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Home My WebLink About0167 RIVER RIDGE DRIVE - Health 167 ;River Ridge 'Drive Marstons Mills F/R LA = 059 007010 TOWN OF BARNSTABLE LOCA ;Q-N ��.a �'�f f 5." E`J i^. SEWAGE # o��I J O 70 s VILLAGE /Am r a—D M:� ✓°i1•'�`�� ASSESSOR'S MAP & LOT 7"J17 INSTAY;LER'S NAME&PHONE NO. All //b SEPTIC TANK CAPACITY LEACHING FACILITY: (type) i ; ".`�^�':e�•T !0�1s`;✓J�X (size) NO. OF BEDROOMS BUILDER O - PERMITDATE: ,7'a7?T"057 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) _ Feet Edge of Wetland and Leaching Facility(If any wetlands exist Within 300 feet of leaching facility) Feet Furnished by j `/ Cif jr �•� /'�: n%J y�` ' 1.�� . ---�� ; � � � f..:K 6 � 'r'�� *7� d.r ., � � � � ., . �, �r�-�, �i % ��' �� , / 3 ._._ , . �� y No. )AM S r 070 --- FEE MIA r d0M 0NWLALTII OF MASSACHUSETTS,- Board of Health, 1 >_ M%, i —.MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) - ❑Complete System Ll Individual Components Location + 'f ��, — Owner's Name Map/Parcel# Address Lot# Telephone# pk) ya 0"979-2 Installer's Name G �G CbH Designer's Name ASSoefATES Address D Address 42 CANTERBURY LANE i3s 3 ovs7hs ,//.� Telephone# _ Jr Telephone# 608/640-2634 Type of Building Lot Size sq.ft. mg No.of Bedrooms 3 .��431%.J O Garbage grinder ( ) Type of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (inin.required) �J� 19 gpd Calculated design flow 7. Design flow provided gpd Plan: Date Z -Z1- Number ofsheets 1 / Revision D Title t- : L W` 7�s- '1�L'&4-4 r q-VL 1 l0'1 �iJMA Description of Soil(s) �i�t'? �► �i��,�� Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation -L —ID.D DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree n to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date (3b � J Inspections No., _. ';. w;,.... FEE ' T} ..�_ tT' 4 _ COMMONWEALTH OF MASSACHUSETTS, Board of Health, 1 ;R M.A S;&,S:bM 1-2,.MA. APPLICATION FOR DISPOSAL YSTIrM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) - ❑Complete System ❑Individual Components Location ((e'� >,V �, Owner's Name 7�y �% "2 Map/Parcel# -1 Address Lot# Telephone# �I Installer's Name Ak `�� . �� Designer's Name DON LE AND ASSOC TES Address 7 nSS if/A Address- 42 CANTERBURY LANE SETTS 02536 Telephone# ��i d _ S 37- Telephone# 508/540.2534 Type of Building Lot Size I A 6D sq.ft. e mg- o.of Bedrooms .0TI Nl 1 Garbage grinderQJQ O Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) gpd Calculated design flow Design flow provided n gpd Plan: Date -L - Zl- *P Number of sheets Revision D l Title -.� —-Au V1- 1 6 L Description) G741,.,•r� - -Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation `C •-LO—D DESCRIPTION OF REPAIRS OR ALTERATIONS Iy. The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITL•E 5 and further agree to not to place the system-in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date_ (3(� Inspections '.e";y.'"`�. .... ..a,,... - � ..n. -R. .:-+:..�..,.vn,....wr. ,«d'!w.av!sFaJ!� ta+,+�`Mm.'._.<r^•a I No. i COMMONWEALTH ® SSACHUSETTS FEE ��0— Board of Health, MA. CERTIFICATE OF COMPLIANCE Description of Work: W'Individual C.omponent(s). _Ll.Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired�Q,Upgraded ( ),Abandoned ( ) has been installed in accordance with the provi ions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. �O00 ,o70_, dated a . Approved Design Flow 3U (gpd) Installer c Designer: Inspector: Date: / �5 r The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. 2 Q05,0 w FEE 16V COMMONWEALTH OF MASSACHUSETTS Board of Health, Q r"r'S)16(P. , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair Upgrade( ) Abandon( ) an individual sewage disposal system at�( , - ,ro 1` �� ul/I< A,.,') f // as described in the application for Disposal System Construction Permit No. OuJ --070 , dated f Provided: Construction shall be completed within three years of the date of thiT rmit. Al ocal conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date D LPA� Board of Health 1 / Q TOWN OF BARNSTABL-E LOCATION �� RP• bar �d�► • : SEWAGE # 26 ��J- d -70 VILLAGE /'/f%� M �i1.' ASSESSOR'S MAP & LOT , .. INSTALLER'S NAME&PHONE NO. T /Z /�� SEPTIC TANK CAPACITY LEACHING FACILITY: (type i'�`n;l F"�";to�.i' /y�c ✓J�X� � (size) NO. OF BEDROOMS BUILDER O PERMITDATE: 2-2of_09 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching.facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) - Furnished by hy' ;, - 6 Q' 24" s Town of Barnstable two Regulat6ry Services . Thomas F. Geiter,Director S sai�t�rAsLs, = Public Health Division Eel " Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: 0A o� D> Designer: Installer: PHEn I DOYLE AND ASSOCIATM Address` 42 CANTERBURY LANE Address: Z 7 r� CfiUSETTS o2sae � r — 508/540s2534 On b.z _ -Zg was issued a permit to install,a (date) (installer) septic system at l b aced on a design drawn by (address) dated e ( si er) I ertify that-the septic system referenced above was installed substantially according to e design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 1 certify, that the septic system referenced above was installed with major changes (i.e. greater,-than ld' 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. ,►_X♦ee��. o► P�tH OF raP�S�, a� ., 1 �`S STEPHEN N ► — 4 J. ► U (Installer's Signature) ; o e' ♦ yp. (Designer's Signature) (' er{sxSv here) PLEASE RETURN TO $ARNSTA.BLE ERTMCATE OF_ COAWLIANCE WILL NGT,,RE::ISS �; � ��.. AND AS- DUILT CARD AIDE RE! ED S?K R�AR NT` " � P '� 3 `C F4:ETHP'D STON. w_..w.. THANK{YOU. Q:Hedth/Septic/Desiper Certification Form TOWN;OF BARNSTABLE :LOCATION l�� Ryer dw �/►� SEWAGE # �r � VILLAGE A'11 SN G ( ® 0 IA ER'S NAME&PHONE NO r',c.(L aera "(( SEPTIC TANK CAPACITY Imo oq4 ACHING FACELrrY: (type) (size) Y'� -NO.OF BEDROOMS 3 tBUILDER OR PERMITDATE: CDSf €F DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i c� I(o ° r f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS n:: r DEPARTMENT OF ENVIRONMENTAL PROTECTION - ._ FA11E® INSPECTION FEB 0 8 2005 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 167 River Ridge Drive -ARCEL s O® l o Marstons Mills MA 02648 WT Owner's Name: Catherine&Paul Benoit Owner's Address: Same Date of Inspection: February 2,2005 Job#05-18 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ��OF��►tt��i�� ,P,.•• .,syc,,� Passes Conditionally Passes = ?• qTR ••�yN Needs Further Evaluation by the Local Approving Authority M X Fails LL :co Inspector's Signature: - —�_. Date: 2/2/05 INSM 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. Notes and Comments: Leaching pit full over inlet pipe. ****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. Title 5 Inspection ct�'p on Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 167 River Ridge Drive,Marstons Mills Owner: Catherine&Paul Benoit Date of Inspection: February 2,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Titles C TncnAntinn Anrm All VIAAn 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddress: 167 River Ridge Drive, rive Marstons Mills s Owner: Catherine&Paul Benoit Date of Inspection: February 2,2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: — Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Titles f inenPrtinn T7nr A/i siinnn 3 Page 4 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 167 River Ridge Drive,Marstons Mills Owner: Catherine&Paul Benoit Date of Inspection: February 2,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No —X_ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool —X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone I of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _Yes_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply — _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Titla G Tnonartinn Fnrm 4i1 si)nnn 4 Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 167 River Ridge Drive,Marstons Mills Owner: Catherine&Paul Benoit Date of Inspection: February 2,2005 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _ _X_ Were any of the system components pumped out in the previous two weeks _X_ — Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ — Was the facility or dwelling inspected for signs of sewage back up? _X_ — Was the site inspected for signs of break out? _X_ — Were all system components,excluding the SAS, located on site? _X_ _ 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? X_ — Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)j Titla f Tnanartinn T:nrm 4/i;r)nnn 5 Page 6 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INS PECTION FORM PART C SYSTEM INFORMATION Property Address: 167 River Ridge Drive,Marstons Mills Owner: Catherine&Paul Benoit Date of Inspection: February 2,2005 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 Number of current residents:5 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2003—163,000 gal.2004—119,000 gal.=386 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped April 2004 ` Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool —Privy —Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed 1988 Were sewage odors detected when arriving at the site(yes or no): No Titles i Tnc++artinn Fnrm rli si,)nnn 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 167 River Ridge Drive,Marstons Mills Owner: Catherine&Paul Benoit Date of Inspection: February 2,2005 BUILDING SEWER:XX (locate on site plan) Depth below grade: 16" Materials of construction:_cast iron X40 PVC_other(explain): Distance from private water supply well—or—suction line: 30' Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 18" Material of construction:_X_concrete_metal fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:8.5'long x 5.2'wide—1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Liquid level at bottom of outlet pipe Baffles intact and clear,outlet baffle should be replaced with a PVC tee at time of repair. GREASE TRAP: No (locate on site plan) Depth below grade:— Material of construction:_concrete_metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Titla G Tnonantinn Rnrm 411;i)nnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 167 River Ridge Drive,Marstons Mills Owner: Catherine&Paul Benoit Date of Inspection: February 2,2005 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Ott 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.): Liquid level at bottom of outlet Pipe Observed trace of solids in box PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Titles 'q Nenartinn Rnrm 4n,;/innn 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 167 River Ridge Drive,Marstons Mills Owner: Catherine&Paul Benoit Date of Inspection: February 2,2005 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type —X_leaching pits,number: One 6x6 pit. leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Liquid level over tor)of inlet Pine it has no effective leaching CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): f Title i incnantinn Fnrm�ii ci�nnn 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 167 River Ridge Drive,Marstons Mills Owner: Catherine&Paul Benoit Date of Inspection: February 2,2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. River Ridge Drive Water service #167 23 16 34 20 48 31 Titlo i Tnonam;nn 17nrm 4/1,;r7nnn 10 Page l I of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 167 River Ridge Drive,Marstons Mills Owner: Catherine&Paul Benoit Date of Inspection: February 2,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 30 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: el.30. Topo map shows property above el.80 and town groundwater contour map shows water at or below Titla G 1ncna tinn T7nrm 4/1 C/,)nAn 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL M AIRS �fAtQ DEPARTMENT OF ENVIRONMENTAL PRO - WI N ONE WINTER STREET, BOSTON MA 02108 (617) 292-5500 8 2040 Fa4RNStgg1F DfpT TRUDY COKE Secretary ARGEO PAUL CELLUCCI fs_'_i_I)AVID B. STRUMS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: I�G`7 VCII L 72 .K13C. Name of Owner U6nc5'-./ zlwd- Address of Owner: 154M c Date of Inspection: - o3j -00 Name of Inspector:(Please Print) Z.*�ojh' I am a DE�P"approved system��— pursuant to Section 15.340 of Tide 5(310 CMR 15.000) Company Name: rnl")G6Ll^/ f gft i Mating Address: 160)C X* q C°L lI�C.0 G Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the pioper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority -� Fails Q Inspectors Signature- Date: 5-31-coo The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of-Environmental Protection. The original should be sent toots system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS QJd�..i.JO— � � 4 e,8 'r' 2 � �, �uJn2/ �jJ�.(joD (JIC kt WQe� Q w'r W n,6,."R) revised 9 2 98 Page 1 of 11 t�� Printed on Recycled Paper ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: I ta n `I��rz`�-�d� P. ►�_u�III owns: Date of Inspection: INSPECTION SUMMARY: Chedry B, C, or A A. SYSTEM PASSES: ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 1-5.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or,repair,as approved by the Board of Health,will pass. Indicate yes,no, or not determined(Y,N,or NO). Describe basis of determination in all instances. If "not determined",explain why not. _ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if.(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced _ - The system required pumphig-more than-four li mes a year due to broken or obstructed pipe(sl. The system wiltIms's inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 P2ge2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A n CERTIFICATION(continued) Property Address: I(D `-1 K•�R_�.d� . Owner: /j1q/C/t!h¢irt Date of Inspection: 5_31-c o 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 the public health, safety and the environmen , 1) SYSTEM WILL PASS UNLESS ARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303 DIN THAT THE SYSTEM IS NOT FUNCTIONING W NER WHICH]HILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspo r privy is within 50 feet of surface water Cass of or privy is within 50.feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING.IN A MANNER THAT PROTECTS THE PUBLIC LTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil orption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water suppl The system has a septic tank d soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic t and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a sep' tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supp well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free has ollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. ethod used to determine distance (approximation not valid).