Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0625 RACE LANE - Health
625 Race Lane , Marstons Mills VA = 103 —035 II TOWN OF BARNSTABLE LOCATI(;N kal l SEWAGE# ZQ2��® 1 VILLAGE :A!t. , ASSESSOR'S MAP&PARCEL/0 INSTALLER'S NAME&PHONE NO. ,®`r'4 c� cll SEPTIC TANK CAPACITY LEACHING FACILITY:(type \� ,�� (size) NO.OF BEDROOMS 3 OWNER PERMIT DATE: La 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) Feet FURNISHED BY 6 `����� ®. �°✓ �—q-Abxi Wool TOWN OF BARNSTABLE LOCATI�IN SEWAGE# •�+ O 13 VILt�-- 4aZ r LACE 4.,..f „__ASSESSOR'S MAP&PARCELe•J •�f)' INSTALLER'S NAME&PHONE NO. pr. o•c SEPTIC TANK CAPACITY '' •� f ���� V LEACHING FACILITY:(type,3 ��0 ,�pD � �(size) _2S NO.OF BEDROOMS 3 OWNER 1 PERMIT DATE:� 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) T Feet FURNISHED BY A C,,. %% L-nf e -Tog(f.- Ste`^ i u7�ta I No. `� 3 Fee / THE COMMONWEALTH.,OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes apphtation for Disposal *pstrm ConstrUttion 3permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. us- k—C cry 1 f Owner's Name,Address,and Tel.No. ("`vkkS ` Uls- Assessor's Map/Parcel 0 3 3�� Mq * Installer's Name,Address,and Tel.No. ��n �c i;s��-� Desi er's Name,Address,and Tel.No. Akt C-qc_. 5e-1,j L L T-* Zal 0ZG7 fnAr- n ►\ p Type of Building: `� Dwelling No.of Bedrooms J Lot Size lz, 000 — sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.re ired) 3 3 O gpd Design flow provided S S gpd Plan Date 0 3 Q`t tf, Number of sheets 1 Revision Date Title Size of Septic Tank 1C`ST:�a �,Ate'=► Type of S.A.S. � � I �� � ���� C. ,4r.�f� Description of Soil S 2� Nature of Repairs or Alterations(Answer when applicable) �� (3 ) TQA c*-j— C 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 Bo of Hea x gned. Date Application Approved by Date7� Application Disapproved by Date for the following reasons Permit No.:.o2® (j ?j Date Issued �� No. 7 Fee = THE COMMONWE/A,� LTH,OF MASSACHUSETTS Entered in computer: ' =+ Yes PUBLIC�HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Disposal 6pstem Construction Permit Application for a Permit to Construct(Vill'Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual.Components Location Address or Lot No. G Z S +1Cia L n r u r r Ali- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 0 34) ✓ / �m 4 ) Installer's Name,Address,and Tel.No. -�-�„ Q, btf`.t� Designer's Name,Address,and Tel.No. \A, Cl\ $LO L t J evcic ..�3c•1. i `6 4n�?S+ CC.k WIT ILA,. Zg WtS - y1r#�)P� � P.V1t Type of Building: a Dwelling No.of Bedrooms Lot Size Lo at,() t sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min..,required) 3 3 o gpd Design flow provided t"f ss gpd Plan Date Q �7 Number of sheets Revision Date Title Size of Septic Tank F� Type of S.A.S. f4 Err Description of Soil S e Q Nature of Repairs or Alterations(Answer when applicable) A 4CC s ; r-ze . _ �-t ' v 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 Boar of Healt i ned Date Application Approved by Date 1 Zv Application Disapproved by Date for the following reasons Permit No. ZC-)Z o -- Date Issued 'Id --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Comptiance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( Repaired( ) Upgraded( ) Abandoned( )by at tv i 1 /�w ` has been constructed in accordance with the provisions of Tit d-fhe of r Dis`posal'System Construction Permit No.2010 dated jIt I Z-07 p X Installer l/�tt: Designer C C,n e t-L t #bedrooms Approved denAE�� 3 gpd The issuance of this ermit spall nottbe construed as a uarantee that the s stem wDate }// / - � g Inspector - ----------------=----------------------------------------.-------------------------------------------------------------------- No.��717 � 3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstent Construction 3permit Permission is hereby granted to Construct( ) Repair(�i Upgrade( ) Abandon( ) System located at 7_5 JQ' �(� � � and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons ction must be completed within three years of the date of this pe Date T// ZvZ c� Approved by 4 4 Town of Barnstable Inspectional Services r Public Health Division • BARNRABM • KAM Thomas McKean,Director ct °� 200 Main Street,Hyannis,MA 02601 I Office: 508-8624644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# Assessor's Map\Parcel D Designer: �,r,(oA �' Installer: Address: Address: 1 �e� r� J"1, s lh��'3oni Usd On 43 Zo L���be f was issued a permit to install a dat ) J (installer) septic system at 1p 2 46e- lev�t based on a design drawn by (address) CdPM dated 3 �� (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations., Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the syste eferenced above was constructed in compliance with the to rms of the RA approv ers (if applicable) of Installer's Signature) ° Scott A. ° MCGarm V #1224 G0 (Deng er's Signature) (Affix D ii is Stamp Her g� S PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH D FICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoaldeptAHEALTMSEWER connecASEPTICOesiper Certification Form Rev&14-13.DOC Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is Y Marstons Mills MA 02648 Jul 26 2014 required for every , page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information G n I on the computer, v\• O u use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr, IRS use the return Name of Inspector key. Eco-Tech Environmental 19 Company Name P.O. Box 1265 Company Address West Chatham MA 02669 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:. ® Passes SkAOF qc ❑ Conditionally Passes ❑ Fails DAVID ❑ Needs �617v ilYt��p a Local Approving Authority UG No 1328 tP�s Ap V�p.