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HomeMy WebLinkAbout0165 OLD MILL ROAD - Health 165 Old-MiftRoad Marstons Mills P r TOWN OF BARNSTABLE LOCATION 165 00) IV1 1 GC F cc�AD• SEWAGE# C,VILLAGE /TuI, 'I I �� S ASSESSOR'S MAP&PARCEL 064 —D 22 INSTALLER'S NAME&PHONE NO. VAA/&Ip IZ CON vC1—tt1/V SEPTIC TANK CAPACITY LX(S7(fi✓Cr- �00 0 SO 8—L74—T75-3 LEACHING FACILITY..(type)Z/ 4G TAIr1jr?47105 (size) q, x NO.OF BEDROOMS OWNER t/ (1 O PERMIT DATE: ,Z 7 15® COMPLIANCE DATE: Z 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) -/4 Feet FURNISHED BY �gA2 �t AA4 ,5 ICY r Zip �✓FiL�A S `�u r� _ No. go I�' ��-� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphCation for Misposal *pstrm Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 6� �� ^� f1 Owner's Name,Address,and Tel.No. 6hf z I?S re c,v U Assessor's Map/Par e1 LC i 3S�� t ®ZZ. A6- 0 M i 11 `2j, �S"�wf �- I 1�. Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. 11 ;�� 99 g�i�rj�� ��ry�e,L 1�, �,' CTO C✓G 11 1C C, 1 `v 1"1 3r, 12... we5iI ����� 2(s�7T Type of Building: 2-74-"(^75-3 S-o 6-471- S7F/_? Dwelling No.of Bedrooms Lot Size ,sq.ft. Garbage Grinder( ) C Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Desi n w provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. MA/-S I tn^h K--S Description of Soil �€ `7 (0[ Nature of Repairs or Alterations(Answer when applicabP3* `/i 1 /1 ' `j f (N /A / f Ccrn r� 5r�C 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 alt . - 2- -7 id Signed A.4 Date Application Approved by Date � � f Application Disapproved by Date for the following reasons Permit No. 8f`� I Date Issued - �� No. O i O Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: %I Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Mmpbsalf 6pstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,(ps C)L /Vj �l �� / �' Owner's Name,Address,and Tel.No. C�1�R j�S F7,ru L L Assessor's Map/Parc�(l Zoo- 33 S� 64- o-zz S M, I( cj, r o-wd ' M MS Installer's Name,Address,and Tel.No. � ^ Designer..'s:Narne,:Address,and Tel.No.Az 7W _,70 wf ll ed. /Z k/,-Sr Type of Building: 2--74- If 75? S-0 6-4-7-7- S'?/3 Dwelling No.of Bedrooms Lot Size •-1 r_ sq.ft. Garbage Grinder( ) 1 rr Other Type of Building No.of Persons Showers( ) Cafeteria) Other Fixtures p, S Design Flow(min.required) gpd Design flow provided -7 + gpd Plan Date �/. // Number of sheets ( Revision Date Title Size of Septic Tank 47X(CIltV 6 K1o00 Type of S.A.S. "T Al fry �- Description of Soil J '7> ' r Nature of Repairs or Alterations(Answer when applicable) e 0 1 A Q IL)6 C f f/1 6 f l,,A ,y 4 (i+, /A Date last inspected: Agreement: i 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-fH" eat") Signed 2A 4 Iftate 12,-7 / (Application Approved by -� ;>. 1 K Date Application Disapproved by Date fWhe following reasons 1�! t Permit No. Date Issued V\ , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system/Constructed( ) Repaired( ) Upgraded( l,)— Abandoned( )by TAY t=9- T(?..r 70J� at ��,� /_�(� /j/� // ep has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '2019 q dated Installer %R�1 /�rt/ /�t Fifll (Z Designer s /y 1 L Al #bedrooms 3 Approved design flow 3 U gpd The issuance of this permit shall not be construed as a guarantee that the system will function as desig ed. Date �/ ,!11 O Inspector _ ° r No Fee j<I7C! THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Vermit Permission is hereby granted to Construct( ) Repair( ) Upgrade f/� Abandon( ) System located at Z�/�/I and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date 74 1 Approved by f Town of Barnstable Regulatory Services Richard V. Scali, Interim Director BAEtNSm8m 9 MASS. 1639. Public Health Division ♦0 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: "1 �2� kof Sewage Permit# Assessor's Map\Parcel C C;4 `-C1 Z- Designer: ��,y,ee�',n� /Wo r.-s, (n C . Installer: Address: 12 W, i`P) Address: Ao Crc�_%44 t\ 'guy On I����cit: �cnscvc� c--, was issued a permit to install a (date) (installer) , septic system at 14 51 C 1 e1 M,I! Jed' V"n t 111� (fJ based on a design drawn by 114 CEn+te fit✓ (addre-s) �y►cf ine_e r"nq C00AU /K C , dated J i (designer) __LZI certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes,such as lateral relocation of the distribution box and/or septic tank. Strip out (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. Strip out (if required) was inspected and the soils f were found satisfactory. I certify that the system referenced above was constructe nee with the terms of the I\A approval letters (if applicable) %OF PETER T. ` McENTEE � - VVIL (Installer's Signature) No.351o9 A�GISTER (Designer's Signature) (Affix Designer tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QAScptic\Designer