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HomeMy WebLinkAbout0408 REGENCY DRIVE - Health 408 Regency Drive Marstons Mills A= 064-054 yc� r I i Commonwealth of Massachusetts r= i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. Inspector Information When filling out p forms on the computer, use Douglas A Brown only the tab key Name of Inspector to move your D.A.iBrown Inc cursor-do not Company Name use the return key. P.o Box 145 Company Address r� Centerville Ma 02632 City/Town State Zip Code 5084204534 S14297 �O Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 3-25-2020 �Inss Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �v I? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L� 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CM.R 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System met all passing requirements at this time. This system has seen very little usage since the new s.a.s was installed in Nov of 2017 ,2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 1 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments = � 408 Regency Dr Property Address Owner Kozyra information is Owner's Neme required for Marstons Mills Ma 02648 3-25-2020 every page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts j: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts I�F Title 5 Official Inspection Form 11.� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 408 Regency Dr Property Address Owner KOZyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: system consists of a septic tank, distribution box and 2 500 gallon chambers with 4 ft of stone. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d Minimum 9 ( y 9 (gP ))� Detail House has seen very little water usage. This system is not designed for usage with a garbage disposal Sump pump? ❑ Yes ❑ No Last date of occupancy: seasonal Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Bas s of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was s�stem pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �m l? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ti 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑, Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: s.a.s installed in Nov of 2017 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 i Commonwealth of Massachusetts �d 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: appears to be 1000 gallon Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was functioning properly at time of inspection. I always recommend pumping some time close to property transfer and at least every 2-3 yrs there after for maintenance. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): box level with no signs of failure or solid carry over. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts r: Title 5 Official Inspection Form ° Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Chambers were dry with no signs of failure or surcharge at time of inspection. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts r: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Dr Property.Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids, Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I; 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts �n I Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I� 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: greater than 5feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 3-2020 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Dr Property Address Owner Kozyra information is Owner's Name required for Marstons Mills Ma 02648 3-25-2020 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Assessing As-Built Cards Page 1 of 2 TOWN OF BARNSTABLE LOCATION q O SEWAGE# VILLAGE 6jGt,NS ASSESSOR'S MAP&PARCELCro H-C'S Ll INST R° NAME&P ONE N0 (ow N BC. G. ao_ys SEPTIC TANK CAPACITY CAI ' LEACHING FACILITY:(type) _ I`'' �h4m� (size) �'�, �X z�X 2 NO.OF BEDROOMS OWNER A J PERMIT DATE: j I ((., j'7 COMPLIANCE DATE: Separation Distance Between the: aUG Ck• 't M Y Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility Of any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility Of any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY c 1�f y�,rJ 0 ".3,,i A out- Iq D -31 r https://town.bamstable.ma.us/Departments/Assessing/Property_Values/HMdisplay.asp?ma... 3/25/2020 Assessing As-Built Cards Page 2 of 2 https://town.bamstable.ma.us/Departments/Assessing/P'roperty_Values/HMdisplay.asp?ma... 3/25/2020 TOWN OF BARNSTABLE `i LOCATION r,,�rNCV ��� SEWAGE# L+ 1LLAGE ASSESSOR'S MAP&PARCEL( Ll-(i LI INST _ R' NAME&P ONE NO..Qc)Q�& A E®W.t,) *' SEPTIC TANK CAPACITY C41-4- i"N LEACHING FACILITY:(type),�)CYILJM� (size) �', � )(2 x .Z NO.OF BEDROOMS 3 lJ ,OWNER A J d '-c-.Io l -e PERMIT DATE: j I.