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0011 PEACH TREE ROAD - Health
11 Peach Tree Road Marstons Mills A= 057-100 5 M E A No.2-153LY UPC 12934 amead.com • Made In USA �p�GYC� FW1MND SFSI0 MUM OIF � o k . C .z l l 1 6)0,,/y 01,E Co eylr -,A a y G-1 d 530 J � � ��r� 3., �f� � 2- 9.edrv--mf Avm -gz o(d 1?),�e d�,e &41 e14 W a} r r Ccf.N C- by G.C]h a drvOAI- 1 VS, 7 G'A,) w�C�f- f + OS-4-- 1 bb Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information S # 1Iry Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails <1� 6/19/20 Inspect r i natur 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/201 E T Ie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c� Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,. 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. i El 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): 3) 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. a. P System will ass unless Board of Health determines in accordance with 310 CMR Y 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2C 18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ,. ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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 p system asses if the well water analysis, performed at a DEP certified laboratory, for fecal Y 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I Commonwealth of Massachusetts ,F Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 Y 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. ❑ ® 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 water supply 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 form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 i Commonwealth of Massachusetts �. ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No . ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: The 2011 engineered plan has 349gpd provided. Letter in file states that property is ok for 3 bedrooms, system is typical of 3 bedroom Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: O ceupied t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �a Title 5 Official Inspection Form ,. Voluntary for Subsurface Sewage Disposal System Form Not f Assessments n t,. 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: Pumped May 2018 per owner .Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? a Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �o 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Original septic tank per age of the home, new d-box and chambers 2011 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/208 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts ,o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 10.1 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: Years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g 4" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness trace-1/2" Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 II c Commonwealth of Massachusetts ,�p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4� -•� 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: El concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts �. ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,.� 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): 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.): H-10 D-box is 2' below grade, box appears to be structurally sound l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l�a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form (( Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41� 11 Peach Tree Road Property Address Mulrenin Owner Owner s Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (con ` 1 Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching chambers were video inspected and have approximately 1"of effluent in them at this time, no indication of past hydraulic failure 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): rev.7 6/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 18 t5insp.doc /2 P 9 P Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �o 11 Peach Tree Road Property Address Mulrenin Owner Owners Name information is required for every Marstons Mills MA 02648 6/19/20 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 TOWN OF BARNSTABLE LOCATION 1 L t�%4tA1-� � (? SEWAGE# 4,011—�S� VILLAGE SSESSOR'S MAP&PARCEL 9S-7- INSTALLER'S NAME&PHONE NO. t I f�t�V•iT-r'� .