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HomeMy WebLinkAbout1356 OLD POST ROAD (CT & MM) - Health 1356 Old Post Road �057-009.002 Marstons Mills op Can J , c y►.i,. �A�v - 7C� Commonwealth of Massachusetts Tale 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owners Name information is required for every Marston Mills MA 02648 4-30-12 page. Cityrrown 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. Important:When filling A. General Information �"`�"u"rrurrui uon se a computer, se 0 ``\\`2 ytN OF ty tab 1. Inspector: ; key to move your a DAMES u' cursor-do not James D. Sears =0• SEARS �4 use the return Name of Inspector key. ' Capewide, LLC i Company Name 'i 5 INS py 153 Commercial St 11'"1�11n"I,II1;0\0� Company Address Mashpee MA 02649 Cityrrown state Zip Code 508-447-8877 S1623 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 CHAR 16.000).The system, ® Passes ❑ 'Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority c 5-4-12 cat c�.k -r ector's Signature Date The system inspector shall submit a copy pf this inspection report to the Approving Authority(Board r` --- 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 0 L ,, repof-4o the appropriate regional office of the DEP. The original should be sent to the system owner `s Eli 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. �-2 t5ins 11110 Title 5 Otfidal Subsurface Sewage Disposal System•Page 1 of 17 P ' f Commonwealth of Massachusetts lugTitle 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owner's Name information fr every is Marston Mills MA 02648 4-30-12 Requirededfor page. Citylrown 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: ® 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: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins 11110 Title 5 Official Inspection form:Subsurface Sewage Disposal System-'Page 2 of 17 'Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments `< 1356 Old Post Rd Property Address Dave Hudson Owner Owner's Name information is required for every Marston Mills MA 02648 4-30-12 page. Cityrrown State Zip Code Date of Inspection B. Certification Cont. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owners Name information is required for every Marston Mills MA 02648 4-30-12 page. CityTrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *'This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must Indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or Clogged SAS or cesspool ® ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•11110 Tittle 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 4 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owners Name information is rewired for every Marston Mills MA 02648 4-30-12 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) x Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence ! of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this forma ❑ ® 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•11/10 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 1356 Old Post Rd Property Address Dave Hudson Owner Owners Name information is required for every Marston Mills MA 02648 4-30-12 page. Citylrown 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 ❑ ED Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received nominal 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? Z ❑ 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. ❑ ED 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: y ' Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•11/10 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 1356 Old Post Rd Property Address Dave Hudson Owner Owners Name information is required for every Marston Mills MA 02648 4-30-12 page. Citylrown State Zip Code Date of Inspection Q. System Information Description: ` The system is a 1500 Gal Precast tank D Box and three 500 Gal Chambers Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? [] Yes 0 No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2011-167,000 2010-202,000 Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of•design flow(seats/personslsq.