-I C„ j `-7 COMPLIANCE DATE: 2-0—I `7 Separation Distance Betweemthe:. `T G 'r 1fh 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�a',! out- (ci t J Town of Barnstable p (SSl t►,f, - — Department of Regulatory Services > LE Public Hea]lth Division Date 1 Z �A t6J9. 200 Main Steeet,Hyannis MA 02601 g Date Scheduled Time ,Q b t ���✓_v Fee 1'd. a_:. Soil Suitability Assessment for k�-► ge Disposal ` Performed By: r�:II4e/ 0 15 s(5_ts,+—z_witnessed BY ) OCATION & GENERAL INFORMATION Location Address Ao, .lp, ,Z Owner's Name, Address Assessor's Map/Parcel: H� Engineer's Name, `� t NEW CONSTRUCTION REPAIR 9L Telephone# 7-7—� r �3 12�s ic,�etn a l Z Land Use Slopes(%) _— Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well �_���ft Drainage Way !�,Y/?'_ ft Property Line f ft Other _ ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) F t � Parent material(geologic) t(;ems I- Depth to Bedrock, Depth to Groundwater: Standing Water in Hole: �"� Weeping from Pit:Rice Estimated Seasonal High Groundwater DETERN TINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing;in obs.hole: _ _ in, Depth to soli. Depth to weeping from side of obs.hole: e in, Groundwater Adjustment,r,� Index Well# Reading Date: Index Well level_. Ad,.faetor,,,_,— Adj.Groundwater Leval PERCOLAT:ION TEST Date Thne Hole# Observation 3 6 /-f-�_ Time at:4" Depth of Perc Time at 6" Start Pre-soak Time @ _ Time(9"-6") End Pre-soak -{de9 Rate Min,/Inch 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 1.00' of wetland, you must first notify the Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC I DEEP OBSERVATION HOLE LOG bole#, Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.% ravel) 3�- h C4 _ �a Sam _ lCj` t.Zr/� - ►Zto C, M SaJ 215'T & - DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv,%GravelL_ V-,►/_ d'` �1V.o1 Ccrgvy 1C YID-l f-L _�- -- "tom e zrJl- DEEP OBLS'ERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistencyL%GMVO) _ DEEP OBSERVATION HOLE LOG T Mle# Depth from Soil Honzo n Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent,°6 aravel�_ Flood Insurance Rate Man:, Above 500 year flood boundary No— Yes Within 500 year boundary No Yes V Within l00 year flood boundary No Z_ Yes. Depth of lolatural)ly Occurring pervious Material Does at least four feet of naturally occurring pfsrvio s material exist in all areas observed throughout the proposed for the soil absorption system? a r Y area o P P P 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 Environmental Protection and that the above analysis was pe:;formed by me consistent with . the required train' ,expertise and experience described in 310 CMR 15.01'►. Signature- — Date�r'��g , Q:\S BPTICVI'ERCFORM.DOC TOWN OF BARNSTABLE `�QCATION ®� C�V J f(V C SSE# n 5 P �• t VILLAGE Mcqr5tons (�(1�`�I ASSESSOR'S MAPn&PARCEL R'S NAME&PHONE NOR'ft�L��l.Ot�1U I� �^ nn SEPTIC TANK CAPACITY t000 QJ LEACHING FACILITY:(type) �it� (size) 1000 NO.OF BED 00 S OWNER I 1 PERMIT DATE: Ctr DATE NAP 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 f f�f f f f.'f f f ! f J f ftf r` f f•f f f f 'f-J J f f f f f 1 f f tf J f.f f f f f f ftftf R \ 4 \ t. t. \ 4 \ 1.••. f r f f f f f f f / f f f\f4f•f4J4f4/\%�f\ \ t ' \ 4 \ 4 \ \ 4 \ \ 4 4 \ \r4 4 \ 4 \ 4 f ! 33 13 25 ?'5 P Ate.• .�r-, - . .,`•,,.. .. No. ;1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes i ZippliLation for Misp *pstrm Construction Permit Application for a Permit to Construct( ) Repair lam) Jpgrade( ) Abandon( ) ❑Complete System ❑Individual Components Locat'on Address or Lot No. iyp$ y Owner's Name Address,and Tel.No. �4,65k05, 4'I Mtn .9✓>i /�l C Assessor's Map/Parcel In ler's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. )05A ��GIGr!!V �NC. N�r'Yi'✓/t! /�Cj �j��JJg—y��'� ` ' Type of Building: Dwelling No.of Bedrooms "�` Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ;3 ) gpd Design flow provided :3 gpd Plan Date %/f yLI 7 Number of sheets !