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HomeMy WebLinkAbout1500 OLD POST ROAD (CT & MM) - Health 500 ©Id Post Road- , Marstons'MillsY •F/R A = 057 005002 / O 1 a COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS -DEPARTMENT OF ENVIRONMENTAL PRO 7EPT. s OC 2003 TOW NISH TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION � ` INCTECTI0 Property Address:. 15no v ` MAP Owner's Name: ,t Owner's Address: PARCEI : O� 'S �� Date of Inspection: 3 Name of Inspector- (please rint) 4 I-T, -&f-)�i/ Company Nam Mailing Address: t A-1A .Telephone-Number: $-- -77 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 Fail e. Inspector's Signature: Date: AG/0? 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 ****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 l 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY,ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL,SYSTEM.INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner 119of Date o ns n: P ectio Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: f "4- I have not found any information which indicates that any of the failure criteria described in 310 CMR 15303 or`in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair, as approved by.the Board'of Health,will pass. Answer yes,no or^not determined,(Y,N,ND) in the for the following statements. If"not determined"please explain:" The septic tank is metal and over 20 years old" or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent, System will pass inspection if the existing tank is replaced with a_complying septic tank as'approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. R ND explain: Observation of se,vage 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: 2 Page 3 of 1'1 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ;W Q Owner:O ' Date of Inspection 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 o-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 I 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 YOLUNTARY,ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART.A CERTIFICATION,(continued) Property Address: Arlal� C Q, WK Owner: Date of Inspection: c73, 0003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yet 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 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. V Any portion of cesspool or privy is within 10.0 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. _ 1 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 bu't greafer 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 certifiedlaboratory,'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 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. 4 Page 5 of 1.1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART R CHECKLIST Property Address: AZO Owner: 4 V&V-A,1 Date of Inspection: �pQ Check if the following have been done. You must indicate"yes"or."no"as to each of the following: Yes No _i� Pumping.information.was provided by the owner, occupant,or Board of Health -tZ 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 ? / V Have large.volumes of water been introduced to the system recently or as part of this inspection? l� 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 breakout? 1� 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? V._ 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 Page.6 of l I -,OFFICIAL-INSPECTION,FORM_NOT FOR VOh'NTARY'ASSESSIVIENTS .,ISUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORIVIATI ON Property Address: CJ�—el Owner: ' Date of Inspection: Q FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):� Number of bedrooms(actual). . DESIGN flow based on'3]O.CMR 15.203 (for example: 11:0 gpd x#of bedrooms): -Number of current residents:_ Does residence have:a garbage grinder(yes or n*. fif Is laundry on a separate sewage system ( es or yes separate inspection required] Laundry system inspected( s or no)� Seasonal use: (yes or no).--/'X ':. - Water meter,readings, if available(last 2 years usage (gpd)): Z4�1,0 ®?, -1 T!T Sump pump(yes or n1-11. Last date of occupancy: 1//eCG>✓ ( E .. ' Jr �� COMMERCIAL/INDUSTRIA.T�{� Type of establishment: J Design flow.