Certification Form Rev 8-14-1 3.doe Town of Barnstable oft"E�Ok Regulatory Services ti0 ' Richard V. Scali, Interim Director ElA L MASS. Public Health Division y MASS. a 1639. �� Thomas McKean, Director AT�D MAC A 200 main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508490-6304 Homeowner Certification Form for Alternative Systems ;Property Address:_ ( ICA M @rS fV4 s Assessor's.Map\Parcel: ZZ--- Property Owners Name: Ch qy'It S f"-e.roll o In accordance with Massachusetts DEP alternative system approval letters, the following ce►tificaton T infbrination is required by the Owner of.record. The Owner of record must place an "x" in the l applicable box next to each line certifying the information. Yes ii \�A/y 1_`i' It�''!✓have been provided a copy ofthe Title 5 IIA technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) ❑ &X.have been provided with the Owner's Manual VI have been provided with the Operation and Maintenance Manual 11 or• Systems installed under a Remedial Use Approval, 1 agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval, U Et-, For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written-notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) ' 1 ❑ If the design does not provide for the use of garbage grinders, the restriction is understood and accepted ❑ Whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the ��environment, as defined in 310 CMR 15.303 agree to comply with all terms and conditions above. Zy Owners printed name i ( 2l �1 � Property Owners Signature Date Note: This form must be submitted alone with the septic system disposal works permit application for all I\A systems including new construction, repairs\upgrades, with and witbout aggregate (stone) and with conventional design criteria or credited design criteria. Q:ASeptic\JA homeowner certification doe Town of Barnstable P# Department of Regulatory Services trnxttsrvste _` Public Health Division bateMAM x�:a 200 Main:Street,Hyannis MA 02601 Date Scheduled Time ` Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: ��/cd !' `G�i't �et✓ 5 i✓-t S� y� X Witnessed By: LOCATION & GENERAL INFORMATION Location.Address Owner's Name �I d �/'�111 Jz. C�Lt Q✓5f�lvzs U'! r�1s Address. old ff / iQ�4tov 0",,Its Assessors Map/Parcel - ®C9 —Q Z Z w Engineer's Name.�rlg r��, r15 wcj✓C,i �k 1 INEWCONSMUCTION LREPAIR • Telephone.# (� — t(7 7 �� -_ Land Use GZe5('4n c q t/ Slopes(`110 _Z 3 :Surface Stones NA Distances from: Open Water Body. ft Possible Wet Area,"l ft. Drinking Water Well fS^d ft Drainage'way ft Property Line ft. Other ft SKETCH:(Street name,dimensions of tot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) 11�69 r O fd M111 ,fit Parent.material(geologic) �'^J Depth to Bedrock Depth to.Groundwater. Standing Water in Hole: Oe Weeping from Pit PACC Estimated.Seasonal,High Groundwater DETERNIINATION FOR SEASONAL HIGHwATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth.IdSol]rrlottlgs,, in. Depth to weeping from side of obs hole: in, t3roundwater Adjasttrient & Index Well# Reading Date: Index Well level Act[,PActor a .� Adf,Groundwater'Uvel.,,,m, PERCOLATION T +'S`z' Date Time Observation Hole# �aa` - Time at h" Depth of Perc 4F Tithe at 6" _ �Z,Ca�I.2 Start Pre-soak Time @ -- Time(9"-6") End Pre-soak I�I i Z + \� Rate Min:/Inch `—ZJ Site Suitabitity Assessment: Site Passed / Site Failed: Additional Testing Needed(Y/N) ~ Original, Public Health..Division I Observation Hole Data To Be Completed on Back----------- ***If percolation test is to he:conducted within 1.00'of wetland,you.roust first notify the Barnstable Conservat on.Division at least one(1) week prior to beginning. Q:ls EPTICIPE RCFORM,DOC �11►. DEEP,OBSERVATION HOLE LOG Hole# Depth from Soil Horizon, Soil Texture Soil Color Soil Other t Surface(in.) (USDA) (Munsetl) Mottling '(Structure,Stones;Boulders• coasigcncy,%Gravel) lay(0)Z �.36 ►3 �artd Garr bY(L � 3(0-132 G AP& Z•5`r GA DEEP`OBSERVATION HOLE LOG Hole_# A- Depih from Soil horizon Soil Texture Soil Color' Soil Other Surface 00 (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Comisten rave �oY(R NIz �r 3 7 t-o y(L ?--V� PLCIC Scli Z-5.y 4J DEEP OBSERVATION HOLE.LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil. Other Surface(in.) (USDA) (Muuscil) Mottling (Structure;Stones,Boulders. Hite G e 1 DEEP OBSERVATION HOLE LOG_ Hole# Depth from Soil Horizon Soil Texture Soil.Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. omi ten w Flood Insurance Rate Ma Above 500 year flood boundary No_ Yes JL within.500 year boundary No 3 LI Yes within 100 yearfloodboundary No 4 -Yes Depth of Naturally Occurring Perviotis Material Does at least four feet of naturally occurring pervious material exist ill all areas observed throughout,the area proposed for the soil absorption systeml Y2 S — If not,what is the depth of naturally,occurring pervious material? Certification I certify that on :N 1 V1 (date)I'Kave,passed the soil evaluator examination approved by the Department.of Environmental Protection and that the above analysis was performed"by me consistent with the required training,expertiseand.experience:dewr►bed in..3IQCNM 15.017. _se Signature 7�'' "c 7:✓`C� Date AJ j QASEPTIC�PERCFORM.DOC !SAG x/n�G P/T ARE 1%9ORE 7—NAJV /2 'FL0-PV MIAI- rrRADE, fA 24�®/AMETEK' CONCA-.ET.-- "C0sA-- SjIALL 8'E QPpOGNT 'TO 4Fj',11 d7�'.CAN ,FXT'RA 4lP11G' PIPE CU/JC,4G�'i E % f-E.4VY CA 57- /A-01V C SE'.D M/N. P/TCN ./F/.N ✓EJVA Y E/ /C`G r7 COVERS ' ' _e.• �g % n9�M. CU/yCR L�TE a GKAZ> CC.) YER' CLEAN SAND 6` DlAdL�� 2+LAYER 6AL. • a f f • A • • • • • a �Av Y4/A5HFD SMA14E ' %4�PEft / r SEPT/C 7A- MC DtsT.. tr f • • • • • • e ! ,. o . • 60X314 p of � o ♦ se ♦ ! .�� • / ♦ b �-FECTTVg 1 . i • 1 ! • ♦ DEP7 H ♦ 1 f ° n o WASH.ED STOi4'E Y D 7 r a.Qi • ! •. a 1 ® wee • p •r JPPRECAST,SFs�P.4rrE V Q f a a s ♦ ♦ e m • a a ' es o P/T OR P/V!/�' GIeL i/.�i�'/OJ'✓S. p w C=G I o 7 7... !/b41/E. '7 AT .3!J/LD/NG I IT /A+J�*P. JNL<E'7 SEA'/C T�},,VK l !4-5- FT, I F7 v/.611�J. T•9�[tL.4Tl a/1/ ; O4.1 T/-E7°'SEPTI C TANH 1A(L_-CT U/5F'R/4!lTtDjV BOX FX' SEG:7'lCft�/.OF GROvNfl kVATER' 7A40LE ®UTL,�TP�i�'�"R�,etlT'iO�i 8OX [l 3..9 FT, 3,-7 FT. TEWAGH O/SP4065A L Se..5?'.EM 7AXII-ATIDIV L�G'fi'"lNc� lT taIMEI�t, ION A z FT D,s=S/6iV CRITEI?IA scAL� NUMD.E'r� ®F B�•,AJ�OC3/'9S -' 7-07--1 Tre�ATEo FLOI�s/ 3 3 G.41./DAY SOIL 7FST A/ SO/L 7.ZFS r .2 kLs ISER Qs 44-ACHl1N1 0/7J ,DA-rE OP-SOIL. T'E.57 SIDE d-eACHIrat AP/7- l 9,L S(P FT. a� i� _ I/e 'RESUJ TS dW17'Ng5SED BYC� ' • aF✓ i%I e Z c 007^1—o/YP LIZA C.K//VG PER A!T $Q P3' 'INYsINCH !` r j 7-07,4L. 4eAC'/4//YC, A,@EA Z-.".G FT. ,t_ S F�FNCOLA770NRATE02 T� %✓ I+➢i.�P.�INCH R E���.�I��LEAC/fJN6,4 R��► .54) FT. OF ILs1fi SW���.Tt.��a � (� ..� 503._RT A• r" v 1 t�+i.'CE �`� ��v 'RSEcn 9oF ISTl- \`a� Li 7I'Z MAIN s'F., 44YANN/s, AIA.5S_ NA FSS/pO"" ._ �}: Nca FR®uNe� J,047T�eT FIIUCau"VT-1—J�,Yria-: lrTAZ0UIYIJ W--117` o.to� 'Vo °tx COMMONWEALTH OF MASSACHUSET'IS - ------ y '' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP O�a� PARCEL ; OZp� LOT 3�5 TITLE 5 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: v Owner's Name: Owner's Address: ' c Date of Inspection: N Name of Inspect please print eT( >. Company Name\. CD Mailing Address: ' Telephone Number: rr—° c0 rn CERTIFICATION STATEMENT I certify that l 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 7/.-.,�—,-3/(j 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. Notes and Comments julW ke IrI1lee-- ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: o/d 1,111 r! Owner: .462 / rl Date of Inspection: 7LIt& 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. Continents: B. 7O, ne tern Conditionally Passes: . or more system components "� as described to 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 infiltratior_or exfiltration or tank failure is imminent. System will pass inspection if the existing tank.is replaced with a complying septic tank as'approved by the Board:of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled o replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health):. broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1'] OFFICIAL INSPECTIONFORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A / CERTIFICATION (continued) Property Address: �F zl'�)w X/////W Date of Inspection: 7 IM9 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A-copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: /b"s Owner. 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/ a� 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 W Static liquid level in the distribution box above outlet invert due to an overloaded,or clogged SAS or 9 cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number Vof times.pumped Any portion of the SAS, cesspool or privy is below high groundwater elevation. Any portion of cesspool or privy is within 10.0 feet of a surface water supply or tributary to a surface Vwater,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 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. 