�O� KI July 26, 2014 Inspector's Signa ure Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Offici I I s ction Form:Subsurface Sewage D/P��Iem•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is Marstons Mills MA 02648 July 26, 2014 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Inspector's Note==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5, or specified by local regulations. The scope of this inspection is limited to health and environmental compliance and the septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. , The septic tank is metal and over 20 ears old* or t t-e se tic t nk( ether metal or not Is structural) p Y � p ,( ) Y unsound, exhibits substantial infiltration or exfiltr tion r tanJallur`els,Imminent. System will pass inspection if the existing tank is replaced with a c-'implying septic tank;as approved by the Board of Health. f° 0:4 � 1,.d, �f,'/{!1 .. *A metal septic tank will pass inspection if it is stru- urally.sountl,notf'�leaking and if a Certificate of Compliance indicating that the tank is less than 20 y� rs oldtls�ava'ilable. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke _ Owner Owner's Name information is Marstons Mills MA 02648 Jul 26, 2014 required for every Y page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N FIND (Explain below): C Further Evaluation is Required b the Board of Health: q Y ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ec,M 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is required for every Marstons Mills MA 02648 July 26, 2014 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is y Marstons Mills MA 02648 Jul 26 2014 required for every , page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® An portion of a cesspool or privy is within a Zone 1 of a public well.Any P p Y p e . ❑ ® 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 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is Marstons Mills MA 02648 Jul 26 2014 required for every y page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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)] D. System Information 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 gpd 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is Marstons Mills MA 02648 Jul 26 2014 required for every Y page. CityTrown State Zip Code Date of Inspection D. System Information Description: A 3 bedroom system was installed by Capewide Enterprises LLC. in 2010 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No 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 ears usage 132 gpd 9 ( Y 9 (gpd)): Detail: 2012: 52,000 gallons 2013: 46,000 gallons 2014 (first half): 22,000 Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments p°M 625 Race Lane - Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is Marstons Mills MA 02648 Jul 26, 2014 required for every y page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '�M ,•''• 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is Y Marstons Mills MA 02648 Jul 26 2014 required for every , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 4+ years. Certificate of Compliance for repair issued 1/14/2010 (Permit#2010-007). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank (locate on site plan): 1 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5 x 5 x 6-1000 gallon Sludge depth: 4 in t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is required for every Marstons Mills MA 02648 July 26, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness 2 in Distance from top of scum to top of outlet tee or baffle 9 in Distance from bottom of scum to bottom of outlet tee or baffle 13 in How were dimensions determined? Design plan 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 is not required at this time. Maintenance pumping is recommended every 2-4 years with year round occupation. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is Marstons Mills MA 02648 Jul 26 2014 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of constriction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <o^M 625 Race Lane - Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is required for every Marstons Mills MA 02648 July 26, 2014 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at 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.): Distribution box appears structurally sound with no evidence of leakage in or out. Few solids in sump. 