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HomeMy WebLinkAbout0457 REGENCY DRIVE - Health 457 Regency Drive Marstons Mills A= 064 - 029 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments , �o 457 Regency Drive f } Property Address t Goulding Owner Owner's Name information is required for every Marstons Mills MA 02648 10/23/19 t 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. A. Inspector Information Sly /ya y Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Citylrown State Zip Code 508.272.6433 13010 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 10/23/19 InspectoU Signatu 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 l i Commonwealth of Massachusetts r: (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 Regency Drive Property Address Goulding Owner information is Owner's Name required for every Marstons Mills MA 02648 10/23/19 page. Cityfrown 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 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 457 Regency Drive Property Address Goulding inform Owneration is Owner's Name required for every Marstons Mills MA 02648 10/23/19 page. City/Town 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 I Commonwealth of Massachusetts ro Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 457 Regency Drive Property Address Goulding Owner information is Owner's Name required for every Marstons Mills MA 02648 10/23/19 page. Cityrrown 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 El E 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 ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 457 Regency Drive Property Address j Goulding Owner information is Owner's Name required for every Marstons Mills MA 02648 10/23/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cost.) 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 Y 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 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. 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 �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 457 Regency Drive Property Address Goulding inform Owneration is Owner's Name required for every Marstons Mills MA 02648 10/23/19 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 aH 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 I Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 Regency Drive Property Address Goulding Owner information is Owner's Name required for every Marstons Mills MA 02648 10/23/19 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: 3 bedroom design plan on file Number of current residents: 1 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 Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: OccupiedDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 I Commonwealth of Massachusetts r- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 457 Regency Drive Property Address Goulding Owner Owner's Name information is required for every Marstons Mills MA 02648 10/23/19 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) Basis 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: No recent pumping per owner Was system 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 Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 457 Regency Drive Property Address Goulding Owner Owner's Name information is required for every Marstons Mills MA 02648 10/23/19 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: Original septic tank per age of the home, new d-box and SAS 2011 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. 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: >10' 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 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 457 Regency Drive Property Address Goulding Owner information is Owner's Name required for every Marstons Mills MA 02648 10/23/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2'4" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound, inlet and outlet covers are raised to 6"of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness trace-1/4 inch � Distance from top of scum to top of outlet tee or baffle >2„ Distance from bottom of scum to bottom of outlet tee or baffle >2" 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.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 457 Regency Drive Property Address Goulding Owner information is Owners Name required for every Marstons Mills MA 02648 10/23/19 page. Cityrrown 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 I 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 t5insp.doc•rev_7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �o v 457 Regency Drive Property Address Owner Goulding information is Owner's Name required for every Marstons Mills MA 02648 10/23/19 page. Cityrrown 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.): H-10 D65 is 3' below grade, cover raised to 6"of grade, and in very good condition t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 AN Commonwealth of Massachusetts �s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ." 457 Regency Drive Property Address Goulding Owner information is Owners Name required for every Marstons Mills MA 02648 10/23/19 page. Citylrown 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: 20 infiltrators ❑ 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 457 Regency Drive Property Address Goulding Owner information is Owner's Name required for every Marstons Mills MA 02648 10/23/19 page. Cityrrown 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.): Infiltrators were video inspected and are damp at this time, no indication of past hydraulic failure 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.): 1 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 t5insp.doc-rev.7/26/20 8 P 9 P Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 457 Regency Drive Property Address Goulding Owner Owners Name information is required for every Marstons Mills MA 02648 10/23/19 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 ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 Regency Drive Property Address Goulding Owner information is Owner's Name required for every Marstons Mills MA 02648 10/23/19 page. City/Town 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 TOWN OF BARNSTABLE LOCATION .t Q.c, SEWAGE# VII.LAGE X th,f/f 01 ASSESSOR'S MAP&PARCEL iPY' A,9 INSTALLER'S NAME&PHONE NO. (a���faLA i 77 P Y7 7 SEPTIC TANK CAPACITY Y/"n 1, LEACHING FACII,TTY(type)bo 2t,i�, (size) �y.SY 2e NO.OF BEDROOMS ,3 OWNER PERMIT DATE: - o l COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility lydria it Feet Priv Water Supply Well and Leaching Facility(If any welts exist on site or within 200 feet of leacbing facility) Feet Edge of Wetland and L—h g Facility(If a y wetlands exist within I 3W fed of learhiug facility) Fed FURNISHED BY C kPe.a:�. `�,ti�CnsLs L 4G • e i I t z � , Hi RI t� I hT wk--L , 3i 3t•d j 8s si•L j - I 3y ss.� Y �3S b3,Y Commonwealth of Massachusetts 6g Title 5 Official Inspection Form S Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 Regency Drive Property Address Goulding Owner information is Owner's Name required for every Marstons Mills MA 02648 10/23/19 page. Cityrrown 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: >120" 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: 2011 NGW 120" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 4'seperation per 2011 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping puts the site at 105'msl and nearby surface water is at 48'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c� Commonwealth of Massachusetts s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �a L, 457 Regency Drive Property Address Goulding inform Owneration is Owner's Name required for every Marstons Mills MA 02648 10/23/19 page. Cityrrown 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 i ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate I 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: i 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 1 1 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 06/09/2011 23:58 5082730367 #0224 P. 002/003 Town of Barnstable Regulatory Services Thomas F. Geiler,Director Ae ' Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Of1•ice: 508-862-4644 Fax: 508-790-6304 Sewa Date. �� a Permit# 2 �' Z !off/ 2`� g ° c Assessors Map/P .rcel Installer &Designer Certification Form Designer: NYC Eng(0f-W%1q, Tor, Installer Ga(��w�dr_ Cnfer�.cfSZS, LLC. Address: 2&5y Cconee-(_yHItkhW�X Address: Q D so>e Z L'3 Easd uiare,henn H R 02,538 On Ou A-' 1--j5 was issued a permit to ins:all.a (date) (installer) septic system at y.5'7 9t5e.,,c Dri u e. based on a desi;;n drawn by (address) �G �dl�tne.e�it1� ., TYIG. dated Sine fc� Z011 (designer) certify that the septic system referenced above was installed substi%nt:<<Ily according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was insl ec.ed and the soils were found satisfactory. I certify that the septic system referenced above was installed witli 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 accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if req ' nShe-:-ted and the soils were found satisfactory. `NOF CHI+�:�!11LL ilk. 1 ---- CIVIL (Insta is Sign,, Na s7697 "RETURN r (Affix est er s ,ili Here) L _ BARNSTABLE PUBLIC HEALTH DIVISION CERT�FICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS I+i)RM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HF m xff DIVISION. THANK YOU. it lollwo 1i'iiu.ildo.signorcertilic:uiun I'omLdoe " Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 457 REGENCY DR is Property Address NESTI s, Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 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 DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 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. 1 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 ��• 5-19-16 Inspe or's 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �b �S Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. City/Town 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 in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM MET OR EXCEEDED ALL PASSING REQUIREMENTS AT TIME OF INSPECTION. THIS REPORT DOES NOT PREDICT THE FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USE. 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 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): I t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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): 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. CitylTown 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 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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•3/13 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 M 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 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•3/13 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 M 457 REGENCY DR Property Address NEST[ Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. Citylrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A 1000 GALLON SEPTIC TANK D- BOX AND 20 ARC 3616 CHAMBERS. Number of current residents: 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 years usage(gpd)): Detail: SYSTEM NO(DESIGNED FOR USE WITH GARBAGE DISPOSAL. HOUSE IS EMPTY SO WATER USAGE WOULD NOT BE ACCURATE Sump pump? ❑ Yes ❑ No Last date of occupancy: Date 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-3/13 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 se`'y 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 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: 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 9 P ❑ 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 457 REGENCY DR Property Address NESTI Owner Owners Name information is required for MARSTONS MILLS MA 02648 5-19-16 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: 2011 PER AS-BUILT Were sewage odors detected when arriving at the site? ❑ Yes ® No 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.): Septic Tank(locate on site plan): Depth below grade: 2 p g 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 GALLON PER AS-BUILT j i Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M s.•�''� 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) 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.): RECOMMEND PUMPING AT TIME OF TRANSFER AND EVERY 2-3 YRS THERE AFTER. 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 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 457 REGENCY DR Property Address NESTI Owner Owners Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. City(rown 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•3/13 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 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. Cityrrown 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" 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 NO LEAKAGE SPEED LEVELS IN PLACE. 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: NO OBSERVATION PORTS I t5ins•3/13 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 ,M 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 20 arc 3616 ❑ 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.): THERE WERE NO OBSERVATION PORTS ON THE S.A.S SO THE ACTUAL LEVEL OF PONDING/STAINING COULD NOT BE DETERMINED. 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•3113 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 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. Cityfrown 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 t5ins•3/13 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 wM 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. City/Town 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 i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 457 REGENCY DR Property Address NESTI Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 every page. City/Town 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: NONE AT 11 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: ATTACHED AS-BUILT CARD Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 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 457 REGENCY DR Property Address NEST Owner Owner's Name information is required for MARSTONS MILLS MA 02648 5-19-16 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 TOWN OF BAMSTABLE LOCATION yt h 4N SEWAGE# A i(-1-7 VILLAGE A,1hl J/f ASSESSOR'S MAP&PARCEL IP y- A 9 INSTALLER'S NAME&PHONE NO. a opn V flsi,&a&I94, y77?77 7 SEPTIC TANK CAPACITY LEACHING FACU=(tyx) �7,0) (size) �V,S Y 2 t, NO.OF BEDROOMS ,3 OWNER PERMIT DATE: - - Z o L f COMPLIANCE DATE: �0'`� Z�i z Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility It Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of lewbiing facility) Feet j FURNISBEDBY eAp" de. C)vk(payes L.liC - I 3 j 4 �t3 30 n �h 147. (III 3i'� �� �tl•Z � I g3 sr•2 .(3S toy y I http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=064029&seq=2 6/8/2016 ` Town of Barnstable P#- ' Department of Regulatory Services Public Health �Kj y l�a"�'aI = Division Date �.J�/ r/ MAIN i639. 200 Main Street,Hyannis MA 02601 Date Scheduled Tune L Fee Pd, Soil Suitability Assessment for Sewage Disposal Performed By:_ "(6ftac.t efine���e.�� �'Z)� CSC Witnessed By: l��l�xld S�vtGtGrfS'. �.$, LOCATION& GENERAL INFORMATION Location Address Ir f 5 9 .12 �` '�5�G7 Q i ll c Owner's Name Alt /1Jej i t Address q i 7 Pl- o j Assessor's Map/Parcel.• C)(o fj'L Engineer's Name �d vi — + N / g C L 3C C,�5. Tv�c. NEW CONSTRUCTION REPAIR ✓ Teleph'one# q 5-0'i-273-0377 Land Use Sin.4C. CIUJtjltnS Slopes(%) 1 Z Surface Stones s Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property line t ft Other r ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) $e'c. d—ac, QJ. 0.0 Parent material(geologic) 00kwaS(4 Depth to Bedrock / Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater 7 t 2 O'b9 S DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: txceci 6tnseiottht)(% Depth Observed standing in obs.hole: '> 2Q In, Depth to soil mottles: Depth to weeping from side of obs.hole: in, Groundwnter Adjustment - fr, Index Well# Reading Date: — Index Well level. Adj.factor- ,m Adj.Groundwater level,, PERCOLATION TEST bate 4°2I l Time /o Of Observation Hole# � - Time at 4" -- 4 Depth of Perc 30" 1 Time at 6" Start Pre-soak Time @ I O:a,5 All _ Time(9"-6") - End Pre-soak it':)6 All Rate MinJlnch tZ Site Suitability Assessment: Site Passed ZS Site Failed: Additional Testing Needed(Y/N) •I Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICVERCFORM.DOC DEEP.OBSERVATIONHQLE LOG Hole# 1 F:nm Soil Horizon Soil Texture Sdil Color (in.) Soil Other (USDA) (Mansell) Mottling (Structure,StonegBoulders. o�sistencv 96 y�30 ( $ /Qyr S/b 30-t20 p C- 2:5Y&4 — Jcos- DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Pi _4-3 ;pY� y/b36-120 Ccs2. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) (USDA) Other (Munsell) Mottling (Structure,Stones,Boulders. it Gravell DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. onsistency, Flood Insurance Rate Man: Above 500 year flood boundary No— Yes — Within 500 year boundary No Yes Within 100 year flood boundary No:V Yes Denth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? !v eS If.no%what is'the depth of naturally occurring pervious material? Certification I certify that on .Z�+9 5 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and ex rience described in 310 CMR 15.017. Signature Date 6-6-0 QAS•EPTIOPERCFORM.DOC TOWN OF BARNSTABLE LOCATION 1&vM c,,V SEWAGE# X c) < < — 17 n,LLAGE /1t N.j,/�� ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. � � ��, A �77 P F 7 7 IF SEPTIC TANK CAPACITY LEACHING FACILITY.(type) ba) 36(1, (size) A,5- V 20 T NO.OF BEDROOMS ,3 OWNER ,� o,,� Ax PERMIT DATE: tli A Z o L l COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility W&ia G/ 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 ( �GAp w L C--w'k eAjw,5 L LG ffZ tcc - /9 114 7, AT ti z It31 3 • _ _ - - . Ct-1� S<° No. OIL Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 4plitation for Disposal �6pstrm Construction Permit Application for a Permit to Construct( ) Repair(K Upgrade( ) Abandon( ) [�Complete System ndividual Components Location Address or Lot No. L4 y rt RE�¢t 1 0-1W Owner's Name,Address,and Tel.No. 11 ck, c/ nJ ES i i r Assessor's Map/Parcel 6 V217 7 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. G�i4�ZL✓a �a ctkIp-oCf ®O�1Car7G� 17 -F 7� �.L. f`��j��^¢t��ln , 2 ''7% �� +�"✓y Z04- WAY Type of Building: Dwelling No.of Bedrooms � Lot Size sq.8. Garbage Grinder ` ( ) Other Type of Building 5+�y le- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 �� gpd Design flow provided gpd Plan Date (cs (, Zc i Number of sheets Revision Date Title q5-1 Size of Septic Tank Moo o ! a*l Type of S.A.S. '6761,e l ciS f-t 'A Description of Soil 3 0 Nature of Repairs or Alterations(Answer when applicable) �1C.5 ► 1^ 1(.O o Yl2,,l c >< —c-6 S cam.�c>s L-&� f��.c u 20 ZO art 3L i k)Lar Date last inspected: 1100 I 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 Hea Si Date Application Approved by N, AL7 QkDate Application Disapproved by Date for the following reasons Permit No. ��a (j= Date Issued V t e A I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - _ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0[ppliratlon for Misposal *pstem Construction Permit i Application for a Permit to Construc 4, ) Repair(fQ Upgrade( ) Abandon( ) [�Co iple e System ndividual Components •_. ,. f Location Address or Lot No. �o u, �11� Owner's Name,Address,and`Tel.No.''"rc,n y fit/E 5 71 a �YS Sr4✓k¢ Assessor's Map/Parcel (p� 29 Installer's Name,Address,and Tel.No. i 1r Designer's Name,Address,and Tel.No. C14�Cw�`� En{wPrrstt �vyoxT�� `l?7 -8Q7_) 5. �L_ C'^ ti ,v S�� PzA,Jx.r� 14 54v,,r+y t•wfalcl�4»1 ✓s Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder 1 ( ) Other Type of Building 5 �t e- 4-11, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3o gpd Design flow provided gpd Plan Date �a (01 Zo 11 Number of sheets Revision Date Title Li Size of Septic Tank ` Q 00 cry*l Type of S.A.S.SlmelcfS - Description of Soil i t Nature of Repairs or Alterations(Answer when applicable) 1 t, J Goo rb r ,.,,; e�,RP,,e-le 3> y 20 ( 10 A4-t- 3L L�� Date last inspected: 7 h\ Agreement: ~�•-•n•-� •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 3� Compliance has been issued by this Board of Heal Sig .�` Date 64^-Za f licahroved b t D — 1 pR Approved y LT- A K ate Application Disapproved by Date for the following reasons i Permit No. r-)O L� Date Issued (,j�--,E—.2 o r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (ertifirate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by (�,419A?A ; 1�L�.Dvt}.e 5 LLB at 3 Di i G.t t"06-;/ram X. , I! has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer ,C1, ,�l.l_Trr}C S LL C Designer 6. Ehq 1 hae t"-f #bedrooms Approved design flow 33(, gpd The issuance of this permit shall no be 'onstrued as a guarantee that the syste will ion si ed. Date �' Inspecto --------------------------------------------------------------------------------------------------- '-='------------------------------- No. 2 U 7' Fee /O U — THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstrm ConstrUttlon Permit Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at_ �I 5 �e� G ✓�­,_-, 44 It,—) ✓ig 1(S and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. r Provided:Co structtiion must be completed within three years of the date of this permit_j Date 0' 0 Approved by 5_ o7f - '� LOCATI Aw� SEWAGE PERMIT NO. VILLAGE INSTA L E ll,'§ 20E b ADDRESS /I/ COR YOIN � � D ATE PERMIT ISSUED DATE C0 M P L I A N C E ISSUED �1 9 T.O.F. EL.= 109.0'± INISH GRADE OVER D-BOX= 107.2'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER BIODIFFUSERS= 106.3' - 107,2' GENERAL NOTES PROVIDE EXTENSION RISER SLOPE @'2% MIN. WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED,'ALL SYSTEM COMPONENTS AND CONSTRUCTION ACCESS BOX TO WITHIN FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE 3"OF F.G. (ONE PER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL. -= 108.3'+ F.G. OVER TANK EL. =108.0' 5 DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. } 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE I DESIGN ENGINEER. EXISTING 4" PROPOSED 4" 36"MIS 36"MAX.N. TOP OF SAS/B.O. = 104,20' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE SYSTEM UNLESS OTHERWISE NOTED. ��» 3"DROP MAX x PROVIDE WATERTIGHIT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6 3 2"DROP MIN 3 9 MIN.SLOPE@ 1% L 20± JOINTS(IYP.) ELEVATION = 104.20' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" 4"PVC IN FROM 1.33' 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" *�Ot�,3'± SEPTIC TANK 4"PVC OUT TO ___ (TYP.) � 16 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE • LEACHING FACILITY 0.90' 10.75"(TYP) o 5. SLOPE ALL SOLID PIPE AT 1.0 /o MINIMUM. SPECIFIED DROP BETWEEN 12" 6» I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL OUTLET TEE 104.00' MIN. 1 ' 103.77' \-=102.87' (laid flat) •2.875'(34.5")--t SHALL VERIFY SIZE 48" VERIFY CONDITION OF 03.83 (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE 5.0' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY (NP') R MIN. 14.375' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE REQ D 20.0` AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (NP•) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 108.00' TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV= < 96.30' BIODIFFUSERS (END VIEW) ESTABLISHED ON A NAIL SET IN A 12"OAK TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS (PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT (BY ADVANCED DRAINAGE SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CROSS SECTION VIEW TO THE DESIGN ENGINEER. j SEPTIC TANK PROFILE ARC 36HC #3616BD BIODIFFUSERS H-20 EXISTING ELEVATION PRIOR DISTRIBUTION BOX DETAIL *CONTRACTOR TO VERIFY \ 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. T T SCALE TO ANY WORK&NOTIF Y ENGINEER IF DIFFERENT. NO O NOT TO SCALE NOT TO SCALE (4 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM PERC NO. 13297 APPROPRIATE AUTHORITY. INSPECTOR: Donald Desmarais 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS (3 �r LOCATED UNDER PAVEMENT DRIVES OR TRAVELED WAYS IN WHICH CASE � EVALUATOR: Michael Pimentel, E.LT. THEY SHALL WITHSTAND H-20 LOADING. O � �0 r Oct. 1 99 C.S.E.APPROVA DATE:. 9 .• L -' � , 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. P 2) 31.1' DATE: June 2,2011 ZONE 2 x pJ TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE C t MATERIAL N AREA BEN TH AN F I F EA D OR 5 FT ON A L S DE O LEACHING FACILITY. L S i E a ELEV TOP- 106.30 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, O o P � G , MAP 64 ELEV WATER= <96.30' FINES OR OTHER UNSUITABLE MATERIAL 1N ACCORDANCE WITH 310 CMR 15.255(3). �o ra :.z 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN -; �p PARCEL 29 /' LOCUS PERC RATE- <2 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 43,639 S.F.± DEPTH OF PERC= 30"-48" ti OEG� #457 (�, 16. PROPOSED PROJECT IS LOCATED WITHIN: N TEXTURAL CLASS: 1 ASSESSORS MAP 64 PARCEL 29 co EXISTING - - OW ER OF RE RD:- N CO A TH NY . N T R P TRI I N O J ES I J & A C A NESTI R M C 3 BED 00 EXISTING 1,000 GALLON SEPTIC' Q HC-1 DWELLING � �� a _ ADDRESS: 457 REGENCY DRIVE J �; x 1 NK T BE UTILIZED IN THIS DESIGN 1 TA O = 0 a TOF 109.0± 106.30 U` 1 " Fill MARSTONS MILLS, MA 0264g EXISTING LEACHING PIT TO BE PUMPED, FILLED o WITH CLEAN COA RSE SAND&ABANDONED Loam Sand Y B FEMA FLOO ZONE C 11_ • 10Yr 5/6 D SWING-TIES ' SCALE: 1 -20 " COMMUNITY PANEL# 250001 0015 C 30 103.80 DESCRIPTION HC-1 HC-2 - Perc 17. DEED REFERENCE: L.C.C.122668 4E, 102.30' 18. PLAN REFERENCE: L.C. PLAN 16427-D t PROPOSED INSPECTION PORT �p�O BIODIFFUSER CORNER(1) 58.6' 35.4' ;�- WITH ACCESS BOX(TYP OF 5) / - . S ` 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. BIODIFFUSER CORNER(2) 45.1' 31.1' ,2t�. PROPER�'i..i�JE JNFQ2tNAT1©I�JaS(�^.�itlYAl�?ROXIMATE.�t`tliS PLAN fS l'OBE{�SED ONLY , ' BIODIFFUSER CORNER(3) 55.7 51.1 FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY C Coarse Sand (i yy FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. ( ) 1 1 .. yl' V. ; - ..: o to PROP. TOTAL 20 ARC 36HC / / O MAP 4 - _ / 6 � Loose o BIODIFFUSER CORNER 4 67.1 53.8 2.5Y6/6 J (#3616BD)BIODIFFUSERS(H-20) / SN IN A FIELD CONFIGURATION PARCEL 30 / PROP. D-BOX r / LOCUS PLAN I / SCALE: 1"= 1000' 120" 96.30' Bena Na I inr12 Oak 1ark 063 ` LP ! No Mottling,Weeping or Standing Observed Elev. = 108.00' 1P.1Approx. M.S.L. /� -10�- ! ,,�� DESIGN DATA TEST PIT DATA LEGEND 1064 �.O� PERC NO. 13297 INSPECTOR: Donald Desmarais 50x0 EXISTING SPOT GRADE TREE (TYP) o EVALUATOR: Michael Pimentel, E.I.T. cP o G� \ NUMBER OF BEDROOMS (DESIGN) 3 - - 50 - - EXISTING CONTOUR 0'6, / a o Gp,F�' DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E.APPROVAL DATE, Oct. 1999 / I \ 2011 50 PROPOSED CONTOUR �oC TOTAL DESIGN FLOW 330 GAUDAY DATE: June 2, / = TEST PIT#: 2 \ DESIGN FLOW X 200 % 660 GAUDAY E/T/C EXISTING UNDERGROUND UTILITIES ELEV TOP= 106.30' #457 USE EXISTING 1,000 GALLON SEPTIC TANK ELEV WATER= <96.30' --W W EXISTING WATER LINE 1 i a EXISTING 3-BEDROOM \ PERC RATE= GAS EXISTING GAS LINE p6, DWELLING eiT�C DEPTH OF PERC= o, \ TOF=109.0'± ?©�s` INSTALL 20 - ARC 36HC (#3616BD) BICIDIFFUSERS (H-20) TEST PIT LOCATION TEXTURAL CLASS: 1 TREELINE SYSTEM CAPACITY EXISTING 1,000 GALLON SEPTIC TANK 'c` 3 (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0" 106.30' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE -108- O 60 �� (100.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)_ 355.2 GAL. LEACHINIG/DAY x Fill 105.9T F� as GAS i S ,�36 4 Q PROPOSED DISTRIBUTION BOX - GAS ~ J ( B to Loamy Sand \ TOTALS: \ , x� ' �- 10Yr5/6 Q PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20) ` .' TOTAL NUMBER OF BIODIFFUSERS: 20 TOTAL NUMBER OF COUPLINGS: 0 30" 103.80' moo , TOTAL LEACHING AREA: 480.0 TOTAL LEACHING CAPACITY: 355.2 REV. DATE BY APP'D. DESCRIPTION PROPOSED SEPTIC SYSTEM UPGRADE � NOTE: PREPARED FOR: EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE C Coarse Sand O CAPEWIDE ENTERPRISES P M T F VI NM NT L PR TE TI N APPROWAL LETTER 2.5Y 6/6 IDE ART EN O EN RO E A O C O MODIFIED CERTIFICATION FOR GENERAL USE ISSUED T(O ADVANCED (loose) G�Q DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST MO)DIFIED LOCATED AT �� JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. G 457 REGENCY DRIVE MARSTON S MILLS, MA 02648 rn �106E I� / NOTES: SCALE: 1 INCH = 20 FT. DATE: JUNE 6,2011 120 96.30 0 10 20 40 80 FEET 1.) MAGNETIC MARKING TAPE SHHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC ,I No Mottling,Weeping or Standing Observed �jH OF Mq 4 SYSTEM COMPONENT. ss9c PREPARED BY: i G T R H LL VERIFIt(SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED RESERVED FOR BOARD OF HEALTH USE o� JOHN L. Pc� JC ENGINEERIN N . f 2.) CONTRAC O S A CHURCHILL JR. G, I C i FA 1 TY TO ENSURE.CONSISTENCY WITH TEST PIT DATA SHOWN ON THlS PLAN. LEACHING C LI CIv >-� 8 2854 CRANBERRY HIGHWAY N0.41 I IF IL ARE NOT CONSISTENT WITH 8 7 REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH SO S o TEST PIT DATA. Po� Rio �� EAST WAREHAM, MA 02538 S / SITE PLAN 3. ENTIRE PROPERTY IS LOCATED WITHIN THE BARNSTABLE WELLHEAD PROTECTION A 508.273.0377 SCALE: 1"=20' OVERLAY DISTRICT AND THE ESTUARINE WATERSHEDS. Drawn By. MCP Designed By:MCP Checked By:JLC JOB No.1996 �� II