�LI�t-'I-L(� SEPTIC TANK CAPACITYX =, Zf �• — LEACHING FACILITY:( t izia4e FF (size) x L�• NO.OF BED��R/OOMS �- OWNER ..i"C PERMIT DATE: - L j COMPLIANCE DATE: I ! Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet i 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(Many wetlands exist within 300 feet of leaching fiLcility) Feet FURNISHED BY G�� Sit J9" O m Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >120" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 2011 ngw 120" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 4' seperation per 2011 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping shows the site at 48'msl and nearby surface water at 2'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2)18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 F Commonwealth of Massachusetts �. (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 11 Peach Tree Road Property Address Mulrenin Owner Owner's Name information is required for every Marstons Mills MA 02648 6/19/20 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. B. Certification: Signed & Dated and 1, 2, 3, or 4 checked C. Inspection Summary: i 1, 2, 3, or 5 completed as appropriate I 4(Failure Criteria)and 6(Checklist)completed D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 F TOWN OF BARNSTABLE LOCATION ( I �L%'✓kC.{ri--�2-IE tc� SEWAGE# 44C)L I VILLAGE & SSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE SEPTIC TANK CAPACITY tS LEACHING FACILITY. (typ (size)815-x NO.OF BEDROOMS. o1_ S"UOs✓ I�L� OWNER Y`'t_ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: s Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ,07 No. Fee V 6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZlppYication for Migpoar *p5tem Cou.5tructiou,permit Application for a Permit to Construct( ) Repairp/lUpgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. �/� h /re e� Owner's Name,Address,and Tel.No..�p 9- y�8. 5-0oSi v�1a,�s{�,r,s �f Jl s Orara.t, MI,la-�,�., o Assessor's Map/Parcels- i 1 Installer's e,Address,and Tel.No. 60 7—��/ 9399 Designer's Name,Address and Tel.No. sV ` qs T/ Qor-I,c,NaN.—, Cap.e 46'1Z inep_ri n i.nc O-O. 801 o M vt i ' i oa475- Type of Building: Dwelling No.of Bedrooms Lot Size o2y,, )L i sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures /� gpd D �j Design Flow'(min.required) C✓ a esign flow provided '— �� gpd Plan Date t O � k Number of sheets Revision Date Title /f / Size of Septic Tank % t / Type of S.A.S. 01 SUU Description of Soil / O Nature of Repairs or Alterations f Answer when applicable) r7 ^ o s ,dJ Date last inspected: Agreement: The undersigned agrees to ensure the con ction an aintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of Environ tal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boa of Health. Signe Date1.41(4 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued No. Fee 0� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: S r Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACAUSETTS 2pprief-tion for bifspota[ &pgtem Cow5true W—Vermit Application for,a.Permit to Construct( ) Repair WUpgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. /// toaCA Te e I2G/ Owner's Name,Address,and Tel.No. ; o - V d 8• S'00.s soars{onS mi-its G'r+arn fY)u ire-n i,•, Assessor's Map/Parcel 5-9 UO ) Tree 1ZJ 11,�tct 9 9 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ' Ens ine-e_r-i r i nC i �S t4 C 9 ' l . r 4 klk 0a49S_ Type of Building: Dwelling No.of Bedrooms Lot Size ay, Z 1S' sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures /�?� Design Flow(min.required) P b, � gpd Design flow provided gpd Plan Date t S ;(0 1 , Number of sheets Revision Date Title a 5 s' t/ �r�e & AarSAnsd'i/,,s Size of Septic Tank ysi� .'; n. Type of S.A.S. c�L Description'of Soil / orl It Nature of Repairs or Alterations /(Answer when applicable) Sit 11D11 I ro+f Il 1/4 m& `aC --5- f' Date last inspected: - Agreement: The undersigned agrees to ensure the consttuctton and maintenance t f the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environ e�l Code aA401t to place�the system in operation until a Certificate of Compliance has been issued by this Board of Health. f Signed / 'Dated 1 Application Approved by ' Date Application Disapproved by: Date j for the following reasons c � Permit No. .7 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewa e Disposal System Constructed ( ) Repaired (f Upgraded ( ) Ab ndoned( )by 13U(� �IS�i t'rr g='S t2.100 at . I 1 8-6 AtoD rev 2 4'' , c,,,4AnI((S has been constructed in accordance l ) with the provisions of Title 5 and the for DDisposal System Construction Permit No. (j/�'c��-�S dated / ! Installer &r�lA ,tt)�� ��� �C�<�t --7-- L b-e'1 l Designer r � —,r) r, #bedrooms _ 3 Approved design flow gpd 9 The issuance of this permit shall not be construed as a guarantee that the sys em ll`f1671 a de igned. IDate ' 7 l� Inspect i ------------— -- - - II Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 1witpoal *pgtem Con fturtion Permit Permission is hereby granted t Construct ( ) Repair ( ) Upgrade ) Abandon/� ) System located at 1 / ex SPA -7,r,e and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of hif s pern3 f' Date C/ Approved by ,, AUG-16-2011 12:47 From:BORTOLOTTI CONST 5084289399 To:15087906304 P.1/1 FROM :down Cape engi+^leering inc FAX NO, :150936PS880 Aug. 16 2011 12:2GPM Pi �q�, ~r'�u`tw� �pjq -��ff nY�IIt9N.l�7��• " ' , ,r'. ��l1AlIRtLi�• u4�'Lrt'y"p. {k ��°�';�J: Pw��Znsr Tac�s�@dll� 'l�Dra'ir.+ti�srtu Thotn 29 t19(OR ep m,Dila-cld 0Y Z�01i11►i»5t�e;nt,'d�ysnfim+�,PRA 02601 pr't is.; 94A 162- 644 tax: +OA 74U-fi3t}el �nAfi��a+ �tx IIA�ffingure�r Q.'e,Ic'hf.�lrrn4'iw>,�,I��r>I�! Date: ��6 � Swap P6 nollfN I�` `�^�.Ar�,i�SWQrP'a 141f toP\Pilydrl L W r` l° 7 On �� �� , � yfis iri-Ltr d o�Irrl�r,i'tP zn'I"U I a, • sc�7Lit S��srtnwflt r� � a Iimyi01 drawn Ey Lhilod I m0ly t1 sl f� Sep yyamn roFLjt 0,M abuvc W , izs:;,fa.11-ed 80,w mblly it'; �iln� ro t3ae desip, whRb Way ))sG11x c miller Kp7?.nvea cs "nfres tilde iy Cis IMI.A rr•1u4-ntirm of#�1� dishi11utio,a hox[tiicfilrsl';srvlic twik. I anrlal"y tint tlta sowdc alp ate. m rePi�r+�le<•".�'l �1114,Vts wll srStra.11ecL Witil n-4j�n chanhjt':7 . �n•bmlt :than 0' lm':dlW.rrJr)rJr.►lauti of the RAS or. ally v+�a`1ica,l,t;�louct'aUL of,r)ry con�w�ent faf the;s� +.ic sfiy;dtc'r�t)hat iu srermaaxu',,tivith Sta7o ' T:u�'ei Tteguls)tirn , Pla" TE.-6>3i,n or e�L�Tifi�d�n ilI by de;;agna to fcilJcnv STI aF h41g�,_ l rLk ON "�C (tssetsl.�l�r' �nutsaia) J CIVIL H No,46ti02 fbr +i[;nt.'r';ibl(;n�:uso} � Y ';If;nr_r 3,`-ytflmsli MT nss:>r ra r ay s �,ays'l��•f 1R Pv,$�,�,9, n �u,1�' c�N, ANSM01-1. n IIr,�Ithl�uut;rJl7eitnl�6C.'e?GY,cay4pF'��19'�G•Gd.,i�•� TOWN OF B LECr v T OCATION �� ` ` SE�I�A� E #/�\ e W� w ti� S ASSESSORS MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �� 5�(�(size) /66 y NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 1 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 ands exist within 300 feet of leaching facility) Feet Furnished by a AA AD�6 .Q� 31 LO CAT ION SEWAGE PERMIT NO. VILLAGE - 037r7-/V0 I N S T A LLER'S NAME i ADDRESS Arc b (d hsT _ e 4-e v Ts .134 aL7-,�• Y sT t U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED— J�� r t: Y e' 2A - __ �j NW.•-- ..... Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................I.. .............OF...................................... ......................................... App ira#iou for Uhipatial Workfi Tomitrurtijan ramit Application is her made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ictc'b th e C' ` i`C' a L .. ..�._. c.................. .... - U a.. .. ------------------------ ocati Address— — y/ or c_.... .:--.... �[ �e�ov�n{• Addresg�� W Yc fL 5 1 Nc lriur� s t'�L �'�' (. ........ ......V.4. ............................ ,-� -- ------------------------------•-••----------•--.............------........................... --•..... - ---- Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............... ---------------------_Expansion Attic Garbage Grinder ) '4 Other—T e of Building ............... No. of persons..........__•_-__._________- Showers — Cafeteria Q' Other fixtures --------------------------•-•-- . Q ...........................------------ Design Flow........... flow..... WSeptic Tank—Liquid capacity/AV-gallons Length-------_------- Width................ Diameter----------------Pepth...._..._....._. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------f----------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) _ aPercolation Test Results Performed by------xiel�' -•'6AX- .................... Date..........Z=C� . .... J ,-a Test Pit No. 1 A.104-t._-.mmu es per inch Depth of Test Pit.................... Depth to ground water_-&P_1.le_.