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•11l10 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 7 of 17 1 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Atdress Dave Hudson Owner Owners Name information is required for every Marston Milli MA 02648 4-30-12 page. Cityrrown state Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA 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 f the DER Elg pY o approval. : Q Other(describe): t5in€•11110 Tide 5 Official hspeoon Form:Subsurface Sewage Disposal System•Page 8 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � 1356 Old Post Rd Property Address Dave Hudson Owner Owner's Name information is required for every Marston Mills MA 02648 4-30-12 page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known)and source of information: 2000 Permit # 2000 -270 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 26t 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.): Pipeing is 4" sch 40 pvc Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: 0 concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: Years 1s age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No ' Dimensions: 1500 Dial Precast Sludge depth: 2" _ t5ins•11110 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owners Name information is re4uired for every Marston Mills MA 02648 4-30-12 page, Cityffown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness a„ 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? Plan 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 at working level, Tank and covers at 18" Below Grade, in and outlet Tee's No sign of leakage or over loading 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts U09 Title 5 Official Inspection Fora V, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owner's Name information is Marston Mills MA 02648 4-30-12 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 t5in5•11110 Title 5 Official Inspection Form:subsurface sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts - y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owner's Name information is Marston Mills MA 42648 4-30-12 required for every page. CitYrrown 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 a 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", 26" Below Grade , Three lines out, Box is clean and solid. No sign of over loading or solid carry over 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.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Y Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owner's Name information is required for every Marston Mills MA 02648 4-30-12 page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ' ® leaching chambers number: 3 ❑ 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.): Leachis three, 500 Gal Dry Well Chambers, Per Plan 4'stone sides and ends, spaced apart 2"water,wall's clean, No sign of over loading or cant'over 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-11110 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owner's Name information is required for every Marston Mills MA 02648 4-30-12 page. City/Town state Zip Code Date of Inspection D. System Information (cunt.) 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-11N0 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owner's Name information is required for every Marston Mills MA 02648 4-30-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 OfficialInspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Property Address - -- — - Owner Owner s Dame information is required for every _ — —� page. Cityffown State Zip Code Date of Inspection D. System Information (coat.) 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 fir i xg , d 15ins-11110 Tim 5 orricia Inspeemion Form:Sutx Sce ssange ttispo i system•?aga 15 0;t i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owner's Name information is required for every Marston Mills MA 02648 4-30-12 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Cneck Slope ❑ Surface water ❑ C_neck 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 4-6-00 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: Bottom of leaching at 5', T.H. on Plan 12'-6" No water, T.H. at 7'6" Below Bottom of Leaching Before filing this inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 1356 Old Post Rd Property Address Dave Hudson Owner Owners Name information is required for every Marston Mills MA 02648 