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. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is Marstons Mills MA 02648 Jul 26, 2014 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: I ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): Soils above leaching system appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into the distribution box and was observed to pass through in a rapid and unobstructed manner, and could be heard splashing down into the leaching biodiffuser units. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts L w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is required for every Marstons Mills MA 02648 July 26, 2014 page. Citylrown State -Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): w Disposal System Pa a 14 of 17 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disp y • g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is Marstons Mills MA 02648 Jul 26 2014 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 LEACHING GALLERY X DISTRIBUTION BOX O THIS SKETCH IS BEST VIEWED IN COLOR FORMAT 1 ® 1000 GALLON LL OCA TIOnNIs 2` SEPTIC TANK -OF SEPTIC COMPONENTS DISTANCES IN DECIMAL FEET A 8 B A 1 27.5 44 2 24.3 50.2 EMS TING 3 61.5 90 DWELUNG 625 NOT TO e SCALE NONE DRIVEWAY 508 364-0894 RACE LANE t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address Bryan W. Burke Owner Owner's Name information is required for every Marstons Mills MA 02648 July 26, 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 30+ 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: 1/12/2010 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Approved design plan on file with the Board of Health shows bottom of system to be 7 feet above the bottom of a witnessed test pit in which no groundwater was encountered. Town of Barnstable GIS Department records indicate that the property is over 30 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 625 Race Lane- Assessor's Map 103 Parcel 35 Property Address - Bryan W. Burke Owner Owner's Name information is Marstons Mills MA 02648 Jul 26 2014 .. required for every Y page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ®Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file GEOHYDROLOGICAL PROFILE — NOT TO SCALE BOTTOM — -- —. OF .. LEACHING w GALLERY O LEACHING IS ABOVE HIGH GROUNDWATER GROUNDWATER ELEVATION PER GIS MAPS t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE o LOCATION &n e SEWAGE# 00-1 VILLAGE 1)4• ASSESSOR'S MAP&PARCEL ly INSTALLER'S NAME&PHONE NO. oYU� SEPTIC TANK CAPACITY �x•s��r. v ��f-,�t� LEACHING FACILITY.(type) /3,t)i/%r (size) 8. 7 r 3 feZ NO.OF BEDROOMS OWNER` .,^ems I A,,,AA a PA &ku r PERMIT DATE: I Z (p COMPLIANCE DATE: t -1,0 t 0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _Z 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) pp Feet FURNISHED BY Ca g RAA_O 1 CJC3_ 4 _ ts A a7.Sc A 2 A 3 Ay ��•� tj� 32 s�o z 93 gc.z 9 f No. —®o 7 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (OZ`j R,'Gc La-7a- Owner's Name,Address,and Tel.No. ��4ibTons r"i)IS 311, l e.X.-T" ST ` Assessor's Map/Parcel p-3 '3 s- ,, /%-- Installer's Name,Address,and Tel.No. PO 13ox, 7 63 Designer's Name,Address,and Tel.No. PPkI� &->Z�-e.,-i es GGG tie TC F-jjLajp-titiC wog-- L73 -u�77 Type of Building: DwellingNo.of Bedrooms ✓ Lot Size �0 0�+ , sq.ft. Garbage Grinder( ) Other Type of Building 151 n t I,*- ��''"r`� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 p gpd Design flow provided 3 3 Z ,_`S" gpd Plan Date I 11- ?,o rD Number of sheets Revision Date Title Ca7_j 12.1'1t-y— Size of Septic Tank J000 gjf(, (=-t'S 14� Type of S.A.S._P, e"141 !3ed Description of Soil e al" 7- Nature of Repairs or Alterations(Answer when applicable) ,%ram\ 0Z"b_L 7y4-VIR, Tb /W,,) 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 ealth. Date Z9 7 p Application Approved by Date 6 Application Disapproved by Date for the following reasons Permit No. —oo? Date Issued J 1 !(/ No. 7 l/ C� 1 0, - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1 _ PUBLIC HEALTH DIVISION -TOWN ORBARNSTABLE, MASSACHUSFTTS Yes - ftphtation for Misposal *pstem Construction 3permit Application for a Permit to Construct( ) Repair 5<) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (,Z,5 9,46CG Z 4,rc Owner's Name,Address,and Tel.No.,tip,�r 1114/srudS /*ii)I$ Assessors Map/Parcel /A 3 35 Installer's Name,Address,and Tel.No. PC) 13nx ,7 t,? Designer's Name,Address,and Tel.No. ��tw,clQ ��ll�✓��iS�S LLG e IL-Qc1 7-7 Type of Building: ^� Dwelling No.of Bedrooms _ J Lot Size 7-0 0QQ i- sq.ft. Garbage Grinder( ) Other Type of Building Si n j e {may,. tt_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 35n gpd Design flow provided 3 3 2. . 4, ' gpd Plan Date - 11- 20 t U Number of sheets Revision Date Title („�.