- (i Test Pit No. 2,2J`C`_`"minutes per inch Depth of Test Pit.................... Depth to ground water........................ .... •••... f O Description of Soil. �----1-61e `r�............................ .......... J'� .�a t�.: ...................................... x U ----•-•••-•--•-----•---••••-----•--•----------•----------•-••-•--------------••--••----------•••--•-•----•••......•--....... ••------••-----•---•-•-•-••••-••••-•----••--••••----••......------... ... 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 L i' L p of the State Sanitary Code— The undersigned further agree not to place the system in operation yptil a rtificate'of Compliance has en i d b t1j boa -health. Date Application Approved BY r!" ...•................•-•---••. ................ .�-=-�' .- ..----- Date Application Disapproved for the following reasons_............................................._.................................................................. ............................................................................................................................................................................. ----------------........... Date p_.•................... Issued..... .Permit No..._.. .`v....'...Q_ ....•. Date .��....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... ----._..._.OF.-.-.-..-..-.....-.-..-..-.-.-....._...--------------.....--------.........--..-.--....... Applirution for Bispnaal Works Tnnutrairtiun thrutit Ate; �i'.. tion is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal PPS Y ( ) P ( ) g P System at: •-- �l i? .... `....J. ------••----•• ................ teroca-ti Addres L .r_'► --.. �___..�°-067 ................ ••... , ....... ........ � Addres W ............ ............. Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms_______________�_. /��...� g— ______________________Expansion Attic YI� Garbage Grinder ,O aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ........................................... .................... •-----•----•••-•---•-------------••••-- W Design Flow............//0_______________________gallons per person per day. Total daily flow---- ......................................._.____._________.._gallons. WSeptic Tank—Liquid capacity .._gallons Length................ Width................ Diameter__-__________.__ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.____.-/----------- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank a Percolation Test Results Performed by........... , Pr..M __________________ Date.......... ��'�� ....... i Test Pit No. 1 W-W____mm es per inch Depth of Test Pit____________________ Depth to ground water-./ . ! /Z 4q Test Pit No. 2a_'��"!¢minu es per inch Depth of Test Pit____________________ Depth to ground water........................ a ff .-•••-••-••- O Description of Soil-- _h ._' .�¢ ! SD/+ a Z j -�i1 ' elE U --••••••-•••-•...-•----•--•-••-••••••••....•---•••-••• I` ------•---=•-------------•-••----•---------------•--------•-----------•---------......................................--••••-••••-•-- UW ----------------------------------------------------..�----••--••••-•----•---••-•-•------••-••••-••••-------•---•-•----•••••-------•••••--••••--••---•---•••-••-•-••--••--•••••._..._..._••••-- Nature 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 i i: . p 5 of the State Sanitary Code— The undersigned further agree not to place the system in operation til a Certificate of Compliance has en i d b t boa health. Si li �. " Application Approved BY_______ ,: -/_--�:__t•/_______ — a __ _ .. __ _ - ___ ._Y_________________________ . -------•---•--- Date Application Disapproved for the following reasons------------------------•---•-----•-----------------------------------------------------..--••---•-•-•_..._..•--- ---------------------------------------•-7• .•-•-•••-•--••••••-••...-••-•••-•••-••-•----•••••-•----••-••••-••••••••••--•-••-----•-----•••✓--1----•-••-••-•- - Date PermitNo No..................................... .............. Issued_ . -----••••_�_✓............_..---•---•-•- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT k.......OF....... . � 'fL.. ..................... w` Trrtif iratr of Toutpliunrr T IS T C T��FY T tithe Individual Sewage Disposal System constructed ( Repaired ( ) by _` • !� ---------------•--_....... ---_-••••------------ - _. ....., Ins � ° �- At.Ali 1 _-.••-••--------------------- has been installed in acco nce with the provisions of 1. 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No__ ___________________________________ da.ted.-.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE�CONSTRUED AS A GUARANTEE THAT THE SYSTEM' V11�L FUNCTIONS TISFACTORY. All DATE........... 1-- �-••••-•-••-------------•----••-•....._.....-•••-_.... Inspector-•--•-U...._ ..._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD22. HEALTH 7�1...� •. .....................•-••........_._.'......... t . ..�f''ji............OF......... � •f No......................... FEE.. _......... Dtupum n s anstr imrn rrutit Permission is hereby granted...... --••••- � -'--=-••- ........................................................... to Construct or Rep, ( an Wlivid Sewa ,D1 osal Sys(s Al at Street as shown on the application for Disposal `'Forks Construction Perm' o_____________________ aped.......................................... `•• --...--•• _ t B d of Health DATE V �e) FORM 1255 HOBBS & WARREN, INC., PUBLISHERS e,t_c- ' -� MIA, G - I i t SSO G-P.tb T4iK. = 330,r Irjo 6.P.D. ! k U si- l c00 6A L . *�ISpOf I&- PIT - USE loco GAL-. -,UEWA" AfZEA . 150 G-F. I�.v { 53=. A t -o /� jV TOTAL ESiG�I = rl25 G..RD. r ToTQ &p.m. I 4c VFFf2GDLATio tJ z&-rE : ►"tut 2M i u' o2 Lam. 7:r Per. .f., tl� 13'-� apt b�Z111IJ �5:�f'i�y �co.& " �Y LoA,N •Pp� luv• ,a I o00 �IJV. ' "OIL- 4' Dtsr. iw. GAL. 9GE 2 -sox 4G,6 Sepnc to A tuv. T"A W Ic IOOD Au o �uv tw. LAN ; PIT SA Nrt;, WAS► CD � STONfc qp p t-OCATIo" AV kd I Z SOAL VATL-Q- GGlZT1F�{ Tt-lA-r TOG- I`ov►Jt�ATiol� 51-OWW PL+41�1 �ZE�`2E►.1G� NF:>?t=L51�I Cc-'kVtPLWS Will-A T►a` Slv�.Ll�tr �pT 3�- Auv SE'MACIG vr--QulcEmcuTS DF -rNr-- PL-40 POa ALA-1.' Z'o w li of . CrA`CG I 30 �b 'N C B A XTC VZ 4. W mil[,- lzEG15 rtrGn LA WCJ SuZv�YoCs THIS C7t_Aw Ie, tJOT L'.ASCv CA-4 AW OS-Tczvtt»l - o t1rCASS. 4 Tt{L- 1i140W D APPLI CA."-7_ 1 kat' trr:_ U�iCC► Tv i�r'1 t�ittl►1i- 1_.o�C' l_INi=�� rzT _ r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY CORE Secretary ARGEO PAULCELLUCCI DAVID B.StR,l1HS Governor Com i`sioner � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION ka Property Address: 11 PEACH TREE RD. MARSTONS MILLS OS�] �b� �—� m T 'oe� ,j19 Name of owner 2 COLELEK 5 � axe` 99 Address of Owner: 2 COLE LANE KENNINGTON CONN.06037lit Date of Inspection: 3116/99 Name of Inspector:(Please Print)JOHN GRACI t 1 am a DEP approved system inspector pursuant to Section 15.340 of Tifle 5(310 CMR 15.000) T Company Name: John Graci Title V Septic Inspection Mailing Address: P.O.Box 2119 TeaTicket,Ma.02636 Telephone Number: (608)664-6813 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of Inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The Inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Further Ev luation By the Local Approving Authority performing at the time of the inspection.My Inspection does Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: Date:3/17/99 The System Inspector sha submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND MOVING TREE NEAR SEPTIC TANK TO PREVENT ROOT DAMGE.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTME'S USEFULL LIFE. revised 9/2198 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 11 PEACH TREE RD.MARSTONS MILLS Owner: STACHELEK Date of Inspection:3/16/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which Indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: na One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. na The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure Is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. na Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _ broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced na The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _ broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 11 PEACH TREE RD.MARSTONS MILLS Owner: STACHELEK Date of Inspection:3/16/99' C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy Is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance nLa_(approximation not valid). 3) OTHER tlLa revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 11 PEACH TREE RD.MARSTONS MILLS Owner: STACHELEK Date of Inspection:3116/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n(a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy Is within 50 feet of a private water supply well, X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS Is over the Invert pipe,is In Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 11 PEACH TREE RD.MARSTONS MILLS Owner: STACHELEK Date of Inspection:3/16/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined In the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)J X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2198 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 11 PEACH TREE RD.MARSTONS MILLS Owner: STACHELEK Date of Inspection:3/16/99 FLOW CONDITIONS RESIDENTIAL: Design flow:,=g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):. Total DESIGN flow: = Number of current residents:A Garbage grinder(yes or no):NQ Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no): YES Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NO Last date of occupancy: n/A COM M ERCIALIINDUSTRIAL Type of establishment: nLa Design flow: nLa gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):M Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):No Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) n& Last date of occupancy: a& GENERAL INFORMATION PUMPING RECORDS and source of information: NONE System pumped as part of inspection:(yes or no):NQ If yes,volume pumped nLa- gallons Reason for pumping: nLa TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: SYSTEM IS 19 YEARS OLD_ Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 PEACH TREE RD.MARSTONS MILLS Owner: STACHELEK Date of Inspection:3/16/99 BUILDING SEWER: (Locate on site plan) Depth below grade: i 6" Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: Lila Comments: (condition of joints,venting,evidence of leakage,etc.) Lila SEPTIC TANK: X (locate on site plan) Depth below grade: i Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) Illa If tank is metal,list age is age confirmed by Certificate of Compliance(Yes/No): MQ Lila Dimensions: L 8'6"H 6'7"W 4'10" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 30 Scum thickness:I Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: A How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM TWO YEARS RECOMMEND MOVING TREE NEAR TANK, GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) Lila Dimensions: n& Scum thickness: Lila Distance from top of scum to top of outlet tee or baffle:_nlA Distance from bottom of scum to bottom of outlet tee or baffle Lila Date of last pumping: Lila Comments: (recommendation for pumping,condition of Inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) Lila revised 9/2198 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 PEACH TREE RD.MARSTONS MILLS Owner: STACHELEK Date of Inspection:3/16/99 TIGHT OR HOLDING TANK: MQ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) n/a Dimensions: n/a Capacity: n/a gallons Design flow: n(a gallons/day Alarm present: NO Alarm level:jil& Alarm in working order:Yes_No_ NQ Date of previous pumping: n a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nla DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LIDIUD LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Page of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 PEACH TREE RD.MARSTONS MILLS Owner: STACHELEK Date of Inspection:3/16199 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: ` n/a Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: jVA leaching galleries,number: jila leaching trenches,number,length: nla leaching fields,number,dimensions: n/a overflow cesspool,number: nla Alternative system: nla Name of Technology: jDla Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY,PIT WAS EMPTY AT THE TIME OF THE INSPECTION.PIT HAS NOT MORE THAN CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: n/a Depth of solids layer: Wa Depth of scum layer. tnla Dimensions of cesspool: nla Materials of construction: nla Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection)n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Ella PRIVY: _ (locate on site plan) Materials of construction:nla Dimensions:nla Depth of solids: a& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nla revised 9/2198 Page 9 of 11 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 PEACH TREE RD.MARSTONS MILLS Owner: STACHELEK Date of Inspection:3/16199 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a I6N A 6 g A4 �, ftA ��u Q� A< as AD Y' gg 2� revised 9/2198 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 PEACH TREE RD.MARSTONS MILLS Owner: STACHELEK Date of