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HomeMy WebLinkAbout1315 OLD POST ROAD (CT & MM) - Health 1315-*OLD POSTAD. MARSTONS MILES •=� -- -- -- - - _ --- ---- ----- - - - A = 057 032 e} > TOWN OF BARNSTABLE LOCATION 04 ST SEWAGE# VILLAGE A 5,/� © ASSESSOR'S MAP&LOT /Ml� �NAME&PHONE NO. /9 SEPTIC TANK CAPACITY 7,,0/7 G 1,yj/lae C /o ti � LEACHING FACILITY:(type,)�/ (size) NO.OF BEDROOMS S rT N l / BUILDER OR OWNER PERMIT DATE: Cif DATE: © a Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet. Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by f K C1� �. COMMONWEALTH OF MASSACHUSETTS T Title 5 Official Inspection Form i1M SjOy� Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form. Inspection forms may not be altered in any way. A. Genera! Information '�7 — � 1. Property Information: MAP 57—PARC 32 d• 1315 OLD POST ROAD - MARSTONS MILLS, MA 02648 Property Address RAYDER, SHAWN & HOLLY Owner's Name 1315 OLD POST ROAD Owner's Address MARSTONS MILLS MA 02648 City/Town State Zip Code J U LY 14, 2006 Date 2. Inspector: DAMES D. SEARS Name of Inspector A & B CANCO Company Name 350 MAIN STREET Company Address 'tip WEST YARMOUTH MA 02673 City/Town State Zip Code 508-775-2800 Telephone Number r B. Certification i 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. l am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: ® Passes ® Conditionally Passes Fails i g� eds Further Evaluation by th Local Approving Authority tv ' ! ector'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. Title 5 Official Inspection Form.Subsurface Sewage Disposal System Page 1 of 16 COMMONWEALTH OF MASSACHUSETTS x Title 5 Official Inspection Form Not for Voluntary Assessments ��^N Syevv Subsurface Sewage Disposal System Form D. Certification (cont.) 1315 OLD POST ROAD Owner's Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name J U LY 14, 2006 Date of inspection Inspection Summary: Check A, B, C, D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: N/A ® One or more system components as described in the"Conditional Pass" section need to be replaced or Repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND)in the ® for the following statements. If"not determined," please explain. ® The septic tank is metal and over 20 years old'or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of compliance indicating that the tank is less than 20 years old is available. ND Explain: Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 COMMONWEALTH OF MASSACHUSETTS a Title 5 Official. Inspection Form '1M ea0"�o Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 1315 OLD POST ROAD Owner's Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name J U LY 14, 2006 Date of inspection B) System Conditionally Passes (cont.): N/A ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ® broken pipe(s)are replaced ® obstruction is removed ® distribution box is leveled or replaced ND Explain: ® The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ® broken pipe(s)are replaced ® obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: N/A ® 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 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 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System Page 3 of 16 COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form t > 0 Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Certification (cont.) 1315 OLD POST ROAD Owner's Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name J U LY 14, 2006 Date of inspection C) Further evaluation is required by the Board of Health (cont.): N/A 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less that 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3.Other: Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments �qM 5�0y`0 Subsurface Sewage Disposal System Form B. Certification (cont.) 1315 OLD POST ROAD Owner's Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name J U LY 14, 2006 Date of inspection D) System Failure Criteria Applicable to All Systems: N/A You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ® Liquid depth in leaching is less than 6" below invert or available volume is less than '/2 day flow ® ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ® ® Any portion of the SAS, cesspool or privy is below high ground surface water elevation. ® N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ® N/A Any portion of a cesspool or privy is within a Zone 1 of a public well. ® N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well. ® N!A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] YES No ® The system is a cesspool serving a facility with a design flow of 2000 gpd—10,000 gpd. 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. Title 5 Official Inspection Form:Subsurface Selvage Disposal System Page 5 of 16 COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form Not for Voluntary Assessments '�N 5yev Subsurface Sewage Disposal System Form B. Certification (cont.) 1315 OLD POST ROAD Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name J U LY 14, 2006 Date of inspection N/A 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. Title i Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Fora Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Checklist 1315 OLD POST ROAD Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name J U LY 14, 2006 Date of inspection Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ® Pumping information was provided by the owner, occupant, or Board of Health ® Were any of the system components pumped out in the previous two weeks? ® ® Has the system received normal flows in the previous two week period? ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ® Was the facility or dwelling inspected for signs of sewage back up? ® Was the site inspected for signs of break out? ® ® Were all system components, including 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)]. Title 5 Official Inspection Form:Subsurtke,Sewage Disposal Svstem Page 7 of 16 COMMONWEALTH OF MASSACHUSETTS W Title 5 Official Inspection Form r Not for Voluntary Assessments G„ 'VPv Subsurface Sewage Disposal System Form D. System Information 1315 OLD POST ROAD Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name J U LY 14, 2006 Date of inspection Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 4 Does residence have a garbage grinder? Yes ® No Is laundry on a separate sewage system?[if yes separate inspection is required] ® Yes ® No Laundry system inspected? ® Yes ® No Seasonal use? ® Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2004-110,000 GALS. 2005-163,000-GALS. Sump pump? ® Yes Z No Last date of occupancy: PRESENT Commercial/Industrial Flow Conditions: N/A 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.- Last date of occupancy/use: Date Other(describe): Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 1315 OLD POST ROAD Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name JULY 14, 2006 Date of inspection General Information Pumping Records: Source of Information: N/A—NOTE:MAINT.PUMP AFTER INSPECTION. 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) ® Tight tank. Attach a copy of the DEP approval. ® Other(describe): Approximate age of all components, date installed(if known)and source of information: 2001 —PERMIT#2000-459 Were sewage odors detected when arriving at the site? ® Yes ® No Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 1 COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 1315 OLD POST ROAD Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name JULY 14, 2006 Date of inspection Building Sewer(locate on site plan): ✓ Depth below grade: 10" 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.): Septic Tank (locate on site plan): ✓ Depth below grade: 14" feet Material of construction: ® concrete ® metal ® fiberglass ® polyethylene ® other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ® Yes ® No --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500-GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum Thickness 2" Distance from top of scum to top_of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? ASBUILT&TAPE Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 it COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form 7 Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 1315 OLD POST ROAD Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name JULY 14, 2006 Date of inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK AT WORKING LEVEL, INLET TEE — OUTLET TEE. NO SIGN OF LEAKAGE OR OVER LOADING. Grease Trap (locate on site plan): N/A 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 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): N/A Depth below grade: Material of construction: ® concrete ® metal ® fiberglass ® polyethylene ® other(explain) Title S Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 COMMONWEALTH OF MASSACHUSETTS d Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 1315 OLD POST ROAD Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name J U LY 14, 2006 Date of inspection Tight or Holding Tank (cont.) 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 a copy of current pumping contract(required). Is copy attached? ® Yes ® No Distribution Box (if present must be opened) (locate on site plan): J Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-BOX IS 16" X 16" —20" BELOW GRADE, CLEAN & SOLID. ONE LINE IN — ONE LINE OUT. NO SIGN OF OVERLOADING OR SOLID CARRY OVER. Pump Chamber(locate on site plan): N/A Pumps in working order: ® Yes ® No Alarms in working order: ® Yes ® No Title 5 Official Inspection Form Subsurface Sewage Disposal System Page 12 of 16 COMMONWEALTH OF MASSACHUSETTS w Title 5 Official Inspection Form o Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cont.) 1315 OLD POST ROAD Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN &..HOLLY Owner's Name J U LY 14, 2006 . Date of inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): ✓ If SAS not located, explain why: Type: ® leaching pits number: ® leaching chambers number: 2 ® leaching galleries number: ® leaching trenches number, length: ® leaching fields number, dimensions: ® overflow cesspool number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): LEACHING IS TWO (2) 500-GALLON DRY WELLS, 8" WATER — STAIN LINE AT 10". NO SIGN OF OVERLOADING OR SOLID CARRY OVER. Title Officiai Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 COMMONWEALTH OF MASSACHUSETTS W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage S e e Disposal stem Form 9 p Y D. System Information (cont.) 1315 OLD POST ROAD Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name J U LY 14, 2006 Date of inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):N/A 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Privy (locate on site plan):N/A Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Title)Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 COMMONWEALTH OF MASSACHUSETTS W Title 5 Official Inspection Fora Not for Voluntary Assessments Subsurface Sewage Disposal System Form D. System Information (cost.) 1315 OLD POST ROAD Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name J U LY 14, 2006 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 � 1 COMMONWEALTH OF MASSACHUSETTS Title 5 Official Inspection Form Not for Voluntary Assessments 'G^ yVPv Subsurface Sewage Disposal System Form D. System Information (cont.) 1315 OLD POST ROAD Property Address MARSTONS MILLS MA 02648 City/Town State Zip Code RAYDER, SHAWN & HOLLY Owner's Name J U LY 14, 2006 Date of inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to NO ground water: 10 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: TEST HOLE 10' NO WATER. TEST HOLE 5' BELOW BOTTOM OF LEACHING. BOTTOM OF LEACHING AT 5'. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 1 TOWN OF BARNSTABLE LOCAT ON h�� ��z� M SEWAGE # =-VILLAGE /S'td �6'� ASSESSOR'S MAP & LOT,5-7— 3 INSTALLER'S NAME&PHONE NO. In t _tits '�o SEPTIC TANK CAPACITY 560 �C... LEACHING FACILITY: (type) s?,.,_ c,\ C Imo-(size) ,NO.OF BEDROOMS 'BUILDER OR OWNER �� PERMITDATE: _tr1A6'L" COMPLIANCE 6"Zad—.011 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 61 on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fee.'`/df l achin ilipy.) Feet Furnished by ! i 4 ' ' I O j� No. " FEE COMMONWEALTH Of MASSACHUSETTS Board of Health, 1 l ` —' , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(L)I<epairO Upgrade( Abandon( - ❑Complete System U4155ic vidual Components Location OL10 PotT �0 Owner's Name Map/Parcel# 0 Address & � Lot# 3 a Telephone# 50- _ d Instal-er's Name �` Designer's Name Y,4,Vkee u.1 WV d-&r S Ay,,. Address �L�J Address�10 g � ySy Telephone# A&tor Telephone# Type of Building Lot Size b 8 —sq.ft. Dwelling-No.of Bedrooms Garbage grinde//0 Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (mint.required) 7 J 3 gpd Calculated design flow 33® Design flow provided 3S � gpd Plan: Date 7 a,G-00 Number of sheets Revision Date Title S tle"1' Description of Soil(s) S��e flu Soil Evaluator Form No. 5170 Name of Soil Evaluat euc w Date of Evaluation 00 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further afireag7re ,psjj9.aa44Q,pI e the tem in peration until a Certificate of Compliance has been issued by the Board of Health. Signed/ Date .� _ �a 1 - ... No. � �¢ FEE w j 440 COMMONWEALTH Of MASSAC14USETTS Board of Health,J /6n sl, /-Q , MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit.to Construct((—Y<,pairO Upgrade( Abandon( ❑Complete System Q-I�ividual Components pp Location 1315 ©L-� VQ FO# Owner's Name Map/Parcel# —7 M �, 4 Address /61 Lot# a Telephone# �/ o Installer's Name Air?" ��` Designer's Name)�Mkez S U f^— d 4/11S U AJ c Address !30 l! � Address�Q g >�Sy V ��•j4AR,0?/US/'I C Telephone# Telephone# Type of Building /� ! ' - Lot Size a 1 8 ±sq.it. ' Dwelling-No.of Bedrooms Garbage grindW0 O�Ih er-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures ` Design Flow (min.required) 330 J gpd Calculated design flow 33 0 Design flow provided 3S 3 gpd Plan: Date O+�—�p Number of sheets _ UC Revision Date Title Description of Soil(s) SPe02 am t Soil Evaluator Form No. f-y y Name of Soil Evaluat ruc o V Ye l Date of Evaluation a 00 i DESCRIPTION OF REPAIRS OR ALTERATIONS t - • t The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a s .aae 1 e the tem in peration until a Certificate of Compliance has been issued by the Board of Health. Signe Date Ins�ecO r' C Ly No. � ' FEE J COMMONWEA .T14 OF MASSACHUSETTS Board of Health, !��/�c��-`ale MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) O-Cbomplete System JV�1V The undersigned hereby certify that the Seiy_age Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) + b ,f�, �,�<I 5'U at 3 (S ©LP PO5T Al,OA has been installed in accordance with the ovisions of 310 CMR 15.00'°(Title 5) and the approved design plans/as-built plans relating to application No- — o ated 9 ''Z pproved Design Flow W3 (gpd) �- f - Installer t 0 r f 1) 4 Designer: ylq %tC t fsn (4&N4S�c� Inspector: t � Date: -7 Z ap f The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. FEE COMMONWEALTH Of MASSACHUSETTS Board of Health, /•Ja1 DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ^�R.,epair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at 13 I S O�-� w�T Y �� as described in the application for Disposal System Construction Permit ,: , dated " Provided: Construction shall be completed within three years of the date of this.���/�� permit.A local con .i ons must be met. A I� f Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health 2ZO t�g NN IND -r_1 An I-a Fs .......... • BLBARNSTAE SFWAGE,# bc"�ftON An V VILLAd ASSESSOR'S MAP &LOT IM :7 ...:'INSTALLER'S NAME&PHONE'NO. III I -SEPTIC TANK CAPACITY LEACHING FACILrrY: -5size) NO;OF BEDROOMS BUILDER OR OWNER; I X PERM ITDATE COMPLIANCE DATE : Separatioh.Distance Between the ev, Fe Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility "Private'Water'Supply; ell and Leaching Facility (If any vkells existat� : Feet thit"Y' facility)200,,'!Ot. o . .; ty) s t.or WR f leaching .,.Edge,,ofWetland_and.Leachi Facility (If any:wetlands exist within:300 fee f I:Jachi'n iLty Feet �Furrushed by 77 77 J, j 401 F At=6 Qce 0 "RF" ZONE: RE GRAPHIC SCALE , - SZONE: OFFSETS: 8 , 30 0 is 30 60 120 FRONT 30' �+ 2 SIDE 15' RO UT REAR 15' ( IN FEET ) 1 inch = 30 ft. � FLOOD ZONE: "C" OQ d ASSESSORS MAP 57 or HSE :; AS LOT 31 GROUNDWATER PROTECTION 4 W CEDAR ROA O VERLA Y DISTRICT AP NECK PLAN REF. 272/30 DEED REF 2402/132 �„9 9b ; LOCUS °02,pCIV 7.,E I' ; �/ �\ `� AS LOT 42 �- 101 \ N77 \ LOCUS MAP AS`LOT 32 i I LEGEND:AREA=21,688f sq/'ft i ,2p EXISTING.' --------- 107 ------- \ �� l 24-� PROPOSED: 100' DRIVE \ L iv .o \IN AS LOT 43 SITE & S'�WA G� PLAN ELEV=100' (ASSUMED) ,i1 38 p' .tiory jt' �� II I TOP OF CA7VH BASIN PREPARED FOR 100 MARGARE'T FITZGIBBONS 400, LOCATED AT 1315 OLD POST ROAD 1 \ i 7°p2'p7 E % i t d` N -''' of BARNSTABLE (MARSTONS MILLS MA. FAG ' ,> '► PAM. y JUL Y 26, 2000 g fi RRHY �� AS LOT 33 ,,,,;�-%"';1YSE t No, YANKEE SURVEY CONSUL TAINTS jNo.749 � a �P• P. O. BOX 265 �q� Eyck UNIT 5, 40B INDUSTRY ROAD ITAR� b suRv MARSTONS MILLS, MA. 02648 ` PH. (508)428-0055 - FAX(508)420-5553 JOBhV 52395 CB SHEET I OF 2 j a= a EL. = 106s MP OF FOUNDATION r' 20' MIN. 10' MIN. CONCRETE COVERS VENT IF SYSTEM IS > THAN. 4" SCHEDULE 40 P. V.C. 3' BELOW GRADE MIN. Pl7rH 1/8 PER FT. 2"LA YER OF { 1/B"-1/2" e MAX ' " ' . . CONCRETE COVER WASHED SR E v I 4" CAST IRON PIPE 12it�AX / � I ilfAX . . i . MUM CLEAN 9 P0I7CH1/4MU VI PER FT. RISER SAND N. FLOW LINE EL=102 IN 1!O" 14" MIN �20 o 0 0 0 0 o a o 0 0° EL.= 103 -- GAS INVERT LEVEL ° ° BAFFLE 6" SUMP o ° o 0 0 0 0 0 0 0 ° °o° _ 99.5 INVERT EL.= IO2.25 INVERT INVERT o o ; - EL.=-ID2.5 : EL.= 10_2_00 EL.=101. 75 4' 4' INVERT DISTRIBUTION E[. 1500 __GALLONS BOX ZZ PROPOSED SEPTIC TANK TO BE WATER TESTED 26' X 12.5' TRENCH FORMATION � IF MORE THAN ONE OUTLET O PLACE ON 6" STONE SOIL ABSORPTION PROFILE 0 F DOUBLE WASHED/STONE SYSTEM (SAS SEWAGE DISPOSAL , SYSTEM BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV.=_89__ NOT TO SCALE NO OBSERVED WATER TABLE (6129100) ELEV.=_ 89' OBSERVATION HOLE 2 ELEV. OBSER VA TION HOLE I ELEV.=102'_ PERCOLA TION RA TE R MIN./ INCH A T _48_ INCHES DEPTH HORIZ TEXTURE COLOR MO TT OTHER DEPTH HORIZ TEXTURE COLOR M07"F OTHER c 0-8" A SANDY LOAM 10YR4-1 0-8" A SANDY LOAM I0YR4-1 8"-72" B LOAMY SAND I0YR5-8 8"-30" B LOAMY SAND I0YR5-8 72"-156' Cl MED. SAND I0YR7-3 30"-156' Cl MED. SAND IOYR7-3 PERC GENERAL NOTES NO WATER NO WATER 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. P = 9770 SOIL TEST TITLE 5 AND THE T19WN OF BARNSLIBLE__-- RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO DATE OF SOIL TEST 6129100 SOIL TEST DONE BY BRUCE G. MURPHY , RS. WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" WITNESSED BY: JERRY DUNNING 3) WITHSTANDLL ING H-10 LOADING UNLESS THEY ARE UNDER ENTS OF THE SANITARY SYSTEM SHALL BE CAR BW THIN DESIGN CALCULA TIONS: 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. NUMBER OF BEDROOMS . . . . . . . . 3 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL INSTALL'TWO (2) ACME GARBAGE DISPOSAL . . . . . . . . . NO BE MORTERED IN PLACE. 500 GALLON LEACHING TOTAL ESTIMATED FLOW 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH CHAMBERS SPACED I' APART W/PIPE ( -11--0 GAL/BR./DAY x —3 _ BR.) 330 GAL/DA Y DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO -- BETWEEN OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. : & FOUR FEET DOUBLE PROPOSED SEPTIC TANK CAPACITY 1500 GAL 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR WASHED.STONE SIDES AND ENDS IS 719 CALL DIG— SAFE' AT 1-000-3x`',c`'-4844 AT LEAST 72 HOUR 26 X 12.5' SOIL CLASSIFICATION . 1 PRIOR TO COMMENCING WORK ON SITE. � DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN. 7) CONTRAC719R IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS i EFFLUENT.LOADING RATE . • 74 GAL/DA Y/S.F. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. LEACHING CAPACITY (AREA X RATE) 353 GAL/DAY 8) PARCEL IS IN FLOOD ZONE___"C------ t RESERVE LEACHING CAPACITY . 353 CAL/DAY 9) LOT IS SHOWN ON ASSESSORS MAP _57_ AS PARCEL _ . f (26 X 125 X . 74)+(26 + 26 +12.5+12.5 X . 74 X 2) SHEET 2 OF 2 JOB NUMBER__ 52395 _____ -