4-30-12 page. CityfTown 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•11/10 Tide 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. � FEE 7 7 ! y COMMONWEALTH Of MASSAC14US EITS Board of Health, 319R N STAB L 6: , MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(t4'lepair( ) Upgrade( ) Abandon( ) - U-1 romplete System ❑Individual Components Location 13 56 o L p PQ51- Rom Owner's Name M p R U/4R(r— FiTZ &i3801V9 Map/Parcel# MAP 57 Address Lot# 1 —A Telephone# 41 oZ 8— Q O 8 H Installer's Name A ` Designer's Name pNk-re SGVVQ 5--c hSU(-14PTS Address � Address y0 8 N 1�US?R R M*Its7b)15 Ml L Telephone# (� Telephone# 4j/a8-O O$S u Tyke of Building J��,(, �1� L!/.�!� /�1'_ Lot Size�7 al 8 3 0 sq.ft. Dwelling-No.of Bedroom's' Garbage grinyl�r yy/A Other-Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures L / Design Flow (min.required) /0 gpd Calculated design flow L/ � L /�0 Design flow provided 6 5 gpd V an: Date 'I— a 7- 0o Number of sheets Revision Date Title S 1 TE t S6PTIG gye,)w Description of Soil(s) See jpt,4 Soil Evaluator Form No.P# 971 J Name of Soil Evaluato3rueCG: MURM DaSte of Evaluation ��6�OO 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 agrees tq not to pla the tem in operation until a Certificate of Co pl'ance has been issued by the Board of Health. Signed Date ;5f-3 Inspections No. 7e COMMONWEALTH OF MASSAC14USETTS FEE—0— Board of Health, 3 aR OTAR L E CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) CKomplete System The undersigned hereby certify that the Sewage Disposal System; Constructed (Repaired ( ),Upgraded ( ),Abandoned ( ) by: at 13S(o OL-P POST P%0Ak has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and e a proved design plans/as-built plans relating to application No. dated ved Design FX-Th-.0 (gpd) Installer `' r 0 Designer: 14 Nkt-t Ju✓!Lei "%Su ILTA Ain Inspector: ate: The issuance of this permit shall not be construed as a guarantee that the cyst w tion as designed. No. s �� FEE f COMMONWWTIJ Of MASSACHUSETTS Board of Health,314RNS1H3Lrt , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct(1rlRepair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at 13 S 6 O L- Po ST Ao4, as described in the application for Disposal System Construction Permit No. ,dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health No. �� "..t FEE Board of Health, 1->i�j�IU s Af�L L MA. ., APPLICATION FOP, DISPOSAL-SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct(t 4ep'airO Upgrade( Abandon( rS<omplete System ❑Individual Components e , Location ' 3 136 oi-P PO T Q Owner's Name M 5 n � 4 c:5� FiTZG133oN°S ' Map/Parcel# M A P S7 Address Lot# 97 A Telephone# y a 8"' Q O 8 y Installer's Name �' Designer's Name p IJkPe S C.✓u p C U In S U L7 ITS Address �- 0 Address yO 13 L N b US?R �� M AR STO/03-M I LL 'Telephone# N,;; ' Telephone# 4-/a O O S S -n X, �a 830 Type of`Building Lot Size 0 sq.ft. Dwelling No.of Bedrooms y' !_� Garbage grin Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures ) C Design Flow(min.required) L/ �0 gpd Calculated design flow ��4/� Design flow provided �6 J gpd Flan: Date 4-1— A 7- Od Number of sheets Revision Date Title 1 S i TE t S&'P7►C f&tq -'Descnption ofSoil(s) e �x o r — �U Soil EvaluatorkForm No.Ptt• 7' y ��. Name bf Soil Evaluator�rute G, M�ReNy Date of Evaluation ,,DESCRIPTION OF REPAIRS OR ALTERATIONS ~' S �1 The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees `not to pla the ggtern m operation until a Certificate of pp"ce has been issued by the Board of Health. Signed Date 1-3 ,3"- 3- ©a Inspections No.;2150V , �� 1 FEE 00 g Board of Health, i319R NSTA a L& , mA. CERTIFICATE Of COMPLIANCE 3 p Description of Work: �C]Individual Component(s) CIKomplete System The undersigned hereby certify that the Sewage Disposal System; Constructed (►<,Repaired ( ),Upgraded ( ),Abandoned ( ) by: at 1 3 SCo CO L7 POST RO+q J7 has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flo (gpd) Installer O 0 + Designer: � 4 N p'/kr•e Sij✓V a'tj''cTw^' Inspector: , I ate: a The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No.� �� FEE /PJo COMMONWEALT14 Of MASSAC14USETTS Board of Health, �P R N S Tel 3 L C MA, DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct(pI.4''Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at 3 S �n 1-� O ST Ro as described in the application for Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date ." Board'of Health \ ROUTE 28 � \\ LOT , \\ 9-1 RES. ZONE.