Inspection:3/16/99 NRCS Report name: r9a Soil Type: nLa Typical depth to groundwater: Wa USGS Date website visited: nla Observation Wells checked: NO Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS AND VISUAL-12+FEET revised 9/2/98 Page 11 of 11 I l , Town of Barnstabhe RE ref j. iDepartznG>lat of regulatory 5ervica s / Y ILI Public Health Division ri Date Scheduled !" g 200 Main Street,Hyunuis MA 02601m_ Tie Fee Pd. `oil Suitability Assessment for a e Disposal ( , I Performed By: A V 1'4 -Q6,P xC-,V Witnessed By.: LOCA7 ION & GE {RA L 11�W ORMATION Location Address // ��° J / Owner's Name Itlu el? 6 l^ A I-t l Address Assessor's Mao/Parcel: 'J /�0 CfIgIgGCr'S NaInC 1 e NEW CONSTRUCTION REPAIR Telephone II J UQ) L�bl a Laud Jse � (d�e Slopes(%) — Surface Shines NdNL DISG7r CCs From: OpenWater Body Ft Possible Wet Area ful-4, fl Drinking Water We�llr f[ Draiha.ge Way / rt Property Line ft Other b SK,TCHt (Street came,dimensions of lot,exact locations of lest holes sr pore tests,locale wetlands-in proxinuly to Boles) 0 61 Zq t�101 / v Parent material(geologic)_vL"tuufty)A' Depth to Bddrock Depth to Groundwater. Standing Wafer in Hole': Myk)� Weeplllg 0rim Fit rtROG A `(1"I/-�-- Estimaled Seascnal High Oioundwawr DE T EWV LINT `KILN FOR SEASONAL HIGH WA.71']TR TABLE, Method Used: Dept:! Observed stondin i obs.Bole: In, Deptla 1u s411!klUllLCB: _ lu, Depth to weeping,from side of obs.hole: e l!l, druuurJwuler.AdJuslment„�_e �e Ft. Index Well 1# Reading Date: Index Well level _Y AdJ,ftletor T AtJ.(DRAInclwuter Level 06servatiorl _ ]PERCOLATION TES N3llle� A'lu'Im_�� Holc)p 1 Timm at 9" Depth cf Pere _ 1'lotp at 61' Start Prs-soak Time @ _0 Time(I 6") d.8nd Pre -soak 10 to g Rate Min./Inch Site Sul4abilily Assessment: Site Passed_✓ SiIq-Failed: Additional Testing Needed(YIN) Origina.: Public Hcalth Division Observation Hole Data To Be Completed on Back---�/ *"It percolation test is to be co>Iiducted vviL4uin 100' of vvelliand, you musi first Uotify Me Barnstable Conservation Division at least one (1) week prior to beginliixog. Q:\S BP?lC\PLRCFORM.DOC DEEP.O][ S]FlftV T][ON it—OL'EL]LOG Depth from Soil]Horizon Hole# Surtnce(in.) Soil Texture Soil Color Sol . (USDA), (Munsell) Other Mottling (Structure,Stones';Boulders, Con iste c % ra el /Z— leo �5 TION HOLE LOG Dcpth from Soil Horizon HoleSurraee(in.) Soil Texture Soil Color ff Soil (USDA) (Munsell) Mottlin Other g (Structure,Stones, Boulders. V 7— U .4 _C. Consis ency, Crave)) !6— �'�y./2G� 7,37 DE Eli O�aSE��. V Depth from ATIO l Texture # HOLE ]LOG ]HIT Soil Horizon Soi 5i�rrace(in.). 5011 Colo[ "—'--- (USDA) Soil Other (Munsell) Mottling (Structure,Stones,B oulders. Consistency,qa Or vet) Depth fi•om Soil Horizon LOG Hole Surface(in.) Soil Texhtre Soil Color (USDA) ,. Soil Other (Munsell) Mottling (Structure,-Stones', Boulders, Consistent_ y_k Oravel �— rV Flood Insurance]Bate Nga e: —� Above 500 year flood boundary No yeS Within 500 year boundary No h Yes En Within 100 year flood boundary No W r- DeRt� e�Hfots IlyQccurningPgrviousMaterlal Does at least four fe©t of naturally occurring pervious material exist in all areas observed tirrpugliout the area proposed for the soil absorption system? '\ 1f not, what is the depth of naturally occurring i 0rvlous mavtmal`? _ w CeHificaf)t]ty I certify that on _ (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 rer)tsired training,, expertise and experiencedescribed in CIO CA4R 15.017. Signature U �►av Dada Q,1S,EPTrCTFRCrO RM.DOC ALL SYSMM SHALL OMPONE SYSTEM PROFILE MARKED WTHCMAGNETIC TAPE OR BE NOTES (NOT TO SCALE) COMPARABLE1. DATUM IS MEANS FOR FUTURE LOCATION. APPROX. NGVD PROVIDE MIN. 20" DIAM. WATERTIGHT ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PERTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 2• MUNICIPAL WATER IS EXISTING Rd. \ TOP FOUND. EL. 49.6' FILTER FABRIC OVER STONE MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 48.0' 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 1naJ5tit Locus BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Zg PRECAST H-10 PROP. TEE PRECAST RISERS UNITS TO BE AASHO H-� Roy o� a RISERS (TYP.) 2'0 47.36' 4"OSCH40 PVC COMPONENTS ALL H-10 QJ�� 4e PIPES LEVEL 1ST 2' COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. 4' (TYP) 'S EL. 44.2' 4' enc P �� �� :• • 0, ENDS SIDES 45. 