(based on 310 CMR.15.203):-- gpd Basis'of dessign.flow('seats%persons/sgft,ete:): 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 Y �J Source of information: 'f Was system.pumped as part of t e nspection(yes or If yes,,.volume pumped:___gallons-=_How was q ntity pumped determined? - ke'miTor.puinping: . TYP 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 x. _Other.(describe): A roxupate age of al] components,date installed (if known) and source of information: Werese. age odors'detected when arriving at the site(yes or no 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PART C SYSTEM INFORMATION(continued) Property Address: 1, ZP34� Owne�lllz� -13J�,dA- 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 line: Comments(on condition, of joints, venting, evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: _ Material of construction:4zconcrete_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: ?,s )((p o X Sludge depth: /�/i Distance from top of sludge to bottom of outlet tee or baffle: ?A9 Scum thickness: Distance from top of scum to top of outlet tee or baffle: Z /� Distance from bottom of scum to bolt Df outlet ter,or baffle' _ How were dimensions de-ermined: Comments(on pumping recomme dations,qnlet and outlet tee or baffle condition, structural integrity, liquid levels related to outlet invert evi ce of leakage,eti.): GREASE TRAP/f&:(lo ate 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 1 Page 8 of 1 I .OFFICIAL INSPECTION FORM--NOT FOR YOLUNTARY,ASSESSMENTS f SUBSURFACE,SEWAGE.DISPOSAL SYSTEMJNSPECTION FORM PART C n SYSTEM INFORMATION(continued) Property ddress: Owner J 2� Date of Inspection: c3QOO 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/day Alarm present(yes or no): y Alarm level: Alarm in working order(yes or no): Date of last pumping- Comments(condition of alarm and float switches, etc.): DISTRI_BUTION,B4OX: f-Z-0 present must be opened)(locate-on site plan) a . . Depth of liquid•level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of eakage into or out of box, etc.): � � PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no):: Alarms in working order(yes or no): r> Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): S 8 t , Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property ddress: (` 2 Owner Date of Inspection:bj SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type iz aching 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, 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:/M1�(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 i Page 10 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURF ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PART C SYSTEM INFORMATION,(continued) PropertyIdd4ress:Owner: /�0 C�Date of Inspe hl)00- 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.. 10 Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) .Property Address: (,�/ j�C� Owner Date of Inspection: 3�Q�03 SITE EXAM Slope Surface water Check cellar Shallow wells y Estimated depth to groundwater f 0 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design.plan reviewed: 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: 10, 11 Permit Number: Date: Completed by: 59��,YpGA HIGH GROUND-WATER LEVEL COMPUTATION Site Location: ���� �6�. �J f / Lot No. Owner: 41� � � �� Address: Ste' �'. "ontractor:_��� ly�/ i ,$ ; Address: 'Z Motes: STEP i Measure depth tawater'table GG�� �j oo��22 , to nearest 1/10 ft. .......................... .........:.... .Date !/G37 U',7 1 I month/day/year �— STEP 2 Using Water-Level Range Zone and_Index Wel-l'Map locate site.and determine: 7 � I A Appro.priate index well..........................•....�,0411 Z-53 Water-level range zone ................................................ :.... S EP 3 Using monthly report."Current Water Resources Conditions" determine current depth to water level or index well .......::.................. ✓�J i month/year STEP Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index.well (STEP 3)., 'and water-level zone (STEP 2B) determine water-level adjustment•............................ j , STEP 5 . Estimate depth to high"water by subtracting the water- -level adjustment (STEP 4) from measured'de'pth to water level at site (STEP 1) .:......._.......... Figure 13.--R� ; ' 9 .,prc�uclole comp�taiion Term. 15 ®�/V EF .� I I TOWN OF B STABLE LOCATION .�00 0.QA -(X U� SEWAGE# O0 -6— r VILLAGE -i3O ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I 000 LEACHING FACILITY: (type) (size) x 30 NO.OF BEDROOMS BUILDER OR OWNER nat� PERMTTDATE: FldtQ a COMPL CE DATE: — 116IN Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility IV4 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 leachin facility) Feet Furnished by�1� , Aoe!n 5P 51 ® � � -bat No. :2 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 01pphration for Digozar *pztem Construction Permit Application for a Permit to Construct( . )Repair( ✓)Upgrade( )Abandon( ) O Complete System eIndividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel 0 02���`5��`y //�s Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. vpl- &ww roe �V, 77/yg3 Type of Building: / Dwelling No.of Bedrooms 3 Lot Size �J �Y1 sq.ft. Garbage Grinder(1W Other Type of Building ,? GP No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3,30 gallons. Plan Date // 3 Number of sheets Revision Date Title S SI ad r S Size of Septic Tank /9r,9 raj .g��%�r9-Type of S.A.S. Z Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b thi Bo d o Health. / Signed kn Date /Zl, Application Approved by - Date Application Disapproved for the Tollowing reasons Permit No. Date Issued A2a No: ''� Fee�`�—�,c/ , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �/ ✓' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEs MASSACHUSETTS 2pplication for Digozal *p6tem Con$truction Permit Application for a Permit to Construct( . )Repair(I/)Upgrade( )Abandon( ) El Complete System Individual Components Location Address or Lot No. O/ Owner's Name,Address and Tel.No. wa�d(�dri,� Assessor's Map/Parcel ��f/s^ rocs'- vt�z Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 71-93W Type of Building: / Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder(/L)9 Other Type of Building �(P_S//Td��Ce No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow % l gallons per day. Calculated daily flow .330 gallons. Plan Date 31/J.3 Number of sheets Revision Date Title S S% ,4Q`>9 1,5,x-^- 15//l tJ//J --V o Size of Septic Tank I(P490 Afl Type of S.A.S. Z `545' l G Q'A1�f/'S Description of Soil, ,✓ �O X J Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. � Signed J in Date /Z//1G3,3 Application Approved by ` �,�,Z/1' Date Application Disapproved for the following reasons Permit No. v r Date Issued Lol --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded ( ) Abandoned( )by at has etat' nstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. b /0 3 Installer Designer t The issuance of this!permit shall not be construed as a guarantee that the system will function as designed. Date 1 I t, 1 !� L Inspector (\ ._�� A \ f 1 r No. �11� "°<) K�L../ ----------------------Fee c, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS MigPoot *pgtem Construction Permit Permission is hereby granted to Construct( )Repair 4 up rade( )Abandon( ) System located at 7`ye-5; and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction dust be completed within three years of the date of this permif. Date: >� I "J� Approved b • TOWN OF B STABLE LOCATION=0 ,004� SEWAGE# 20 -- VILLAGE'.: ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY G 00 - LEACHING FACILITY: / (type) (size) NO.OF BEDROOMS PP - � BUILDER OR OWNER lJL� PERMTTDATE: I&ID 3 COMPLIARCE DATE: 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 leachin facility) Feet Furnished by . Ij } d 60� LE �i�l Town.of 13r'IIStiaile . P rE Deplrtmept of f eaitll,Safety, and Lnvironmerital Services �zlur, . `Pu.hlie H6, lth.Divisiol;, ante .367 Main 5trcct,llyannis hIA,02601 onrwrrraoc$ S MA59.f o,q ,y .b� Tim /, G' 1�ee Pd. " Date oMx+ .Scheduled 'oil Secitability'Asse�ssi�zerzt foq� Sewage Dios�cl Peiformcd+l3y: e.a�}�i t pJ r ''`'rl � Wiutessed:By' I+.O�✓ rJI QA,. YJr :�lr�n JW MlY �0r4rylf� �0 �Locittion Address c / Owners Name i ex� Address Assessor's Map/Parcel: Engineer s:Name XciAL✓ .