-7 L I- L I 9f �Ti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .