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HomeMy WebLinkAbout0438 REGENCY DRIVE - Health 438 Regency Drive Marstons Mills _ A= 064-052 t. i e -w.A� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair Owner Owner's Name information is required for every Marstons Mills MA 02648 4-13-15 page. CitylTown 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:When A. General Information fillip out forms / , `p�uutiitwrr'r on the computer, u .......`���`yet'►OF Agq•��o�� use only the tab �� 1.Cl key to move your 1• Inspector: cursor-do not ,lames D. Sears ?• JAMES y use the return : Name of Inspector key. CapewideEnterprises,LLC IG�I Company Name s,V. F 5„r ..C' �• 153 Commercial Street ����iuniIII,Ar i,tnu,�tw�" Company Address Mashpee _ MA 02649 City/Town state Zip Code 508477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-13-15 nspectoes 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 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. terns•3n3 Ti1Ie 5 official Inspection Form:Subsurface Sewage 015posel System•Page 1 ur 17 l.'d d6Z:90 9 L 0 L ad` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor- Neal Blair Owner Owner's Name information is required for every Marston Mills MA 02648 4-13-15 page, Citylrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gallon Tank and pit. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be i 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. v i 0.Y ❑ N ❑ ND(Explain below): t5ins,3113 Title 5 Official Inspectlon Form Subsurram Sewage Disposal System-Pepe 2 of 17 Z'd d0£:90 91• £i,adV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Ragency Drive Prope Address Eleanor- Neal Blair Owner Owner's Name information is required for every Marst ns Mills MA 02W 4-13-1 S page, Cityfro n State Zip Code Date of Inspection B. CL% tification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B)j 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): 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 wetfand or a salt marsh t5ins•3113 Tide 5 OQcdel Itspeaon Form:Subsurface Sewage Disposal System•Page 3 of 17 £•d d0C:90 9 l• £l AV CommonweaM of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair Owner Owners Name informrequire for Marstons Mills MA 02648 4-13-15 required for every page. City/rown State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health (and Public Water Supplier,H 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. E] 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 ❑ 0 Liquid depth in ammillimiM is less than 6"below invert or available volume is less than %day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 t,'d doe:90 9 l, £l add Commonwealth of Massachusetts FILME Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair Owner Owner's Name InforM21JOn Is required for every Marstons Mills MA 02648. 4-13-15 required page. Citylrown 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 faits.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-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 9'd dLC:909L E dV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair O'er Owners Name information is Marstons Mills MA 02648 4-13-15 required for 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 1110A ❑ ❑ 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? ❑ f2 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) 1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Wrhs.3/13 Title 5 Offidal Inspecdon Form:Subsurface Sewage Disposal System•Page 6 of 1 r 9-d d6£:9096 £L add Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair Owner Owner's Name information is required for every Marstons Mills MA 02648 4-13-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gallon Tank and Pit. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No 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 2013--42,000Gais g ( y g (gp ))' 2014-36,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design How(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: 145ns-3113 Title 5 Ofiidal 4wpedicn form:subsurface Sewage Disposal System-Page 7 of 17 L•d dl£:9091 £l adV i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair Owner Owners Name information is required for every Marston Mills MA 02648 4-13-15 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: 04108/11 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) © InnovativefAltemative 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 11A system by system operator under contract ❑ Tight tank, Attach a copy of the DEP approval. ❑ Other(describe): Wang.3113 TAfe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 g'd dZ£:90 9 6 £L adV I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair Owner Owner's Name information is Marsbns Milts MA 02648 4-13-15 required for every page. City/Town State Zip Code Date a(Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: NA Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3' 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.): Pipeing is 4"PVC SCH 40. Septic Tank (locate on site plan): 2' 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. 1000 Gal. Precast H-10 3" Sludge depth: t51ns•3r13 Title S Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 6-d dZ£:90 9 l, £l add I Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor- Neal Blair Owner Owner's Name information required for every Marstons Mills MA 02648 4-13-15 page. City/Fown 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 1 Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Tape-Slide Judge 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 at working level. Tank and outlet cover at 2'wlinlet cover at 10". Inlet tee, outlet baffle. No sign of leakage or over loading. 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.3/13 Title 5 official Inspection Forms Subseaoe Sewage Disposal System-Page 10 of 17 06'd dZC:909l, C6 AdV Commonwealth of Massachusetts WTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair _ Owner Owner's Name information is required for every Marstons Mills MA 02648 4-93-15 page. CityrTown 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 I� t5ins-3/13 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 l,l.'d d££:90 9 l, 0 l,adV i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair Owner Owner's Name information is required for every Marstions Mills MA 02648 4-13-15 page, CRylrown 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 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.): 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. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: l5ins•3113 Tide 5 Offidal Inspedion Forn Subsurface Sewage Disposal System•Page 12 of 17 ZL'd d££:909l, £L jdV i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair Owner Owners Name information is required for every Marstons Mills MA 02648 4-13-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: ❑ 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.): Leaching is a 100 Gal.Precast Pit. Pit at over 5'below grade. Did not dig up pit. Inspection of pit done w/camera T water in pit. Wall's look ok. No sign of over loading or solid carry over. 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 15ins•3113 Title 5 Of iaf Inspection Form:Subsurface Sewage Oispusal System•Page 13 of 17 £l'd d££:909l, 0l•AV i Commonwealth of Massachusetts Title 5 Official Inspection Form IM 1i: Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Regency Drive _ Property Address Eleanor-Neal Blair Owner owner's Name information is Marstons Mills MA 02648 4-13-15 required for every page. Cityrrown 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.): Kns•3113 Tile 5 Otficiei Inspection Fortrc Subsurface Sewage Disposal System•Page 14 or 17 d dtC:909l• `;t adV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair Owner Owner's Name information required for every Marstons Mills MA 02648 4-13-15 page. Citylrown 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 a,.tached separately rr U :a - 5;" ° "3 3 o -3 = 78 5 �' t5in5-W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 9 L'd dt C:90 9 l, E l,adV I II Commonwealth of Massachusetts Title 5 Official Inspection Form ? Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair Owner Owner's Name information is required for every Marstons Mills MA 02648 4-13-15 page. Cilyrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /VO Estimated depth to igh 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: You must describe how you established the high ground water elevation: Abutting property and site no G.W_. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15Ins•3/13 Me 5 Official tnspedon Form:Subsurface Sewage Disposal system-Page 16 of 17 9l,'d dt£:90 9 I• £I,ady I F Commonwealth of Massachusetts Title t e 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 438 Regency Drive Property Address Eleanor-Neal Blair Owner Owner's Name informatiois n required for every Marstons Mills MA 02648 4-13-15 page. Cityrrown 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•3l13 Title 5 Ofridal Inspection Fom c Subsurface Sewage Disposal System•Page 17 of 17 L L'd d90:90 91, E 6 AV 4-1 /� TOWN OF BARNSTABLE � +LCATION (Zt'(�ac7 � .:-c SEWAGE # VILLAGE (91/� ��- � ,,�;L�S ASSESSOR'S MAP & LOT0(041.5.-2.-, I I INSTALLER'S NAME & PHONE NO. IZr ajA SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) /o op> NO. OF BEDROOMS PRIVATE WELL OR B�WATER�_ BUILDER OR OWNER 9 ' DATE PERMIT ISSUED: ?/13 7 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes r No :T �3`s- all THE COMMONWEALTH OF MASSACHUSETTS. BOARD OF HEALTH ...................... ..............OF........... .lam:P� ............................,.......... 1 AppDisposaltttUan for �t�� �tt1 Works TomArnxuan ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: _ V .....:., » ......�...» .r . .....»... ......»..............».... .......».............»........ :..».... eat a-Address _ ,,y or LooNNo. .»owner ea +� a .. ......n... .... PO ... /tddrea• .. .. .E.� :.. Installer `J,�.1i(�cC.ul/�E •�a�tST /0`3� . Type of Building �'++Jh 4 Size Lot......-�'�. j� jjl....Sq. fe t v Dwelling—No. of Bedrooms........... .Expansion Attic (�o) Garbage cinder aOther—Type of Building ........'�)..A......... No. of persons............................ Showers ( ) — Cafeteria ( ) Design Flo .. lons per person per,dad. Total da}y flow......... �......................................................... ons. d� 05 lons Len .... Septic Tank Liquid'capac>, Length 1�:.�. Width...��.."�... Diameter....���... Depth...... .'.® x Disposal Trench—No !`� ....... Width. t.....�,_.........Total Length... {. ., Total leaching rea...................sq. ft. 3 Seepage Pit No.........�.-....... Diameter.....(�,::Q.... Depth below inlet....��.: .... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing to ( ) a Percolation Test Results Performed by........ C,? �-..... ...... Date.... :�d ......... ..... .. .. ,.a Test Pit No. 1.... .......minutes per inch Depth of Test Pit..... D th to ground water..... ..).V.Q f<.. f=, Test Pit No. 2�... ,.....nunutes per inch Depth of Test Pit......1:��...... Depth to ground water.... .• t�? !V2.1ia� cYi ......................................................V................I.. .. ...............4...........•...r........... .................. O Description of Soil ...�., ?..��.:? l.�; ..9.�P .`r :a..- .:4�}. I�S i ..5: .'..«:4��. 4 f?I.. °? a V ....................�?.. ...... t?Q"s? .. n� �..1:Q. .: .�.... lJ1PSc.........t. p.... ..�'�.�. .............. 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 Sanitary Code—Th dersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d e board of health. Sigried. .......................................................... . fir .....».... Application Approved ....- .. ........ ... .. ..........................................» ..... . Date Application Disapproved for the following reasons:............ .....................................................................»..» ...................................................................................................»................................................................................................ o..Permit N �1�`.�. �J...l�......»..».. Issued.......^` ::.. a.T'....» Date No.. Fas...... ,. .....�..:..... THE COMMONWEALTH OF MASSACHUSETTS. BOARD OF HEALTH OF........... Applutttum fur DispusallYurks Minstrurtton Frrutit Application is hereby made,for a Permit to Construct ( , or Repair ( ) an Individual Sewage Disposal System at: `' - ..... ...»...».».»...» ...........»» »»»..................��.......»..»..»» ......» ».... eat n•Address ,,y or W'"� .... 1�:r.1N.�..?�:.�:�::^..:::..:.... V:Own .............�..............�.......t.._........»....» ... 1�Glt d N.... ICS� ,I N_o, .Ae ...... �..... .......... ew__ / /U l �......-------------- Installer ,Address Type of Building Size Lot... :...S f t q• V Dwelling—No. of Bedrooms........... ............................Expansion Attic (�� Garbage Grinder aOther—Type of Building ........ ?. A.......... No. of persons............................ Showers ( ) — Cafeteria ( ) 4 ther fixtures ......... .A.............................,............................................... ......... . .. .. Design FloAl"Fi"ta.0 .` Xx?.... gall lons per person per,�f. Total da}ly flow.......... . ..................... jons.Septic Tanquid'capaCi ..1 `,�C. lops Length. :.5P. Width...r.?".... Diameter....A7.A... Depth... 1.. Disposal Trench—No.....!J ....... Width. .... .Total Len Total leaching real...............»..s ft. x t.....�.1... .. gth..........1.....,�, g q. 3 Seepage Pit No.........�. -....... Diameter......(, 5?.... Depth below inlet....5..�.... Total leaching area..................sq. ft. Z Other Distribution box ( ) , Dosing ( ) a Percolation Test Result Performed by... �:L?arx_%-... ...... Date.... ?:.Z 5 ......... .... . ... .. . . a Test Pit No. 1.... .......minutes per inch Depth of Test Pit....... D th to ground water..... ..Iti2.9m.~. tz. Test Pit No. 2 ... ......minutes per inch Depth of Test Pit......I ....... Depth to ground water.. .r0 O Description of SPA Q...S?..'.lr.Q .5.5?t.X7, .. YS..�...1�o..rya.t4i.... �Sot� +:D..p.� .Q.......... ....ri:..:. t� w j .�. r... UNature of Repairs or Alterations—Answer when•applicable................... .............................................................. .............................................................................................................................................................I................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—=The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. .. . ..... ............................................................. ...... ..............».... 1 ..!...Dam Application Approved .,. ..r.::?n::?.�.:..... s... `:.:. �: :: �^` ................. ... .. .:: :•�:. •• Date Application Disapproved for the following reasons:................................i .....................................................................»»»» .................................................................................................»....».............................................................................................._ Permit No...01*71.r.`.. ��...'..��.... :.........., Issued.......,,��'". .-�.... Data .Z_ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............,/ fill?'! .......OF.....,.A�t,2l :.:..:................... Ttrfifir& of Bunt Il nr�e THIS IS,TO E TIFY That the Individual S wa a Disposal ys em consucfed: s g ) or Repaired ( ) by...» at..,..'. ... (......... ..<�..�...: :> .... '> ...... ..� - ::',�!.� 1... f�.....::t� : :.. ..,:�::s::.' 1•:lfS ,...� has been installed in accordance with the provisions of T5�f The tate Sanitary". ode as described in the application for Disposal Works Construction permit No..?154 ^THE ISSUANCE OF THIS CERTIFICATE SHALE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ",• :� DATE......�.�r...?....��... ...... 'Inspector;' :. ..�..........` G :/.......»..... ... THE COMMONWEALTH.OF MASSACHUSETTS �� .. BOARD OF HEALTH� No..�..�..`.....`...... ........ :.......OF...... ..................................�-� I ....... ................. �F1...................... FEE.. DtspuuaI Marks flu Mfr sari per i Permission is hereby granted.......:: .�..,.....,::::J C ��� % to Construct ( o Repair ( ,) an Individual Sewage:Disposal•System •,.•.•.• •.....-. .................... ..... .»»��• at No..........�o. .: `....» o u�z..1........:.. ....»�� .�.` `` .. G,��:,- ,�4 i,c' �; 'X Al ' as shown on the application for Disposal Works Construction� 't N�o,,f ....✓....7 ated..,. ../�......................::..... G � »......:......�.�.. .. ...Board of Heal .ti���� ....»..... DATE.......................... FORM 1255 A. M. SULKIN, INC., BOSTON — r 1 } C � E � c�v E 0 � ors E N N .N 0Z Ln � v t4 Q � ' v � 15'-5 1/2" BEVERAGE REMOVE CASING REFRIDGE ON EXI5TING OPENING z OPENING TO INCREASE IN HEIGHT TO ALIGN YVITH In 36"HEIGHT GOUNTERTOP tU ,62T I I sza, —1 Q I I I 503 PT Z W . - 4068 -..