� ��6t'Nlircv'a / sari�.1. S4 [ 5 �vu',lle LNEW CONS I'RUCTiON V , REPAIR telephone N j 4-z- Slocs(a 1 p. ) Surface Stones Land Use w(jt s /a 0 Distances from Open Water[3ody' R Possible Wet.Area R Drinking Water Well R Drainage Way .it[)` R Properly Lind R. Other R S](�� '( ��: (Street name,dimensions oCiol,txact locations:of lest holes&perc Icsts,'locate we.11ands.in proximity w holes). 0. sJ I'arent'material(geologic) Depth to IJcdrock-it . n [ `` Wec in frown Pit race _ J s Depth to Groundwater Slanding Water in hole sweeping tt. Estimated Seasonal.illgh Groundwater xx, . . Method Used hi ice? in Depth to soil mottles:' . in; . Depth'Observed slanding.In obs hole: p R. Dcpih to weeping from side of obs.hole in Groiutdwnlcr AdJgslmcnt ^ index Well N mending Date: .index Well Ievcl Ad.I,factor AaJ:Groundwater Level_. i a -r—,�„-m,•.•.�,-•-,. T�, /.-fir V �+�t �,C • 1.�lu�,L"4JA.�f�,�'1�11 r�'l,'..,i7'r� I).gft;'.. '' l{lit4 e Observation tin at9 I lule N 6 Depth of I ere r , ri me at 6 $tart 1're-soak Time. 1ei1�/ Time ) Cnd Prc•sonk I.I ;� -' '- , ..,..(_.y�"�i ✓LL� �.y.L jtZ:Lg 1..t1'A t:�t,,ry�/� _ 771 Rate M10111cit Site Suilnbility Assessment Srle I'essed SUe Pniied .Additional'Iesli.ng Needed(YIN) Onginnl; Public i1callh Divislott Observation Mole DAti1 TO De Completed on DRcic j pTt'.p3SX2'VA 'XC , ftlGXale # Depth"from Soil Horizon Sol[Texture,:, Sol[Color Soli Other Surface(In,) (USDA) :(Munsell). Willing (Structure,Stones,Boulderes. 04a�2Z . 1711 2 o � 5 o , 4 . DE ' OBS;GR�'A' ..:Z[�1L Depth frorn Solt Horizon So Texture Solt Color. Soil Other Surface(In;) (USDA) (Munsell) Mottling . (Stru'cture,Stones,Boulderes. a _, :7777 Depth from Soil}lorizon Soil Texture Soil Color . Solt Other Surface(in,) (USDA) (Munuil) Mottling (Structure,Stones,Doulderet; QonskiencV.e p E1✓I' 0)�SERV ATION ;CaL L+�G. Depth from Soil Horizon Soil Texture, Soil Color Soil Olhcr Surface(in.) 0 (USDA). (Mansell) Mottling., .(Stricture;Siones.Boulderes. good Ins►irance Ratt an. Above 500 year flood boundary No_ Yes r Within 300 year boundary No 1� Yes . Wllhln 100 yeei flood boundary N0 Yes Dfspt f tit trally Occurring Pervious Materlal Does.at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the.soii absorption system? If not, what is the depth of naturally occurring pervious material? Certificat►on L.certify.that on Y► �5 (date)I have 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 tfain.in , ex ertise and experie , o described in 310 CMR 15.017. r Signature Date9 ++QQ a � va --y-6 Fim N .................. THE COMMONWEALTH OF MASSACHIJSETTS BOAR® OF HEALTH /G�Gvta.............OF.......f. r� - ....................................... Gov Appliratiun for t911uua1 Works Tonstrnrtlun Errant s boa�✓ Application is hereby made or a to er it or ruct ) or Repair ( ) an Individual Sewage Disposal System at: ......_..... _ .. .. ..: ! .1.. .. / Qr'.So!� -ills........................:......... ..... . /Location-Add res or Lot No. •............ ----�'-0....... owner Ad ess-• OZG.3 Z W a -----------------•----...--••--•----•--.......Instal---•••-••-•-•---------••-------•-•--•......-- .............................................•-- es.a........................................... ._.......-----.. � ler Address d Type of Building Size Lot...... ____..__�..Sq feet U Dwelling—No. of Bedrooms...........-3 .Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building d!/L'QQ..�� No. of persons ............. Showers Cafeteria a YP g ------- ---- - P (oZ) — ( ) Q, Other fixtures ---------------------------------------------- W Design Flow................... s........_.___..gallons per person per day. Total daily flow......................a.............gallons. WW B4 Sep is Tank—Liquid capacity./Vogallons Length... - ... Width...4�'!�. Diameter................ Depth...4.-�... Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........L--------- Diameter........Z.42..... Depth below inlet......G......... Total leaching area..2G7.7..._sq. ft. Z Other Distribution box (✓f Dosing tank ( ) Percolation Test Results Performed by.