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no. _ — the system is within 400 feet of a surface drinking water supply the systetn 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 I1 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a.significant threat,or answered. "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat.under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 I Page 5 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: oi-,ow , Owner: Date of Inspection: 60 Check if the following have been done. You must indicate"yes" or"no"as to each of the followine: _ Yes No _tL _ Pumping.information was provided by the owner, occupant,or Board of Health V 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 J — Was the site inspected for signs of breakout? _ 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: Yes no �/_ Existing information. For example, a plan.at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 r Page 6 of 11 OFFICIAL INSPECTIONTORM--NOT FOR VOLUNTARY ASSESSMENT S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION Property Address: / / rtk Owner Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): a . Number of bedrooms(actual): DESIGN flow based on 310 CvIR 15.203 (for example: 11.0 gpd x#of bedrooms): Jj('� Number of current residents: 9 Does residence.have:a garbage grinder(yes or no): /-C) Is laundry on a separate sewage system ( es or no):,jr�V.[if yes separate inspection.required] Laundry system inspected(yes or no): Seasonal use: (yes or no):1 C0 ... l Water meter readings, if available(last 2 years usage(gpd)): ��" �G�d�� —7,Vl d� Sump pump(yes or no) / Last date of occupancy:: (� m r �J �2,t � J ,�Ye COMMERCIAL/I NDUSTRIAoC(f Type of establishment: Design flow.(based on 310 CMR.15.203): op d Basis of design flow(seats/persons/sgft,etc.); Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system (yes or no):-_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records / Source of information: !/(� 4 4,& li w Was system pumped as part of the inspection(yes or,no): If yes, volume'pumped: gallons--]-low was quantity pumped determined? Reason'Torpumpmg: TYPOF SYSTEM _t 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): rApproximate age of all compo cents, date i�pt ed (if know i) ar�d source of informatioll` ' Were sewage odors detected when arriving at thesite(yes or no): IV . 6 Paee 7 of 1 1 ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: r Owne ' Date of Inspection' BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC other(explain): Distance from private water supply well or suction liner Comments(on condition of joints, venting, evidence of leakage,etc.): SEPTIC TANK: _(locate on site plan) Depth below grade: E� 4 Material of construction: concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age: _ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Dimensions: Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle: J Scum thickness:_ i1 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bott�orilj�of outlet tee or baffle'. How were dimensions determined: iLLt2 f,��, ( i:Le.�ldYdi/ I��Y� Comments (on pumping recommen ati�nlet and outlet tee or baffle condition, structural integrity, liquid levels related to outlet invert, evidence of leakage, etc.): _ d Knee � . �, >� us ,e a , If GREASE TRA�> Jocate 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(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTIONTORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C .SYSTEM INFORMATION(continued) Property Address: ,(r� Owner: Date of Iiispectio r' 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 otlier(explain): Dimensions: Capacity: gallons Design Flow: gallons/day. Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments (condition of alarm and float switches, etc.): ll t/ . i ISTRIBUTION BO X.: if resent must be o ened locate on site plan) i ( P P )( P . ) Depth of liquid level above outlet invert21"d P/�(O Comments(note if box is level and distribution to.outlePequal, any evidence of solids carryover, any.evidence of `.— ,leakage into or�ut of ox tc.): � fr X fy �c�/' �' � rye f i•� PUMP CHAMB);4/)U) (locate on site plan) Pumps in working/order(yes or no): Alarnis in working order(yes.or no): Comments (note condition of pump chamber, condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Own, Date of Inspection: y SOIL ABSORPTIO SYSTEM (SAS): locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers, number: leaching galleries, number: leaching trenches, number, length: leaching fields,number,dimensions: overflow cesspool; number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, c.)'i �`` /n /Cce �.� . A 6m l I ,• !r 41� e 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 or no): Comments(note condition of soil, signs of hydraulic failure,•level of ponding,condition of vegetation,etc.): PRIVY(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure;level of ponding,condition of vegetation,etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART-C SYSTEM INFORMATION(continued) Property Address: 5 Owner. C, 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. eat �(dc 1 q b _ �a 1 L)bo, cis..