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HomeMy WebLinkAbout0025 PEACH TREE ROAD - Health 25 Peach Tree Road Marstons Mills P r A = 057 099 I i I OWN OF BARNSTABLE ✓ LOCAT10N t°G,�, Y 28 � SEWAGE # Z I3� 1 Vl�'LLAGEt/11., ASSESSOR'S MAP & LOT 5-7 q INSTALLER'S NAME&PHONE NO..�l�,4 6`7 i � SEPTIC TANK CAPACITY 14O LEACHING FACILITY: (type) (size) IJ-3 x ZS NO.OF BEDROOMS e BUILDER OR OWNER ' ✓ � PERMITDATE: -S �� COMPLIANCE DATE:s�z Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fa Feet Furnished by O— {�� � . � _ ��� a � '� � � /� Zs� / � �"Z <�..� � � / � `✓6 _ I -- r,�» . 01� � � ��S,j _ C �� C3 j j- � � � �'Z`�" Z� ��� a OWN OF BARNSTABLE f ' CATION )Pra4d 7ree XJ SEWAGE # [LLAGE —ASSESSOR'S /MAP &LOT / INSTALLER'S NAME&PHONE NO. "//P A SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 1 ev' (size) �3 X Z57/ NO.OF BEDROOMS BUILDER OR OWNER A"n`::7 PERMITDATE: -S �� COMPLIANCE DATE: V:�� 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 Feet within 300 feet f leaching fasili Furnished by D z 1 o� 5 3 Zt3Sj, z ZF 7 NO. �� ( � r Fee 100c , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for i5p gal bpgtem �tCougtruction Permit Application for a Permit to Construct Repair Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. L {10(f G, IrrPe Owner's Name,Address,and Tel.No. ,Assessor's Map,Parcel d m� ✓ ��� '7 1' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Ir Type of Building: / Dwelling No.of Bedrooms Lot Size Z j sq. ft. Garbage Grinder ( ) Other Type of Building Sl/p l No.of Persons Showers Cafeteria( ) Other Fixtures Design Flow(mein.required) 3-3o gpd Design flow provided �7, gpd Plan Date Jy //� Number of sheets z Revision Date Title 0 Size of Septic Tank lavo Type of S.A.S. /k/ O� w �A CAS Description of Soil ^6 Nature of Repairs or Alterations(Answer when applicable) •n Date last inspected: , Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date ���' Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. o�(� �_� _ Date Issued MNO No. d V V I FeeT- THE COMMONWEALTH OF MASSACHUSET S Entered in computer: �r PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for ioogal *patent Construction Permit Application for a Permit to Construct Repair Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 2- O -4 7 Pe Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 0S7 ��f y T()n7 , l Installer's Name,Address,and Tel.No. yzy Designer'srName,Address and Tel.No. Type of Building: / Dwelling No.of Bedrooms 1 Lot Size j F� sq. ft. Garbage Grinder ( ) Other Type of Building Sii?f l No.of Persons 3 Showers(./ ) Cafeteria( ) Other Fixtures —fir Design Flow(min.required)` 3 3 gpd Design flow provided, /, gpd Plan Date S /y/ Number of sheets Z Revision Date Title / Size of Septic Tank Type of S.A.S. 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 Certificate of Compliance has been issued by this Board of Health. Signed 44tDate Application Approved by Date S l a Application Disapproved by: Date for the following reasons w. Permit No. o_nf� — ?j Date Issued THE COMMONWEALTH OF MASSACHUSETTS- BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY!hat the ,On-site Sewage Disposal System Constructed ( ) Repaired (✓) Upgraded ( ) Abandoned( )by at .1�_) "Qack"k. has been constructed in accordance �s with the provii-scions of Title 5 and the for Disposal System Construction Permit No.11)00'�— 13 3dated f O Installer 1' r- 1 C Designer 1 G i,7v, _ #bedrooms `� Approved—de ignow f� 2, gpd The issuance of this permit hall not- a construed as a guarantee that the s stem w 11 fun'ution design d. Date Inspector - No. & � [/��" � ----- - ---- -___._-- - ---- -- --' - Fee.THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS �Diopogal * ,otem Co 5truction Permit Permission is hereby granted to Construct ) Repair Upgrade ( ) Abandon ( ) System located at 3�pz�l 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 must be completed within three years of the date of this permit. Date `�/ �� Approved by y F'L 05/21/2009 08:30 5084775313 ENGINEERING WORKS PAGE 01 Town of Bamstgbje Rtwawry Sces Tbamos P. Q.eiter,Dlre.ctor POW Red*.RI4 nmmss MCKCBD,.Df1!."pr . 3119�ain.�.treet,H�.aan�,lldA t�601 0 4 Fax: 508-794-6304 . : SgW49P PW92k# - Assoisor's M* S 7— 9 9 BOOM k1 Ad2dress: was issued.a,pu mit to install a AW (suer) septic,sY y; t. 2 5 Ae cL C-4 Tree 12Abawd an a design drawn,by.. (address) f e�-ea�T nc? C'rr ke dp'�- dated_ JJig -�-.Sa5;sep* system.refaemd above wass inElude nunor roved changes such.as latea�l.tank. �P re - sag! tit the septic system mferenced above was installed with err c} ea .10 lmmW relocation of the SAS or any vertical relocation of.atiY. a pwnt 1 c:s�yystem) but is accordance with State�t Local Rmgula�ions. Pia 071'00MOr =bit by desiper to follow. �I"OF Aggs PETER T. o MCENTEE CIVIL ,0 9 No,35100 0 1YAL��G\ (Affix Designer's S.. . ) I Q:Heatfb/ VdWDW6w Cmacaflon Form 3-26-04.d. 1 TOWN OF BAFNSTABLE CATION re n P iLLAGE I S ASSESSOR'S MAP&PARCEL C76 t1 09 9 S NAME&PHONE NO. C— Fick p 1 y —11�I f SEPTIC TANK CAPACITY 1000 LEACHING FACILITY:(type)pI'fi (size) 100 NO. OF BEDROOMS OWNER "'-7GCP4 W o 6-ft 'S PERMIT DATE: C@MPL4At#@E DATE: �� IU 16- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r Peachtree Road Water y Service YJ • Vie^ 8 18 F 23 23 . II COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION t OW I v by0 TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION 06-q_ O 9,? Property Address: 25 Peachtree Road \ Marstons Mills MA 02648 Owner's Name: Todd Wilantis Owner's Address: SameCD Date of Inspection: May 10,2007 Job#07-97 Name of Inspector: IPATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Ln Mailing Address: 189 CAMMETT ROAD f MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 P rn, e*s 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: _X_ Passes Conditionally Passes Needs Further Evaluation by the cal Approving Authority Fail Inspector's Signature: Date: 5/10/07 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: Leaching pit has 6-8"of effective leaching,tank is not in need of pumping at this time. 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. 't Page 2 of 11 OFFICIAL]INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 25 Peachtree Road,Marstons Mills Owner: Todd Wilantis Date of Inspection: May 10,2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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: 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. ND explain: Observation ofsewage 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: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 25 Peachtree Road,Marstons Mills Owner: Todd Wilantis Date of Inspection: May 10,2007 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 4 f. Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 25 Peachtree Road,Marstons Mills Owner: Todd Wilantis Date of Inspection: May 10,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ X_ Backup of'sewage into facility or system component due to 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_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 _ _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of 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 1 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. [This system passes if the well water analysis, performed of 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.] _No_(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. i Page 5 of 11 OFFICIAL]INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 25 Peachtree Road,Marstons Mills Owner: Todd Wilantis Date of Inspection: May 10,2007 Check if the following have been done.You must indicate"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_ Were any of the system components pumped out in the previous two weeks 9 _X_ _ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection _X_ _ 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? _X_ _ Were all system components,excluding the SAS,located on site ? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 25 Peachtree Road,Marstons Mills Owner: Todd Wilantis Date of Inspection: May 10,2007 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents:3 Does residence have a garbage grinder(yes or no):No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):No Water meter readings,if available(last 2 years usage(gpd)): 2 yr.meter readings include irrigation:476,000 gal. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INI)USTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped November 2006 Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for,pumping: 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) _Innovative/Altern:ative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1980 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 Peachtree Road,Marstons Mills Owner: Todd Wilantis Date of Inspection: May 10,2007 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _x_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: XX (locate on site plan) Depth below, grade: 1" Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain)_ If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:8.5'long x 5.2'wide—1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:28" Scum thickness: trace 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: 14" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Baffles are intact and clear,liquid level at bottom of outlet invert.Tank is not in need of pumping at this time. GREASE TRAP: No (locate 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.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 Peachtree Road,Marstons Mills Owner: Todd Wilantis Date of Inspection: May 10,2007 TIGHT or HOLDING TANK: No (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): Alarm level: Alarm in working order(yes or no): Date of last pumping:. Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: No (if present must be opened) (locate on site plan) 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 leakage into or out of box,etc.): PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL )INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 Peachtree Road,Marstons Mills Owner: Todd Wilantis Date of Inspection: May 10,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. 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, etc.): Liquid level is currently 12 14"below inlet pipe with high stain lines indicating pit has 6-8"of effective leaching. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number ar:d configuration: Depth—to-3 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: No (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.): r Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 Peachtree Road,Marstons Mills Owner: Todd Wilantis Date of Inspection: May 10,2007 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. Peachtree Road Water Service #12 . ...... ..... sw .......... ............... -XXX, ............ ...... .... ... ............. .......... .............. ........ ............ 8 18 23 23 f Page 11 of 11 OFFICIAL)INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 Peachtree Road,Marstons Mills Owner: Todd Wilantis Date of Inspection: May 10,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: _ObtEined 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) X Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el.20 and topo map shows property above el.50. t Town:of Barnstable r# ) 2 S33 ' r Department of Regulatory Services Public Health D><v><s><on Date Q 200Main Street,Hyannis MA 02601 Date Scheduled � .. Time Fee Pd. [ ;CI d Soil Suitability Assessment for Sewage Disposal Performed By: •�02- rJ E i�� 2 G Witnessed By: �,vt LOCATION&.GENERAL INFORMATION Location Address Owners Name. 1 IGVS t'1YL3` U"W��T Address Z�j ? e-CtC, T(�eR Assessor's_Ma /Parcel: Q G C (ld/l3 its.� ij M p — q Engineer's•Name © �� NEW CONSTRUCTION REPAIR Telephone# �0-73-7 14-7& Land Use Slopes(` ) Surface Stones Distances from: Open Water Body ft Possible Wet Area. ft , Drinking Water Well ft Drainage way. ft Property Line _ft Other` ft • SKETCH:(Street name,dimensions of lot,exact locat➢ons.of test holes&Pere tests,locate wetlands in pro imity to haw -. C:7 t t!) N c . t Z r f i( -E C . Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: /"M77 . Weeping from Pit Flee Estimated Seasonal High Groundwater DETERMINATION FOR.SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs:hole: in. Depth to soil mottles: In. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. . Index Well# Reading Date: Index Well level „ Adj,faetor Adj.,Q-oundwater i eval PERCOLATION TEST bete . Tlme,, Observation Hole# . . ,-... . .. ,,. ... �, Time at 9" ..�..�._.�.. _.•.._._..,._ Depth of Perc f lu--s Time at 6" 2 Oil Start Pre-soak Time® 1 U ` j J� V'W 1-tj 'lime(9"•6') End Pre-soak ` Rate MinJlnch Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(YM) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:4S EPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# l Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA).; (Munsell) Mottling (Structure,Stones;Boulders: t v 01 0--lY 5 - DEEP"OBSERVATION HOLE]LOG " Hole.# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o ns 3 y ids .-11`9 G ,M_c SC-4 Z,5- Gy� • DEEP:'OBSERVATION-HOL_E LOG Hole# Depth from Soil Horizon Soil Texture Soil Color.` Soil Other.. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. O .Ve DEEP'OBSERVATION HOLE LOG Bole# Depth from' Soil Horizon Soil Texture Soil'Color Soil Oth_ee Surface(in.) (USDA) (Munsell) Mottling (Structure,States,Boulders. { Flood bsuranceRaWM—ae:" - -- boun No Yes I ` Above SOQ'year flood dary _ Within 50o year boundary No Yes : Within 100 yearflood boundary No l Yes es. Depth'of,Naturally Occurrina-Pervious Material Does at least four feet of naturail'yoccurringperyious material exist in all areas observed throughouG.the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious,matorial?„�,_....._...,_. Certification I certify that on• -it ('q'Lg- (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 trai f` expertise-and ezpenence descrlbetl in 31U CIvIR"-15 017: h A y Signature` Date 2f � i 1SEpnC�PBRCFORM.DOC TOWN OF BARNSTABLE OCATION T ��` �V`pQ > SEWAGE #M ILLAGE 1 I_11 i S L�ASSESSOR'S AP& LO INSTALLER'S NAME&PHONE NO. oo SEPTIC TANK CAPACITY � G� A�� /-�n P LEACHING FACILITY: (type)' 0 l t l 0vt. 3 ;(size)" I " NO. OF BEDROOMS \ f BUILDER OR OWNER PERMITDATE: COMPLIANCE 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 leaching facility) �//1(^/0Z Feet Furnished by �� �Q UC ct 1-1 Aa Af PA �9 �c as COMMONWEALTH OF MASSACHUSETTS EXECUTIVE jOFFICE OF ENVIRONMENTAL AFFAIRS z w DEPARTMENT OF ENVIRONMENTAL PROTECTION r s ti r OW .y gvev - ;. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSE SMENTS SUBSURFACE,SEWAGE DISPOSAL SYSTEM FORM RECIi/ED PART A CERTIFICATION JUL 2 5 2002 Property Address: 25 PEACH TREE,RD MARSTONS MILLS,MA 02648 C)S 1 OCt C1 TOWN OF BARNSTABLE P Y Owner's Name: DONALD VANWAGENEN HEALTH DEPT. Owner's Address: 25 PEACH TREE RD MARSTONS MILLS, MA 02648 4:4t (0°Z 3 Date of Inspection: 7/16/02 Name of inspector: (please print) T ,JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number.: 508-564-6813 FAX 508-564-7270 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: X Passes ;, `t, , ; _ Conditionally,P sses _ Needs Furt valuation by the Local Approving Authority Fails'' Inspector's Signature: s Ot�n Date: 7/16/02 .1 b, ; The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti n. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shallsubmit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to thabuyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING NOW AND THEN EVERY YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE:RECOMMEND MOVING TREE THAT IS OVER PIT. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address hpw the system will perform in the future under the same or different conditions of use. Title S IncnPrtinn Pnrm A/l si,?nnn I �, I"ti�i.i.a •s+il Page 2 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 25 PEACH,T-REE RD MARSTONS MILLS,MA 02648 Owner: DONALD VANWAGENEN ' Date of Inspection: 7/16/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D 3 A. System Passes: X 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: ' SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING NOW AND THEN EVERY YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE. RECOMMEND MOVING TREE THAT IS OVER PIT. 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. n/a The septic tank is metal andjover�,-20 years`•'bld*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or eAltrat onlor 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_s less than 20 years old`is�a'vailable. ND explain: n/a n/a Observation of sewage backup or brdak 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 _ distributio'n box is leveled or replaced ND explain: n/a '�` n/a The system required pumping6More.,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: n./a 6 It LF flZ Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 25 PEACH T;REE RD'•MARSTONS MILLS,MA 02648 Owner: DONALD VANWAGENEN, Date of Inspection: 7/16/02 C. Further Evaluation is Required by_the.Board of Health: yj: a .r v!. _ 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 the5'environment. 1. System will pass unless Boa rdiof Healith 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: e: _ Cesspool or privy is withini5-.0,feet of;a surface water _ Cesspool or privy is with in)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 functioningin 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 septicrtank 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 n/a "This system passes if the w'el¢'l'wate'r`analysis, performed at a DEP certified laboratory, for coliform bacteria and t.r. •p'e.'s. volatile organic compounds`e.F"indicates. that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal toIor less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be aft`ached to this form. 3. Other: n/a Page 4 of OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) J Property Address: 25 PEACH TREE RD MARSTONS MILLS,MA 02648 Owner: DONALD VANWAGEN.EN Date of Inspection: 7/16/02 D. System Failure Criteria applicable to all systems: You t indicate"yes"or"no"to each ch of the following for alLinspections: Yes No X Backup of sewage into facility or system component due to 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 '/2 day flow X Required pumping more than 4 times in the last year NQTdue to clogged or obstructed pipe(s).Number of times pumped SY4TFM HAS NEVER BEEN PUMPED. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of 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 1 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 This system asses if the well water analysis,performed at a DEP no acceptable water.quality analysis. J y p Y E certified laboratory;for:coliform bacteria and volatile organic compounds indicates that the well is free from pollution from thi'at`facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,`prbvided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) tff _ (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 Nii`s!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'sys'tem 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 X the system is within 400 feet of a s4face drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply .qR A _ X the system is located in a'nitroge'n sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered,"ye$"`to any question in Section E the system is considered a significant threat,or answered " ysleip has,failed. The owner oa•oheralor of any large system considered a significant threat yes" in Section D above the l�ar.�;c s under Section E or failed under^Nctaon D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate ronal'office_of Department. ega •.i' . . Q I� Page 5 of I I i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE"SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 25 PEACH TREE RD MARSTONS MILLS,MA 02648 Owner: DONALD VANWAGENEN Date of Inspection: 7/16/02 Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes No X _ Purnping information,'was provided by the owner,occupant, or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection '? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X Was the facility or dwellin 'inspected for signs of sewage backup? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manhole's 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 ? X _ 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 t.'4 X _ Existing information, For`e`x6mple,a`plan at the Board of Health. X _ 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)]; k ' Y 53. � E Page 6 of I 1 ` r OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C iF SYSTEM INFORMATION Property Address: 25 PEACH TREE RD MARSTONS MILLS, MA 02648 Owner: DONALD VANWAGENEN Date of Inspection: 7/16/02 FLOW.CONDITIONS RESIDENTIAL Number of bedrooms(design):3` `NOr'ber.of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.h3 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required) Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO t . Water meter readings, if available(last 2 years usage(gpd)):m4n -00 �3� Sump pump(yes or no): NO 0 Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL' Type of establishment: n/a Design flow(based on 310,CMR 15.203)::n/agpd Basis of design flow(seats/persons/sgft;etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available:n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: SYSTEM HAS NEVER BEEN PUMPED Was system pumped as part of the inspection(yes or no): NO If yes, volume pumped: n/agallons+;-How was,quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM # X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(il'yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a4copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a =< Approximate age of all components,date installed(if known)and source of information: 201'EAM II1' OIVNE11 •a Were sewage odors detected when.arrividg at the site(yes or no): NO Page 7 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ,,:,*..:;,t SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 'SYSTEM INFORMATION(continued) Property Address: 25 PEACH TREE.RD MARSTONS MILLS, MA 02648 k.Owner: DONALD VANWAGENEN Date of Inspection: 7/16/02 BUILDING SEWER(locate on site plan);.!; Depth below grade: 18" Materials of construction:_cast iron _40'PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints;venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site,plan) Depth below grade: 12" Material of construction: Xcon!crete ,metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is'a�g4'confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8'6".H 5''71�,', 4' 10"" Sludge depth:3" Distance from top of sludge to bottom of,outlet tee or baffle: 31" Scum thickness: 3" 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: 15" 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.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING NOW AND`THEN EVERY YEAR TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan):., Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Continents(on pumping recommcndatigns,,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leak Eat ge,;etc;):; n/a Page 8 of l 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 PEACH TREE RD'MARSTONS MILLS,MA 02648 Owner: DONALD VANWAGENEN Date of Inspection: 7/I6/02 TIGHT or HOLDING TANK:i (tank must be pumped 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(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a 'G1 . DISTRIBUTION BOX:X(if present Must be opened)(locate on site plan) Depth of liquid level above outlet invert: LE DEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-BOX IS STRUCTURALLY,SOUNO. z PUMP CHAMBER:_(locate on site plan) , ,4 Pumps in working order(yes or;no):'NO` Alarms in working order(yes oe no):NO Continents(note condition of pump chamber,condition of pumps and appurtenances,etc.): - n/a 4 , lP. 4 R Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 PEACH TREE RD MARSTONS MILLS,MA 02648 Owner: DONALD VANWAGENEN Date of Inspection: 7/16/02 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a ; (innovative/alternative system A'. ; Type/name of technology: n/a Comments(note condition of soil,signs,of1hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): DID NOT EXPOSE LEACH PIT.41IT WAS VIDEO INSPECTED AND APPEARS TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE.RECOMMEND MOVING TREE OVER PIT.THERE IS 6" OF LEACHING LEFT IN IT. BOTTOM IS AT 9 FT. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a . Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Q Page 10 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 PEACH_TREE`RD MARSTONS MILLS, MA 02648 Owner: DONALD VANWAGENEN Date of Inspection: 7/16/02 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. I DLf .•s i ��". '•., V 1�1 � tp z 10 fit 10 Page 1 1 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 PEACH TREE<RD MARSTONS MILLS,MA 02648 Owner: DONALD VANWAGENEN Date of Inspection: 7/16/02 SITE EXAM _Slope + _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-if checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavatdrs 'installers-(attach documentation) NO Accessed USGS database-explain; n/a You must describe how you established the high ground water elevation: HAND AUGER- 10+ FT. i L10 A T ION S E W A G PE RMIT NO. VILLAGE 1 a INSTALLER'S NAME i ADDRESS �oti, nT . e U I L 0 E R OR OWNER DATE PERMIT ISSUED _ _ ®, DATE COMPLIANCE 15SUED r y e yr ;. �. �'� � � ��. P �o �, NO.......�'?`....... r`~ Fps.. ...... THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH ..........J.D W.0..........OF........ AvOration for Biiivoii ai Works Tonstrur#'inn Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ..............••---- - .._ :......11 . 1 ►��___ ... -- -1-� ----•-- .Location- dress �— )or Lo-No. ................... _ _ ._--.... owner j dress a P AA r........`-5�.��k'C� .............. ................ .L ......................... Installer Address UType of Building Size Lot..T �!7-•----Sq. feet �--� Dwelling—No. of Bedrooms............... ........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building � yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow...................S5.... ....__.._-gallons per persong day. Total daily flow.._..............................gallons. WSeptic Tank—Liquid capacity Ck 2.gallons Length...... o___ Width-4-.-1 Diameter................ Depth...S.-_8.. x Disposal Trench—No..................... Width-- .... Total Length....... _* Total leaching area....................sq. ft. Seepage Pit No........./.......... Diameter........ os•- Depth below inlet.....6........ Total leaching area...IoP----sq. ft. Z Other Distribution box (-t) DosiLqg tank ( ) n -90P9 Percolation Test Results Performed by. XT�:4'0V5..(AC.^--N!-: .. Date..._.._ ' Test Pit No. 1.... ...minutes per inch Depth of Test Pit.......I ..... Depth to ground water....` ............ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..----.-.-_-_--..-..---. GG ..--•------•----------------•-----.....------------•--•--------....-----•....--•--•-•---•--••••-:.--................................... --.................. O Descr1 tion of Soil... � ,C0�4l4 d-S b 13-S d/ L -Z'" • L S (� - jz.__..... �_1,119n,..--•---...- -� 5..............--•f©-•..�N. ............... 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 TITLU 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. Sign --------•--......••-- ................................ 07//- Date Application Approved BY / '�'! r•._... Date Application Disapproved for the following reasons:................................................................................................................ ..•••..............•......••••---••---•--•........-•-••••--•...:,...•-••••--••••-••••-•---••---•--•....--•••--......--•--•-••-•...-------••--•-•...----••............................................. Date PermitNo......................................................... Issued........................:.............................. Date L Or .9............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..( ..�...:....OF...........1�..11 . .l� iT f { �.,.. Allpfiration for Vtspooai Workii Tontitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ �' ................_.... G - ►? .... G'"; ---- ....... �r_°�.t_�5 ...._................. �......--3- - ................ Location Address .��� or Lot No. i �!....•--------•---•-•-_..�_.`. i'-• •-{, i +'...±..�.....--- ------••-- ---••------•---------••--•-•------•-•--------•....................................•--•------...... j� Owner Address 1 Installer Address Type of Building Size Lot....t2�!6..`�' ......Sq. feet •. Dwelling—No. of Bedrooms..................,,,...........................Expansion Attic ( ) Garbage Grinder ( ) W Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtu— res •------••--------------••---•--•---------•-----....---.••••---••••----•---------------•-•-----------•-•----•-••-•--•-••-•-•.._...-•----•-•....__••--•- W Design Flow.....................: .................gallons per person pqr day. Total daily flow__._.._.._...._............3t� .............gallons. WSeptic Tank—Liquid*capacity_6r_ .gallons Length..f .=.... . Widthl__'_A . Diameter________________ Depth.__`:+!-.,V x Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area....................Sq. ft. Seepage Pit No........./.......... Diameter.._..._.f�!.__._.__ Depth below inlet..... ............ Total leaching area...! 2....sq. ft. z Other-Distribution box ( 4) Dosing tank Percolation Test Results PerflSrmed by.. ._..__ ....__....... tang - .� --1 - • ' Date---......--•-----•-r•-••... Test Pit No. I...... .....minutes per inch Depth of Test Pit....... ----- Depth to ground water..................... (-14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R: ' O Description of Soil..................--------------------------------------F'!••--••...--•-•-••-•----•••--•---•••----•-_•-•.-----......................................................... - ... . V ----•-•-•-•--•----••-•-----••-•-----•••-'-'--•-- r =--�' •4y -"•........... .r-.....---'._.Hof.......................................................................................... W U 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 TITIL 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. Sigd. ... ---- . •_. .. .....----•-•......... .......................... Application Approved By----- -----•---•-•. ----•- - -- �_ (�e / Date Application Disapproved for the following reasons:........................................................................................................:....... Y 1 T Date 1PermitNo....................• -••-•--••---•------•-----•••----- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH < {li? � F� ."� f `fit OF..... ... ... ................................... (Zrrttfirtttr of Tontpliatta TH IS T CE IFY, t the Individual Sewage Disposal System constructed (L''�or Repaired ( ) b Installer � �. at... -U---- --L� •--••-- �1'- 4--- has S'.....�f7 'Q_Y_l s_.. E? y been installed in accordance with the provisions of TF �o�f�The State Sanitary Code as describ d in the . application for Disposal Works Construction Permit �o.__ ._..._ ......................... dated_... ."_� .` '_ ............_... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE << `. SYSTEM WILL FUNCTION SATISFACTORY. DATE........... 8d.......................................... Inspector .__ --�'4.... . ..................--.............. lo,.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF •HEALTH Q ............ l j -l e �J 4 4 i l° t�..f. .......................OF.......:..•..................................r?._..................................... No......'l FEE........................ too l orkii trud n err tt Permissionis_,beeby granted_ ..?"e. ..---•-••... .. ........ ...... . .................................................. to Const t Rep • ( In iv' ual Sew a isp sal tem at No r 1 ....a �GL ...._7j4......_._ leR_ I LS„ �- t '� .�....---.... Street as shown on the application for Disposat Works Construction. mit Dated__»_.1"Z.'_ ........... `� Board of FIealth, �r+ DATE-- •.........•-•-••...•--� --......_---•-•-•---_..... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS '` ' Q r t4��t 1�1C C-�Atz13AG� Gel tiJD�SZ � Tedi t-�C >~LO\.'✓ = lib -4 S 6-P-b. \ 1 -IG T�`tr1LL = :?�&ov Ir7o % * 4-95 6.Ro. 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QLAi-1 S, I>P--r FG?s 2, I9-11 t2cLtS rc_I;�D t-ANa ,U�vE.`(o�S �`1-�1�a C7t_A!-t I LIC)T L'A��EL7 Ut~-1 A, J OSTC--ZlV►LLG c) MA61i, f lt.lyt-Q:J:,♦����J�' >>UF:�/t=�{ �• Tt{� U�=l.:��'�♦> �I�tGW4.D ��I�LI Cl>.!-J'S� �, t•k>l t?,C: U r L i�, ri., l�r:.t-C c�•M►�J t- l�'7T t_i W��� - � I(�� �V IJ►Jf fJC,.�-,�.I.S�1 1 : m Rr i -Ti} v (� - - ' �91325 - '` vT -r t .. u�-•y�1ia-=g.e�S�3btLL- I I w I I \ � I �RtitiCT ELE\iilTlON FL1cNT Etkl-,,/,TkoN .. _ A ' ... � COwZAilG10R Tca�.lR1iY hl,L,,nvwEV5C0 NS ON avrC ._ - . a(� .. 9 774-23"773 a -.-... .-.....— ._............. t _ ----- I Y Ben chm ark Set N 0, Top Re t. Wall a t Corn er EXISTING LEACH'PIT '` 28 TO BE PUMPED, FILLED W/ QG• EL.=97.29 (Assumed) Roue SAND & ABANDONED OCUS 9�e EXIS77NG SEPTIC TANK TOP OF TANR;, EL.=95.66 INV.(OUT), EL.=94.33ES'o 7 N 00 i S 50'00'07" W x 98,38 a o 0 '114.80' 1 x i0p,4 - LOCUS MAP I NOT TO SCALE J. I I cD or i O \ — CE 6�>>S�1 x 93,38 x 101.67 ,`7.72 1 6j i ��" I � I �• N. °' x100.18Ab '�•.. x. 98.59 Brick Patio � j %/ x 93.) TW-2 VENT Ln o \�'�.� 98.19 97.84 97.0 �\ � rn o Sr. I o X 98,11 PORC i co ,EXISTING 94 7 HOUSE (#25) 9 RET. WALL 90.71 TOF=98.3E .13) r ' J s -. bs 0 Paved bZ16 Driveway Jshr�'bs /�35 4� CV h/ • , G� arc i �' ^ o J moo/ RET. WALL ; x 89,39 i N o 02,96 i x 9 .84 Q LOT 35 09't/6 a / L VC'S6 x ° 7 ' � � 22 68�7f S.F. I Map 57 Purge/ 099 �� 1'� cl� 0 I L=106il26' I SOt6 R- o1.72' % I, 9 EDGE 'OF PAVEMENT �/ N Sg 49 4 �! o <' c� 6 GENERAL NOTES PEA � '-ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL REE R �Ss CD fX BOARD OF HEALTH AND THE DESIGN ENGINEER. " ' 0A :7: 2'ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 7 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: i9 310 CMR 15.405(1)(b): W 1) A 2' variance to the 3' maximum cover requirement, for no greater than 5' of cover. S.A.S. shall be vented and H-20 Rated. 3-THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4 ANY FROMCTTHOSEONS SHOWN ENCOUNTERED SHALI BE CONSTRUCTION TO TDIFFERINGHE DESIGN ��`P��� OF Mgss9rfr ENGINEER BEFORE CONSTRUCTION CONTINUES. o PETER T. � LEGEND 5-ALL ELEVATIONS BASED ON ASSUMED DATUM. MCENTEE 6.THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF CIVIL "' ——100 —— EXISTING CONTOUR THE CONTRACTOR OR, OWNER TO NOTIFY THE LOCAL BOARD OF No. 35109 x 100.98 EXISTING SPOT GRADE HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. o REFR�`o �� UNDERGROUND WIRES 7•WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. �OFSS/GIST � G ` EXISTING GAS SERVICE 8-THERE ARE NC WELLS WITHIN 150' OF THE PROPOSED S.A.S. W EXISTING WATER SERVICE 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 9 TEST PIT AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE Sal'/� I $ BENCHMARK DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY PROPOSED SEPTIC SYSTEM UPGRADE PLAN THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 25 PEACH TREE ROAD, MARSTONS MILLS, MA r 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND Prepared for: Thomas King, 25 Peach Tree Rd, Morstons Mills, MA 02648 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). Engineering by: SCALE DRAWN JOB. NO. 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE Engineering Works Inc. 1"=20' P.T.M. 132-09 ,INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 12 West Crossfield Road, Forestdale, MA 02644 DATE -CHECKED SHEET NO. IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. (508) 477-5313 5/1/09 P.T.M. 1 Of 2 V 5''At NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT EE < EL:90.33 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D—BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT OVER END UNIT T.O.F. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ,Z CHARCOAL WA-rC—iL:'r1GY11 eon VENT EXISTING F.G. EL.=97.4t f F.G. EL: 95.0,E F.G. EL: 95.3(MAX.) / MAINTAIN 2% GRADE (MIN.) OVER S.A.S. A j L = 42' L = 12'(MAX) INSPECTION ® S=1% (MIN.) ® S=1% (MIN.) PORT 4"SCH40 PVC 4 SCH40 PVC 6" w TOP LOAD UNITS LLi 10"I 14" 6 1.64' TO EXISTING 48" UQUID INVERT LEVEL ADD GAS DAPPLE INV.=93.17 PROPOSED INV.=93.00 INV.=94.33t D-BOX INV.=90.64 4 ROWS W/4 UNITS AT 6.25'/UNIT = 25.0' EXISTING (WATERTIGHT) ELt EXISTING SEPTIC TANK 4 OUTLETS (MIN.) SOIL ABSORPTION SYSTEM (PROFILE) ESTORE VEGETATIVE COVER t. BACKFlLL WITH CLEAN PERC SAND TO TOP OF CHAMBERS INV. ELEV.=90.64 BREAKOUT EL.=TOP E . " TOP ELEV.=90.33 FILTER FABRIC OVER UNITS NOTES: (RECOMMENDED) 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BOTTOM ELEV.=89.00 m®IIIII®lull®III EXISTING INVERTS, PRIOR TO INSTALLATION. 2.83' SUITABLE 2 D—BOX SHALL BE SET LEVEL AND TRUE TO GRADE 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH=11.3' MATERIAL ON A MECHANICALLY COMPACTED SIX INCH CRUSHED T.P. EXCAVATION OR G.W. STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). NO G.W., EL=79.8 — 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 4 ROWS OF 16" (H-20) ADS BIODIFFUSER UNITS WITH 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO SEPARATION BETWEEN EACH ROW & NO STONE AS MANUFACTURED BY TUF—TITE, •ZABEL OR EQUAL. TYPICAL SECTION ILM SEPTIC SYSTEM PROFILE N.T.S. SOIL LOG 21" 6-4- POLYSEAL OUTLETS DATE: APRIL 21, 2009 (REF#12,533) 2" 2" 1-44ER4..LE SOIL EVALUATOR: PETER McENTEE PE WITNESS: DAVID STANTON R.S. q HEALTH AGENTELEV. TP 1 • DEPTH ELE—V TP-2— DEPTH N Lo 93.1 A 0» 92.3A0" LOAMY SAND LOAMY SAND 10YR 4/2 10YR 4/2 iv To View 92.8 B 4" 92.0 B 4 — D—BOX Section LOAMY SAND LOAMY SAND —/� 10YR 5/8 10YR 5/8 90.6 30" 89.3 36" C1 C1 PERC 75" 48"/60" M—C SAND M—C SAND 2.5Y 6/4 2.5Y 6/4 76" 81.1 144" 79.8 138" PROFILE PERC RATE <2 MIN/IN. ("Cl" HORIZON) NO GROUNDWATER ENCOUNTERED 16" 11 t !7v 34" 0. SECTION END CAP DESIGN CRITERIA 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT NUMBER OF BEDROOMS: 3 BEDROOMS MODEL 16" HICAP SOIL TEXTURAL CLASS: CLASS I LENGTH 76" NOTE: UNIT CONFlGURATION AND AVAILABILITY SUBJECT DESIGN PERCOLATION RATE: <2 MIN/IN EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY DAILY FLOW: 330 G.P.D. SIDE WALL HEIGHT 11.2" DIFFER SLIGHTLY FROM,ACTUAL PRODUCT APPEARANCE. DESIGN FLOW: 330 G.P.D. OVERALL HEIGHT 16" GARBAGE GRINDER: NO OVERALL WIDTH 34" 4640 TRUEMAN BLVD LEACHING AREA REQUIRED: (330) = 445.9 S.F. 13.6 CF ® HILLIARD, OHIO 43026 .74. CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PROPOSED D-BOX:: 1 INLET, 4 OUTLET (MINIMUM), H-,o RATED PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 4 ROWS OF 4 — 16" (H-20) ADS BIODIFFUSER UNITS 25 PEACH TREE ROAD, MARSTONS MILLS, MA W/ NO STONE FOR AN S.A.S. WITH DIMENSIONS 11.3' x 25.0' Prepared for: Thomas King, 25 Peach Tree Rd, Marstons Mills, MA 02648 (HIGH CAPACITY INFILTRATORS MAY BE SUBSTITUTED) SIDEWALL AREA: NOT APPLICABLE Engineering by: SCALE DRAWN JOB. 0 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) Engineering Works, Inc. NTS P.T.M. 132- 9 16 UNITS x 6.26 LF x 4.7 SF/LF = 470.0 SF 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 x 470.0 = 347.8 GPD (508) 477-5313 5/1/09 P.T.M. 2 of 2