HomeMy WebLinkAbout0072 REGENCY DRIVE - Health �t=Regency Drive, Marstons Mills
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TOWN OF BARNSTABLE
LOCATION Z2R 3 SEWAGE
VILLAGE tSA',JJS ASSESSOR'S MAP&PARCE156 Lp
INSTALLER'S NAME&PHONE NO. -Do,,sle, A \a(-ow,-z Loc—
SEPTIC TANK CAPACITYya sfii,�s
LEACHING FACILITY: (type) size) 1:),,$3 X 2-5 (2
NO.OF BEDROOMS`X `S 3c! I
OWNER JL 1 ��
PERMIT DATE: COMPLIANCE DATE:S/®
Separation Distance Between the: peEL
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
I
opt -;ZC,
t h
o
No. t�[/��P � Fee (/O
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t/
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppfication for ]Disposal'*pstem Construction Permit
Application for a Permit to Construct( ) Repair(14upgrade( ) Abandon 00 ❑Complete System ❑Individual Components
Location Address or Lot N 7 2 V r,.t�� V f Owner's Name,Address,and Tel.No.
�0 AA&(5 m% WIMIC,
Assessor's Map/Parcel G V— I I S S
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
S
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building f C'S 1C76y�(C,` No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 2-2,® gpd Design flow provided 1H 7 gpd
Plan Date 'S---1''� ►�� Number of sheets L Revision Date
Title
Size of Septic Tank Type of S.A.S. 9L, SCX--->
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) lNS1-L i\ j N t'CJ r� �[lr7K mac) ";7-60
S hQ/y
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.
igne Q Date
Application Approved by Date �l0
Application Disapproved by Date
for the following reasons
Permit No. /0 S� Date Issued
No. �� �l Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered;ncomputer: e/
Yes 1
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
9ppIication for 0sposar 6p t m Construction Permit
Application for a Permit to Construct( ) Repair(t4upgrade( ) Abandon j' ❑Complete System ❑Individual Components
Location Address or Lot No,,7 2 rrjC 7 _D( Owner's Name,Address,and Tel.No.
lvIV(5}Q NS /Nk0)'S '
Assessor's Map/Parcel G 6
Installer's Name,Address,and Tel.No. Designer"s Name,Address,and Tel.No.
�v<1 1 ` T t='n `tA? ris L O roti C
v
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building f PSic J�rrIC,� No.of Persons Showers( ) Cafeteria( )
Other Fixtures �.
Design Flow(min.required) 12 2,0 gpd Design flow provided —� / t ' gpd
Plan ` Date 5 - 1 '� .. 1� Number of sheets L Revision Date
Title
Size of Septic Tank X y sF-t,u Type of S.A.S. 9, SC,C� a G lJr.•.J / �r nn�7'!v
Description of Soil
Nature of Repairs or Alterations Answer when applicable) t N /
P ( PP ) SH ra 1
1n 1 w S F r rr 1F
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.
tgne Date
Application Approved by Date /��p
Application Disapproved by Date
for the following reasons
Permit No. J� f Date Issued �6
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS To CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(k< Upgraded( )
Abandoned( )by s ,,-_\c•S A :2ycnc..aJrJ —T.niC
at 7 Z C J P_fG y r !�.(G c� ��5AA,1`t G% has been constructed in accordance
with the provisions of Title 5 and
-the
for Disposal System Construction Permit�_ O/6 5-t dated � p
Installer 1 J,� �T(�„f,� 1 n�C Designer 111,4 rT�c j/ c,
#bedrooms / S L� Approved design flow gpd
The issuance of this permit shall not be construed as a guarantee that the system will gtfon as designedl.
Date ''
---- ------- ----------- ------ ---------------------------- ---------------------------------------------------------------
No. 0�� -- 51 Fee �' O
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair(v Upgrade( ) Abandon( )
System located at 7 2 Qr•4t r.vC%�r 1l e O jo ".,,(S VWj C 11A t) S
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 perunit.