<< IC f Page 1 l of I 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARI ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) .Property Address:. rR 0wne p ` Date of ns ection: 7y I SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet �I Please indicate(check)all methods used to determine the high.ground water elevation;) Obtained from system design plans on record - rf checked, date of design plan re�iewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Necked with local excavators, installers-(attach documentation) Accessed USGS database-explain: I You must describe how you established the high ground water elevation: e i l l I syry r-t,....�... --. ,w:..,., .. - K Permit - - �lu b r Date: - '4,g.'�,.<�az�.I-;iY= :=-- feted b NNE i;4.¢?,Y : . H c P O..R L ins. .I ER LEVEL COMPUTATION .._- _.. ... ite Location: ,��c����// o�o. xs 3 "'Owner; Address: 115, Contractor: �D� / �� � C.����y�`',gddress: ✓�' L yr / Notes: > r STEP 1 Measure depth to \stater table �� r r71e�Z;> to nearest 1s I 0.;i. .............................................................................. Date ';-mi.>`" month/day/Year n� STEP 2 Using Water-Level Range Zone and Index Well Map locate �- site and determine: I -.... g, Appropriate indexwell.................. . � Water-level range zone ........................ STEP 3 Using monthly report Current I � I Water Resources Conditions„ � I determine current depth to water level for Index well ........................... nc�th/year i STEP 4 Using Table of Water-level ,adjustments for inde.,well (STEP 24), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determine water-level adjustment ..............t....................................................................... ..... "( STEP 5 Estimate depth to high water by subtracting the water- level-adjustment (STEP 4) from measured deoth to water _ level at site (STEP .1) Rour, 13.--rSBrJfO�UCjrjE computation fi fiTl. V� i I -1 O CAT 10N SEWAGE/ PERMIT NOy VILLAGE 1 ' "W4 J (/17S-//I I I/S INSTALLER'S NAMES L ADDRESS � _!� . e f)o- e U I L D E R OR OWNER DA T E P E R M I T I S S U E D :DAT E COMPLIANCE ISSUED v. - _-_- ��� � a� �.� a �` i t�2 � �� I �� .: No.. `��....7� Fps........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �j................OF....... c .-----------...------------ App iration for Uhipas al Workii Toro rnrtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - ....�.�. miu, .. 1 b �►.�U..`, 7 --o . 3 ...... ..... - ---....... . -.cation-Ad- F!it..B or Lot No. ..................... ....... -®--•'------- ----•---•-------•- -......._....^___•------------•- --------------------------------- caner _Address +,StT�............ .._. �t; ... �............................. �'�.t ._.__IL 1 ' IDS.... .A.. 4 ! �iCyl Installer Address Type of Building Size Lot.._51..+.;47Sq. feet Dwelling—No. of Bedrooms...____...................................Expansion Attic (✓f Garbage Grinder { aOther—Type of Building No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------------------------------------•--•--•------------------------------------------------....._.........•-•--• W Design Flow.....65...............................gallons per person per day. Total daily flow......... 3© ........... WSeptic Tank—Liquid capac't _1 ---gallons Length---6"�--- Width.4_"1.0 . Diameter-- Depth.-5 Disposal Trench—No._ ...___. Width._._..`............. Total Length.................... ....... Total leaching area..__..._:__--_____sq. ft. fe Seepage Pit No--------/.......... Diameter.......lo....... Depth below inlet....._6.......... Total leaching area_sa_.(V4_.�sq. ft. Z Other Distribution box Dosing tank ~' Percolation Test Results Performed by.......___�-� � �vm A"Yew4y--_-------- Date.....4 .._11 �_l..-.....__.. ,.Test Pit No. 1 k-------minutes per inch Depth of Test Pit__- -_...._... Depth to ground ater...A __- fi, Test Pit No. 2 -minutes per inch Depth of Test Pit____________________ Depth to ground water........................ 40101-- --Y.....------------------- .............................................................................................................................. O Description of Soil........ _ _�....._1�U �� U ----------- ------------------- -`'�---r W ----•------•----------------------•-•---------------•---------------------------•---------------••-----------------------------------•---•-----•-------------•---•---------•--•-----......--•--•--_--... UNature of Repairs or Alterations—Answer when applicable___________________________________________•_•-_•_•-__-__________.-_-_--_---__.----_-•------__- ------...