�L Revision Date Title // t Size of Septic Tank 1:5(eit1V i Type of S.A.S. .2— S O CCc/lGn) /'/lcsvl Dr/S etJi� y Sit+N� Description of Soil Nature of Repairs or Alterations(Answer when applicable) �.✓„��/ < n/Y w �J t 2 5 �i G/�,J��1�✓e�l�1y f y' S&W Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si d Date 11116 11.7 Application Approved by r Date'A Application Disapproved by Date for the following reasons Permit No. v Date Issued wt ,,No. Fee y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21ppl tation for Mispolat Opstrut Construction Permit ` Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1-1(�Ae` I� Owner's Name,Address,and Tel.No. M 7 Assessor's Map/Parcel 6 y Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms ✓ Lot Size q.ft. Garbage Grinder( ) Other Type of Building l esid A-i No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided -3 gpd Plan Date t1Ytl 7 Number of sheets a Revision Date T� Title l Size of Septic Tank Type of S.A.S. ,2 SOS <G/�Cr�., (ftGna�P/5 l�llf,� -0ivd� Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 V5fG/l -Oi it✓,,°w d/4^X A1,G " SIX �G`�l �/�G✓'T�19S 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. Signed Date /� /G / Application Approved by s Date Application Disapproved by Date for the following reasons 1 Permit No. ! / "°� r Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )b .4 / il.+e� ) zrvC �� �t at ND�I /��°�rr�.l/ .)9/1 y'{ �Ge��i✓5 It If/ S has been constructed in accordance { f with the proviisions of Title 5 and the for Disposal System Construction Permit No /) " �_ dated { 1 ! 1J Installer yt.of j<kG S X 91,0U4-1 1;X Designer #bedrooms Approved design flow gpd The issuance of this permit shall not belconstrued as a guarantee that the sys e,m will function as designed. Date I Inspector-- t � •. --------------------------------------------------------------------------------------------------------------------------------------- No. nj", """ cJM+ ' Fee %fJ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS MispoSal 6pstent 'onstrUttion i9ermit Permission is hereby granted to Construct( ).�} Repair( y Upgrade( ) Abandon( ) System located at df3 /ZPIUeC 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. _ J Provided:Construction must be completed within three years of the date of this permit. Date IJ Approved by ! ' lswI i.::I u Town of Barnstable VWW °'�,� Regulatory Services Richard V.Scali,Interim Director BARNSTABLE MASS. m Public Health Division �FDA+At° Thomas McKean,Director 200.Main Street,Hyannis,MA02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form 1, Date: 1( Sewage Permit#.1CX7•-y/2 Assessor's Map\Parcel C� -``{)Sy Designer: (;ny'.n��,nr, Wor-ks., Inc. Installer: R A , �Jla"•S(\. t",L Address: IZ WA Cray,_ n/,e(d -4 Address: �'a 0>< (y ores ulQ �� 62G4y HA Q2(t3�Z On G2w ti 1 was issued a permit to install a (date) n , (installer) p� septic system at �b� `�9�✓lU� �� t"1,���� based on a design drawn by (address) ,t Eingineen'nq Wo-W /KC, dated (designer) ' 1L I certify that.the septic system referenced above was installed substantially according to the design; which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. 1 certify that'the septic system referenced above was installed with major changes (I.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in'accordanee 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 constructe nce with the terms of the l\A approval letters(if applicable) �BIIF WENTEE CIVIL C' staller s Signature) NO•35109 �GlSTER (Designer's Signature) (Affix Designer tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. TIJ ANK YOU. Qd\ ptic\Designer Certification Fonn Rev 3-14-13.doe ZJ@jv�@V&d uo>go NP0Dg9 *2I Registration Confirmation Page 2 of 2 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 408 Regency Drive Property Address Tom Collis - Owner Owner's Name information is Marstons Mills MA 02648 March 8, 2012 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General:Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 ren� Cityrrown State Zip Code 508-428-1779 _ S112855. Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that,he information reported below is true, accurate and complete as of the time of the inspection. Tbh inspejtion was performed based on my training and experience in the proper function and:mlantenance,gf on sire y' sewage disposal systems. I am a DEP approved system inspector pursuant to Section M340 01 Title 5(310 CMR 15.000). The system: � 1 ® Passes ❑ Conditionally Passes ❑ Fa:sils c L1 r ❑ `Needs Further Evaluation by the Local Approving Authority March 8, 2012 Job# 12-37 Inspector Sig ture Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 1 of 17 V v Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described M 310 CMR 1523.03 or in 310-CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank was not in need of pumping at time of inspection, leaching pit had 20-24" of effective leaching. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the ezistiny tank is replaced with a complying'septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 1 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 l5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than'100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is Marstons Mills MA 02648 March 8, 2012 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): N/A Irrigation System & Pool. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: August 2008 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date: 10/14/94 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 6" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 3 l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 2 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 12 How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom o foutlet invert, tees were intact. Recommend pumping tank in next 12-18 months. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): `Observed a trace of solids carryover, no high stains or evidence of surcharge. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One 6x6 pit ❑ leaching 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.): Liquid level was found 20-24" below inlet pipe with no high stains. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I l5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .. 408 Regency Drive Property Address ----- Tom Collis Owner - ------------ ---- ---------------- Owner's Name — information is required for Marstons Mills ___ __ _ MA_ 02648 March 8, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately / r / J'•t/v ! / r J, \ \ \ \ \r\ \ \ \ \ ♦ \ \'\ \ \ \ \ 33 13 25 4.: 25 5 Regency Drive • r � Commonwealth of Massachusetts r Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. City[fown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database -explain: USGS topo map. You must describe how you established the high ground water elevation: Pond adjacent to subdivision is 18-20 feet lower than property. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Regency Drive Property Address Tom Collis Owner Owner's Name information is required for Marstons Mills MA 02648 March 8, 2012 every page. City/town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Y-�f le l�� BARNSTABLE ff LQCATION L.D� SEWAGE # qq- VILLAGE Moti-; 14 g VAS \�S ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 3, Oc,Scold 7(- IoLi 0 SEPTIC TANK CAPACITY 1 , 000 Q llati S LEACHING FACILITY:(type)4q_C,� Q (size) (,0001 S K'�0 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �� s i�{ �y`��'4`5 Cp. DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No °S 6 4. �.�-/'11J11 0 i sz I � ' $� l lr �F..`� �� n 1• � �Q� I ,t Fps............ ®.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Uiripnoul Mi orkii To>It itrnr#inn ramit Application is hereby made for a Permit to/Construct (V ) or Repair ( ) an Individual Sewage Disposal Systemat: ............................................ _ -�Z (.O ......... .....--•... a...... J ess do dd.... i yoj�"oV �� •----•• --•---- ........ �encr _................ ............. .. ... ................................................... .....N� '.6 `�!�G� .Addr ss ....................................................... Installer Address UType of Building Size Lot............................Sq. feet -., Dwelling—No. of Bedrooms,�_..,�._.>.3-- ------ ------------_.__Expansion Attic {�(� Garbage Grinder ( ) p`4 Other—Type g ___lL7Gf �✓601a_.No. of persons............................ Showers ( ) — Cafeteria ( )Other—T e of Buildiu ____ a' Other fixtures ------------------------------ - - ----- - - - - - - -- Design Flow............... P l P y• y ... v-----........-----.-----.gallon.. W �L�____________________gallons per per day. Total daily flow..............._...._.....................__gallons. WSeptic Tank—Liquid capacity/AIVV.gallons Length_._-__--_.•____- Width________________ Diameter................ Depth................ x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter__--.-__-..----__- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing nk ( ) `G�/ ~' Percolation Test Results Performed by----- .�'. ------------------------- Date.... ../�`......(-......._.. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ - - - - 0 Description of Soil..... --------------------------•------------.....-----------------...---------------------------------------..........------ W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ....--••---•••••••-••---•---•-------------•------------•-•-••---•-•••-------••--•--------------------••---•--------•------------••--••--••---------•---••----•-••----••-•---------•---....----......---- Agreement: The undersigned agrees to install the aforedescribed Ihdividual 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 Coml Ia ce has beeyisued�b�boardSigned .7�'� ....... ......---------- ..... .--'- --Dare..........:...... Application Approved By .......... .. ..--..1 e:.... y.. Application Disapproved for the following reasons: ......... ......... ......................... . ................ ........... ........................................ ......................................... ..... ...................................... ........................................ ....................................... Date PermitNo. ..-.... �. ...................... Issued ...... ........................ Dare •.'�r.�.....r..rc��/�.ti../as••v...._..-`..•..w..��..•.. _Sy,,.,,.-(`s,�,..e-.�..:.,.y..`.a... ... �. ,)J` ti. , � .r L,,. ,.; --- .. _,�,�.. __ .. •-� _ - v -" - -+ Gj V_ 5�o No........ Fxa.... .....��1Q� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripaml Morlm Tonitrnr#inn rnmit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: Yt 9 � ,P/ t ..............�..--........--------------••••• ��A,ilAi 1��.,�� Lo^cation Rddress jporjl Bot No. ner � �� � .....Address Installer Address UType of Building Size Lot............................Sq. feet .., Dwelling—No. of Bedrooms.__-___-_3_______________________________Expansion Attic .(fit/) Garbage Grinder ( ) aOther Other—Type of Buildiug�Z,_/.�T7 R No. of persons............................ Showers ( ) — Cafeteriafixturs e ------------------------------ r 9--------------- - W Design Flow............... ....................gallons per person per day. Total daily flow------;�3.O._.......................gallons. 1:14 Septic Tank—Liquid capacity;AIV_rZ gallons Length________________ Width---------------- Diameter--.............. Depth................ Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing,tank (�) W Percolation Test Results Performed by.... � e v.`. '_ .u! .......................... Date..../X- !__! Y Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------- �} -------•-----------------•----•-------------.......•....•.....------•--•-••---..............-•-----•---••-•----------•-••-. WDescription of Soil-••-- a- •-••7'-�`---14''...................................................................................................................... V .----------------•----••••........••-•--•••••----••...----•-•--•••-•••••••---•--•-•-•-•-........----••-•••-••-•--•--•---••-•--•--•-••----•••••---•••-.....•--•••-•-..............••..•--•......----•-.... W UNature of Repairs or Alterations—Answer when applicable........................................__..._..__._............................................ ......•.............••-•--•••••-•....•--•••-••-------•---•••---•--••-••-•----•••---•••••••-•••••--••-•-•••-•-.....----------•-••---••-•• .............................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com.`is e ce has been is Ued b the board f'� �h9 Signed -------- ----- ------ ------------ ----- ...... `/%.. .. / C� ................................'-----' --_ ! !�e................. Application Approved By ....... � •s.t�t. ...-.. te:.... Y Application Disapproved for the following reasons: ......._............_............... .- . . . .......................... . ......--- ........._...---.................. ...................................................... ............................. . .. . ... . . . . ... --....................................... . ........... ........................................ qq PermitNo. -------- 1.--y_------,,r` -,�.-..1 1 0...................... Issued ......................................................... _ Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BAR����NSTABLE _ VT1 PXttft.CMte d VTT ampltanve '` THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( V ) or Repaired ( ) by .-,JX]....).X---I.5.-C6 L.._.................................................i -...er...--------------�---.---------............---- ......._............................................ till at ......L-. ?.VT........: .�5........ .. ..��..F.�C/C ........... � ....... �'.._........f�.........LL�. .... .. .................. . -: has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------ _4-f_.-....:_,..O... dated ..........._...........- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 'i ----...... Inspec r/. '` . 1--/ ...... _....... DATE.......--�L-� _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH qq No. TOWN OF BARNSTABLE _..L..�'�.�._:. FEE. .o Q ....................... �t��rnottl nr�� �n�n��r�r#inn �rrnti� Permission is hereby granted.......J.0 ....... .------------------•------------------------------------......................... to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at No... (�'7 .....r�� •&-F N C'y.........t�IL.:.. ----- « .5--------------------- ............. Street as shown on the application for Disposal Works Construction :V'eIrlit No.�_ R:_5.1n_.__ Dated< - DATE. ' r ✓ ....................... Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS 1J�S l C�IJ e �7A-TAB - I� FAMIL-( 3 BEL.- �n-cW 2 �,; �o l>AizF�A�E G1zfiJ�E� 'PAIL( FLOW '3 XJ1n. '390 4PD SEEM C TA�I V- S33D elpb X FX/u=49 s 6f'D UxF- (OOO — PL.AIJ C)N 'BAeV. 9t-2.—=0F D16Fc6AL. PIT i--Ivgo KAI, /2 S'1041 . 51 D C-WdLL A2C-A , 100 S F LO-r sp) BoTToM A2eA _ ` O sT= UJ G� `D21 v 'N, ,�,r A i.o "70Grr' , M Ae-,,-rv)s MIL,/-,� TOT-AL t)&51Z W = 54-6 6f!p, TOTAL. VA LY rLOY/ =3`�o Z-P /.r PE26 a(-A-n oN OATS. =j"I�1 ZK�W��s5 or �M OF PETER SULUVAPI RX34ARD s' BAXTER N A. No. 29133 No.24048 '� o STfi�� /STFR� s N s�OAfAt 9 ?ZmoVV AWY OWSUIrABLE /A XT�c-I A L io' AU- A►2o0Afl Ss'?nc sys�Nt A u p, 2ePt.A&--- wrt-a CC.FA j�,iZA u u LA z M 4:rL=-rZ1 AL - 1 oLI= '`IG'9� Z 101 TF Ioz' R V.c. SuaGoiu „ 5�, loon IuJ Y `" biST Ih!✓ GAL I� 9q a ic0v — IN IN gtK S�rlc � $ GAL q� qua rain LEAa4 W,w,,�,�� 5'C¢tzruQEs sir STONE MOW TgAiJ 44 -DEE? Q4AL BE A-Zo G —�2 MAP � - y�l o CAI FIED R.Or FlA N Lo�Iot1 : hf A2SfDas M I LLS ------------ 4c L4/AT VL— PLAN PrERF�JC.E 1 CFYCIFY T+IAT T* 'Fovu�M-iot4 38 S�IDwtJ HE2EDN -M'P� S wI�'� TKE S�UE�+JE LoT L �r�, Cl'- TI(Er TDWN OF- AO AO 15 �br !-04ATV V,/l %X'r6Z hl E I NC. 'P2VFE tCg4AL. LA1Ja 'Su�il yraz5 7015 FLAQ IS NcT T3Q/,© oN AN r-kQ I L- EiJ�I N EE�.S Su2vL/ AIJD TNiE OWE e1 4aoul) Ljor Z3E oSTEtzvtuL MAC . uSC-1� To ESTQ��-.ISM P�E�Ty U Nc-5 QPPL1cANT; �,a slbE`$Vlc:�IIJC ��1c. . < , ; 1 50eET Z ar' 2 s 5 2 G o 1J -BA r SXDG '13v1 c.ti i uc INC- TowN Vi/AT-w— -rlom �_ -------=— SCALE GU-) MILL QO btu — G� �. I co!o A%Lwten, Lr / o Z I�ap qq.i � F � Tiw1 \00 .4 3o Opp 100.1 /// - 33 f n 'DW ELLUJG N i / Sef�tlG LZI-1TIOW ✓ �0 FZO,A PL• P,. Not a � oW ioz.o toa- Io1J PETER SULLIVAN No. 29733 FL. FL. N \o 0.09 A \ y� SAx7ER _ AS Dc maul F. R• — 98——EXISTING CONTOUR m N x 100.98 EXISTING SPOT GRADE m W EXISTING WATER SERVICE o °G EXISTING GAS SERVICE ,pe LOCUS — J- GVV— UNDERGROUND WIRES <) TEST PIT �a1ry BENCHMARK Q� Qa ` 2o`r Qo c I U LEGEND G I o' a m 10 M Dnve a LOCUS MAP NOT TO SCALE 43,632 ±S.F. PARCEL ID: 064-054 LOT 38 ——POOL AREA �W 1 O' 10i.i \ O Z PORCH I i CX GARAGE EXISTING i I C4 w HOUSE&408) I I N w T.O.F.=101.8f 1omi BENCHMARK COR./80TT. STEP C0 100.9 EL.=104.48 100,01 --- 00------- 100,37 \ BM 99.94 EXISTING SEPTIC TANK ' 100.48 101.E p TOP OF TANK, EL.=99.80 0.35 —" ',, ..,•.: .. INV.(OUT)=97.45t(VERIFY) ,6� / 0021100.06 ;.;:r,:• ;1: :: 100.99.1 \ — Cr C) p 100.04 �:~ • p LP . 2 ~' 10 :1 99.35 12$ � C N99.32 TP 1 �L 3 00, 99.2 Rr132 8 WSB L=147.04 99,70,. 99.54 R=151 •a5 ' 99.57 =* 100.23 \�1 + 99.66 100.02 EXISTING S.A.S.S.A.S.PK SET 99.76 SE TO BE PUMPED, FILLED W/SAND & ABANDONED r F MgREGENCY DRIVE ER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN � CIVIL CIVIL "' No. 35109 408 REGENCY DRIVE, MARSTONS MILLS, MA fGIS1 R� Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 IlI4 I OWNR OF RECORD Engineering by: SCALE DRAWN JOB. No. AVITABILE, BRIAN A & JESSICA Engineering Works, Inc. 1"=20' P.T.M. 282-17 1 l 408 REGENCY DRIVE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. MARSTONS MILLS, MA 02648 (508) 477-5313 11/14/17 P.T.M. 1 Of 2 NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=96.50 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 ONE CHAMBER AND T.O.F.=101.8t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=100.5t F.G. EL.=100.4f F.G. EL.=100.0t F.G. EL.=99.7t MAINTAIN 2% SLOPE OVER S.A.S. ` L = 13' L = 5' ® S=1% (MIN.) ® S=1% (MIN.) 6-'- 4"SCH40 PVC 4"SCH40 PVC 2- LAYER OF DOUBLE WASHED+STONE TO 2p. iol 6 aaaSaaa (OR APPROVED FILTER FABRIC) 4" 6aaaaaa EXISTING 48' LIQUID aaaaaaa -3/4- TO 1-1/2" DOUBLE LEVEL WASHED STONE ADD 1 INV.=96.67 PROPOSED 4' 4.8' 4' GAS BAFFLE INV.=96.50 1• INV.=97.45t � EFFECTIVE WIDTH = 12.8' � FIELD VERIFY)) 3 OUTLETS INV.=96.00 EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP CONC. ELEV.=96.8t BREAKOUT ELEV.=96.50 INV. ELEV.=96.00 aeaaa NOTES: aaaaaaaaaaa aaaaaaaaaaa 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & BOTTOM ELEV.=94.00 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. LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=88.9 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. SEPTIC SYSTEM PROFILE SOIL LOG DATE: NOVEMBER 1, 2017 (REF 15,516) SOIL EVALUATOR: PETER McENTEE PE SE#1542) GENERAL NOTES: WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 99.4 A 0" 99.5 A 0" 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SANDY LOAM SANDY LOAM OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 98 10YR 4/2 10YR 4/2 LOCAL RULES AND REGULATIONS. '9 B 6" 99•0 B 6" 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR SANDY LOAM SANDY LOAM TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 10YR 5/3 96 5 10YR_ 5/3 36" DESIGN ENGINEER. 96.2 38 C1 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING C1 PERC FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN SAND 36"/54" COARSE SAND COARSE ENGINEER BEFORE CONSTRUCTION CONTINUES. 10YR 5SA 10YR 5/6 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 95.4 48" 95.5 48" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF C2 C2 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. MED. SAND MED. SAND 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 2.5Y 6/4 2.5Y 6/4 8..THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 88.9 126" 89.0 126" AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE PERC RATE <2 MIN/IN. "C" HORIZONS DIRECTED BY THE APPROVING AUTHORITIES. NO GROUNDWATER ENCOUNTERED 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. , 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS TING GARAGE 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). HOUSE#408) 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 NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC 3r, 9, SYSTEM COMPONENTS NOT SHOWN ON THE PLAN N DESIGN CRITERIA P �� �j NUMBER-OF BEDROOMS: 3 BEDROOMS N SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) i vai o DESIGN PERCOLATION RATE: <2 MIN/IN 0 i N DAILY FLOW: - 330 GPD a DESIGN FLOW: 330 GPD GARBAGE GRINDER: NO-not allowed with design �12$- LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF .74 GPD/SF SEPTIC LAYOUT EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 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 408 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. 282-17 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 11/14/17 P.T.M. 2 Of 2