Date �`"l Cr" 4 Approved by\",
Town of Barnstable
Regulatory Services
Richard V. Scali,Interim Director
BARNSTABLE
MASS.9�A9: � Public Health Division
�fOsp Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
installer& Designer Certification Form
Date: S 1 F-Jt 6 Sewage Permit# `241-t0—I.,z1 Assessor's MaplParcel �o`i—6'G q
Designer: _r►ca i v�ge�;*.a ��f � 1�.c_ Installer: P� A , ►3 c a w, I—(-
Address: 1 "L r,ti Ct� ,c ;.� 1t tir�g Address: P a •
On $- l 6 It 6 AA -aw et- !,t c was issued a permit to install a
(date) (installer)
septic system at 72- )Ze ev-�. C)V /q, based on a design drawn by
(address)
$` Cr'1*-e_C Pc—
dated / 3
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box andfor septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes i.e.
greater than 1 U' 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 co. liance with the terms
of the EA approval letters (if applicable)
or h9gss9
o PETER T. G�
(Instal is Signature) o McENTEE
CIVIL
No. 35109
Af GJSJ-
9Cs Ft �a�
(Designer's Signature) (Affix Desia Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL. BOTH THIS FORMI ARID AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC .HEALTH DIVISION.
THANK YOU.
QASeptic\Designcr Certification Form Rev 8-14-13.doe
oF�
Town of Barnstable P# SDI Z
Department of Regulatory Services
t MRNszABM : Public Health Division Date 3 3d ( r
A t6-19. ,e�' 200 Main Street,.Hyannis MA 02601
ji
Date Scheduled (p &C/
Time U M Fee Pd.
'aft
Soil Suitability Assessment for Sep We Pisposal
Performed By: messed By: QJ,7Cyr �1_
i
LOCATION& GENERAL INFORMATION
Location Address 7 Z G s
--. Owncr's'Name;-�- C
Address 7 2-" 1jSL n CY
d�4rs WVLc l S
Assessor's Map/Parc•el: 0-co —� 6 Engineer's NameEF��
NEW CONSTRUCTION REPAIR `X Telephone# _ff_d1e 7 7—_5'-3t.3
Land Use $ Cam[Iyi-i q slopes Ro �— �2?
P ( ) Surface Stones
Distances from: Open Water Body 3'n�ft . Possible Wet Area N A ft Drinking Water Well l" d ft
Drainage Way ft Property Line �� / ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands(n proximity to holes)
t
G 1 s'a
Parent material(geologic) Depth to Bedrock
'y��'�_
Depth to Groundwater. Standing Water in Hole: Weeping from Pit FpCe
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: in, Depth to soil mottles: in.
Depth to weeping from side of obs.hole: --in, Oroundwater Adjustment
Index Well# Reading Date: Index Well level,: � Adl,factor— Adj,Groundwater]level
PERCOLATION TEST
Hole# / Time at 4"
Depth of Perc L1 J Z�f" ���t I�f'"' Time at 6" \\
Start Pre-soak Time @ Time(9"•6")
End Pre-soak
Rate Min./Inch. 7— R
Site Suitability Assessment: Site Passed " Site Failed: Additional Testing Needed(Y/N)_
Original:;Public Health Division " Observ,ition Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
DEEP.OBSERVATION HOLE:LOG Hole#-- --
Depth from Soil Horizon Soil Texture .Sdil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling; (Structure,Stones;Boulders•
on isten ravel
1Z
aq
Nt 5'�Jj
z�s
DEEP OBSERVATION HOLE LOG Hole# L
Depth frcm Soil Horizon. S0i1 Te.tLre Soil Colo; Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Cons' ency.% rave
DEEP OBSERVATION HOLE LOG Hole# ;
Depth from Soil Horizon Soil Texture Soil Color Soil % Other
Surface.0n.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
on i ie c o G ve
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other.
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consist n °
Flood Insurance Rate Man:
Above 500 year flood boundary No— Yes l_-
Within 500 year boundary No Yes
Within 100 year flood boundary Nu Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious tntiterial exist in all areas observed throughout the
area proposed for the soil absorption system? J --
If not,what is the depth of naturally occurring pervious material? -
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Envir mental Protection and that the above analysis was performed by me consistent with .
the required tra • g,expertise and experience described in 310 CMR 15.017.
Date �2�i/�:(�'
Signature
Q:\SBPTICTERCFORM.DOC
Town of Barnstable P#
Department of Regulatory Services
aARN&rABLF Public Health Division Date
200 Main Street,Hyannis MA 02601
CFO MA't w
Date;Scheduled Time 710_0: Fee Pd.
Soil Suitability Assessment for S v e , isposal
-
Performed By: f e l e� ��'1� C_ 5c- �'
1
j ` itnessed By: ✓r
LOCATION & GENERAL INFORMATION
Location Address
-7 Z r1 L,J fir- Owner's Name.1-,,A�k< t I ss
1"l Address 2-' tZ'eG)1L Y�CY
Nl-Gt'.� E-FTw• b�'l-� I lS• (`il 9� (f�..�P��
Assessor's Map/Parcel: �j l p�� - Q 6 Lf Engineer's Name (jy
NEW CONSTRUCTION /REPAIR Telephone# 7 S 3L3
Land Use $ r-OLn SurfaceStonesSlope (30 )
z
Distances from: Open Water Body�� � ft . Possible Wet Area ft Drinking Water Well_Z/J__O�ft
Drainage Way ft Property Line ft Other g
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands(n proximity to holes)
00,
s we-l�
------------
Parent material(geologic) Q J4,� Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: lJ4,-,e Weeping from Pit Face
Estimated;Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
.Depth Observed standing in obs.hole: --in, Depth to soil mottles: in,
Depth to weeping from side of obs,hole: in, Groundwater Adjustment .- n ft.
Index Welll# Reading Date: Index Well level Adl,factor,,,,, �.P Adj.Groundwater Uvel
PERCOLATION TEST bate��.-� Time,
Observation
Hole# -�'� Time at V ...�
Depth of Pere IV�i. J� 1Gri t"I, I j Time at 6"
Start Pre-soak Time @ / i ti Time(9".6")
End Pre-soak
Rate Min,/Iitch.
- 7—
Site Suitability Assessment: Site Passed �' Site Failed: Additional Testing Needed(Y/N)_
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
i
Barnstable Conservation Division at least one. (1) week prior to beginning.
Q:ISEPTfWERCFORM.DOC
i
1
DEEP.OBSERVATION HOU,LOG Hole# `
Depth from Soil Horizon Soil Texture :idil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency. Gravel)--
UZI
DEEP OBSERVATION HOLE?.LOG Hole# �
Depth from Soil Horizo
n Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, rave
_ A
DEEP OBSERVATION HOLE,' LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,iBoulders.
risistency. o O' el
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other.
Surface(in,) (USDA) (Munsell) Mottling (Structure,Stones,lBoulders,
Consi t °
i
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes J, .r
Within 500 year boundary No Yes
Within 100 year flood boundary Now. Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? --
If not, what is the depth of naturally occurring perviorts material? — - .
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of EnvirYn.eniltal:�In otection and that the above analysis was performed by me consistent with .
the required tra}n g,expertise and experience described in10 t✓MR 15.017.
.` Date
Signature -- ----I-'�.
i
•
Q;\.S.P PTICAPERCPORM.DOC
r ' /
t ,
3
� Q
nNCommonwealth of Massachusetts
Executive Office of Environmental Affairs Ja, l 5 1997
®apartment of
Environmental Protection
Wllllam F.Weld
�mw
Trudy Coxe
Sec+etuY,EOEA
David B. Struhs
comminioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,
PART A
CERTIFICATION
Property Address: 72 /fpg Jy rj,pf,,�o b� Address of Owner:
Date of Inspection: /—7— 97 (If different)
Name of Inspector: TOA
Company Name, Address and Telephone Number:
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
asses
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signatu . Date:
The System Insp4lctor shall submit a copy of this inspection report to 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 authori[,.
INSPECTION SUMMARY:
.Check A, B, C, or D:
A] SYSTEM PASSES:
I 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:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, 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 conforming septic tank as
approved by the Board of Health.
(revised 8/15/95) 1
One Winter Street a Boston,Massachusetts 02108 a PAX(617)W&1049 a -Telephone(81 292-MW
Printed on RwydW P&W
r� r
.�y»
,,.L V
"9 to SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
_4
PART A
a }sT ° CERTIFICATION (continued)
Property�Ad,dress- '72 �PagJ/-sc7 �iivB � -st,"s /)/i,//-S 'Mu,
Owner:�+�f rr G 17 04, q� Tk•,i To�rhso�,
Date of in/
ection `2
/=-•7—9 7
BJ SYSTEM CONDITIONALLY PASSES (continued) ,
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health):
broken pipe(s) are replaced
obstruction is removed
�\ distribution box is levelled or replaced
_ The system required pumping more than four 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
C) FURTHER EVALUATION IS REQ\U RED BY THE BOARD OF HEALTH:
Con
ditions exist which require. rther evaluation bY,:the.Board of Health in order to determine if the system is failing to protect the
public health, safety and the envirpnment.
1) SYSTEM WILL PASS UNLESS BOARROF HEALTH.DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLI HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 fe t of A surface water
Cesspool or privy is within 50 fee of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF EALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING,IN A MANNER HAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The cvstem has a septic tank and soil absorpu, n system and is within 100 feel to a burface water supply or tributary to a
surface water supply..-
,
_ The system hay a septic tank and soil absorption s,Ystem and is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless'a well water analysis 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.
D) SYSTEM FAILS: .'
I 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 failure.
Backup of sewage into facility or system component due to an 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.
(revised 8/15/95) 2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner: l�glY 3o�NS ovr� �' ��+N t �L�h fo•�
Date of Inspection:
D] SYSTEM FAILS (continued):
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
Required pymping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of tfrr)es pumped
Any portion of th'e,Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool''gr privy is within a Zone I 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\Mess than 1.00 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If tl<ie well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic comppund's, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to\the criteria above:
The design flow of system is 10,000 gpd or.greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following con4tions exist:
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 600. Please consult the local regional office of the Department for further information.
(revised 8/15/95) 3
1
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: -72 . r0_e"Cy .�!'• /j'lurs "c �•//sue /emu.
Owner: ,�,/G, ry G Job+.,sv7 h
Date of Inspection:
Check if the following have been done:
IZPumping information was requested of the owner, occupant, and Board of Health.
PNone of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
ZAs built plans have been obtained and examined. Note if they are not available with N/A.
_/The facility or dwelling was inspected for signs of sewage back-up.
✓The system does not receive non-sanitary or industrial waste flow
✓The site was inspected for signs of breakout.
V All system components, e*e4ed+ng the Soil Absorption System, have been located on the site.
_/The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
ZThe facility owner iand occupants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal 5vstem.
(revised 8/15/95) 4
I -
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: _Z2 / , .��-,c7 ••��3ths
Owner: Het- y S Y7Alson q �, JFNr Jo4v�so•+
Date of Inspection: /
FLOW CONDITIONS
RESIDENTIAL:
Design Flow: T*7y gallons
Number of bedrooms: 2
Number of current residents:L
Garbage grinder (yes or no): e
Laundry connected to system'(yes or no):_ e
Seasonal use (yes or no): M
Water meter readings, if available: Nnn 2
Last date of occupancy: occcr "'I
COMMERCIAUINDUSTRIAL:
Type of establishment:
Design flow:_gallons/day
Grease trap present: (yes or no)_
Industrial Waste Holding Tank present: (yes or
Non-sanitary waste discharged to the Title 5 system;.Cy so no)_
Water meter readings, if available: \,
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy: %
GENERAL INFORMATION
PUMPING RECORDS and source of information: ,1
System pumped as part of inspection: (yes 6r no)_-�
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
Other(explain)
APPROXIMATE AGE of all components, date installed (if known) and source of information: �y `f Pars �MfP oy gfdu��f�aY�
Sewage odors detected when arriving at the site: (yes or no) /Vo
(revised 8/15/95) 5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 72 111, ,0,,,✓I e /r/l+r�4,,s 10,'115�IVO,
Owner: /7�arr� `y- 7u�v,foti/
Date of Inspection:
/- 7- 9r7
SEPTIC TANK:
(locate on site plan)
Depth below grade: /0
Material of construction: ✓oncrete _metal _FRP —other(explain)
Dimensions:
Sludge depth: L
Distance from top of sludge to bottom of outlet tee or baffle: /S'"
Scum thickness: 0 „ 1,
Distance from top of scum to top of outlet tee or baffle:_
Distance from bottom of scum to bottom of outlet tee or baffle: /y
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outl-.invert,N structural
Jr, rIGN L Oo S S 'H O O�V'i�/o H
integrity, evidence of leakage, etc.) sP / '� ��Q ssar
7t t 7%
/ 4 ,.z r,v Pr
�nf [vvdv /p�� �t�ow r�-�c�P �ut�[ �D /2�� d�44✓O,vnA�
GREASE TRAP:_
(locate on site plan)
Depth below grader
Material of construction: _concre metal
—FRP
_ of her(ex I in) .,
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee r baffle:_-
Distance from bottom of scum t- bottom of oull tee or ahle:
Comments:
(recommendation for pumping, condition o ' let and utlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
6
(revised 8/15/95)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: W-) I?e, ,fir 7 prr S7/o",?3 IM,11 r.-I AA.
Owner:
Date of Inspection: p,
TIGHT OR HOLDING TANK:_
(locate on site plan) �.�
Depth below grade:
Material of construction: _concr a _metal _FRP —other(explain)
Dimensions:
Capacity: s allons
Design flow: rzallons/day
Alarm level:
Comments: %
(condition of inlet tee, condition of alarm an float switches, etc.
DISTRIBUTION BOX: L/
(locate on site plan)
Depth of liquid level above outlet invert:_
Comments:
(note if level and distribution is equal, evidence of solids carry %,ir, evidence of lea age intp or out of box, etc.)
�iSr �oiT� �a S ,s du ens Ar— �f evc Iva fish o curryoveY
let
Cow/!re -2 eJ,�✓ cayr
PUMP CHAMBER:_
(locate on site plan)
Pumps in working order:(yes or n I
Comments:
(note condition of pump chamber, condition pumps and u enances, etc.)
(revised 8/15/95) 7
_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION .(continued)
Property Address: 7,� R Pubjl
Owner: � ;- f04" n 4
Date of Inspection. �_ 7-97
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:
Type:
leaching pits, number:
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition /off soil)/ signs of hydraulic fail//d ire, level of
ponding, condition of ve etation etc.)
//�7 N vs L/ N�O F!/C i+ I000 IW e Oc✓P�7
O T '�R, s.v� •
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 inspection)
Comments: (note condition of soil, signs f hydraulic failu��, level of ponding, condition of vegetation, etc.)
PRIVY: _
(locate on site p/ndition
Materials of con Dimensions:
Depth of solids:
Comments: (notsigns of hydraulic failure, level of pondin condition of vegetation,etc.)
(revised 8/15/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 7,7 �Q� .�hE 1y�'v t /
Owner: Nary y t�sc�i.��o•, 4 r fuH-e �GL7c So��
Date of Inspection:
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
I�
0 2
3 31 ' y�
�3
W� LoCG�inh
C�r�hy" n� Lot '�1s awu j
y
DEPTH TO GROUNDWATER
Depth to groundwater:—!�IvZfeet
method of determination or approximation: 7a wh /fiIG O 41 6 V
(revised 8/15/95) 9
LOCATION � �� SEWAGE PERMIT NO.
VILLAGE
I N S T A LLER'S NAME i ADDRESS
R U I L D E R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
N atC -
Fo 2 w�Lt
L d c��✓o a/ �F2o,v r
oA c6r 2is' pe„�pyj
0
3 /
r
LOCUS N
m
0
0
t -o Re9e
o� icy
\ Ire. >p3 p2 r S
10
1 s ''a ti0 3• 1
i 102.96 x163S2 08' Ora s o2 4 py 0`° c j
/ \ b 102.20 � o
Dnve
102.42
\ LOCUS MAP
�s \ NOT TO SCALE
7" \
BE SET I ' .° ° 16 ? ? Su &Q
OUTSIDE COR./BULKHEAD
EL.=104.48 ` + T -
\ / A QQ O L� 103.19 103.09 j
\ 4 / �� '':` :.•:"'Y TP-2 +103.52
�\ r x 102.33
\\ 103.91 x ��`�-' 103.64 �( \ EXISTING LEACH PIT
\\ �• / �\ 103.52 (PER RECORD AS-BUILT)
N
\I \ TO BE PUMPED, FILLED
8H a \`mob W/SAND & ABANDONED
104.48 B � 103.9 n �
0 77 x 104.78 x \\ 102.26
(( \ 1
1 G x
104.60
\ 10 \\ EXISTING SEPTIC TANK
HOUSE(#72)
T.O.F.=105.5 1 TOP OF TANK, EL.=102.90
\ I x 103.81 1 INV.(OUT)=101.50t
v 104.62 104.70 11
x 103.80 1 02.53
04.55
103.98 +10 .
LLI 104.72
O .,104.. 95 104.65
�V 0
o \` PATIO
d / 44.83: \\
(V \
1D \\ 104.6$
/Z 104.98 r \
,
GARAGE n
04,87.
/ Ctii`'bjx 1 .90
O \
/ 104.31 x x 103.28 \ M \\ \✓
1 <
102.97
05,49 -,
'�.. 105.24 - N N -- x 103.05
105.73
105.65 1
t A.
\\ LOT 51\\
46,161 f S'
PARCEL ID: 64"064
WELL 6.13 i\
\_ 1 \
105.81 \\
I \
105se100.00' _
L=50.00' \ OF
N 27'08'30" W I R=285.33' 4' surz1 64 MAs�9�9
I
1os.s6 = PETER T. s
1os.a6 i �\ McENTEE
_ I
l \\ CIVIL
= \ o. 35109
105.74 105.82 105.88 edge of 105.61 povemell 104,06 O�n usjj
REGENCY DRIVE
LEGEND 98--EXISTING CONTOUR PROPOSED SEPTIC SYSTEM UPGRADE PLAN
--
x 100.98 EXISTING SPOT GRADE 72 REGENCY DRIVE, MARSTONS MILLS, MA
F9-7-1 PROPOSED CONTOUR Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632
UWl EXISTING WATER SERVICE
---UGVd-- UNDERGROUND WIRES OWNR OF RECORD Engineering by: SCALE DRAWN JOB. NO.
TEST PIT KIISS, IMBI & VALDO Engineering Works, Inc. 1"=30' P.T.M. 137-16
BENCHMARK 72 REGENCY DRIVE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
MARSTONS MILLS, MA 02648 (508) 477-5313 5/13/16 P.T.M. 1 Of 2
�
NOTE: TO PREVENT BREAKOUT, FINAL GRADE
SHALL NOT BE AT, OR BELOW, EL.=100.40
FOR A DISTANCE OF 15' FROM THE EDGE
SEPTIC TANK PROPOSED D-BOX OF THE PROPOSED S.A.S.
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER PROPOSED S.A.S.
OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE
INSTALL RISER & COVER OVER EACH CHAMBER AND
T.O.F.=105.55t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT
F.G. EL.=104.0t F.G. 'EL.=103.9t F.G. EL.-103.3t F.G. EL.=103.5t
MAINTAIN 2% SLOPE OVER S.A.S.
L = 27' L = 5'
® S=1% (MIN.) p S=1% (MIN.)
4"SCH40 PVC 4"SCH40PVC 2" LAYER OF 1/8" TO 1/2"
s" 3:=T
DOUBLE WASHED STONE
io'I s as $ 90 (OR APPROVED FILTER FABRIC)
°4 aaaaaaB
EXISTING 48" LIQUID aaaaaaa -3/4" TO 1-1/2- DOUBLE
LEVEL ADD PR OPOSED 4' 5.2' 4' WASHED STONE
GAS BAFFLE INV.-100.17 A BOX INV.=100.00
INV.=101.50 EFFECTIVE WIDTH = 12.8'
3 OUTLETS INV.= 99.90 _
EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS
SURROUNDED WITH STONE AS SHOWN
H-10 RATED
TOP CONC. ELEV.=100.7t
BREAKOUT ELEV.=100.40
INV. ELEV.= 99.90 aaaa
NOTES: eases
aaaaaaaaaaa
B6
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & BOTTOM ELEV.= 97.90 aa69aaa6B
INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. 4' 2 x 8.5' = 17.0' 4'
2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0'
ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL
STONE BASE, AS SPECIFIED 310 CMR 15.405(2). 5' (MIN.) ABOVE G.W.
3) INSTALL INLET & OUTLET TEES AS REQUIRED. LEACHING SYSTEM SECTION
BOTTOM OF TEST PIT, EL.=93.2 -
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. EST. HIGH G.W. 50' t BELOW GRADE - BARNSTABLE GW CONTOUR MAP
SEPTIC SYSTEM PROFILE
GENERAL NOTES: SOIL LOG
DATE: APRIL 29, 2016 (REF#15,012)
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL EVALUATOR: PETER McENTEE PE(SE#1542)
BOARD OF HEALTH AND THE DESIGN ENGINEER. WITNESS: DAVID STANTON R.S. HEALTH AGENT
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS ELEy. TP- 1 DEPTH ELEy. TP-2 DEPTH
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: 103.2 0 103.2 A 0"
SANDY LOAM
102.2 12"
1) A variance, S.A.S. to cellar wall, for a )lamsetback. A 10YR 4/2
7
I SANDY LOAM 102. B 6"
3. THE SE GE DISPOSAL SYSTEM SHALL NOT BE BA�FILLED PRIOR 10YR 4/2
18"
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 100.2 - -
DESIGN ENGINEER. B SANDYLOAM
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
SANDYLOAM 10YR 5/4
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 10YR 5/4
ENGINEER BEFORE CONSTRUCTION CONTINUES.
5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 99.9 C 1 40" 99'9 C 40"
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF PERC MED. SAND
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 40"/58" 2.5Y 6/6
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. MED. SAND
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 2.5Y 6/6
8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 93.2 120" 93.2 - 120"
DIRECTED BY THE APPROVING AUTHORITIES. PERC RATE <2 MIN/IN. "C" HORIZON
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY NO GROUNDWATER ENCOUNTERED
THE LOCATION OF ALL UNDERGROUND UTI_ITIES, PRIOR TO BEGINNING CONSTRUCTION. EST. HIGH G.W. 50' f BELOW GRADE - BARNSTABLE GW CONTOUR MAP
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL.
13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND I--12 8'-1
NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. r---
14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC I rn I
SYSTEM COMPONENTS NOT SHOWN ON THE PLAN 1 a 1 `fl 74.4'
vi I �-
l 0-
DESIGN CRITERIA 1i a 0a,�6
tiR
NUMBER OF BEDROOMS: 2 BEDROOMS /EXISTING
SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) �."'_ 1HOUSE(#72)
T.O.F.=105.55t ,
DESIGN PERCOLATION RATE: <2 MIN/IN
DAILY FLOW: 220 GPD PORCH
DESIGN FLOW: 330 GPD
GARBAGE GRINDER: NO-not allowed with design
LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF
.74 EXISTING SEPTIC TANK: 1000 GA GPD/SF GALLON CAPACITY SEPTIC LAYOUT
PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED
USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN
SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 72 REGENCY DRIVE, MARSTONS MILLS, MA
SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: D.A. Brown, Inc, P.O. Box 145, Centerville, MA 02632
BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO.
TOTAL AREA:.............................................................. 471.2 S.F. Engineering Works, Inc. N.T.S. P.T.M. 137-16
` DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
(508) 477-5313 5/13/16 P.T.M. 2 Of 2
a