� jle_ Lp Size of Septic Tank (Oc) w L 4-c'S r Type of S.A.S. /, 1� Description of Soil t ie ,Q�la-1�l ` ,r (� �� Nature of Repairs or Alterations(Answer when applicable) t✓X,S;�•c L, S-e p bL Ty?-yk Tb 0, �_tp_w 1)--4-,"(, Td 1h R,0,),,i,"Zto 04e 3 (. j3 t-3o Date last inspected: ZtXA . 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. igned Date Z 1 o Application Approved by _ Date / Application Disapproved by Date for the following reasons Permit No. C'O Date Issued () THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CEnRTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by r at Yt'�1.Ac P L✓1vu /e,3 k>n) ly ((1 has been constructed in accordance f P i p y r�1d - ?dated with the provisions of Title 5 and the for Disposal System Construction Permit No. Installer C�1,,)O'L �{,(I Ii PN L,IC Designer J. C #bedrooms ) .� Approved design I/� Q gpd The issuance of this permit shall not be construed as a guarantee that the system will nc S)designed. Date t L� Inspector v �`� v-'No.r-�U' .''�CJ�---- - -_--- -__.____._______---__�------------------_----z-------------=-===--FeeTHE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS VSVOsal *pstem Construttlon Permit Permission is hereby granted to Construct( ) Repair(K) Upgrade( ) Abandon( ) System located at ( Z,{ 144 2 1 s rh /Li and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructig n must be •ompleted within three years of the date of this pQy _ Date ��� Approved b Town of Barnstable P# .2 y i Department of Regulatory Services Public Health Division � 200 Main Street,Hyannis MA 02601 Date Date Scheduled Time Fee Pd, Z at/ ,Soil Suitability or Se Assessment for U1i wage zsposal Performed By: !1taL cie,( Ptphen�( E L 1 C$CC i Witnessed By: V It,/. LOCATION & GENERAL INFORMATION Location Address /_2Si- 1� �v t& Lc r� Owner's Name /17 S�"ems Address Assessor's Map/Parcel: 163 ( ' / Engineer's Name NEW CONSTRUCTION 1/ � � C-g5,We,-1i(5 REPAIR Telephone# r6 1� '{ Ato,*-Iq 31 273 e 377 Land Use __ Sttt�[= Z (y /re�tcten4t4 Slopes(%) 1` Surface Stones Distances from: Open Water Body _--�_ft Possible Wet Area ft Drinking Water WellDrainage Way - -ft ft Property Line 710 -- ft Other ft SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands In proximity to holes) See_ a tt -tom� P loo Parent material(geologic) 6o*wash Depth to Bedrock Depth to Groundwater. Standing Water in Hole: 7 l 32 (GnS - -- Weeping from Pit Pace 7132 b�5 Estimated Seasonal High Groundwater 132 055 DETERMINATION FOR SEASONAL HI UGH WATER TABLE Method Used: r'0C d-setUa�A'1 Depth Observed standing in obs.hole: 7 13.4 Depth to weeping from side of obs.hole: > 13L in, Depth to loll mottles: >132 Index Well# In, aroundwaterAdjustment In, Reading Date: Index Well level ft. -�-a �_ AdJ,factor- Adj.Groundwater Level Observation PERCOLATION TEST Dote %-s-/�7TI= 16Hole# Time at 9"Depth of Pere3Z-SOTime at 6"Start Pre-soak Time @ 0:/0 Time(9"-6") ^ End Pre-soak l0:!-7AP1 Rate Min./Inch < 2 - Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) - AJ Original: Public Health Division Observation Hole Data To Be Completed.on Back--------___ ***If percolation testis to be conducted within 100' of wetland, you must first notifythe Barnstable Conservation Division at least one (1) v eek Pbeginning.rior'to ' Q:\SEPTIC\PERCFORm.DOC Depth from DEL,P-OBSERVATION HOLE LOG Hole#Soil Horizon Soil Texture Surface(in.). .5di1 Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders, �_y oti i to c °k ravel ------ A j0 3�Z _ \ 41--32_ 3 2-13 2 G --_ DEEP OBSERVATION HOLE LOG Hole# 2 _ Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders, © _y A Consisten %Gavel) L S j 0 Yr 3/2 I'S /D r516 32 13z L n cs 2.� t o lc�sz Depth from DEEP OBSERVATION HOLE LOG Hole# Soil Horizon Soil Texture —------ Surface(in.) Soil Color Soil Other - (USDA) (Muuscll) Mottling (Structure,Stones,Boulders. Co i tency,3' G vel DEEP OBSERVATION HOLE LOG Hole# FDpthSoil Horizon Soil Texture Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi ten i I Flood Insurance Rate Map.• Above 500 year flood boundary No_ Yes _ Within 500 year boundary No- yes Within 100 year flood boundary No yes , Depth ofN aturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Ye-S If not, what is the depth of naturally occurring pervious material? Certification I certify that on X-2-7-99 (date)I have passed the soil evaluator examination approved by the f Department of.Environmental Protection and that the above analysis was performed by me consistent with . the required training, expertise nd e ence described in 310 CMR 15,017. Signature Date Q:%S BPTIC\PERCFORM.DOC 1. own ot-isarnstame Regulatory Services Thomas F'.Geiler, Director � BApNNr'ABLY. � MAIN, Public Health :Division Thomas McKean, Director ZOO Main Street,Hyannis,MA 02601 C)fficc; 508 fiG2- tG44 Installer & Designer Certification-F(lrin Date. �..,T.��—�C Desigperr .1 F_vicl c►rr'_' Installer; _�_�-PuWictC^_ ���►etc �. i5e.., Address-, L %`� ( ic►Itv�:rt� pllyy���1 Address: C7 3(Dk 7G`3 M � "' ' �I Uri was issued a permit to install a (date) (inst�illerj... septic system at Z (` m(,.e, /-r..10 C, based on a design drawn by (address) .-- .: -- ------ datedsoAVWO(r 11 2 c)( 0 (designer) _- ----�-- ----• ._._. ✓ I ccalif'y that the septic system referenced above was Installed substantially accordi,118 to —"~ the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. —� I certify that the septic system referenced above, was installed with major chwiges (i.a. greater than 10' lateral relocation of the SAS or any vertical relocatir)n of any component of the septic system) but in accordance with State & Local Regulations. Plan revision nr certified cis-built h.y designer to follow, JOMN L. CHURC11LL .A % ~ ( a11eY''S t att2re '41CIVIL a 0y 7 esigner's ignawre (Affix l�esigtier's St;imp Here) EASE RETURN TO BARNSTABLE PUB C HEAL ' D SI(ti Y. f lwRT C:A'I E O LIANC ILL NO ED B I T S AN AS. 13ULLI'CARD A,RE RlE(�CEIVED :BY THE BAWSTABE U`B C HE A I TH OV 1HANK YO`U. Q• Health/Scpticmr.signer Certification F orrri TO *d L9S0 S"J_Z RnQ WA 0T 7.0 O1Tn7.-Ci-NHf Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4M 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every 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. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name P.O.Box 763 Company Address Centerville Ma. 02632 � City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® ;Fails Needs Further Evaluation by the Local Approving Authority v 11/03/2009 lnspvorV Signature Date. The system inspector shall submit a copy of this inspection report to the Approving Aut—03ty( 'oard of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use p Y p at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. f� l l� t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disp al System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M , 625 Race Lane - Property Address Mary Anne Choriton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of W Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® 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)] D. System Information 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 l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is Marstons Mills Ma. 02648 11/03/2009 required for , every page. CitylTown State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon tank and overflow cesspool. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available:. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. City/Town State Zip Code Date of Inspection D: System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1975 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC Orangeberg pipe ® other(explain): Distance from private water supply well or suction line. 10'+ feet Comments (on condition of joints, venting,Evidence of leakage, etc.): Joints appeatr tight.no evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: Z concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 3" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" u Distance from bottom of scum to bottom of outlet tee or baffle 12 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.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness I Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 625 Race Lane Property Address Mary Anne Choriton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 111 of 117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forml Not for Voluntary Assessments 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Box not present. 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(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ 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.): Sandy soil.Overflow cesspool shows signs of hydraulic fai I ure.Overflow dry at time of inspection.Stain !line observed up to invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top'of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 i every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size Zoom Out ®In y r R..a r R ry \ J f 00 �a fi Ni I j . e 20 Feet. Set Scale 1° = 20 I Aerial Photos ! I MAPbISCLAIMER r'—,Hi hf innr_')nOO Tn... of INAA All Hi hfe rcecnfi httn,-//FF.2101.95.23f/arcim./a..ringeoa.nn/man.asnx?nrcnertvIT)=103035&ma.nna.rhack= 11/7/2009 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of Overflow 35' 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: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts w r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 625 Race Lane Property Address Mary Anne Chorlton Owner Owner's Name information is required for Marstons Mills Ma. 02648 11/03/2009 I every page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed System Information—Estimated depth to high groundwater Z Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Cape Cod Marstons Mills, MA CONSTRUCTION NOTES RAISE MIN. 20" DIAMETER COVER RAISE MIN. 20" DIAMETER COVER Airfield 1.) ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE, TITLE 5 (310 CMR 15.000): EL=82.0± TO WITHIN 6" OF FINISH GRADE TO WITHIN 6" OF FINISH GRADE �pc� STANDARD REQUIREMENTS FOR THE SITING. CONSTRUCTION, INSPECTION, UPGRADE, AND EXPANSION OF ON-SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE TRANSPORT 80.0± 79.5± EL=79.0± Barnstable AND DISPOSAL OF SEPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. ����� \������� �0 Course 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE IS POTENTIAL FOR \��\� , \ \� VEHICLES OR HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 X LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. 3.) TO MINIMIZE UNEVEN SETTLING, SEPTIC TANKS AND D-BOX SHALL BE INSTALLED ON A STABLE 79.1± rn n GCS LOCUS MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. G FABRIC ILE 79.0± 76.2 FABRIC 4.) COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK, THE DISTRIBUTION BOX, AND _ THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN 6" OF FINAL GRADE. LEACHING Existing \0 FIELDS, TRENCHES, AND OTHER SOIL ABSORPTION SYSTEMS WITHOUT ACCESS MANHOLES SHALL HAVE AT LEAST ONE (1) INSPECTION PORT CONSISTING OF PERFORATED 4" PVC PIPE PLACED _ 77 7± 3 GO\ 6Sf VERTICALLY TO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP, .TIED WITH MAGNETIC o 76.07 75.9 } t°r MARKING TAPE, ACCESSIBLE TO WITHIN 3" OF FINAL GRADE. 78.0± Existing 3/4" tT Existing N 75.7 N! 1-1/2" STONE RO 5.) PIPING SHALL CONSIST OF 4" SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A GAS BAFFLE DB-3 H-20 (Double wosh) / OQ. 3 MINIMUM CONTINUOUS GRADE OF NOT LESS THAN 2% FROM THE BUILDING TO`THE SEPTIC TANK, fl AND NOT LESS THAN 1% OTHERWISE. D-BOX THREE (3) 500 GALLON H10 PRECAST 6.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4" DIAMETER SCHEDULE 40 73.7 CONCRETE LEACH CHAMBERS WITH 4' OF c� PVC (OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE CAPPED EXISTING STONE ON ENDS AND 4" ON SIDES AT END OR AS NOTED. 1,000 GALLON -32'± -� � 10 ±--- 5 7' M1 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO (2) FEET BEFORE SEPTIC TANK LEACH CHAMBERS SITE LOCUS PITCHING TO THE SOIL ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED TO (To Remain) (END VIEW) NOT TO SCALE ASSURE EVEN DISTRIBUTION. 8.) GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE STRUCTURES FLOW PROFILE EL=68.0 Bottom Test Hole IN ORDER TO PROVIDE A WATERTIGHT SEAL. 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE NOT TO SCALE DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. \ 10.) IN ACCORDANCE WITH 310 CMR 15.221, ALL SYSTEM COMPONENTS SHALL BE MARKED WITH \\ . ASSBSSOr'S a MAGNETIC MARKING TAPE. 1 \ ) Map 103 Parcel 35 11.) THERE ARE NO KNOWN WELLS WITHIN 150' OF THE PROPOSED SOIL ABSORPTION SYSTEM. \ 2.) Bk 28355 Pg 23 12.) FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL RECEIPT OF 3.) PL BK 157 PG 97 THE CERTIFICATE OF COMPLIANCE, THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT \ 4.) This property is not in a Wellhead USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. (\ Protection District 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS Map 103 �; 5.) This property is in the Saltwater CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE Parcel 34 \\ r [~ 3 Estuary Protection Area 14.) THE BOARD of HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE 80 / \ �,6j0 / 5.) This property is not in the Flood Zone BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE \ �� / Firm Map 25001 C0542J 7/16/14 SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE IS REQUESTED, 15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR DETERMINING THE LOCATION OF 'ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO �� ! w' " \ SYSTEM DESIGN CALCULATIONS COMMENCEMENT OF ANY WORK, THIS INCLUDES, BUT 1S NOT LIMITED TO REQUESTS TO DIGSAFE, �o. Top Concrete Ftg. ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. TBM EL 80.2 i ooa SEWAGE DESIGN FLOW: THREE BEDROOM DWELLING @, 110�GPD/BEDROOM = 330 GPD 16.) CONTRACTOR SHALL VERIFY.THAT ALL WASTELINES ARE CONNECTED BY WATER TESTING r. \ SAS ' w SEWAGE DESIGN FLOW PROVIDED: THREE (3) 500 GALLON CHAMBERS WITHIN, THE DWELLING PRIOR '� INSTALLATION OF ANY SEPTIC COMPONENTS._ � r�, '� i , 17.) CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY po �� , p ors \ WITH 4 STONE ON THE ENDS AND 4 STONE ON THE SIDES SEPTIC SYSTEM COMPONENTS. -- h� o a0 '`� w \L�hoy \ \ °° \ Vt = [(33.5 x 1.12.83) + 2(33.5 + 12.83) (2) x .74 = 455 GPD PROVIDED 18.) TEST HOLES COMPLETED PER STATE ENVIRONMENTAL CODE, TITLE 5. SOILS CAN BE 455 GPD PROVIDED > 330 GPD REQUIRED as VARIABLE AND TEST HOLE DATA IS NO GUARANTEE OF SOIL CONDITIONS IN OTHER AREAS. IF SOILS DIFFER FROM THOSE SHOWN IN- THE SOILS LOGS, DESIGN ENGINEER IS TO INSPECT THE 79_ .,'`• ,," DB /I #605 � \ SEPTIC TANK CAPACITY REQUIRED: 330 GPD X 200 = 660 (MINIMUM) SOILS PRIOR TO PROCEEDING WITH INSTALLATION OF ANY SEPTIC COMPONENTS. ' \ 3 Bedroom 19.) EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND AN i TOF EL = 82.0t \ SEPTIC TANK CAPACITY PROVIDED: 1,000 GALLON SEPTIC TANK (EXISTING) ABANDONED IN PLACE OR REMOVED AS REQUIRED. AREA TO BE COMPACTED TO MINIMIZE SETTLIN .\ f TP ��''�^ \"`~ ` ! \ �, TP #2 Leach Pit \ \ Beck <�\ \ See Note \ \,-, TEST HOLE LOGS \ \ Bedroom \Shed > Above\ \ \ \ \ Ground #3 I Test Hole 1 (EL=79.0±) \ \\\ \> 1\ Pool 1 �OpO Bedroom Family Proposed 'y / 1 #2 5' Cased Opening Depth Elev. Layer Soil Class Soil Color Notes \ `/ _ \ Bath \\ Living 0"-4" 78.7 A Loamy Sand 1OYR 3/2 \ yA'�s Lot 45 9 \ �o°o• 20,000± Sq. Ft. F, Kitchen 4"-32" 76.3 B Loamy Sand 1OYR 5/6 61,E \ - y000 32"-132" 68.0 C Medium Sand Coars 2.5Y 6/6 Loose J \\ �,°a Dining ��X'�f Masao ,6 �� Mop 103 Be room �? Parcel 361 �30 e,,N 0 0 Floor Plan McG � Test Hole 2 (EL=79.0±) L� \\ N.T.S. Depth Elev. Layer Soil Class Soil Color Notes \ his e 5 0"-9" 78.7 A Loamy Sand 1OYR 3/1 \ 9"-28" 76.3 B Loamy Sand 10YR 5/6 \ \ Note: 28"-120" 68.0 C Medium Sand 2.5Y 6/3 Loose This plan is only valid for current regulations and may \ \ not be suitable for future regulation changes that may occur. Proposed Sewage Disposal System DATE OF TESTING: 01/5/2010 PERC NO. 12796 SOIL EVALUATOR: MICHAEL PIMENTEL 625 Race Lane Marstons Mills, MA WITNESS: DAVID STANTON, BARNSTABLE BOH PERCOLATION RATE: LESS THAN 2 MIN/INCH Prepared by: PERC IN C LAYER (32-50" Deep) Prepared for: All Cape Septic LLC NO GROUNDWATER, NO MOTTLING ENCOUNTERED GRAPHIC SCALE Ste hanie Souza �- P 618 Route 28 30 0 15 30 60 120 625 Race Lane West Yarmouth, MA 02673 Ci Marstons Mills, MA (508) 771-4200 ollcopeseptic@gmail.com ( IN FEET ) 1 inch = 30 ft. Date: 3/04/20 Sheet 1 of 1 By: MA Check: SM Project No. AC-218 = $1.9�± PROVIDE PRECAST CONCRETE 4"SCHEDULE 40 PVC MIN.SLOPE 1% FINISHED GRADE OVERBIODIFFUSERS= 78.9' - 79.4' GENERAL NOTES T.O.F. EL. EXTENSION RISER WITH CONCRETE INISH GRADE OVER D-BOX= 79.3 ± SLOPE 2%MIN. COVER TO WITHIN 6"OF F.G.OVER INSPECTION PORT WITH @ INLET AND OUTLET COVERS. REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN 1- UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE RISER TO WITHIN 6"OF FINISHED GRADE 1.2'LONG-13" HIGH COUPLING 3"OF F.G. (ONE PER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL, 80.0 ± FINISHED GRADE OVER TANK EL. = 79.5± 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. rn 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE i f DESIGN ENGINEER. EXISTING 4" PROPOSED 4" 9�MIN. 9'wMIN. � 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PIPE 36 MAX. 36 MAX. TOP OF SAS/B.O. = 76.49 / SEWER PIPE _ SYSTEM UNLESS OTHERWISE NOTED. - - - -- -_-- - " p 3"DROP MAX p p PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6 3 2"DROP MIN 3 9 JOINTS (TYP.) ELEVATION =76.49' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A p MIN.SLOPE 1% L L 1 4"PVC IN FROM 1.08' p 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF � `0 13 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 14" `_* 7,%�'#a SEPTIC TANK 4"PVC OUT TO (TYP) n P j ---- LEACHING FACILITY 0.59 7.13I ITir ) o 1 SLOPE ALL SOLID PIPE AT 1.0 MINIMUM. !_ 5. /o IMU CONTRACTOR CONTRACTOR SHALL 1 12" 6p 76.00' 75.41' (laid flat 2.875"(34.5")--I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 77,00 MIN. 76.83' ( ) (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES 22"ZABEL FILTER 6"CRUSHED STONE 5.0' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS MODEL#A1801-4x22 OVER MECHANICALLY (TYP.) 5 MIN. 8.625' TANK NECESSARY COMPACTED BASE REQ'D NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 31.2'(TYP FOR ALL ROWS) AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX _ 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 80.00'ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 68.00' B,IODIFFUSERS (END VIEW) ON A NAIL SET IN TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 18 - BIODIFFUSERS (PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW (BY ADVANCED DRAINAGE SYSTEMS-,, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 18 _ ARC36 ( 3613BD) BIODIFFUSERS TO THE DESIGN ENGINEER. 'CONTRACTOR N VERIFY EXISTING ELEVATION PRIOR 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. TO AN`'WORK� NOTIFY ENGINEER IF DIFFERENT NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING NOTES: � �,,�r � p ' ', I TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM �` PERC NO. 12796 APPROPRIATE AUTHORITY. , INSPECTOR: David W. Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. - EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE HC 1 #625 r� THEY SHALL WITHSTAND H 20 LOADING. _ C.S.E.APPROVAL DATE: Oct.27, 1999 2. CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF EXISTING r ` 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. 3-BEDROOM 1 l /' + C� ._ , E � � A. DATE: January 5,2010 THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH _ / CONTRACTOR SHALL REMOVE ALL LOAM SUBSOIL AND UNSUITABLE DWELLING / / iftf`�un ¢, z : TEST PIT#: 1 14. WHERE REQUIRED, , TEST PIT DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND TOF= $1.9'± ! '` - ._ MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. LOCAL BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT , ELEV TOP= 79.00' I REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, DATA. LOCUS 1 ELEV WATER= <68.00' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). M 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN 3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHED. (1v + , �� PERC RATE_ <2'min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. (2 ,f �': . ; t .. DEPTH OF PERC= 32"-50" <C ^ ' `` 16. PROPOSED PROJECT IS LOCATED WITHIN: ,� N ■ ,, ■■' ■ * �' TEXTURAL CLASS: 1 ASSESSOR'S MAP 103 PARCEL 35 Ln HC-2 O SHED a ■*.,,, ■ r ■ YO � ■■`■ ■ , i; � OWNER OF RECORD: DANA A. & MARYANN CHORLTON � ■ � • s,. r ~ ■ ■ * ' ■ s ` f 0" 79.00' ADDRESS: 312 LEXINGTON STREET m Loam Sand a 4) 0 ■ ✓/ A 10Yr 3/2 WOBURN MA 01801 (' �` 3) � � ` , f = 4" 78.67' .�ZONE 2 ■ '' p` FEMA FLOOD ZONE C 4e > �► t � B Loamy Sand O yi' A # ■ " s 10Yr 5/6 COMMUNITY PANEL# 250001 0015 C SWING_TIES v Cj 17. DEED REFERENCE: DEED BOOK 9119, PAGE 320 ?yam SCALE: 1 -20 32" 76.33' _ HC-1 HC-2 *. � Perc � 18. PLAN REFERENCE: PLAN BOOK 157, PAGE 97 U.P.#4/82 DESCRIPTION �� F 50" -`5 74.83' r w 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. BIODIFFUSER CORNER(1) 59.9' 89.2' 2 ONLY 1-- � 0 PROPERTY LINE INFORMATION IS ONLY APPROXIMATE THIS PLAN IS TO BE USED 2' 4 - 94.6' , _ cn SEPTIC SYSTEM BIODIFFUSER CORNER(2) 68 __ ._._ __ FOR SE T C S ST UPGRADE. -JC ENGINEERING WILL NOTASSUME ANY LIABILITY FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. Med.-Coarse Sand BIODIFFUSER CORNER(3) 68.3 73.8 z - C 2.5y 6/6 .. BIODIFFUSER CORNER(4) 59.9' 66.7' (Loose) MAP 103 $a f / LOCUS PLAN n , PARCEL 34 MAP 103 � °, � 0��9 SCALE: 1"= 1000' 132 68.00 PARCEL 35 OG� No Mottling,Standing or Weeping Observed 20,000 S.F.± DESIGN DATA TEST PIT DATA LEGEND PERC NO. 12796 ,PPROXIIv)ATE LOCATION OF EXISTING p2 00 �� O �\ INSPECTOR: David W.Stanton, R.S. 50xO EXISTING SPOT GRADE LEACHING PIT TO BE PUMPED AND �rO o / ,gam ° NUMBER OF BEDROOMS(DESIGN) 3 - - 50 - FILLED WITH CLEAN COARSE SAND -`'� \ a L y EVALUATOR: Michael Pimentel, E.I.T. - EXISTING CONTOUR �GL DESIGN FLOW 110 GAUDAY/BEDROOM y� C.S.E.APPROVAL DATE: Oct.27,1999 50 PROPOSED SPOT GRADE °s TOTAL DESIGN FLOW 330 GAUDAY DATE: January 5,2010 80 �"S 0 660 TEST PIT#: 21 PROPOSED CONTOUR ��- 0 / DESIGN FLOW X 200 /o = GAUDAY PROPOSED DISTRIBUTION BOX �P HN #625 Oy `-'� �Ps y ELEV TOP= 79.40' ❑/H/W EXISTING OVERHEAD WIRES y1o0a o�N,u ° EXISTING �`\ ' USE EXISTING 1,000 GALLON SEPTIC TANK PROP. 13" HIGH ARC 36 / ___ i O s <68.40' COUPLING (TYP OF 3) � o!� O 3-BEDROOM O � �-- �° � ELEV WATER= GAS EXISTING GAS LINE } OQ O DWELLING /om!w� ✓ t 1� C �/ TOF=81.9'± 5� \ �� \ \ \ INSTALL 18 - ARC 36 (#3613BD) BIODIFFUSERS PERC RATE_ -X-X-X-X-X- EXISTING FENCELINE TP 1l79_ s S\,� / y� -W-W EXISTING WATER LINE a \ DEPTH OF PERC= 79.0' J O ` ' o SYSTEM CAPACITY TEXTURAL CLASS: 1 TP 2 O ° TEST PIT LOCATION 79.4' FC y� (TOTAL L.F. OF BIO'S$COUPLINGS)(4.8 SF/LF)(0.74 GPD/SQ.FT.) GPD U.P.#629/3 ° 63 r \ (93.6')(4.8 SF/LF (0.74 GAUSQ.FT.)= 332.5 GAL. LEACHING/DAY' ' � � � EXISTING 1,000 GALLON SEPTIC TANK Avlk S0 ° 0" 79.40' yam\ �'i2 y y A Loamy Sand PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE oo TOTALS: 10Yr 3/2 �Ot 6 SHED 36"STUMP g o0 Q PROPOSED DISTRIBUTION BOX o_ srjo �o o TOTAL NUMBER OF BIODIFFUSERS: 18 4" 79.0T �° sOo o ��. �` ►�6 MAP 103 TOTAL NUMBER OF COUPLINGS: 3 Loam Sand PARCEL 36 TOTAL LEACHING AREA. 449.3 B y PROPOSED ARC 36 #3613BD BIODIFFUSER row 79� TOTAL LEACHING CAPACITY: 332.5 10Yr 5/6 0 ( ) 32" 76.73' PROP. 18- 13" HIGH ARC 36 (#36136D) �� a �-EXISTING 1,000 GALLON SEPTIC TANK TO NOTE: REV. DATE BY APP'D. DESCRIPTION BIODIFFUSERS IN FIELD CONFIGURATION y� BE UTILIZED AS PART OF THIS DESIGN EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE PROPOSED SEPTIC SYSTEM UPGRADE PROPOSED INSPECTION PORT(TYP OF 3) DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER ° TREELI' C PREPARED FOR: y� ( P) Benchmark "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3,2003 (LAST MODIFIED JUNE 30, Med. -Coarse Sand Nail in Tree c CAPEWIDE ENTERPRISES \°s Elev. =80.00' 2009). TRANSMITTAL NUMBER=W000052. 2.5Y 6/6 Approx. M.S.L. (Loose) LOCATED AT �S. ��'� y� 625 RACE LANE o� �� \° MARSTONS MILLS, MA 02648 y O�0,�f 132" 68.40' SCALE: 1 INCH = 20 FT. DATE: JANUARY 11,2010 G� 7O \a_y 0 10 20 40 80 FEET No Mottling, Standing or Weeping Observed H of \ \ 31 JOHN L. w PREPARED BY: O CHURCH � JC ENGINEERING, INC. RESERVED FOR BOARD OF HEALTH USE JR ° Na 1 2854 CRANBERRY HIGHWAY EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 SCALE: 1"=20' ., ._ Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1741 I T I