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HomeMy WebLinkAbout0117 REDBERRY LANE - Health 117 Redbegy Lane - - ——— Marstons Mills A= 047 012 007 C f A: t � -� COMMONWEALTH OFMASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS A DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR'VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: ° ,A Owner's Name oaf Owner's Address , CGS s� Date of Inspection: �L . P,t.r�, � "),alx_)�y � Name of Inspector; ple e. rint), Company Name �t(e'• (. e'j`. T cv- �, r , Mailing Address: 64 Telephone Number: ) - ry > CERTIFICATION STATEMENT *=' C) r- I certify that I have personally inspected the sewage disposal system at this address and that the in rmation reported below is true,accurate and complete as of-the time of the inspection. The inspection was performe 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(3.10 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ,IF is Inspector's Signature: Date. � '�U The system inspector shall submit a copy of this inspection report to the Approving Authority(Board;of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the. DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection.and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title,5 Inspection Form 6/15/2000 page 1 Page 2 of 11 p OFFICIAL INSPECTION FORM I NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) ! Property Address: Owner:• Date ofI ection:. Q(jy Inspection Summary: Check A,B,C,D or.E/ALWAYS complete all of Section D A. System Passes: i 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: i i ! 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 repairs as approved by the Board of Health;will pass. I Answer yes,no or not determined(Y,N;ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and'over 20 years old* or the septic tank(whether.metal or not)is structurally unsound,exhibits substantial.infiltration or exfiltration or.tank failure is imminent.System will pass inspection if the existing tank is replaced with a.complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. . ND explain: Observation 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 obstruction is removed distribution boxl is leveled.or replaced i; ND explain: The'system required pumping more thanA times a year`due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the.Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: i ! Page 3 of 11 OFFICIAL INSPECTION FORM-.NOT-FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTIONYORM PART A CERTIFICATION(continued) Property Address: Owner: Date of'I pection: /2 Q 1 C. Further.Evaluation is Required by the Board.of Health: Conditions exist which require flirther evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. L System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail y unless the Board of Health (and Public Water Supplier, any).determines that the PP ,if 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 Y r t? Y (SAS) surface water supply or tributary to a surface water.supply: _ The system has aseptic tank.and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the.SAS.is less than 100 feet but 50 feet or more from a private water supply.well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform. bacteria and.volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must.be attached to this form. 3. Other: 3 t Page 4 of. I I OFFICIAL.INSPECTION.FORM—.NOT FOR VOLUNTARYASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION:FORM PART A . CERTIFICATION(continued)' Property Address: ` l/'L12) Owner: Date of I ection: (� D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no."to each.of the following for.all;inspections: Yes N j 1J Backup of sewage into'facilit or stem com one t due Qo —� a y y p n to overloaded'or clo,-led SAS or cesspool Discharge or ponding of effluent to the surface of the ground.or surface waters due to an overloaded or clo-led SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or / cesspool. 19 Liquid depth in cesspool is less.than.6"below invert or available volume.is less than %day flow Required pumping more than 4 times in.the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100'feet of a surface water supply or tributary to a surface water supply. . Anyportion of a cesspool.or.privy is within a Zone 1 of a.public well. An onion of a cess ool or privy is - -. Y P p p y within 50 feet of a.private water supply well. — — AnY portion of a cesspool or-privy is:less than 100 feet but,bo e ater.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 coliform bacteria'and volatile organic compounds indicates that the.well is free from pollution from that.facilityand,the.:presence of ammonia nitrogen and nitrate nitrogen is equal:to or less than 5 ppm,provided that no other failure criteria are triggered..A copy of the analysis.must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of:the above.failure criteria exist as described in 310 CMR 15:303,therefore the system fails. The.system-owner should contact the Board of Health to determine what will be necessary to correct.the failure. E. Large.Systems To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes" or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) es no Y _ 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 Ina nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well.. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE`SEWAGE DISPOSAL.'SYSTEM INSPECTION-FORM PART B CHECKLIST Property Address: j Owner: Date of In ection: I— . 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? V 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? v Were all system components,excluding the SAS, located on site I/ _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees. material of construction, dimensions, depth of liquid, depth of sludge and.depth of scum V —. Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS) on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] A . Page 6ofI1. OFFICIAL INSPECTION FORM-NOT FOR:VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM:INFORMATION Property Address: r Z V. Owner: Date,of Ins ection: FLOW CONDITIONS RESIDENTIAL 1� Number of bedrooms(.design): a Number of bedrooms(actual).: DESIGN flow based on 310 CMR 15.203 (for example: 11.0 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): jy/0 Is laundry on a separate sewage system.(yes or no)�j.[if yes separate inspection required] Laundry system inspected 4( es.or no)Seasonal use: (yes or no): S Water meter readings, if available(last 2 years usage(gpd)): `'h�� �_1 � Sump pump(yes or no): XV0 Last date of occupancy: � J , k9e'e 0x Ata&A-mv, a COMMERCIAL/INDUSTRIAL./V 16 Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding-tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records , Source of information: P.al (,(�/ZG1`� Was system pumped as part of the mspect (yes or no): /Vc) If yes,volume pumped: gallons--How was quantity,pump ed.determined?. Reason for pumping: 7TYP F SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool. _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a.copy of the current operation and maintenance contract(to be obtained from system owner). —Tight tank _Attach.a copyof the DEP approval b. L Other(describe): oximate a-e of all comp ne s,d to i talled.(if own) and sou. e o information: Were sewage odors:deiected when arriving t the site(yes or no): 6 Page 7 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property P y Address: Owner:._ Date of In ection: BUILDING SEWER(locate on site plan) C� Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting, evidence of leakage, etc.): , SEPTIC TANK: (locate on site plan) rd Depth below grade: Material of construction: t/concrete_metal_fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 's (�° �eal + Sludge depth: DLC)d/ Distance from top of sludge to bottom of outlet tee or baffle: I Scum thickness: C4)// 1 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botto .of outlet tee or baffle: 1•7i How were dimensions determined: Comments (on pumping recommerfdationse inlet and outlet tee or baffle condition, structural integrity, liquid levels s related to outlet invert, evidence of leakage, etc.): GREASE TRAP: on site plan) L` /,f7�� Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom,of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): :>. 7 Page 8 of I I 'OFFICIAL.INSPECTIO.N FORM-.NOT F©R:YOLUNTAPW ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM"INFORMATION(continued) Property Address: q`` �.`'r . /C1�J Owner Date of In ection: 4&jJ D a must e pumped at time of ins ection locate o .site plan). TIGHT or HOLDING TANK: � t nk m s b m n .,L�( P P P } P Depth below grade: Material of construction: concrete metal fiberglass___polyethyleneother(explain):. Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present.(yes or no):. Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments.( :condition of alarm and float switches etc.): DISTRIBUTION BOX: (if present must be opened)(locate on.site_plan) Depth of liquid level above outlet invert: L � Comments(note if box is level.and distribution totl4ets equal,-any evidence of solids carryover,any evidence of eakage into or out of box,etc.). �_ x e o WW PUMP CHAMBER: l O (locate on site plan). Pumps in working order(yes or no): Alarms in working order(yes or no): , Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FORNOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Ag4 Owner: �, — Date of In ection: � �,� 1- ,QW6 SOIL ABSORPTION SYSTEM (SAS): i� (locate on site plan,excavation not required) If SAS'not located explain why: Type leaching pits,number: Teaching chambers,number: leaching galleries,number: leaching trenches, number; length: leaching fields,number, dimensions: overflow cesspool,'number: innovative/alternative system "type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.):ow m CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth*—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of.groundwater inflow(yes or no): . Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc'.): 'PRIVY:)VO (locate on site plan) Materials of construction- Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): 9 -------------- Page 10 of I.1 OFFICIAL INSPECTIONYORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEMM-INSPECTIO FORM PART C SYSTEM`INFORMATION(continued) ,Property Address: 9 Z iXILI Owner Date of In ection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate.where public water supply enters the building. 1 ° • -tic Ul, ® 3' Pi 10 ' Page I 1 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C r. SYSTEM INFORMATION(continued) Property Address: An21A Owner• l " k. Date of In ection: SITE EXAM Slope Surface water Check cellar Shallow wells y Estimated depth to ground water fr'-�--feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site (abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: hecked with.local excavators, installers-(attach documentation) _-Accessed USGS database-explain: You must describe how you established the high ground water elevation: J 11 Permit Number: Date: Completed by: + � HIGH GROUND-WATER LEVEL COMPUTATION —,•r r Site Location: 7 Lot No. - = Owner: Mhm, Address: yr` l- - Contractor: �'�� 01,2 Address: � Y Notes: t`' t 5%* v - `` STEP 1 Measure depth to water table to nearest 1/10 ft. Date 31 zO.e ................................................. month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: l`A Appropriate index well....................:. OWater-level range zone ...................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well ........................... y, month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 213) determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water 'level at site (STEP 1) .............................................................................................. � Figure 13.-Reproducible computation form. 15 �, �,ra f To of Barinstable. P# , - Department of Regtilatory Services ' Public ealth Division Date H s �ART1BiABt$ � Y 16 tee$ 200 Main Street,Hyannis MA 02601 At Date Scheduled f Yj, . Time - Fee Pd. ' . l • ew DisV os, Soil Srr�ata�rlaty Assessrxie�t fop S p Performed By: VY��u�- �� C� Witnessed By: p . j LOCATION &: GENERAL INFORMATION Location Address'. 1jE�) 1� `P L1J Owner's Name S1ALt.IvJ§- a� ,V N LL� '-D�/ �\T I Address Assessor's Map/P4rcel: b Engineer's Name NEW CONS1RUtj0N REPAIR Telephone# Land Use 1 L; ',/� A-�-, Slopes(%) ® l• Surface Stones Distances from: Open Water Body>. 0 D ft Possible Wet Area >Z6 rL ft Drinking Water Well 'Lam`_' ft Drainage Way a ft. Property Line / 0 ft Other ft TCH:(Street name,dimcnsions'of lot,exact locations of test holes&pert tests,locate wetlands in prozitnity to holes) rG p Sa .I Parent material(geologic) 1 I Depth t0 Bedrock Depth to Groundwater. Standing Water in Hole:' '/" i Weeping from Pit Face Estimated Seasonal;Iigh Groundwater N /d ! — DtTERMIN ..`TION FOR SEASONAL HCGH WATER TALE Method Used: ! Depth �b erred standing in obs.hole: in. Depth to Soil mottles: Depot to weeping from side of obs.hole: i in, ©roundwater Adjustment D. Index Well# _� Reading Date: Index Well level ! A .fletor,,.,._.� AdJ,OroundwateeLevel,,,,e. ' I PERCOLATION TEST . Daite_,_,.T..e. Tlnsc . Observation I Time at 9" Hole# Time at G" ......�.---- Depth of Pere Time(9"-6") Start Pre-soak Time.@ End Pre-soak Rate MinAnch ! y' Additional Testing Needed(Y/N) Site Suitability Assessment: Site Passed '` Site Failed;._� ' Original:.Public I c;itth Division Observatiod Hole Data To Be Completed on Back-- ***If percolaibn test is to be conducted within 1001'of wetland,you must first notify the rioi to beginning. Barnstable C44servation Dig ision at least one (1) wedk g DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel ry / rr �J 'p -7"` 1 Loam Jca�4 1 (�v DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture . Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) lv , n �'1 DEEP OBSERVATION HOLE LOG Hole# NK Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Cher Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ra I Flood Insurance'Rate Map: Above 500 year flood bounds No Yes Y boundary Within 500 year boundary No Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of natural] occurring erviou_ material exist.in all areas observed throughout the naturally gP area proposed for the soil absorption system? If not,what is the.depth of naturally occurring pervious material? Certification I certify that on tA 06 (date)I have passed the soil evaluator examination approved by the Department of Envirohmentall Protection and that the above analysis was performed by me consistent with the required 7'ynexperli a and�experie�ncedles�cribed�inla-10 CMR 15.017. Signature Date Q:\SEPITC\PERCFORM.DOC No. Fee vil THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01P.Plitation for MispoBaf 6pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(VI"Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /7 / Owner's Name,Address,and Tel.No. ,47A4Un-AfS A4,G1 s I I/ Assessor's Map/Parcel -- &W Z QO'7 YSULL I VAS 117 20 362)v/ to Installer's Name,Address,and Tel.No. 'e"C,0'-C o NS T, Designer's Name,Address,and Tel.No. � (A�E fL Type of Building: 0 2,5-5 V 02 S 3 7 Dwelling No.of Bedrooms Lot Size 3,:5_37� sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Desi provided gpd Plan Date / Number of sheets (i Revision Date Title / �- Size of Septic Tank iyo/ , Ida Type of S.A.S. CSC P U 12— Description of Soil Nature of Repairs or Alterations(answer when applicable) Get cF /�i sr, / r1,11714 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date Z �S Application Approved by Date o� Application Disapproved by Date for the following reasons Permit No. �DI�`— 1p� Date Issued �' No. Fee "'- THE COMMONWEALTH OF MASSAC`HUSETTS Entered in computer: Yes k PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplicatlon for Disposal .pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(VIAbandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1/7 vt7v Owner's Name,Address,and Tel.No. /�'IA25/n.N M 'It S S.S��C 1 Uri✓ Z �. / Assessor's Map/Parcel — Q/Z Q6'7 1l 7 2�i2 31 a/ to Installer's Name,Address,and Tel.No. �.c nj&C TL ('o N S T , Designer's Name,Address,and Tel.No. �-(✓�� '��2 `,� 626WCt( �� �. t—aCMduTN /IiA fi 0 $07� Type of Building: 0 Z Sle 02 S 3 7 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) I(/G1' & Other Type of Building No.of Persons Showers( ) Cafeteria( ) 4 Other Fixtures Design Flow(min.required) gpd Des' v provided 3 gpd .. Plan Date / Number of sheets ) Revision Date Title I / Size of Septic Tank ��/S �60y Type of S.A.S. L� S—d 0 12— S X Z Description of Soil Nature of Repairs or Alterations(Answer when applicable) C� C �l j7 / r 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 b this Board of Health. P Y Si i..� «:•,� � Date Application Approved by Date a`Z Application Disapproved by Date ' for the following reasons 4 Permit No. ��JI�— Q Date Issued a -5 ------------------------------------------------------ ---------------------------- --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS g ' BARNSTABLE,MASSACHUSETTS (Certificate of Compliance . THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by �/V&E_-)�— (OA. T P U CTJ O / at 11:7 12-&-, —9k 2 e y bl/11 / has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Ngj�GS dated Z71111 Installer 7iAN ZF Vwit/G 6,� Designer :D� O &Z #bedrooms 3 Approved design flow ! gpd The issuance of this e k it shall not be construed as a guarantee that the system will fuel"'n as designed. p Date Inspector ----------------------------------------------------------------------------------------------------------- ------------------- No. ) 5 Fee y�Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction permit Permission is hereby granted to Construct( ) Repair( Upgrade(Vf' Abandon( ) / I System located at E /2 2 AIJ 1 (C 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 mZ121 co pleted within three years of the date of th's permit. Date Approve A?R/10/2013-MI, ' 0:38 AM FAX No. P, 001 'own of Barnstable Regulatory Services a Richard V,Scali,Interim Director Public Health Division " Thomas McKean,Director 200 Malh Street,Hyanau,MA 02601 Office: 508-862-4644 Fax: 508-790--6304 Installer&Designer Certification Form f Date: d 0 i S- Sewage Permit# 0I g"-06 Assessor's MaplParcel 41 1400 � Designer: q. e,/, Installer: Address: l J �( f Address: L I Il ruly-a pa On v�' /� 1- was issued a permit to install a ( ate) (installer septic system at b" • based on a design drawn by (address) U"��''� a,��v►s vt dated 15 l .� (designer)D�„ Y kt ++��� 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 tame. 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 (Le, 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 system referenced above was constructed in compliance with the terms of the approval letters(if licable) OR (Installer's$igztature) goer j #r't�9lk�t` eSi 'S Si 8t1]re) "1 PLE.AR RETVRN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE O)F COMPLLANCE WILL, NOT BE ISSUED UNTM BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLF PUBLIC REAL DIVISTON. THANK YOU. Q:15apdc\DWgncr Certification Form Rev 8-14-13,doc TOWN OF BARNSTABLE LOCATION 11 c-A ded -� SEWAGE # U ":ALLAGE te ASSESSOR'S MAP & LOil Pfo1o?-oo? 9 &PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS $ HER G.R,OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet P-ivate Water Supply Well and Leaching Facility (If any wells exist f 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 Page 10 of li OFFICIAL INSPECTION FORM-.NOT FOR;YOLUN.TARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL SYSTEM.INSPECTION FORM PART.C SYSTEM INFORMATION(continued) Properly Address:119, I Owner. A Date of I ection: c � SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a sketch ofthe sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate when public water supply enters the building. y ��' •(ot t I CCO�a llU✓1 C 33 tze�pit , �� G TOWN OF BARNSTP LF. ILO CATION 9,2G1 Lqe L SE WAGE ASSESSOR'S MAP & LOT/QPY7 .— INSTALLER'S NAME & PHONE NO.Ai C SEPTIC TANK CAPACITY k0Q LEACHING FACILITY:(tppe)At-f..S4 (s17.e)�Q NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER__ BUILDER OR OWNER Cc,/ DATE PERMIT ISSUED: ,� � 3 • � � — DATE C 111"TLIANCE ISSUED: - 6 ^ 06 _ V ARIA NCH' GRANTED: Yes—�-- —_No._ E � ��q rya V _` ��, �i6 � � � ____.� TOWN OF'B_ ARNSTABLE Lll\\ r LOCATION /&7)8697Z� �a{C.N SEWAGE# 2 ` 0(01 VILLAGE , 1 I/S ASSESSOR'S MAP&PARCEL 1 47-/ A,9 7 INSTALLER'S NAME&PHONE NO. 'RAA16C12 (f o,&S % 5OY-2 74-'I7S3 r SEPTIC TANK CAPACITY c X I ST I G-11o,.l LEACHING FACILITY:(type) l�/L G SOU Z (size) Z•g 5 NO.OF BEDROOMS _ OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: y r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility o ^' Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) .`..•_. N61`r' Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching/facility) r IA Feet FURNISHED BY // ! r A Z' A3= A = 41 goX 3 i13Zz 215 i 3 Ex S�,�'!, . °ter, ��� �-y LEGEND MARSTONS MILLS i PROPOSED CONTOUR P-4cE LANE ® PROPOSED SPOT GRADE EXISTING CONTOUR 2T + 96.52 EXISTING SPOT GRADE W— EXISTING WATER SERVICE z TEST PIT q SITE 0 tiso• I "Ob' i rye. 1 LOCUS MAP LOCUS INFORMATION 1�" 2`30o TITLE REF: CERT. 183265 PARCEL ID: MAP 047 PAR. 012/007 pro 100 SEPTIC SYSTEM REPAIR PLAN LOCATED AT: 0o Z i 99X3 117 REDBERRY LANE MARSTONS MILLS, MA. LOT 7 �� PREPARED FOR 43550f SF p� 1.001t AC ' �P- ^�,•`;� SULLIVAN \� MARCH 29, 2015 iooxi �/ O ^ \i • O i OF EX15T. 1 ,000 GAL % �" \ \ \\:\ \ DA E M. yGn SS8 SEPTIC TANK j" N . o 3�• � \ •may ?2j vent � MEYER & SONS INC. fib ' P. O. Box 981 � � �y. i E. SANDWICH MA 02537 '�� EXIST. 1 ,000 PIT ' PH. (508)360-3311 (see Note 10) 99X fax (774)413-9468 i ? meyerandsonstitle5@gmail.com SCALE 1"=30' -- SHEET 1 OF 2 J#1491 ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE (99.3) = 100.80� F.G.EL: 100.1 F.G.EL: 99.9 F.G. EL: 99.3 VENT 4 MAINTAIN 2% MIN SLOPE OVER LEACHING AREA n \ :c 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" F.G.EL: 98.13 STONE OR FILTER FABRIC DOUBLE WASHED STONE ,. Q l 6 4" SCH 40 PVC 4. ®®®® p ®®10® 10 I (MIN. ®®®®®®®®®®® 14., 6' @ S= 1% � ) ®®®®®®®®®®® TEE'S ARE TO BE INV.95.75 2 EFF. DEPTH ®®®®®®®®®®® 4 SCH 40 PVC `...n.: INV.96.80 " INV.95.55 4' 2 X 8.5' 4' GAS PROPOSED DB-3 EXISTING ouTLEr BAFFLE DISTRIBUTION BOX EFFECTIVE LENGTH = 25' .....,, ..,..... . .. . INV. 97.05 (1-120) INV. ELEV.= 94.60 EXISTING 1 ,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON P��� OF �Assq BREAKOUT OUTLET TEE AS MANUFACTURED BY �� �ti� ELEV.= 95.60 TUF-TITE, ZABEL, OR EQUAL RR NRM' TOP CONC. ELEV.= 95.60 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING y o. 1140 INV. ELEV.= 94.60 �E399~ 0 .ER PIPE INVERTS PRIOR TO CONSTRUCTION E3EO®®Ea ER 2) D-BOX SHALL BE SET LEVEL AND TRUE TO Rf�/SjER�� l ®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX SANITAR�P� BOTTOM EL.= 92.60 ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN �v� 3.75' 5 FT. 3.75' 310 CMR 15.221(2) 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK EFFECTIVE WIDTH = 12.5' WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPARATION 5.20 FT. DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SEPTIC SYSTEM PROFILE SOIL ABSORPTION SYSTEM (SECTION) 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 87.40 4 GAS BAFFLE AS REQUIRED (500 GALLON (1-120) LEACH CHAMBER) GENERAL NOTES: SOIL LOGS DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL P#: 14638 NUMBER OF BEDROOMS: 3 BEDROOMM BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: MARCH 12, 2013 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 - 310 CMR 15.405 (1) (B): WITNESS: DONNA MIORANDI, BARNSTABLE B.O.H. DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. 1) A 1.6 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING GARBAGE GRINDER: NO (not designed for garbage grinder) TO BE 3.70 FT (APPROX.) BELOW GRADE VS REQ'D 3 FT. (H20/VENT PROVIDED) FILLED PRIOR Elev. SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACK T P- 1 Depth Elev. T P-2 Depth TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 0 A 99.4 0 DESIGN ENGINEER. 99.3 LEACHING AREA REQUIRED:A (330) = 445.94 S.F. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING LOAMY SANG LOAMY SAND FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 98.72 10YR 3/1 7" 98.73 / 8" 1OYR 311 .74 ENGINEER BEFORE CONSTRUCTION CONTINUES. B LOAMY SAND B LOAMY SAND USE TWO (2) 500 GALLON (H20) PRECAST LEACH CHAMBERS W/ 4' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 10YR 5/6 10YR 5/6 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 97.14 C 26 97.15 C 27" STONE ON & 3.75' STONE ON SIDES: 25' L X 12.5' W X 2'D THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF SANDY LOAM SANDY LOAM HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 10YR LOAM SANDY OYR LOAM BOTTOM AREA: x 12.5= 312.5 SF 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 94.63 56" 94.82 55" SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 8 ALL TO AREAS ONOTION AGREED UPON BETWE N OWNER AND CONTRACTOR.DISTURBED DURING CC TION SHALL BE RESTORED PERC ® EL. 94.30 C2 C2 TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING MEDIUM SAND MEDIUM SAND CONSTRUCTION. 2.5Y 6/4 2.5Y 6/4 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. PROPOSED SEPTIC SYSTEM UPGRADE PLAN 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 87.3 144" 87.40 1 44" 117 R E D B E R RY LANE, M. MILLS, MA 12, THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PERC RATE <2 MIN/IN. ("C2' HORIZON) Prepared for: Sullivan 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. NO GROUNDWATER OBSERVED Engineering and Survey by: SCALE DRAWN 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. MEYER&SONS,INC. DMM 15. ALL PIPING TO BE 4" SCH 40 ® 1 8' FT UNLESS SPECIFIED ' 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 N.T.S. / / ( ) to conduct soil evaluations and that the above analysis has been performed by me consistent with the PO BOX 981 DATE CHECKED SHEET N0. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. EAST SANDWICH,MA 02537 508-362-2922 03/29/15 DMM 2 of 2