--••-----•-••---•-------••••--•-----••--•-•................•---•--..............----•-----•------------•---•----------•-----•-------•-----------------•---••---•--------------.........._---- Agreement: he undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with he r visi us of'"I Y^ 5 he State Sanitary Code—The undersigned further agrees not to place tm in o atio Compliance has been issu by the board of health. �/_ IRVn A roved B � . ,. _ -•---.- -Z 9 PP PP Y Cf ._...._.... Date plication Disapproved for the following reasons---------------••------•----.._..-----------------------•-----------------------------------•----•--------•-_..._ ....-----•-•--•-----•----------•------••-----•-----------------------••----------•-------....--------•---•-----•-------•-----•-•----------•---------•-•--•------•--•--•---------------•--••---•---•--- Date n� i 4 Permit No......._--• _ .� -. Issued_._..-_--1.._.. �.... Date No. ......_'::......... FEs............ . . ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH vc) .� ...............OF......�tKvlFaC��..��.� AVV irafion for %VoiiFal Works Tnnstrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................_. L , ..............1 ...... �:.v t. %'.... - ' ....'--�` --------- --------•---.........---.................. •-ocation Ad s or Lot No. .. .......-. _ � r..._ � L .. ....... ............ Owner y„ Address _ ._._....... .:..�f v `------•----•................. ...... �T....G t- � Installer Address U Type of Building Size Lot..S!, . '..Sq. feet I—I Dwelling—No. of Bedrooms..... ...............................Expansion Attic (-,I Garbage Grinder A�t aOther—Type of Building _11� .................. No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----•-----=---------------- ------•------------••---..----•-------••-•....._..-••---.._ ............................................................. Design Flow....45................................gallons per person per day. Total daily flow.........530. .......................gallons. W r t. r C4� Septic Tank—Liquid capa ity/tom_.gallons Length..&C! ._.. Width:."C A.r.. Diameter��-___._.. Depth 5..-�?_ -.. W x Disposal Trench—No.. j........... Width................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......�........... Diameter.._...to.r_..__. Depth below inlet.....�?.A........ Total leaching area`��._....sq. ft. Z Other Distribution box (v'j Dosing tank ( ) '-' Percolation Test Results Performed by......... . Ni?!(U6Z1 f __ j 7i Date----•� ................... Test Pit No. 14X___--_-minutes per inch Depth of Test Pit--- ........... Depth to ground water:_/,, ?* ---- rZq Test Pit No. 25. ;4M ..minutes per inch Depth of Test Pit.................... Depth to ground water........................ ........................................................................... ----------- --•...... . D Description of Soil---..--0-' !......!!�t�LG �p x �j W ----•------------------------------•-----------•--------------------------------------•-----------------------------------------------•-•--------------•--•----------•-----------------•-----•-------- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ --------------------------------•--•-------•--------------------------••----------------•--._...--•--------....-------------------------------------------- ........................................... A eement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with th rovis'ons o i the State Sanitary Code—The undersigned further agrees not to place the system in erati f'ifi f Compliance has been issu d by the board of health. / , ) J p on Approved BY--- .I.....•r...................... ....... ..-.. ....... �--••--•--- Date pplication Disapproved for the following reasons-----------------------------------•--------------------•-------------...-=-----•--------------------------•---•- Date PermitNo..................................•----•-•-•----------- Issued....... ..........-- ............_..--- Date a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH %lurdifirttte of fP ontlrfitanrr THIS I TO RTIF ', Thak t e Individual Sewage Disposal System constructed (f14r Repaired ( ) by at ©� °v......------ F �_�t.1"�!''--._ f�uer `�.!fI.✓ ----- has been installed in accordance with the provisions of TITIF j of The State Sanitary Code as/dIcribeA in the application for Disposal Works Construction Permit No........ ,�,h`: .......... dated_...______.___t . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............ ..�. ?. S-•----•.............. --•--- Inspector.... .. R THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `-� ...........................................OF..................................................................................... No......................... FEE........................ Woo o saal Workii ('60notrnr##ion amit Permissionis hereby granted---•- ........................:.............................................................................................................. to Construct ) or=;Repair ( ) an Individual Sewage Disposal System atNo...........-----........................................-................-.................................... -w- t` Street as shown on the application for Disposal Works Construction Permit N .................... Dated...... , _ . .......... ............. •-- ---- .._.._... - ,w ` r Board of Health `s DATE----- ......--------- ...................................................... FORM 1255 A. M. SULKIN. INC., BOSTON •v 20 FT. M/N. NO7"E' : /F ElTNER 7"NE SEPTIC TANK OR LEAChI//vG P/T ARE MORE TNAJV /2"BFL0tt/ ' /O FT. /1-1IAI. ;IRAOE�, A R4"O/AME7-,ER CONCRETE C'OYE.P SWALL BE BROUGHT TO GI{AO ACE .6AN•.EXTRA I_ CONCRCTE •rj'.PNC P/PE JOe,4V"Y CAST /RO/V COVJ--R SH.gLL DE USFO i M/N. P/TCAI c ll:;PR/V4=WAY =- 2 MiN. co a�Ac_ CO✓ER CLEAN .SANO BACX/e'/G L <J^D1/1 1 2"1AYfR a SCHED ULG 4O GA L. o v o 0 D/ST, / • • • ►. • •• > •+ yYASHFO 57t7NE SiEPT/C_ TANK • • • • • • • • e • / • • a too FECT � � • :.: • D P WASHED STONE k :"'e /��x ZS� {7C> � •a a 1 • • • • • • � ' opo PA-EC.A5TSEEPAGE 7� r �- _79 • •.• 1 • • • • • e.e • p ••p o /T DR EQU/✓ I NV4wA-r 41,4 RV 7-14 /S pl-r G/{/��a. T�' .;fi n y a .o• / • • • • • � ' e L /o a 77' /NYERT AT FT. � 6 F7: D/AM. INLET SEPTIC T.4AW ! 14-5- FT, / FT O/i4Jrl. C(--WETAB//L..4TJQN) OUTLET SEPTIC TANK IA(4dFT 0lST/4/B!/TIOH/ BOX ! l` / FT SECT/ON.OF GROuNO N�iITEi"� TABLE Ot/TLETD/STRIBI/TION®OX It 3,9 FT, LFACNIM2 o/7- / /3,7 FT �AGE OIS� S'.�4 L SY.ST�/�1 Ti4QU1�9T/DN LEACH-IlV PIT- 2- FT. SCALE : %s R /=O' DIMEN.S/ON A AF51 SJY CXI T.ERI�S D,AfaN,5t o N a-�—FT. NUMOER OF BEDROOMS 3 DIMENSION C FT. ��' GAs4QAG.E'D/yPOSAL UNIT ��r/F_ SDIL. L.OG TTAL TIWAr,-O FLO*V .33 o G.aL./DAy SO/ TEST A/ $o/L TEST.02 s®�� TEST O E.IV i1 umaER OP 4eAnvisr. PITS —,tee / U,5 ELEY, �/S OAY"E OF' SOIL TEST S/DE LE.4CH/NG PEid P/T !fs� 9Q. FT. f r. G2vssM.�� MyeRay RESULTS iYITNESSED BY 00r-ro^f LdaACN/NG PER P/T7 a Pam?ULCr. L =. A,' ., PERCOLAwoN Ri4TE#/ ��� M//►�INCH sq. A'T. z G ?o' TOTAL LEACH/NG. REA S Q. FT , r / 2FE RCOLATON RATE Tffs,ni /y/N. INCf! Z,o 6 ARE T.A F RESERVE L�CMlN SQ.` s,.n T� 57 C -- -- z 6 �-•. ' .0 J C'" �F sir (Y+,.QF HAS `�'P�C1� M,gs�9 C J r: rz S L- ROBERT BRuCE "i ORSE y Tv nl E5 ELDREDr .. NO.10951 O < ®R +�r'�Go Lw) �"RlAW CQl/YG. 9o�FSGrsTEa���a�. 7I2 /lA/N -9-r., /•/YANA1.15, MASS. /ONAI� IVOOROVVP 1�YWWO ENCOC//YTL�REO @L/.ENT: /�qc 1£�0/,1 D.tTe5: / ��F,� 93 GRO[1NG� 1N�4TE AT ELEY' —__ .106 ND: 8 5 o o_ #IEJ fir- ZOP 2. !4 - 98--EXISTING CONTOUR Locus m N x 100.98 EXISTING SPOT GRADE g W EXISTING WATER SERVICE R@ G EXISTING GAS SERVICE .o gen H.yam-OVERHEAD WIRES �a TEST PIT BENCHMARK F - X LEGEND w I m n Io a / 84.00 Drive LOCUS MAP NOT TO SCALE �O i i 82.95 � I 82.04 edge ' 81.29 80.64 ' 82.52 82.33 101.37 l GARAGE 8 .54 i / / / / / / x 101/52 / 84.42:: 101s398.61 / 102.05 er olio / ��; .` \ \ \\ \\ M.64 \\ - ... LOPS? /� •86.993•' 101.73- 102.00 _ EXIS77NG \\ 10240 a \ �\ 9008\ \ 92.83\\ W, .OB / .94 HOUSE(#165) �\ 87.44 \` Hx� G W 1 T.0.F=102.6E .-101.56 `\ Z �\ \ �• G 8 ` ` x .14 \ <Ja \\\ \\\ \ 1 97.36 01.13 /� XS 103.06 I S J \\ 1 �195.68 96.4 DECK ,p / \0 . 0. x \\ \\ 100.25 9e.2�\ A \ 96.OL�' \ \ x 100.20 \ 4\'�\\ 12 302.43 BENCHMARK ''\`Y,rc, \\ \\\ x 99.59\\ 100.9iTP-2 % ��\ `V OUTSIDE CORNER BOTTOM STEP 89.22�\ EL.=101.50 \\ \\ \ \\ \\ \\\ `�`"A EXISTING SEPTIC TANK 9 5 TOP OF TANK, EL.=100.73 \\ \\ \\ \\ \\ \ INV.(OUT)=99.40E \\ \\ \\ \\ \\ \\\ EXIS77NG LEACH PIT (PER RECORD AS-BUILT) \ \'LOT 335\ TO BE PUMPED, FILLED \\ \\ �\ 51 226 tS.F\\\ j" W/SAND & ABANDONED \\\\ \\PARCEL I`D. 064 \022 OF 44ss9�yG o PETER T. McENTEE N PROPOSED SEPTIC SYSTEM UPGRADE PLAN No.. 35109 35 165 OLD MILL ROAD, MARSTONS MILLS, MA OWNER OF RECORD Prepared for: Charles Ferullo, 165 Old Mill Rd., Marstons Mills, MA 02648 IQ I FERULLO, CHARLES M Engineering by: SCALE DRAWN JOB. NO. 1 PAULA A Engineering Works, Inc. 1 =30' P.T.M. 132-18 165 OLD MILL ROAD 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. MARSTONS MILLS, MA 02648 (508) 477-5313 5/9/18 P.T.M. 1 Of 2 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:98.8 FOR A DISTANCE OF 15' AROUND THE SEPTIC TANK PROPOSED D-BOX PERIMETER OF THE S.A.S. INSTALL RISERS & COVERS OVER INLET & OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER PROPOSED S.A.S. T SET TO 6" OF GRADE INSTALL INSPECTION PORT OVER ONEH ROW MIN. T.O.F.=102.6t ROW(MIN.) 1 =101.2t F.G. EL.