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HomeMy WebLinkAbout0055 REGENCY DRIVE - Health 55 Regency Drive, M. Mills A= 063-068 l � TOWN OF BARNSTABLE .00ATION re- GA c- a�'. SEWAGE# Y VILLAGE M. M il'-C ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY �Ub LEACHING FACILITY:(type) �"'!c.�C (size) 90,X 3 0 NO.OF BEDROOMS / OWNER 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) Feet FURNISHED BY �r-fl s �vT T, (,or y l d� (3 3 3E' 33 y 4(Y 39 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTIONFORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATIONy 1 , Property Address: 55 Regency Drive • ` Marstons Mills:MA 02648 Owner's Name: John Hansen Owner's Address: l� l� Date of Inspection: April.9, 2008 Name of Inspector:(Please Print) Janes M.Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville:MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems: .I am a DEP approved system inspector pursuant,to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Ne ds Further Evaluation by the Local Approving Authority F I Inspector's Signature: kw6f� Date: April 14, 2008 The system inspector shall sub t 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-1_0,000- gpd or greater,the inspector and the system owner shall submit the report to the:appropriate regional office pfthe 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 conditio�s of uwat that,:,, time. This inspection does not address how the system will perform in the future under thfe same dr different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: SS Re—aencv Drive Marstons Mills. MA Owner's Name: John Hansen Date of Inspection: April 9, 2008 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. 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 box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Property Address: 55 Re encv Drive Q Marston Mills. MA Owner's Name: John Hansen Date of Inspection: April 9. 2008 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines.in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within.50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: SS Re, eenna Drive Marston Mills. MA Owner's Name: John Hansen Date of Inspection: April 9, 2008 D. System Failure Criteria applicable to all systems: You must indicate either"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 ✓ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must.be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should.contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400.feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question;in.Section E the system is considered a significant threat,or answered . "yes in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. i 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: SS Regency Drive Marston Mills. MA Owner's Name: John Hansen Date of Inspection: April 9: 2008 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: 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)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C .SYSTEM INFORMATION Property Address: SS Rezency Drive Marstons Mills. MA Owner's Name: John Hansen Date of Inspection: April 9. 2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: I Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable. Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310.CMR 15.203): apd 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:_ Never Pumped -per owner Was system pumped as part of the inspection(yes or no): Yes If yes,volume pumped: 1500 eallons--How was quantity pumped determined? Reason for pumping: Maintenance 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Date of installation-6120197 Were sewage odors detected when arriving at the site(yes or no): No. 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 ReQena Drive Marston Mills.MA Owner's Name: John Hansen Date of Inspection: April 9. 2008 BUILDING SEWER(locate on site plan) 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) Depth below grade: 16" Material of construction: ✓ 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: 1500 izal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle:. 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measurinz stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present.. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage The tank was pumped after inspection. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: _ SS Rezencv Drive Marstons Mills. MA Owner's Name: John Hansen Date of Inspection: April 9. 2008 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBU TION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Commments(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.):The D-box was clean.. No solids were present. PUMP CHAMBER: None (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.): 8 1 • Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: SS Rezencv Drive Marstons Mills. MA Owner's Name: John Hansen Date of Inspection: April 9. 2008 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching.trenches,number, length: ✓ leaching fields,number,dimensions: 20'x30'per as-built 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.): There did not appear to be any signs offailure A camera was used for the inspection CESSPOOLS: None (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: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of pondin& condition of vegetation,etc.): 9 Y ` Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 55 Regency Drive Marstons Mills. MA Owner's Name: John Hansen Date of Inspection: April 9, 2008 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. �rvnt �3 O a o 3 _ y a3� 3 i 3 3(3' 33 . 10 • � 1 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 55 Regency Drive Marston Mills, MA Owner's Name: John Hansen Date of Inspection: April 9, 2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 50+/- 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: Topographic and water contours snaps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topo r gghic and water contours maps, the snaps were showing gpproximately 50'+1-to Qroundwater at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of.the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or implied, relating to the septic system, the inspection, this report and/or any coniponents,of the septic system which have not been located and inspected. 11 THE T Town of Barnstable Epp � Regulatory Services BARM ,,SjAB Thomas F. Geiler,Director plFD ,gyp Public Health Division . Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This sep tic syst em y m inspection report was completed by a private inspector who is certified by the State of Massachusetts,Department of Environmental Protection. Although the To wn of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit'. If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. TOWN OF BARNSTABLE LOCATZN 55 �� �r ��-- SEWAGE # 7 7— VEjLAGE ►AarVeG^ W`i tt S 044. 0ul ASSESSOR'S MAP & LOT ;3 1 INSTALLER'S NAME&PHONE NO. -0111, f11 i-i-d ,SEPTIC TANK CAPACITY 1 S06 Ga Il o�S LEACHING FACILITY: (type) Fir- 1d (size) 2,0 K 36 ©NO.OF BEDROOMS BUILDER OR OWNER Lo-cc CkI t' n®$ [Edge RMTTDATE: q 1- l�6. COMPLIANCE DATE: paration Distance Between"the: ximum.Adjusted Groundwater Table and Bottom of Leaching Facility Feet vate Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet rnished by 4L-i 04Y"3t l � ASSESSORS MAP NO: FARRCELP N 01 THE COMMONWEALTH OF MASSACHUSETT`S i BOARD OF HEA TH , TOWN < ......................OF..... ........... . Appliratiou for 11wpoal Works Towitrurtinn Urrutit Application is hereby made for a Permit to Construct (!/j or Repair ( ) an Individual Sewage Disposal S em t• . E../c ...�:.. ....../..^... ... ��. . .........1... : ........................2f ✓�............................ ............... Location-Address o. ........:� .'�L� .....A.. . .........................................». ................ Address ......................»..... --- Owner .............lee^. .. . .-?: ................................................... ................................................................. ............................ i S Installer Address Type of Building /L Size Lot`�'`f���71:.f ......Sq. feet <: a Dwelling—No. of Bedrooms........... ............................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No., of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures .......................................... .. . ......................................................................................................... WW Design Flow..........lf42.........................gallons per person per day. Total daily Row...:...... .....................gallons. WSeptic Tank.=Liquid•capacity.).S�gallons Length.....d!:.fi.. Width.....(a-........ Diameter........... Depth.......... Disposal Trench—No......../.......:.. Width.....2.R....... Total Length.................... Total leaching area....(4,Q........sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by....eEke......I.FF...ls ?`! S ..... Date... .... Test Pit No. I.....?.......minutes per inch Depth of Test Pit....ZJ "..... Depth to ground water......�5�. ........ t� Test Pit No. 2................minutes per inch Depth of Test pit....1±.`t Depth to ground water.. / f� o ` ......... ............ ..` . . ... ... .ODescription of Si . .... . 4 ....... .............. U ............ .zit.. ......7Z.....T.aPsa�c ✓13s�: .. ..1Z -f. 4:`./ylFl�t�^ ...Sr°Y! ....................................... ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli e h been ZisuAeythe board'of health.Signed ........... . .................... .. .. ............................................ . ..1�,� u.• ApplicationApproved B �........ .................. :. '...: .... .. :. ....... .. ........................................... ..... ........`.. . :... � • Dau Application Disapproved for the following reasons: ..............................................:.........:............................................................................... ........................................................ ...................................... ................................... Permit No. ............��` ..4.....:............................ Issued ...........,. r" ....... ... Date TOWN OF BARNSTABLE LOCATION 55 �t�y 1�r;�� SEWAGE # Y 7- �6 VII LAGEJN��('Ska� 1'h i t�S Iv[y ouYB'ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. To 1.,, h SEPTIC TANK CAPACITY Sna G e.t l u w S LEACHING FACILITY: (type) (size) 201C 36 NO..-0F BEDROOMS BUILDER OR OWNER N (t;IL LotC-,G\ 110$ PERMI'FDATE: q7- 174 COMPLIANCE DATE: Separation Distance Between 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 Edgeaif Wetland and Leaching Facility(If any wetlands exist , within.300 feet of leaching facility) Feet Furnished by wkty f � ' No._............. ; Fsx_..... ._._.._...._ THE- COMMONWEALTH OF M'ASSACHtJSET'1'Sf' BOARD OF H:EALT.H .' TOWN ........................................................ Application fur 11i,opla,ittl Works TunilrlUrtinrt Prrutit Application is hereby made for a Permit to Construct (41 f or Repair,' ( ) an Individual Sewage Disposal System at: ............. ............... ................................................................................. Location-Address or Lot No. ........................................... ................................................................................_... .... jJ1 ( .Owns=........................ Address........... ' ............................ .1K �..1..Y.:1Fn'.1.' .� Installer `� { ' Address Type of Building Size Lot.`t'`�le.7...:r......S feet /L a Dwelling—No. of Bedrooms........... ..:. Expans:oii Attic (' ). Garbage Grinder( ) pt Other—Type of Building ............................ NO), of persons................::........... Showers ( ) — Cafeteria ( ) Otherfixtures ................................... ..,. ,_.... ........................ . ........ . ....... WWDesign Flow...........1..i�'..........................gallons per person per day. Total daily flow...:...... .....................gallons. w Septic Tank—Liquid'capacity.l.5.....gallons Length.....ZL5..'.Width.....kz........ Diameter................ Depth................ Disposal Trench—No......../........... Width.....Z(?).......Total Length. :� , al• P Length...:, ......: To.:I .. t leaching area....4eO?......sq. ft. Seepage Pit No..................... Diameter.................. Depth below 'inlet................. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank } ' Percolation Test Results Performed by.:.. kP. �i....Ls ^! 5 u2S/ .)'...... Date..: ... Test Pit No. 1.....Z minutes per inch _Depth of Test Pit....l. De' th to ground water.......f .. ........ fs, Test Pit No. 2................minutes per inch Depth of Test Pit....L.f..`f'..... Depth to ground water..N..f ......... O .. .. .. Description of Soi&Q'::`.6.........Taps ,� w........................... .....4n:".-.�: ` . ...: 1 ?�Ls�.M...SQL! ..................... V ...................s '..C7::...7z....:To�s��� :�:.. ..J2.` '1..4�:`./fl ..................................... UNature of Repairs or Alterations—Answer when ap licable...........•.•............ ....:.........•.............................................. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual.Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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 ............... ::...... .. :... 'u...' ApplicationApproved By .................................................................. .:. Application Disapproved for the following reasons: ........................................................ ........ ... ................. ...............o:<i.................. Permit No. Issued ........:.................. ................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. ............................................. OF .................................. ............................. ...................... Ter#ifitrate of Tom IittnrE THIS IS TO CERTIFY, That the Individual Sewage Disposal,System.constructed ( ) or Repaired ( ) by..........................................................................................:................................::..:.: ............................... ................. ..................................................... ' Inrnikr -at .................................................................................................................. .......... .........:........:. has been installed in accordance with the provisions of TITLE 5 of T e State Environmental Code as described in the application for Disposal Works Construction Permit No. ........................::.................:.... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL-NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................................................................................ Inspector .............................:................................................................... . THE COMMONWEALTH,OF'MASSACHUSETTS BOARD OF HEALTH No......................... ...............................OF..................................................... F> ........................ Ujigp,annl Mirka Q.T1,11nstr iun Vantit Permission is hereby granted.......................................... ......:...... ... .. .................................._.... to Construct ( ) or Repair ( ) an Individual Sewage.Disposal System atNo.................................................................................................... ................ .. ..... .... Street as shown on the application for Disposal Works Construction Permit No.:................... Dated.......................................... ........................................................... i .......................................eaihDATE..................................................................:............. _ FORM 1255 A.M.SULKIN CO. MARSTONS + GRAPHIC SCALE oQ� MILLS ACCORDING TO THE TO TfW WATER O WNER, THIS WELL 40 2 0 40 8 0 160 PRO VIDED HAS BEEN ABANDONED IN AS A POTABLE WA TER SUPPL Y" RACE __ ( IN FEET ) LOCUS 1S��G -_ GAS UTILITY 1 inch 40 f t. v - -- WELL DRI 7-7 1 \ OLD 0 C.\B. OKEA . L07' 32 � tip• / '� �\ '�, ' LOCUS MAP \ 3 TEST PIT PLAN REF ASS. MAP 64/48 I /Qj �� rP2 \\ p L. C. 16427 D p RIP -Joy' '� RES. ZONE RF CD- TEST PIT i ~, \ Z:� ASSESSORS MAP 63 TOVITN WATER AVA ILA BL 0'�� N, � 0 C'i+iy ,a � � �As�9c _ i:20 0 150 \ \v- o '� to ER GA y i PROPOSED 'o ( T �\ \� PAl1�o�. `�' . " LOT 33� \ I 4 BEDROOM. 5 O \�' a VIZ 1 m% HOUSE °' 6 go �\ � \y � MERITHEW a ASS. MAP 64/2 o. i ,a_ 0• R A W .e BENCHMARK- CHISELED SQUARE IN CONC PAD R • / /� \\. o o \` \ 'A. �\ ELEV.= 100.00 (ASSUMED) $lll \\ \\ I�oN PROJEC T TI L OCA ON=F \\ PIPE , LOT 31 REGENCY DRI P IV ARSTONS MILLS, IIA. LOT 345 \\ \\ // 9.90, o ASS. MAP 631126 �� 2 9 APPLICANT- LOT 31 C� � � � NICK LA GADL_TITO, \ AREA=44,871 S.F. f \\ \\ ASS. MAP 63/68 = _ YA NKEE SUR l/E Y CONSUL ,�'A l\-'TS , 9 a 31 P. 0. BOX 255 \\ \\ o �0 _ UNl T 5, 405 INDUS TR Y R OAD LOT 346 LOT\\ `\ 30 --- WELL MARSTONS MILLS, MA. 02648 - ASS MAP 63/30 \o`\ ASS. MAP s3/s� --_ __ PH: (508)428—0055 — FA X(508)420-5553 TOWN WATER PRO VIDED r \\ SCALE: 1 „=4 0, FD7A TE 2106196 REV. REV. I JOB NO. 508 73 SHEET 1 OF 2 p 102 0 PROPOSED F.F. ELEV.___• _ - O'min. - ELEV.= 100.0 ELEV.= 100.2 4" CAST IRON OR CONCRETE COVERS ' SCHEDULE 40 P.V.C. 4" DIA. SCHEDULE 40 PERFORATED PLASTIC PIPE �t 4" CAST IRON OR ' END CAPS ON ALL PIPES SCHEDULE 40 P.V.C. 5' ON CENTER A 3" LAYER OF __ 12 min DIST.=10.:6_ SLP.= 0.02 SLP.= 0.00 INVERT CONCRETE COVER ------------ FLOW LINE DIST.=4.5' DIST.=37.5_ � WASHED STONE SLP.=0.02 9618 ., °.,o"o"o"o"o" o"o"°"o"o"o"o o"o o"o` ELEV.= 96.91 96. 70 — INVERT ELEV.=__ _ °O°Oo0o0 O OO OO OO OO OO o0 o0 o0 o0 o0°Oo0o0°Oo0°Oo0°O°Oo0° °O°O°O°O°O°O°Oo0o0°O°C ELEV.=____ 10" MIN. 191, — 1_0_0_0_0 o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_ _o_o_o_o_o_o_o_o_o_o_ ELEV=96.0 ELEV.= 96.45 96.36 ELEV.= 96.19 0 o 6" LAYER OF ELEV.= c o /4" To 1-1/2" 4" CAST IRON OR �OvO�OvOvOvOVOVOVOVOVOVO�. �O�OU VOV000C)0 O0 WASHED STONE SCHEDULE 40 P.v.c. DISTRIBUTION BOX ,o 0 0 0 0 0 0 0 0�0�0�0� � ono 0 0 0 0�0 0� ELEV.= 95.5 IF MORE THAN 4' OF COVER. USE H-20 LOADING USE STONE A i 1500 GALLON SEPTIC TANK TO BE WET TESTED IF TO LEVEL THE TO BE PLACED ON MORE THAN ONE OUTLET. BED AS NEEDED. 7.3' j 6 OF STONE OR TO BE PLACED ON 1 6" OF STONE OR 1 MECHANICALLY COMPACTED SOIL. --------------------------------------------------------- ' MECHANICALLY COMPACTED SOIL. BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV =88.2 ! USE A TANK WITH THREE COVERS. I USE H-20 LOADING SOIL TEST DONE BY: CAPE & ISLANDS SURVEY WITNESSED BY: JOHN JACOBI ____________ I IF MORE THAN 4' OF COVER. PERCOLATION RATE: _9___MIN/INCH P# 3503 IrAYER,°F TEST HOLE 1 DATE: 6=15=84_ ELEV._I00.0 __ o;o o v o v to o"_o`o_o erssr�sroxe 8' YER °F PROFILE OF DEPTH HORIZON TEXTURE COLOR MOTT. OTHER SEWAGE DISPOSAL SYSTEM 4 PERFORATED PIPES NOT TO SCALE 0"-48" TOPSOIL & SECTION is SUBSOIL HN I GENERAL NOTES: 48"-144" MEDIUM 1. THIS PLAN IS FOR THE CONSTRUC TION OF ANEW SEWAGE DISPOSAL SYSTEM. SAND 2. RLAN REFERENCE 16427 D LOT 31 BARNSTABLE REG. OF DEEDS. SS AL 3. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC SYSTEM AND NOT TO BE USED FOR SURVEYING AND ZONING PURPOSES. DESIGN DATA: 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. ! TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. NUMBER OF BEDROOMS 'OIIE��Z___ 5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN TEST HOLE 2 DATE: 6=15=84_ ELEV._$9.5___ 12 OF THE FINISHED GRADE. DEPTH HORIZON TEXTURE COLOR MOTT. OTHER GARBAGE DISPOSAL NONE'(0)---_-- 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE TOTAL ESTIMATED FLOW _4_4Q GPD SAME, UNLESS NOTED BY FINAL CONTOURS. 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE GAL/BR./DAY X ___ OF WITHSTANDING H-10 LOADING UNLESS THEY -ARE UNDER OR SEPTIC TANK CAPACITY (LQ�dL__ WITHIN 10' OF DRIVES OR. PARKING AREAS. H-20 LOADING 0"-72" TOPSOIL & SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING SUBSOIL AREAS UNLESS NOTED. - LEACHING AREA REQUIREMENTS 8. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL SIDEWALL AREA 0 GAL/S.F. BE MORTARED IN PLACE. BOTTOM AREA _�QO GAL/S.F. 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO 72"-144" MEDIUM LEACHING CAP.(BOT. & SIDEWALL)__444 _ GAL OBTAIN SUCH DETERMINATION FROM APPROPIATE AUTHORITY. _ 10. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF SAND ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. RESERVE LEACHING CAPACITY _444 GAL. APPLICANT: NICK LAGADINOS DATE: FEBRUARY 6, 1996 SHEET 2 OF 2 JOB # 50873