-..,&,- Ale-1W................................ Date........A 7/.f`A-----:.. PSG97 Test Pit No. 1.....a•.......minutes per inch Depth of Test Pit------l.3....... Depth to ground water... N�?_ .... G%, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --•--------•-•-•-•. -••-.......... -_...._ ..... -•-._...---.•-•-- ---••---......................................................... O Description of Soil....................49�-A.'_7_e!o�- .146 t0o1 r 2 13 �� = - ea'y W V ..........................................................••-••-•-••-•-•-••-•-•••-•-----•-•-•-•••-•••••••••••-----------.....-----------•----•-•••-••-•-......-------••••--•-•-••-•--..._---•--•---•---- W UNature of Repairs or Alterations—Answer when applicable............................................................................................... t �' ------------------- ----------------------------------------------------------------------------------------- -............ Agr Bement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLEj 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the board of health. �ateAigned _.. -------------------------------•---------------- _AS /121ate pF<lication Approved BY ------.--• ----•-•••••................•..-•--- -•-•--_. ��....�----- ........... Application Disapproved for the following yeas ns:.......................................................•----...-•-----------_--- ....:__._..._ --•--•-•...............•-•-•-•---...--••--•--•--•--•-------••--•------.......------...-----•------------.--------------------------------------------•---••-•-•••-•--.....-------•--••••--••--------•--- Date Permit No...... --7-a- ....-•-•---•--•-....... Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 2 l 1-tom .............OF...... 5../ jvl.A�...................................... Appliration for Disposal Works Toustrurtiun Frrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: �. a ..�...--... •-©ice Location-Addres or Lot No. ' Owner Ad4fess OL�o 3 7 W Installer Address dType of Building Size Lot......4.4=,_2z Z_..Sq. feet V Dwelling—No. of Bedrooms............ ............................Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ��.Je No. of persons...........Y............. Showers Q2 — Cafeteria ( ) Q' Other fixtures ................................. . W Design Flow...................53- ........................ per person per day. Total daily flow..................... .............gallons. Ri Septic Tank—Liquid capacity//.gallons Length... ... Width... Diameter________________ Depth..a:!,._.. xDisposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------I.......... Diameter........!_ ......... Depth below inlet...... �. ......... Total leaching area.. '7_....sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by._-f��!-iGC....!�s_/1--------------------------------- Date.__....:? � i:........ ,aa p5e-97 Test Pit No. I.....2.......minutes per inch Depth of Test Pit------l:,�......... Depth to ground water-__i�l�.rt. fz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------- --------------------------------------------------------••••-••--•••••••--------••-••---•--•------------•----••........••---•...... O Description of Soil.................... ......777?', ._!5" x W ----•-.................................................................................................................................................................................................. UNature of Repairs or Alterations—Answer when applicable................................__.__...____......_......_.._...................._.......___._.. -------------------------•------...-----------------------•--------•---------------........--•------...........------------------------------------................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed----- - ------------•.....----••-•'----------••---•-------•• ............. ate Application Approved By................ ��=` �`f `'� -'�`'`--------------•-----------•-------- q � ate te Application Disapproved for the following re ns:-•---------•--------------•-----•-••-•••-----------•----------•--------•--------•-------------•---._...•----- ----------------------------••---------------------------------------------------......---.....-----•---------------------•-----•••----------••----------------------•------•-----------•--••--•••.-••- Date PermitNo.-----��--..--..•-- .......�--------------------••-_. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7........ ��1 ..............OF.....6 �f/ �;<�-........ Trrtifiratr of Tuutplianrr TI5ZS-IS'0 CERTIFY, That the Individual Sewage Disposal System constructed V) or Repaired ( ) ..J�'l���CL Installer f a....._�=�-�------ .... ._.... ,..........f _.... -� ------------- = 't ' / ----- = ....................................... has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------------------------------------------------ THE ISSUANCE OF THIS .CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS .J BOARD OF HEALTH 6 �0-7 ............/�..W!: ...........OF...... {"✓�/�� � '�:..................................... � . No......................... FEE. ..�-•-•--........ Dish owl Works T.snstrurti in je`r' m t Permission is hereby granted......._._._ ...�'..�� �-_._._...._ to Construct (✓) or Re air ) an Individual Sewage Dis osal System at No... '` l�r ..... ! & ------- -'�................................................................... IZ Street as shown on the application for Disposal Works Construction Pe t �0.1�ofealth No....r-ll............__ Dated.......................................... �— I DATE.--------- i�6 FORM 1255 ORBS & WARREN. INC., PUBLISHERS :.. .s A / SITE PLAN , SHEET / OF 2 SCALE: I"= Sn L� i LOT g n � r \V LOT 4t- � A o I l 44,02 S77-7:f'.2Fcr13T come. Woo Gwe �^ , J �, �j � , tz-� 57D.P.25c'•95T Catk'. a q% a T 55 --T �Tp Uzi neon. L 170 BOA D E9�,H OFF�9s g M..: �', No. 1®"I e" . �EPSTEa���¢ FOR /,34Y,SIO,E e!J/L 0/ti/6 CO REGISTERED LAND SURVEYOR L o T T- 12a,q o ZONE seF M,�,F.S T: .,1-15 /0/ 4 5, ",fM-37iaf3LE M PLAN ,REF ©e-�T /k2,4P 57 PGL- 5' DATE ` BENCH MARK DATUM WM. M. WARWICK B ASSOC., INC. DOMESTIC WATER SOURCE -7-aww Kllg rE/z BOX 8OI - NORTH FAL MOUTH FLOOD ZONE. /VoA/- IVRZ,9220 C MASS. 62556 - (6/7) 563 -2638 +I f : LEACHING BASIN SECTION NOT TO SCALE Shecr/ 2 '7Z Z 24 C.1.MH COVER EARTH L F/L 1 BRICK AND MORTAR COURSES AS REO'D• TO BRING j •• 4 � _,r.�_- + _ COVER TO GRADE (j B'FLOW LINE INLET �_ i F" "TO%" WASHED PEASTONE FREE OF IRONS, f P/PE FINES AND DUST /N PLACE OPENING WITH 4% ' 1•• •' 314" TO /%2"WASHED CRUSHED STONE FREE OF .�� Gv B IRONS, FINES AND DUST /N PLACE OUTER DIAMETER 1 AND 1314" INS/DE DIAMETER •• ; 1. CONCRETE TO BE 4000 PSI 28 DAYS 2. REINFORCED WITH 6 x 6 NO. 6 GA. W W:M. 3. 2'AND 4' SECTIONS ARE AVAILABLE FOR -GREATER DEPTH REQUIREMENTS 40„ --2' —} 6'0" 4. NUMBER OF PITS REQUIRED / j_ MIN. I io' NOTE: EXCAVATE TO ELEVATION 41.6 OR EFFECTIVE DIAMETER l (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL 1 J WATER TABLE - ,Vw7,9 LOAM AND CLAY BENEATH PIT. REPLACE ' EXCAVATED MATERIAL WITH CLEAN TYPICAL PROFILE GRAVEL TO DESIGNED GRADE. I —/B"STD LT. WGT. C.I.MH COVER 4"C./.PIPE 4"B/T.FIBER PIPE TIGHT JOINT OUTLET LEVEL i DWEI LING FLOW L/N£ _ o o - p TO FIRST JOINT - -•T 1 coo C.I. TEE ,5l 29 I I o 1 0 0 1 1 D.0 I 11000 00 1 1 1 1 Sr PRECAST CONC. 5/,gG0 D/ST. BOX TO BE s, ' 11000 O 0 I 1 i I . AL.SEPTIC TANK. . INSTALLED ON LEVEL ! I I 1 0 00 0 0 0 1 I I t: 11f 000 00 0,1 I 1 STABLE BASE 10 O O e , 111 O 1111 y \SEPT/C TANK To BE 1 1 1 0 0 0 O 0>D 1 1 1 INSTALLED ON LEVEL, I I f 100100 11 ' i STABLE BASE. 1 1 1 0 0 0 0 0 0 1 1 1 11100 1 LEACHING BASIN 0 Op 0 00 D I 1 BASE TO BE LEVEL-, 1 f 1 8 0 0 0 1 11 4S•e 1 SOIL AND PERC. DATA i PERC. RATE : A_ MIN, /IN. 011 TEST PIT NO. I 01� TEST PIT NO. 2 a TEST BY : 136"cif A,!�k WITNESSED. BY: 7_ AV!&!s� �.td TEST PIT GR. EL. •0 �• ti� DATE.: s m� DESIGN DATA GENERAL NOTES BEDROOMS 3 NO HEAVY EQUIPMENT TO RUN OVER'SYSTEM. .1 -DISPOSAL wore SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD I - PRECAST REINFORCED CONCRETE UNITS. EST. TOTAL DAILY EFFL.•054GPD. I . SEPTIC TANK boa© GAL. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE SIDEWALL AREA. GAL./SO.FT. TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE, MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA_L0GAL./SQ•FT. SANITARY SEWAGE EFFECTIVE ON JULY 1 , 1977. LEACHING REQUIREDJ-MSQ..FT.. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ACTUAL LEACHING AREA OF HEALTH. 2/,zZ.SQ.FT. AT -COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. t PITCH ALL SEWER LINES I/41 / FT. , UNLESS INDICATED OTHERWISE. `SN or SEWAGE DISPOSAL SYSTEM MARTIN 'PC �23417�(') 32 IfAI E �i SCALE AS INDICATED aATE_��` WM. M.--WARWICK 8 ASSOC., INC. 8OX.:80/ - N4RtH fALMOUTN ` MASS. 02556 - (6/1) 563 -2638 PROFESSIONAL EN61NEER I , TOP FNDN. AT EL. 51 .8' SYSTEM PROFILE TEST HOLE LEGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: RICK JUDD, RS ROUTE 28 F MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM , 49.0 WITNESS: SAM WHITE, RS EL, 50.7' RUN PIPE LEVEL 2" DOUBLE WASHED PEAS ONE I Locus / FOR FIRST E DATE:_ 1 1/21/03 EXISTING 1 0 / 3 MAX. PERC. RATE _ < 2 MIN/INCH GALLON SEPTIC 49.3't* f 46'8 CLASS 1 SOILS P# cAJnYN cIR TANK (H- 10 ) GAS - o '• RE-USE BAFFLE 46,67' �o0 46.5' f� (� (� 0 0 46.0' CI � CICI C MEDj- o o 6" CRUSHED STONE OR MECHANICAL ED E CJ 0 0 D C1 0 0 QJ o ELEV. 4' COMPACTION. (15.221 [21) MIN oo Fa 2' O 0 Q I� 1� 0 ,4,0' 0" 49.0' o DEPTH OF FLOW - ( 6 % SLOPE) ( 1 % SLOPE) A TEE sizes: 3/4 TO 1 1/2 DOUBLE WASHED STONE P 6 INLET DEPTH = 10" SL OUTLET DEPTH = 14 _ . _ 9" 10YR 2/1 LOCATION MAP NTS Bw FOUNDATION--- EXIST, SEPTIC TANK 43' D' BOX 16' LEACHING LCS *THE INSTALLER SHALL VERIFY THE FACILITY 5.2' 32„ 1OYR 4/6 ASSESSORS MAP 57 PARCEL 5-2 LOCATIONS OF ALL UTILITIES AND ALL TREE LEGEND 46.3' BUILDING SEWER OUTLETS AND ELEVATIONS PRIOR TO INSTALLING ANY PORTION OF 10" - 14" OAKS SEPTIC SYSTEM C 3" - 6" WHITE PINES 38.8 CS 10YR 5/4 250 02, _I 6" ORNAMENTAL 10" - 12" PITCH PINES 122" 38.8' a9 9 NO WATER ENCOUNTERED NOTES 5 150.2 SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) 0.2 7 1 . DATUM IS APPROXIMATE L1GVD D_.Slr'N FLOW: -3 RFD9( 0"S ( 110 rPD) - 33 ) (fPn Y - I USE A 330 GPD DESIGN FLOW _ 2. MUNICIPAL WATER IS I_XLA iNG -i-4'�T.3 r . _ - = 9.8 SEPTIC TANK: 330 GPD 2 6�60 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT, � PAVED4g-6-- ^' i 49.8 �+., 1000 (�) 4. D';SIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 I DRIVE i .4Oo b USE A ____ GALLON SEPTIC TANK (RE-USE EXIST.) 5, PIPE JOINTS TO BE MADE WATERTIGHT. I LEACHING: 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 149. 48.3 _0 1496 O SIDES: 2(30 + 9.83) 2 (.74) = 118 ENVIRONMENTAL CODE TITLE V. 1 / 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT LOT 2 I 0.0 i BOTTOM: 30 x 9.83 (.74) = 218 TO BE USED FOR ANY OTHER PURPOSE. 43,606t SQ. FT. I / •7 i 454 336 GPD 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. I + 0.1 ,� i TOTAL: S.F. + 48,ra 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 50.7 i + I USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED o + $ EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' FROM BOARD OF HEALTH. FLAG STONE + o W d BETWEEN UNITS10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING LEACH PIT WALK n 3.5 i ui 0 + 7 4S 49.3 BENCH 11ARK` - CENTER OF + 0,7 ---�+� CATCH BASIN EL. = 48.5 LEGEND a W + e + 48.6 W I TI TL� 5 SITE PLAN .,..1 I �� 8.5 + 0.9 75 .6 & 5 �, I � . PROPOSED SPOT ELEVATION OF0 1 ,5Oo POST EXIST. DWELL. Co I OLD D ROAD r` TF = 51 8' 5 I \/ 8'6 100x0 EXISTING SPOT ELEVATION � + + I 10o IN THE TOWN OF: � .e + 2 I PROPOSED CONTOUR ( MARSTONS MILLS BARNSTABLE � DECK �''' + 019 50.6 I �8'6 100 EXISTING CONTOUR + 1 .0 I PREPARED FOR: BORTOLOTTI .9 0 + 3 .9 6 1 r 49. I I+ 50.8 .8 CONSTRUCTION/WOODBURY 0 49.2 20 0 20 0 60 + 2 •0 + .6 I - BOARD OF HEALTH RH�'D I MA SCALE: 1" = 20' DATE: NOVEMBER 23, 2003 0 r II i APPROVED DATE 51.0 TH 48.5 01off I 08-362-4541 49.6 + I fox b08 362-9680 -10 49.1I ( t`HOf �rR ��}M x _x�X�x____x�x +- ,x x a - i down cape engineering, inc, A�,"'� 5` ��� ARNEH, ���� 49.3 OJALA ;iI o OJALA CIVIL ENGINEERS s NO. 26348 C� CIVIL + 232.61 // LAND SURVEYORS " ��' No. 30792 939 vain st, y arrlouth, ma 02675 03-333 AR E OJALA, P.L.S. DATE __ ------- - ---- - - ----- _