- "RF" OFFSETS.• Wo 1 \� tiN FRONT 30' Q E ti WW E LOT i \\� tip SIDE 15 W DAK TpAD �lr E ti � _ C ti KR s 78 ti C ti s � EAR 15 W NE R 12 tip O� cS GRADING WALL BY OTHERS spy 0 FLOOD ZONE: "C" 4 LOCUS ti ti ( tip tip p� Oti = HSE. ASSESSORS MAP 57 LOT ti� / 9 LOT 9-2 LOCUS MAP 79 _ GRO UND WA TER PROTECTION 6 J roo 0 VERLA Y DISTRICT "APlV T r, 0 9 stO \ \ PLAN REF 404146 \i GARAGE l O O nl FL00p2. \ I . C.B. fnd. )l/ 4j 2 20 4 z ti o 0 0 0 � o; SITE & SEPTIC PLAN ' ° 1 O z ti ti ti o\ 98 .� O4p l� lb PROJEC T L 0CA T1ON I o 114 1305' 4%� o o /y 1356 OLD POST RD. � . o o ,SO 'ti \99 113 112 111_ c� U.POLE Z MARSTONS MILLS, MA. 109108gl� W \ 100 APPLICANT• 10 0 i �9105 134 5, w � MARGARET FITZGIBBONS 105 —104 • LOT 9 104 3 J 1 W � LOT s8 so 10 =_ `� l YANKEE SUR VE Y CONSUL TAN TS 10-1 103 — _ 6's�;eQ, gyp$ AREA 42,830 SQ. FT. ti �, P. O. BOX 265 UNIT 1, 408 INDUSTRY ROAD - .. (6 o MARSTONS MILLS, MA. 02648 OF l / Q PH. (508)428-0055 - FA X(508)420-5553 s J I CALE. 1 =30 ,s ?"� I ' ]IFDA TE.- 4 A?7 1O0 x' i =ram "> SIN > BENCHMARK. ��' ` ►s� REV. REV EL=100,O(ASSUMED) / . TOP OF STONE BOUND ►'� JOB No. 5230 7M SHEET 1 OF 2 r EL. = 109.5' - TOP OF FOUNDATION 20' MIN. '6. 10' MIN. CONCRETE COVERS ~ 4" SCHEDULE 40 P. VC VENT MIN. PITCH 1/8 PER FT. 2"LA YER OF EL = 108.5 CONCRETE CO VER WASHED STONE EL=109.0' . . . . .4" CAST IRON PIPE 6" MAX ' ' ' 6" MAX ' (OR EQUAL MINIMUM PITCH 1/4 ' PER FT. CLEAN SAND MIN. FLOW LINE a EL-104.75' N INVERT 1 N 14" EL.= 106 0'_ CAS tNVERT �2 0' ° o 0 0 0 0 0 0 0 0 0 ° ° BAFFLE _ 105.5' 6 SUM LEVEL o o °o 0 0 0 0 0 0 0 0 o a ° EL.= 10z.25 INVERT EL.— INVERT INVERT o EL. = 105. 75' EL.= 105.0' EL.= 104. 75' 4' ° 4' (TO BE PLACED ON FIRM BASE) DISTRIBUTION INVERT MECHANICALLY COMPACTED OR 6" OF STONE BOX EL - 104.25 ' 35.5 X 12.5 GALLONS TO BE WATER TESTED TRENCH FORMATION SEPTIC TANK IF MORE THAN ONE OUTLET O PLACE ON 6 STONE 3 4" TO 1-1/2" SOIL ABSORPTION PROFILE 0 F sHED S71UNE SEWAGE DISPOSAL SYSTEM SYSTEM - (SAS) NOT TO SCALE BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV.= TESPIT SOIL LOGS NO OBSERVED WATER TABLE (416100) ELEV.=__91.5' SOIL TEST P.#9714 OBSERVATION HOLE I ELEV. 104.0 PERCOLATION RATE MINI INCH AT _3CL" INCHES OBSERVATION HOLE 2 ELEV.=_ 106.5 DATE OF SOIL TEST 416100 DEPTH HORIZ TEXTURE COLOR MOTT. OTHER DEPTH HORIZ TEXTURE COLOR M07T. OTHER SOIL TEST DONE BY BRUCE C. MURPHY , R.S. 0-8" A SANDY/LOAM IOYR 6-1 0-8" A SANDY/LOAM IOYR 6-1 8"-3' B LOAMY/SAND IOYR 5-8 8"-3' B LOAMY/SAND IOYR 5-8 WITNESSED BY: JERRY DUNNING 3'-1216" Cl MED./SAND 10 YR 6-4 3'-11' Cl MED./SAND IOYR 6-4 GENERAL NOTES NO WATER NO WATER 1) ALL WORKMANSHIP AND MA TERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF _BARNSTARLE____ RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" DESIGN CALCULATIONS.' 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN NUMBER OF BEDROOMS 4 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE GARBAGE DISPOSAL NO USED UNDER. OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL TOTAL ESTIMATED FLOW BE MORTERED IN PLACE. ( 110__GAL/BR./DAY x _4__ BR.) 440 GAL/DA Y 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH REQUIRED SEPTIC TANK CAPACITY 1500 GAL DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO INSTALL THREE (3) ACME OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. SOIL CLASSIFICATION . . . . . . . . _ _ 500 GALLON LEACHING I 6J UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR DESIGN PERCOLATION RATE � 2 MIN./IN. IS TO CALL "DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS CHAMBERS WITH FOUR FEET 74 PRIOR TO COMMENCING WORK ON SITE. STONE SIDE'S AND ENDS EFFLUENT LOADING RATE . . . . . . GAL/DA Y/S.F. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS SPACED ONE FOOT APART. LEACHING CAPACITY (AREA X RATE) 465 GAL/DAY SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. RESERVE LEACHING CAPACITY . . . 465 GAL/DA Y 8) PARCEL IS IN FLOOD ZONE___"C"-____. 35.5 X 12.5 (35.5 X 12.5 X . 74)+(35.5+35.5+12.5+12.5 X . 74 X 2) 9) LOT IS SHOWN ON ASSESSORS MAP _ 57_ AS PARCEL __29-2_. SHEET 2 OF z 52307M JOB NUMBER