6• B IN ACCORDANCE d • Cb EXISTING 14" y CONSTRUCTION DETAILS TO E poe ae oe oe�e o°o°o0 WITH 310 CMR 15.000 (TITLE 5.) TEE SEPTIC TANK** TEE °°°°°°°° ®®®® ®®®�r12 O -®®�® 'a°o°o°o° ° ° ° ° °°°°°°°° 45.96 s" MIN SUMP °°°°°°°° ®®®®®�®®®®� ®®®®�®® >°° °°,000,000000 b >°°°°°°°° o >°°°°°°°° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND 0 0 0 0 0 0 ° ° ° ° ®®®®®®®!�®®C ° ° ° °GAS BAFFLE::: °o°o,°q°o°o° 12" MIN INT. DIM. �i ;°o°o°p°o ®®®®®®�®®� ®O0®�®® ;00000goo NOT TO BE USED FOR LOT LINE STAKING OR ANY o °°°°°°°° 42.2' o 45.0' 44.83' °o°o°o °°°°°°°° OTHER PURPOSE. r a, o Baxfer ,:., ';,,..r•.••- :.:.:•,. - 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. y a 3/4 1-1/2" DOUBLE WASHED STONE 4' MIN.LH-10 500 GAL. LEACHING .CHAMBER BY ACME PRECAST .OR EQUAL. ALL ROUND PRECAST STRUCTURES (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEHEALTH AN H AND PERMISSION OBTAINED 6" CRUSHED STONE, OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25' X 12.83' WITHOUT INSPECTION BOARD OF COMPACTION. (15.221 [21) b +I ' HEALT FROM BOARD N OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP ( 24% SLOPE) ( 7 % SLOPE) CALLING DIGSAFE (1-888-344-7233) AND 38.2' BOTTOM TH-2 VERIFYING THE LOCATION OF ALL UNDERGROUND & EXIST. 4' LEACHING 38 GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE FOUNDATION SEPTIC TANK D BOX 11 FACILITY (G-W EXPECTED AT EL. 20t 11. ANY UNSUITABLE MATERIAL ENCOUNTERED ASSESSORS MAP 57 PARCEL 100 PER TOWN MAP) SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL AND REMOVED OR PUMPED AND FILLED WITH CLEAN UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS SAND. PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT 47.39 SYSTEM DESIGN. 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE GUY 7.39\ TH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE WIRE Q CONDITIONS IF NOT SUITABLE � 47 3 \\ � WI Q GARBAGE DISPOSER IS NOT ALLOWED N \ �o \ .p EXISTING 2 BEDROOM DWELLING 0,o\\ DESIGN FLOW: 2 BEDROOMS CAD 220 GPD = 220 GPD �.�F\7.44 J` USE A 220 GPD DESIGN FLOW \ SEPTIC TANK: 220 GPD (2) = 440 \ 46. \ �0 **RE-USE EXISTING SEPTIC TANK BENCHMARK: N /�6 / "45 >-4 �47.52 COR METAL �, i / BULKHEAD �► 10 \Fo LEACHING: EL.=47.8' ,446.14 1 1� SHELL 7+-ae�? s.21 �1 +\45.63 DRIVE �+' 55.s \� SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD 46.55 \ / o- \F`� BOTTOM 25 x 12.83 (.74) = 237 GPD +49.95 TEST HOLE LOGS Z� �' \+ 47.61 TOTAL: 472 S.F. 349 GPD \ G CHAMBERS ACME OR EQUAL . LEACHING�F 47.34 USE 2 500 GAL ( ) !, +5 QEz � "� ( ) ENGINEER: ARNE H. OJALA, PE, SE 61.18 PQ o� \ 86 48 F� \ WITH 4' STONE ALL AROUND DON DEMARAIS, RS 4 78 747. `�` \ WITNESS: +48.43 48.10 DATE: JULY 25, 2011 + 1.07 k° .39 48 y5A \ - 2 MIN INCH /.�48.33 9.1E 0..§1 48.15 j- \ PERC. RATE - g� 47.25 h // 48.25 +48 47 2 \ !� CLASS I SOILS P# 13355 h +4 . 2 5 -K48.48 EXIST. 4813 U �c� MA oA +48.43 EXISTING GARAGE .� LOT 34 1 APPROVED DATE BOARD OF HEALTH ELEV. ELEV. +51.6 +4 48.36 DWELLING4 .71 TOP FND. \ 20,215 SF 4 4 EL.= 49.6' 4 s \ �2 019 48.5 1 -V 47.36 \ 0" 48.2 TOP TANK $� 48.54 EL. = 47.36' ,� TH 4 4:3 49. 5 FILL - 8.87 \ STONE 46.54' 12" FILL SM. PIN LP / + 48.51 \ DRIVE // TITLE 5 SITE PLAN 12 4 . f �`� \ 1 // OF E +50.8 ` 61 EXISTING \ / E 18" 1 49.21 POOL 47.3 \ / LS O� 97.96 \ / E6.57 TREE ROAD LS Q �. 11 PEACH T +47. 6 P 7.5YR 6 1 6. 1 F 51 46 r1G / 7.05 / 16" 7.5YR 6/1 gyp, s� 49.30 2.9, /� / MARSTONS MILLS 1 6 _ +45.99 0 / #47.87 56 46.71 .p \ B B 41. ,P 1 / 46.79 PREPARED FOR Ls LS ,� ��J 47.59/// CONSTRUCTION 40" 7.5YR 5/4 45 2' 7.5YR 5/4 49.05 r� BORTOLOTTI CO 40 44.8' +46.6 7 �� {r� / O 47F-j .63 fop. MULRENIN NOTE. 5' REMOVAL OF / UNSUITABLE SOIL MAY BE f{`�' l` l 7.9 / 7.a4 l� C C REQUIRED FROM 48' So.o2 .11 /' � JULY 25, 2011 PERC CONTOUR SOUTHERLY (B LAYER - SEE TEST HOLE / PG` "F� •.. off 508-362-4541 / LSNOFMgs i �<N0 Mho ' '� OF LOGS) / �� sqc j s^\ . ���iN Mgss9c �oF Mass� fax 508-362-9880 MCS MCS REPLACE WITH CLEAN MED. SAND, TO MEET / o`' ti� o�' DANIEL �'�,p E 9c" \ downca e.com / CANKiLA. u o� o DANIEeLA. G " o` C3ANi�` P o OJALA OJALA l OJALA o down cape engineering, /nC. SPECIFICATIONS OF 310 CMR 15.255(3) / A T i" g / CIVIL CIVIL O A cn „ry 2.5Y 6/6 2.5Y 6/6 48 4 2 rdo. So P No. 2 980 civil engineers 120„ 38.2 120" 3$.5' , �� k 0' STD q c�sTE� Scale: 1"= 20' =ZS'-11 S AL tiNG AlS � ' 11 ����' land Surveyors NO GROUNDWATER ENCOUNTERED rwfyt � �, � 939 Main Street ( Rte 6A) 0 10 20 30 40 50 FEET " _ ' �� DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675