=101.1 t F.G. EL.=101.5t F.G. EL.=101.8t F.G. E MAINTAIN/27. GRADE MIN. OVER S.A.S. L = 30' INSPECTION ® S=1% (MIN. L 9' PORT ) � S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 6" 10"I G 14" 11" TO EXISTING 48" LIQUID INVER LEVEL I _ I --------------- ADDINV.=98.70 PROPOSED INV.=98.53 3 ROWS OF 7 UNITS AT 6.25'/UNIT = 43.8' GAS RAFFLEI1 , . NV.=99.40t 3 OUTLETS INV.=98.42 EXISTING SOIL ABSORPTION SYSTEM (PROFILE) EXISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER BACKFILL WITH CLEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS NOTES: BREAKOUT=TOP 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP ELEV.=98.83 INVERTS, PRIOR TO INSTALLATION. INV.=98.42 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=97.50 GRADE ON A MECHANICALLY COMPACTED SIX 5' MIN. SEPARATION "� INCH CRUSHED STONE BASE, AS SPECIFIED TO GROUNDWATER 2.83' 6" 6 IN CMR 15.2 4' (MIN.) OF NATURALLY EFFECTIVE WIDTH=9.5' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. OCCURRING PERVIOUS SOILS SUITABLE SOILS 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE AS MANJFACTURED BY TUF-TITE, ZABEL OR EQUAL. NO G.W., EL=89.9 USE 3 ROWS OF 7-HIGH CAPACITY H-20 INFILTRATOR UNITS WITH 6" SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE TYPICAL SECTION SOIL LOG GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL DATE: APRIL 3, 2018 (REF P#15,631 BOARD OF HEALTH AND THE DESIGN ENGINEER. SOIL EVALUATOR: PETER McENTEE PE(SE1542) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ELEV. DEPTH ELEv. TP-2 DEPTH LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 101.1 A 0 100.9' A 0 TO INSPEC-ION AND APPROVAL BY THE BOARD OF HEALTH AND THE LOAMY SAND LOAMY SAND DESIGN ENGINEER. 100.4 B 8 10YR 4/2 100.2 10YR 4/2 „ B 8,. 4-ANY-CONDITIONS. ENCOUNTERED -DURING CONSTRUCTION DIFFERING Y -' SANDY LOAM SANDY LOAM FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER 3EFORE CONSTRUCTION CONTINUES. 98.1 C 10YR 5/4 36" 97.8 C 10YR 5/4 37" 5. ALL ELEVATIONS BASED ON ASSUMED DATUM (BARNSTABLE GIS±). L6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF PERC THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. M-C SAND M-C SAND 2.5Y 6/4 2.5Y 6/4 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 90.1 132" 89.9 132" THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PERC RATE <2 MIN/IN. "C" HORIZON CONSTRUCTION. NO GROUNDWATER ENCOUNTERED 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS REFERENCE PERC 4/21/81, < 2 MIN.INCH, WITNESS TOM McKEAN IN THE AFEA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND o 0 0 0 0 0 r-.0-.00.0 0000NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 00000000 F- 28"--i 28" -i Closed End Plate men End Plate t.� DESIGN CRITERIA W (`:• NUMBER OF BEDROOMS: 3 BEDROOMS 16" SOIL TEXTURAL CLASS: CLASS I DESIGN P-ERCOLATION RATE: <5 MIN/IN 75 34" DAILY FLOW: 330 GPD 1.25 Side View End View DESIGN FLOW: 330 GPD GARBAGE GRINDER: NO HIGH CAPACITY INFILTRATORS, H-20 LOADING eXISTING SEP-IC TANK: 1000 GALLON CAPACITY INFILTRATOR CHAMBERS LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF .74 GPD/SF N.T.S. DISTRIBUTION BOX: 1 INLET, 4 OUTLETS (MINIMUM) USE 3 ROWS OF 7. HIGH CAPACITY INFILTRATOR H-20 UNITS. WITH PROPOSED SEPTIC SYSTEM UPGRADE PLAN NO STONE. SPACED 6" BETWEEN ROWS. FOR A 9.5' x 43.8' BED 165 OLD MILL ROAD, MARSTONS MILLS, MA SIDEWALL AREA: NOT APPLICABLE BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF) Prepared for: Charles Ferullo, 165 Old Mill Rd., Marstons Mills, MA 02648 (INFILTRATORS) 21 UNITS x 6.25 LF x 4.73 SF/LF = 620.81 SF Engineering by: SCALE DRAWN JOB. NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(620.81 SF) = 459.4 GPD Engineering Works, Inc. N.T.S. P.T.M. 132-18 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. NOMINAL BED AREA: 9.5' x 43.8' = 416.1 SF (400 SF REQ'D) (508) 477-5313 5/9/18 P.T.M. 2 Of 2 _ w f jo ly CK Lo-r 3 / r a: W L,P'r ,• � \ , .ems 3011 \ u LJN A s Cs \ L2-r 3 f s ii ` LEGEND a °Ffu ss CERTIFIED PLOT PLAN EXISTING SPOT ELEVATION OxO EXISTING CONTOUR ——— 0 -- - D�� ✓�Ir � Tc',r�: " .-FINISHED SPOT ELEVATION tRSE /A/ A'.:5 011— F}' $ FINISHED CONTOUR 0 IN : h "APPROVED , BOARD OF HEALTH FssioNn\ SCALE DATE DATE AGENT ��� � Mc'/� :c?N _ �RCR€�2° f ,CERTIFY THAT THE PROPOSED ,€LDREOGE ENGINEERING CQ IN CLIENT a EGISTEpE REGISTEREDr BUILDING SHOWN ON THIS PLAN JOB NO,,,—..— .._ w y,� A'0 r CIVIL LAND -CONFORMS TO THE ZONING t�AMYS : { ENGINEER U V Y DR.9.Yj ,.,...__' t 4F:l3l�I'n/STe�f3c. , .MASS s° 712 MAIN STREET CH. 8Y� ftR �t �*1, �-Y, ` �` b t F NYA NN I S MASS. �z L{! ° Z- R ' ° D_ TE REG. LAND" SURVEYOR � .1 �� 8NEETt..OFs S � r ��= __. -. .. a .. .- _ �r-Y��a�ir.7• r .3,��"'?cr�. .'`D �.P "'x5�'�._ .. .: