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HomeMy WebLinkAbout0099 REDBERRY LANE - Health 99 Redberry Lane, Marstons Mills A= b�2- TOWN OF BARNSTABLE LOCATION )tf-M%7R`7 U✓ SEWAGE# 20 20 - 394- VILLAGE MA R)7uAd A ILL k ASSESSOR'S MAP&PARCEL &V? (26 INSTALLER'S NAME&PHONE NO. S P6A W1't.A N tKU v,rA,y( GLr-- SEPTIC TANK CAPACITY loot) LEACHING FACILITY:(type) 1 Fly-f/*?c-ytN (size) lc/,,Z S r 44•S NO.OF BEDROOMS OWNER Allvwu> M l Ct ot- PERMIT DATE: 1Z//s 12 c,) COMPLIANCE DATE: lxltd3Cj 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 w exist within 300 feet of le mg ac 'ty) Feet FURNISHED BY i 132" 3 0" I2 16'41' 26 T, W•s" 31' 23•-7,, � g Z 0 0 G 1 a No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplitation for Misposal 6pstem Cunstruttion Vermit Application for a Permit to Construct(py Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. q 4 RgM� WP14 4N Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel L}7 p) O*Nll A[WoLD MiLLLW ik Installer's Name,Address,and Tel.No. 196 Desi 's Name,Address,and Tel.No. 5fil�&WAAAI L-X(.4V,4-rWf DO-vt AA Pf", I Type of Building: Ac. Dwelling No.of Bedrooms 3 Lot Size f sAol. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 4 gpd Plan Date /6I2e.I2ta Number of sheets / Revision Date 1)/lam/2p Title $1 TC AAA-, 0Ir' ►�l�a Oul tb CU✓vil7fl-,Cam!/4.v 0 Size of Septic Tank low OWPMJf Type of S.A.S. 1AnC (r r1L91WS Description of Soil S Ert 1�1 N Nature of Repairs or Alterations(Answer when applicable) j>-f1 u1C +JA_S . 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 Titl nvironmental Code of to place the system in operation until a Certificate of Compliance has been issued by this Bo, of Heal X Signed Date Application Approved by Date0- —�? Application Disapproved by Date for the following reasons Permit No. 62,2o— ,L�L? Date Issued No. f �� Fee THE COMMONWOALTO OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS r.� Rl hration for Nsposal 6pstem.construction Permit Application for a Permit to Construct(?,) Repair( ) Upgrade( ) Abandon( ) F-1 Complete System Individual Components 0 Location.Address or Lot No. W(,:I> Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Lai 2 �b(pM I t A rt��Ut i; Al rat ;7 y ,a" Installer's Name,Address,and Tel.No. U S) / Designer's Name,Address,and Tel.No. S ; 6 Nf "",,Av tX U�,a l Ivf �� �1 \ ... 1= L(eA 1_1L. AA u ° �r Type of Building: tf � Dwelling No.of Bedrooms 1 �1 Lot Size / 5q:/ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3U gpd Design flow provided 4 S% gpd Plan Date 1 b)7 6 l 1 v Number of sheets 1 Revision Date l i /Z y /70 Title S 1%C ;'1� v it 117u 0&j1 cn el ,v;717 L,, Size of Septic Tank /0U.-1 �L '> °� f,� Type of S.A.S. I A.,j 14 %RA 7v)(S Description of Soil C i I'I-A IV - Nature of Repairs or Alterations(An`sw r en applicable) t '3 u x + 1^ S - Date last inspected: y 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 Titl =Hea ronmental Code ata not to place the system in operation until a Certificate of-Compliance has been issued bythis Bo d . Signed Date / ?5-4V _ Application Approved by //ll Date✓ — Application Disapproved by V Date for the following reasons 2, g Permit No. a0'?v / Date Issued �� �� -iX L) --------------------------------------------------------------------------------------------------------------------------------------= THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for sposal System Construction Permit No.7 y�J.— Mated' Installer Designer - #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system widh'chon as desgned. Date I ' u Inspector U i - .::.,----_ -----__-- - -= - r - - - = -- ---- --- --------------------------- No. 0) 'j Fee E v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction permit a jPermission is hereby granted to Construc ( ).g Repair( ) j Up ade( ) Abandon( ) f System located at A/L/I(j 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:Construction must be completed within three years of the date of this permit. —'1 Date ' 1 9L Approved by CGS t i down cape engineering, inc. SIEVE SOILS,ANALYSIS 99 REDBERRY LANE M. MILLS, MA.xlsx DATE OF REPORT: 11/11/2020 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 99 REDBERRY LANE, MARSTONS MILLS LOCATION: DAN A. SPEAKMAN CONSTRUCTION TEST HOLE SIEVE ANALYSIS Weight Sample(Grams): 209.4 SIZE ;WEIGHT RETAINED % RETAINED % PASSED (sum ------------------- -----)------------- -------------------- ------------------ 1" 0.0; 0.0%: 100.0% ------------.--•--•-------••---------V--------------------- ------------0.0% 3/4" 0.0� 0.00 100.0% ------------ ----•-------- ---- ------•t--------------------- ------------------ 1/2" 0.0: 0.0%: 100.0% --------------r--------------------------r---------------------r------------------ 3/8" 0.0; 0.0%; 100.0% #4 0.0' 0.0%: 100.0% -------------- •........................ b-------------------------------- ------ #10 9.5; 4.5%: 95.5% #20 41.0� 19.6%� 80.4% _------------- ------------------..._..._•t---------------------t........... #40 121.8: 58.2%', 41.8 0 --------------i---------........... ------r---------------------r------------------ #50 163.8 7'9- 21.8% ---------------------------------------- ---------------------•-- --------------- #80 192.3: 91.8%: 8.2% #100 196x 93.9%: 6.1% #200 207.5: 99.1%: 0.9% --------------1------------------------- r------------------o-r---------------o- PAN: 209.0, 100.0%: 0.0/o SAMPLE: 209.4; NOTE:TEST ON PASSING#4 ONLY, 8.6% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-1-b(SAND &GRAVEL) (UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% OK #100 0%-20% OK #200 0%-5% OK SAMPLE MEETS TITLE 5 FILL SPECIFICATION ��p�1"OFNs >99% SAND ��`� DANIELA. yGJ, o OJALA -4 RESULTS: PERMEABLE MATERIAL-CLASS 1<2 MINJIN. MATERIAL " CIVIL co NONCOMPACTED �No.465020 SOIL DESCRIPTION: MEDIUM/COARSE SAND 0 s IST J �--�-- - - - - = o m a = Town of Barnstable � � E ' � -0 n o Inspectional Scrvrcesei D it Public 1 ca11h DivisiuuS `�11d7Ili�.9' McKes,me�imctor ry, m C H r+ Z 't7 n ocC,oc SCB.bSi.4" Tax, M44906610 4 C O O- 0 rp O ii Ttstailer fie }esien"erCtriificeri4n Forte .whit Lf-0 ;oat '$�''` Atacssor'a d4ir►ptptccl � fF o, v p lla�lgner. '�7cr� Si ms _.cati, a -.wleutalEer �a Lvrss , ✓ +3-Lf o tld4rRss, I�_��,��� lh+c.�-i. nddraa,, t �'�,��'fd:g e,lt,.4� � � --i CD lat Q; On�'P d { '� a 1 4 « :iss c9 a Fusn]4 v oaf t e �' CD D < 4 _ m C a isaslTcr - __ - O ��i, -D o O -, i r Q attic ays at:- "k 4 4't[ [ F;Gi+�t._ liakd fn b d siva try ¢, v o n N _.. m-..� -... - - _ (DD � a- : N co\ daetE1�i" a�0ity dy o O S tZ ... �_ T.SX ,_ .-_.-. N tA N to O ^' 1 dW ehc [efeamocd;eb`oae tiaststind a alxsfanya�l?y, as ieu�g to `" co - d=dr-WN vAdch m�ey wwo ml*or app�vad dma�ge�a�rh a�Ia��Ilas�oa at[he w Q S tra6uuae,bax mndloc ?e Sinp out O req[ugO ia��OO,the soils; , m rD vreec�utycfd Saris F�'. _ _. 3 i, by !she aeptis}� ftrsa ibovc idled vih etas.�`�c-s8es(i o 3 gte.rcr than ltl?lacaem!rslaaaco of SAS or � u9 seioars c£aaiy rappccnt' 3 R. p of'dne seplilY 7 rn accnSancc= t�Sate dt i acaf izeSule�ocaa ar v — �. certified as-�Cr,6[1py+�fe�lgpes ra f,�pa+rr, Sip out(i£r�vie®d�wn�in�a�od�!���ta CCe[Ily It1aT eCdG119LCCLt OwKO;lVBf 6bt3SC5 6b to mpll *fth Ihi"[o aF (A ap endf yag Vto) S A E' - ;uto _thiLtic; M a 8 .� t� s A"i! 6TI .e H a ec, A A _ - /-r 3 i?�it bikfs fJC &s {wf�(ada+�a ti;44*1lo r+ N O .a m � 3 fD TOWN OF B SABLE 1-OCA'.TO 6 5r SEWAGE# VELLAiE ( ASSESSOR'S MAP &c LO v b&04 INSTALLER'S NAME&t PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size)© NO.OF BEDROOMS !� BUII.DER OR O PERMTTDATE: 167 COMPLIANCE DATE: Separation Distance twee the: Maximum Adjusted Groundwater Table and 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 / � 1 w�\�� !, �' '. l/ ��� TOWN O B STABLE 7� LOCATION !) SEWAGE VILLAGE M_ �`� S ASSESSOR'S MAP & LOT O ` Y INSTALL -ER S NAME & PHONE NO. � SEPTIC TANK CAPACITY C LEACHING FACILITY:(type) 'Poi (size) (, Vo--,Z� NO. OF BEDROOMS -3 PRIVATE WELL PUBLIC WATER UILDER O OWNER �_�/� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: /® - Z- `/ VARIANCE GRANTED: Yes No �o- _4.in �� �j14�� PJ�' �Q�� �'� ' / � _ � | '_'---------------'J J t� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ---.'�'.�✓�.` ......OF... .f .�- .a_�.�.............•- Appliration for Bispti ai Workii Tilustrnrtinn Pumit Application is hereby made for a Permit to Construct (k<or Repair ( ) an Individual Sewage Disposal System at: . E,'n 5 '-' / / ................__........................................•----------...-•-------..._........... � ----------............-----•--- •--•----•--•.....-•••-••-------.........•---......-- �. Location-Address or Lot No. ... .......... ......-• ............. ' Owner "; Address _ ................. ................... �. M Installer Address U Type of Building Size Lot-4--_�4.. .Sq. feet Dwelling—No. of Bedrooms.................+3..............._..__.._..Expansion Attic-�-�--)- Garbage Gfin�Ier("�`� .4 Other—Type T e of Building / ' ' No. of ersons_•...__.e................ Showers � YP g --------------------------- P ( )'.A=•`Cafeteria(......')_ Otrler fixtures . --•- -- W Design Flow................. ............gallons per person per day. Total daily flow.......,__--�..`'�..............._gallons. • r, WSeptic Tank—Liquid capacityf Q.0_�)_gallons Length__ ..e ..�:". Width-7''_ _. Diameter________________ Depth_,.• _`-_5_ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........ Diameter.................... Depth below inlet................... Total leaching area'..:- .%....sq. ft. Z Other Distribution box (Vj*_ Dosing tank Percolation Test Results Performed by........ _. `. _ . ti -- `.. . �� y� `� •••... Date.`•-•-- ---2- ------••. Test Pit No. 1--- __-�?-.minutes per inch Depth of Test Pit..` .e...... Depth to ground water................. GT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' -••-----•-••-----------------------•-•-•---•---•----••----•-------•--.....--•---------.....---------....._---•------•-•-•......1-...._('a- . D Description of Soil-----------`'`'..:' ., . . 1 -r "_... -4:2..1...3............?-��.5 1:F.•-•----=5''9.__ x ---- V .............•-•---------.•••••--•--------•-•.......--------••-•......••--.......--- 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 TIT11 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.. ✓• -n. -c.,._.4_.... '.r../as� ---------------------- '- _..Dz:3...-'. - ate Application Approved By................. ,r..- '�..:.. =`:..............................•. --•---.. v Date Application Disapproved for the following reasons------------------•-------------------------------------------------------------•------------------•---•------- ...............••-•-...-••------•------•------•-•---••----------•-•------------.......-----._...--------••----------•---•---•--------••-----•-•--•----••-•-------••-•---•--•-••-•••--•---••-------...--- Date PermitNo........... .J_...... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF... ✓ %TrrtifirFatr of TomVIiatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed 0--1'_o_r Repaired ( ) by...... A' <L-' c-_-7 "V--'7— --------------------•••- ----•-....--------•-----•-....-•--...-----------•-•--•------...-•------......-----•-------_.._. Installer at... ,�... ... r ,/C: ! has been installed in accordance with the provisions of TI T I,r, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... � *_. �..._ dated................................................ rid = ,` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................Q.'fZ. q ...................................... Inspector............... .................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD- OF HEALTH No.....;l ...2..J a.. FEE....... �i��rr��1 nrk� �nn�trnrtilan �erntit Permission is_,.hereby granted...._ !`........:...........- '' __.___��- ` �"�`-' to Construct ( ) or-Repair ( an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No.___,?t: .12 Dated.......................................... ...................................... . Board ofHea------lth•--------•-------••---------------•-------- DATE............... `Z"1+�-•--•---•-------•------------•------- FORM 1255 A. M. SULKIN, INC., BOSTON V 1 .V51 ' Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of ti 3 �, Environmental Protect N " p 4 r ' WilliamGovernoc F.Weld "� RECEIVED r7id, Coxe hrgsornor Cellucci MAR 2 199L .str"hu ss walorw 04 TOWN OF BARNSTABIE HEALTH DEPT. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSP ONyFORM r PART A CERTIFICATION._- Property Address: 99 /Pe,Dd ee4Zy "A"r 1"4Ird1bA"X/4/CGS Address of Owner. Date of Inspection: 2. a C, . 9B (If different) Name of Inspector. W,4Lx.R_ LEd%r Company Name,Address and Telephone Number. I_f fit/ - 14. c- CERTIFICATION STATEMENT Ot1G�t v eLLEJ Af'�1 I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site se disposal systems. The system: Passes Conditionally Passes — Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: G xe�PD�r// /2— 0 The System Inspector shell submit a copy of this inspection re rt the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] ASSES: 7SYS7T have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: t One or more system components.need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate , no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or exfiltration,-or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revised 11/ /95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292-SM A ice}Printed on Recycled Paper :-,- r r a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 99 �t°Fo�ER�!y �a M a Rs ra as 441 i.,L r Aix x S. Owner. . A44, C✓. Date of Inspection: B]SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or b out or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, or uneven distribution box. The \ISREQ system wall P inspection if(with approval of the Board of broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced requite P Ping more than four times a year due to broken or ructed pipe(s). The system will pass with app val of the Board of Health): broken pipe(s)are replaced obstruction is removed C] THER EV IS REQ RED BY THE BOARD OF H TH: Conditions require furthe evaluation by the Bo of Health in order to determine if the system is failing to protect the public head the environm t. SYSTEM WILL PASS UNLESS BOAR OF H TH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE U C HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet a ace water Cesspool or privy is within 50 f of a ering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS TH BOARD OF TH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) D INES THAT THE SYS IS FUNCTIO G IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND S TY AND THE ENVIRON ENT: The system has a tic tank and soil absorption m and is within 100 feet to a surface water supply or tributary to a surface water sup y. The system a septic tank and soil absorption system d is within a Zone I of a public water supply well. The system a septic tank and soil absorption system is within 50 feet of a private water supply well. The syste a septic tank and soil absorption system and ' less than 100 feet but 50 feet or more from a private water 9PPIy w unless a well water analysis for coliform bacteria d volatile organic compounds indicates that the well is free from tion from that facility and the presence of ammonia gen and nitrate nitrogen is equal to or less than 5 ppm. 3) OT HER (revised 11/03/95) 2 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 9 9 /I�E�BEiQ�Q y 4A Owner. /14Rjfk % --1 jt4a A?&7V t'?• G,N4���a rxS Date of Inspection: p b� ' p'Z .s• !� D] SYSTEM FAILS: 1 have determined that the system violates.one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Dischacr ponding of effluent to the surface of the ground or surface waters due to overloaded or clogged SAS or cesspool. Static liquid le v in the distribution box above outlet invert due to an overloa or clogged SAS or cesspool. Liquid depth in I is less than 6"below invert or available volume ' less than 12 day flow. Required pumping mo than 4 times in the last year NOT due to ogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Abso tion System, cesspool or privy ' below the high groundwater elevation. Any portion of a cesspool or pri is within 100 feet of surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is 'thin a Zone of a public well. Any portion of a cesspool or privy is wit ' 50 t of a private water supply well. Any portion of a cesspool or privy is less t 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the ell been analyzed to be acceptable,attach copy of well water analysis for eoliform bacteria,volatile organic com ds, onia nitrogen and nitrate nitrogen. E]LARGE SYSTEM FAILS: The following criteria apply to large sys ins in addition to the crite ' above: The system serves a facility with a ign flow of 10,000 gpd or greater System)and the system is a significant threat to public ealth and safety and the enviro ent because one or more of the folio conditions exist:===:: the system is within 00 feet of a surface drinking water supply the system is wi . 200 feet of a tributary to a surface drinking water ply the system ' located in a nitrogen sensitive area(Interim Wellhead Protectio Area(IWPA)or a mapped Zone II of a public water sup y well) The owns or operator of y such system shall bring the system and facility into full compliance with t e P� groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for er information. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Q 9 REo BERRY L.oaf a Rr;a/✓s M r I-Lr tit 4 s s Owner. '44.4,e,t- J. .4 MA-'Zy8 'T/1 g. WlLL/AMS' Date of Inspection: Check if the f owing have been done: Zing information was requested of the owner,occupant, and Board of Health. one of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates d that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. t plans have been obtained and examined. Note if they are not available with N/A. The ility or dwelling was inspected for signs of sewage back-up. system does not receive non-sanitary or industrial waste flow e site was inspected for signs of breakout. system components, excluding the Soil Absorption System, have been located on the site. Th.". eptic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or terial of construction,dimensions, depth of liquid, depth of sludge,depth of scum. rT44' size and location of the Soil Absorption System on the site has..been_dete=uned.:based on existing information or proximated by non-intrusive methods. The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �9 �ED���Py GR V16 1k,4,QJ•n,V,r "a`-Lr A44,rr. Owner. iLfQR� ,/. r MakY&c7jj 9. Date of Inspection: RESIDENTIAL: FLOW CONDITIONS Design flow: Number of ms: Number of current residen : Garbage grinder(yes or no): Laundry connected to syate (yes or no) / /qg �, B 73 0 6` Seasonal use(yes or no): Water meter readings,if available: v Last date of occupancy: _COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow:_____gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (y a o no) Water meter readings, if available: Last date of occupancy: OTHER (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: S ystem pumped as part of inspection: (yes or no) If yes,volum umped: ¢allons Reason pumping; TYPE F 9 STEM Septic tank/distribution box/Roil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed(if known)and so of information: Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 IL SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 iPE�eF��Y �-A NE ,y a.?s ra Nr MI LGJ /u a s S. Owner. A#Ajfk✓. Date of Inspection: Zncrmetemetal SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction: FRP—other(explain) Dimensions: Sludge depth: 411 / Distance from top of sludge to botto of outlet tee or baffle:_ Scum tluckness:J0" _ Distance from top of scum to top of outlet tee or baffle: 7 Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of li 'd evel in relation to outlet invert,structural integrity, evidence of leakage, etc.) Ph C E �2- GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction:_concrete_ etal_FRP_othe xplain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or Distance from bottom of scum to bottom of outlet or baffle: Comments: (recommendation for pumping,condition o inlet and outl tees or baffies, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C Q SYSTEM INFORMATION(continued) Property Addreaa: 99 /PF'� ERR y ka NE 144 R,r r1jA0 N([44.r MAsl+ Owner. �g4.4,f& t/ j A1.4 re Yoe fW R W l"1.4 4V Date of Inspection: a • a s-. 9g TIGHT OR HOLDING TANK_ (locate on site plan) Depth below grade: Material of constructio _concrete metal_FRP_other(explain) Dimensions: / Capacity: ¢allo Design flow: ¢aYlo /day Alarm level: f Comments: / (condition of inlet ted, condition o and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER_ (locate on site plan) Pumps in working order:(yes or no) r Comments: (note condition of pump chamber, condition o pumps and appurtenances,etc.) (revised 11/03/95) 7 r • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Q9 445D16FRR'/ <-ANr I-WkR.rr'ajvl A411 Owner. 44.4,9k✓. •, ,4Aa 2y8EV4 S. k1jLLL./a4ts- Date of Inspection: 8/ SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: leaching pits, number._ — leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool,number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS:_ (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(cesspool must be pumped as part of ins n) Comments: (note condition of soil, signs of hydraulic f ' , leve f ponding, condition of vegetation,etc.) PRIVY (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of ydraulic failure,level of ponding,condition o vegetation,etc.) (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 99 y ,c,Ai►'�' /k 14,f Pr,0Ns tit/LLD M4.rs'• Owner. 1f4-,f& Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYST!EM:...,-_ include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' V �L 5 DEPTH TO GROUNDWATER Depth to groundwater: _feet method of determination or approximation: i % A (revised 11/03/95) 9 77 PORI rrim cove r &Var r h. 0 p Va min. W&;t :17 VVPer tf.: /7. v r- p ip _(o in e-g36 P7 77 V.0 4C V. gel, s lhv. t 75 h'e-Z:f. el OUMd wol mr 71;m6/ e-lev. -k hole 4ele q G E_ S76 K . ..... 7 os 7 TAJ E-S S a L:. 7^A�7. r> F 4-a ILI�i p �p m J�A7 �GA /0 A-1.1/xI C.�4 < ''Hol- E .2 E .141AJG Ae A U/R_E rs .ins GAL lc�Ir WA LL q73 a 0 T7 0/4-� 7'07A 4_' CE A C HIAJ :CAI A YR6 18 40 CAPACI S EF R V& e- E- CHIAJ�G,, L Aid .7� Ile L L ORkt-7AAJSHIP "MATER OqL�S :�� &!b 7' AID _HE 7 77� �k : ':��:, �: �,: : /0 -7 OF,- RUL _ S Aj SA AJ 'rA A2'e G c 0 C OMP4�1A AJC -4 G �LA_rIOAJS L L: TE 7t � rJAJG' AAjO ` Fj�VAI��eEM YAJ �E-S S S AJ IA L LY , 7/4& S A M A o4g AD P)e 0 V/ /70 'OF HE q LTA-1 K5 i5A AGCiV7 -7,k� IVE AJ CO STk_ UC7 7 �-q 7 F:-, /.:I AJ PV/?-c k�N 0 4�a cs gs Ai Ar.;) DAM qi : " �*/ , VID V A B. e. iS*ir74C? OJ-7-�c u r kN :1 V MA SPEAKW SON O�UOQ er ;po* No 3940,2,: 066 c BENCH MARK : TEST HOLEP . D A T E 171, F/ WITNESSED 3 Y � , ' /fw � !ev"Gr, - ---- - -TEST HOLE/ TEST HOLE 7 v i q I 1 ,�.. c �~- ! ; 'ef�GROUND WATER GROUND WATER / Pnapla =• '� ENCOUNTERED ENCOUNTERED �, � v l F'•�.v� l? Misr G�' � +'` � 3. 0 � 1� Z)W Zz, s Pric .+r l ;a; S V. TOP OF I`MANHOLES AND COVER TO BE BUI LT TO \ I l T,glv,k r/�+� h ; � FouNDATION �'/' 1t� ITH1 N 12 OF FINISHED GRADE _ \ FIN I S H E D GRADE ' �3— MIN. % SLOPE �GegR .max L I / .` �( D I A. -- - -- `:_� 4 I I D I A. PIPE I R S 12 M I y :':• PI P E r .�%f✓. _ - MIN . 2 11 LAYER OF G . MIN . PITCH % T. .-` i-2, _ 'LEVE( -MIN. PAH �a ,�.� 1 I w r � . a N"— -'►�2 EAST T ( 1 11 P � '. � � �� .e. �.r. � dim � ` ; :.r ( �'y �. .' 4• - �/ I N v r T . �� Ira ."EU,INVERT : . GALLONr�y 1 dE €7T "' "� - ) --eL"; ' y t ®z - AStiEC1 PTIC 7 IrK BOX V R'T c FOOTING TO BE PLACED \` W 5l�t�N ` - 0l A MINIMUM OF IS" OF, INVERT 9t� E ? � � k � - PLACEN a I ,r c� tt ,•,` ALL AROUND D VIRGIN OR COMPACTED' �> � ---� F( R �1 BASE --�==( I'�---!3 7 °- � �:' BOTTOM �+,T E L5 y, 4 2, .� 2 3 ►5' - - '"' SAND :_ 0' MIN.) GARBAGE ( 20' MIN.) /� G i 1c1 ` GRINDER ?r ELEV. 38.5" 1.. v � 2 PROS- I LE O GROUND WATER TABLE T" 7SYSTEM SANITARY DI POSAL SYSTE M ( NOT TO SCALE ) D E S I G N DATA CONSTRUCTION OF SANITARY DISPOSAL BEDROOMS SYSTEM SHALL CONFORM TO THE MASS. DESIGN FLOW �`�c' GAL./DAY ENVIRONMENTAL CODE TITLE Y • ' LEACH RATE (REVISED 7- 1-77 ) AND THE TOWN -� MIN.�INCH HE/�LTH DEPARTMENT REGULATIONS REQUIRED LEACHING CAPACITY : " �TQ ov v SEPTIC TANK, DISTRIBUTION BOX AND LEACH - PROP© SED� 27 GAL/DAY ING UNIT TO BE OF REINFORCED CONCRETE , MIN . CONCRETE STRENGTH : 3000PS.1. REQUIRED SEPTIC TANK : / 000 GAL. MIN. STEEL STRENGTH 20 , 000 PS- I . MIN. DESIGN LOAD I N G : H10 PROPOSED SEPTIC TANK . . /000GAL. e0 DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM / UNLESS H2O DESIGN LOADING IS USED 6 ALL PIPES AND FITTINGS TO BE WATERTIGHT -� AND TO DE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL DATE %0.3 1 T E P A N SHOWING PROPOSED CONSTRUCTION DATA L � N D LOCATION : ZONING DA -ry ZON E : _ _. TEST HOLE LOCATION n � � . REFERENCE _�--.O I � AS SHOWN� REVISIONS : _ REQUIRED AREA ' — _. "�' ' s-6oST EXISTING SPOT ELEVATION 17.6. P2-AN 3>1 oajN W W14c,-aK REQUIRED FRONTAGE _. EXISTING CONTOUR 16oalr REQUIRED FRONT SETBACK : 3� � � � PROPOSED CONTOUR --- 16 SAL REQUIRED SIDE SETBACK / PROPOSED WATER SERVICE ---W— ss �� ua� REQ UI RED REAR SETBACK : �`� PROPOSED GAS SERVICE - G � EN PROPOSED ELEC. TELE --•••E a 'TCj 17­1 A 'I G� �R,� S R T P. E . PRO FESSIONAL C IV I L EN.G I N I E R -. ICI OLD ROUTE I 2 IIYl Nth ISm MA. 02601 FILE NO. BUfLDING INSPE3'TO`°R APPROVAL DATA ( TELE . (617 ) 362 - 9411 ) SHEET / OF / BENCH MARK : TES `` HOLE RESULTS ". P DATE WITNESSED BY �. " '- ' �/'%'' /`�✓'°G7 �.�?, //. c.-✓"'"� � `,,'tea-"7 r"-- TEST HOLE L c� T TEST HOLE I p r ls��y fir 1 "`GROUND WATER GROUND WATER ENCOUNTERED ENCOUNTERED 7r*-g ric X 0 � � MANHOLES AND COVER TO BE BUILT TO r ! ro T ELEV. OP OF " Q ow N, co FOUNDATION WITHIN 12 OF FINISHED GRADE `� � ' FINISHED GRADE 9- MIN, 2 /a SLOPE 12 MI 1 n7z�v -}�, ' o PI P Eni� �.^ ---- ° DIA. PIPE SIRS MIN . 2' LAYER OF M I N . PI TCH I, FT. . v LE EL7 f z .W,w I�g` a�2' P E A S T 0 N E ,� �'. cJ -.: MIN. PITCH o',��,.. n/ 49, 00 '�- �j F T. / oc) 5 �"RV4r / INV T G" Om INVERT S- INVERT GA.LL0N cn G7 ; I ' ¢- 3... �o � ,� r � 21,� TAN DIST. <t4-® I �2 D1A. FOOTING TO BE PLACED ;.Y INVERT SEPlT IC _ INVERT' BOX - 4- ''' s' Ca w U W. WASHED STONE ON A MINIMUM OF I $ OF = INVERT . ; � ,-'• ALL AROUND VIRGIN OR COMPACTED , ��-� FI RM BASE ' L,� lW °- El '" • I`'` BOTTOM AT ELEV. 42, � 2 3 - S A N D I nI ) „� , �. 0 • : �--- GARBAGE { 2 0' MIN.) 1' � � GRINDER 77 ELEV. 8•.5 PR 0 F I L E OF GROUND WATER 1-ABLE 7- 7 5 � SANITARY DISPOSAL SYSTEM ( NOT TO SCALE ) D E S, I G N D ATA 0 CONSTRUCTION OF SANITARY DISPOSAL BEDROOMS SYSTEM SHALL CONFORM TO THE MASS. DESIGN FLOW' GAL ./DAY ENVIRONMENTAL CODE TITLE Y , (REVISED 7- I--77 ) AND THE TOWN LEACH RATE -- MIN. INCH HEALTH DEPARTMENT REGULATIONS REQUIRED k EACHING CAPACITY 0 SEPTIC TANK, DISTRIBUTION BOX AND LEACH - PROPO ED / 2.7 GAL/DAY ING UNIT TO BE OF REINFORCED CONC R E TE 2, C t, MIN . CONCRETE STRENGTH =• 3000PS. 1. ,M REQUIRED SEPTIC TANK / oo'© GAL. MIN. STEEL STRENGTH w 20 , 000 PS. I . MIN. DESIGN LOADING : H10 PROPOSED SEPTIC TANK : /000GAL, DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM UNLESS H2O DESIGN LOADING IS USED ALL PIPES AND FITTINGS TO BE WATERTIGHT AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL DATE t tilTL F% LAN SHOWING PROPOSED CONSTRUCTION ZONING DATA LEGEND LOCATION : 3�1;?IV S 7 � L22L-)r� � r�N. r�, �� �� / 5 , P0R : LEBEL- SOLLOVVS DEV. CORP. DATE : .�" } g ' ,q Z 0 N E : _ _ _ _. TEST HOLE LOCATION 4�_ LOT � �`' AS SHOWN ON REQUIRED AREA ._ _• �-3,, .5"Gos� EXISTING SPOT ELEVATION 17.6 qE . REFERENCE �� REVISIONS : Aga-�+� PL! N 1 1 0;3 J N W, W14 a.K R .L. S REQUIRED FRONTAGE :— EXISTING CONTOUR --- 16 J-_ CPAIG REQUIRED FRONT SETBACK : 3o PROPOSED CONTOUR / REQUIRED SIDE SETBACK � PROPOSED WATER SERVICE --�--�--WR°—= ALE / - O REQUI RED REAR SETBACK : �'� PROPOSED GAS SERVICE —G �sf° AL ��'� PROPOSED ELEC. & TELE E a T /y/vC R A I G S 'Hu' R T , P. E . y PRO FESSIONAL CIVIL ENGINEER BUI LD I NG INSPECTOR APPROVAL DAT E � 131 OLD ROUTE 132 HYANN IYS , MA. 02601 FILE NO. ! = � ( TELE . (617 ) 362 - 9411 ) SHEET OF / i -