�.... NEW GOAT 1_- 6 ' v °' v CL05ET �[ (n (n N SITE-BUILT TABLE `fl AND LEG SILL @ OPNING BASE GAB FOR ' TO MATCH TABLE PEN DOG FOOD/ r. 5066 NDED W21339 PULL-OUT v � UPPER , - _ RAWER=TRASH Q a WALL OVEN 2D62115 DRAWER CONFIG. N � KITCHEN ROUNDED OVERHANG zass EXISTING FLOOR TILES TO @COUNTERTOP/ YNIDEN EX. Q -- ss — REMAIN/PATCH A5 OPEN UNDER G OPENIN ) NECE55ARY TO BE COMPOSITE BEADBD @ ARCHED D ARED in BACKSPLASH NO CA5ING ? i r L o m SPICE TRASH1 m N N o.' (BASE) EXISTING BATHRM Q. A u�i AND CL05ET t M m REFRIDGE N +' L----� DW MICROWAVE Q N 9' NOTE: B 44R SB36 ° 7 ASYMMETRICAL ' I •-I I LAZY SUSAN N DCW2433R 11833R I ,W7533 W2733 F 3068 rZ 3839DC TALL FILLER Date: Sl"TOP OF 9-10-15 EXISTING Y40D N Revisions: 9-25-15 Final: BUILDER TO CONFIRM ALL CONDITIONS KITCHEN LAYOUT scale: 1/4=1-0 AND DIMEN51ON5 ON 51TE Note: These plans are for the sole purpose and use of Gapizzi Home Improvement and are not to be distributed or used for construction other than by Gapizzi Home Improvement. i C B. -JAW BENCHMARK. TOP OF SPIKE \ IN 18"PINE ELEV.=50.0' (ASSIGNED) 10' STRIPOUT-REPLACE WITH CLEAN COARSE SAND. LEACHING P Ar - RESERVE LOT 37 H OF r � L� PAUL `q D-BOX �. �Y.. � xn d \ m 3 a J 0 H N �r LANCERS-CAULEY CIVILoo r, No.35101 UTILITIES. `''�. `9 \\2�. $�U - O o \FbVAl ELEC., CABLE & `'.s ;0, �5E= 2e 4I� sue\ 9 TEL PROJECT LOCH TION LOB' 36 REGENCY DRIVE MARSTONS MILLS, MA. LOT 35 / LOT 45 APPLICANT FIENBERG FAMILY TRUST LOT_ 36 O� 5 MECHANICS CT., BOSTON, MA AREA=55,972fs f. .� ��\ C.B./DISC / �' YANKEE SURVEY CONSULTANTS 07��„ 51 �� P.O. BOX 265 UNIT 5, 40B INDUSTRY ROfaD LOT 46 MARSTONS MILLS, MA. 02648 (C.B./DISC PH.(508)428-0055 — FAX(508)420-5553 r NOTES: LOT 52 I I SCALE.• 1"=50' DA TE.• 9/7/94 PLAN REF.: 16427D SH.1,2 IREV I [I?E v• RES. ZONE: "RF" FLOOD. ZONE' "C" JOB NO. 50559 Fs HEET 1 OF 2 _5_0.0_PROPlJ. L"D TOP OF FOUNDATION . 20' MIN. , � 10" min I CONCRETE COVERS 2"LAYER OF • 49.5 PROPOSED 1/a"1/2" 49 O� CONCRETE COVERS WAS ED STONE �T7 / / / 49.Of" / / / � 10' STRIPOUT 4" CAST IRONOR 1 f P. V.SCHEDULE 40 C. PIP 4" SCHEDULE 40 P. VC. I 12., DIST. BOX D=20.1' FLOW LINE S=O.02, =27' PRECAST S=0.02, 1 to" INVERT EL. 47 61_ MIN. 19" c LEACHING INVERT46.96 2' OR I q ° EQUIVALENT' INVERT EL.-- I 0 EL.= 47.21 LEVEL L - - - - o oC- - - - Jl IN VER INVERT INVER ° `5 V 314 710 1-1/2" 1250 GALLONS - 46.54 - 46 0 0° : w c w.�SHED STYINE SEPTIC TANK EL.=-46. 71 EL.-_---- EL.__-_-- o _ W o o c` EL.= 41.0 LEACH PIT I ----- 3 6' 3 PROFILE OF 12'DIAM.-- � SEWAGE DISPOSAL SYSTEM NOT TO SCALE BOTTOM OF TEST HOLE OR VSGS PROBABLE WATER TABLE EL--_37.0- ALL ELEVATIONS ARE ASSIGNED BOTTOM OF TEST HOLE # 2 IS 12 FEET BELOW SURFACE. SOIL LOGS ` J LANDERS-CA ULEY, PE WITNESSED BY: .:,., I T)IIN11rIArr e JOHN j �rdCERC-cAt;LEv ! � P# 8270 C L GENERAL NOTES PERCOLATION RATE MIN./ INCH No.35101 1. THIS PLAN IS FOR CONSTRUCTION OF A NEW SEWERAGE DISPOSAL SYSTEM. 2. PLAN RE FERENCE.• LC16427D, SHEET 1&2, LOT 36, BARN. REG. DEEDS. :- DATE 08-23-94 DATE 08-23-94 Uv 3. THIS PLAN IS FOR INSTALLATION/ REPAIR OF SEPTIC SYSTEM TEST HOLE I TEST HOLE 2 AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES. EL- DESIGN DA 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO R E.P. 49.0 t EL= 49.0� TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 0 ' 0 0' NUMBER OF BEDROOMS THREE (3) 5. ALL COVER TO SANITARY UNITS SHALL�BE BROUGHT TO WITHIN 1.0' P 1.0' TO & SUB TOP & SUB NONE 12" OF FINISHED GRADE. SOIL SOIL GARBAGE DISPOSAL 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENT ALLY THE SAME, UNLESS NOTED BY FINAL CONTOURS. TOTAL ESTIMATED FLOW 330 GPD . I 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 6.0' 0' ( 110 --GAL./BR./DAY x 3__ ER.) OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING MED. SA1VJ MED. SAND SEPTIC TANK CAPACITY _I 250�1 SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING. 10.0' _- UNLESS NOTED. LEACHING AREA REQUIREMENTS 8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED IN PLACE. SIDEWALL AREA 188.4 GAL/S.F. 188.4*2.5=4 71 9. NO DETERMINATION HAS BEEN MADE AS 'TO COMPLIANCE WITH BOTTOM AREA 154 - GAL./S/F 154*1.0=154 DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO LEACHING CAPACITY (BOTTOM & SIDEWALL)___GAL. - OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 10. THE EXCA VA TOR CONTRACTOR SHALL VERIFY THE LOCATION OF ALL UNDERGROUND ( 3.14 X 6 X 12 X 2.5 ) + ( 3.14 X 6'2 X 1.0 ) UTILITIES PRIOR TO ANY EXCA VA TION. THE WA TERGA TE WAS NOT FOUND, THE GENERAL RESERVE LEACHING CAPACITY _6_25 GAL. CONTRACTOR SHALL VERIFY LOCATION WITH WATER DEPARTMENT. 1 JOB NUMBER__ 50559------