- 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(corrtinued) Property Address: (b`2 2i lu F=IL Owner: Date of Inspection: D. SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes N� -T- Backup of sewage into facilitiror system componertt•dae7o an overloaded or-cloggedd-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. '4 Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). - Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. - Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for -coliform bacteria,volatile organic-compounds,ammonia nitrogen and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either"Yes" o�r7No" to each of the following: /operator ing criteria ply to large systems in addition to the criteria above: serve a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public safe and the environment because one or more of the following conditions exist: Yes _ he system is within 400 feet of a surface drinking water supply he system is-within 200 f set of•a-tributary to surface-drinking water supply ----• - --- •• - - he system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public ater supply well) The otor of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional officeent for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 16�1 Zi � cz , AL Owner: IXAOICs1/�m Date of Irupectioo: Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health. None of the system components baw.baen pumped:#aGatleast two weeks and-the'system hasbeew-mceiviagaesmw flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. x _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System,have been located on the site. _ The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge, depth of scum. The size and location of the Soil Absorption System on-the site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)] k _ _ The facility owner(and ocrupants,if different from..owner).were,provided.with information..on.tha4raper.rnaintananra-0f SubSurface Disposal Systems. revised 9/2/98 P2ge5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM r PART C SYSTEKJMFORMATION ( Property Address: l b '� 1�wC-:2 �ac�he.rl2e)64 N•. Owner: d71'a1fr-1hq-7 Dace of kupection: t—31—r,r�, FLOW CONDmONS RESIDENTIAL- Design flow:__Lc c o g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual Total DESIGN flow 3 g o Number of current residents: Garbage grinder(yes o o)•_ Laundry(separate system) (yes or no):/I/0 ; If yes, separate inspaction.required _ Laundry system inspected (yes or no) Seasonal use(yes or no):_,A/0 Water meter readings,if available(last two year's usage(gpd): NIA Sump.Pump(yes or no): NO Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: 9Pd ( ed on 15.203) Basis of design flow Grease trap present:(yes o o)_ Industrial Waste Holdin ank present: (yes or no)_ Non-sanitary waste di charged to the Title 5 system:(yes or no)_ Water meter readin s,if available: Last date of occu ancy: OTHER:(Desc be) Last date of ccupancy: •4 EPdERAL INFORMATION . PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) n�c) If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM ✓Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date instaged4if known)-and source of-information: -�►�- — — - - Sewage odors detected when arriving at the site: (yes or no) revised 9/2/98 P2ge6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1I10-1 Owner: lkhric Pi m Date of Inspection: S-3t—o o BUILDING SEWER: (Locate on site plan) Depth below grade:_ Material of construction-_cast iron_40 PVC_other(explain) Distance from p• ate water supply well or suction line Diameter Comments condition of joints,venting, evidence of leakage,-etc.) -- SEPTIC TANK:_ (locate on site plan) Depth below grade:3� t Material of construction: ✓ncrete_metal_Fiberglass _Polyethylene_other(explain) If tank is(petal,list age_ ls.age_confirmed by Certificate of Compliance_(Yes/No) Dimensions: �rfS�8 Sludge depth: PA"(- � Distance from top of sludge to bottom of outlet tee or baffle:• - Scum thickness: iJO%f- 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 dimensions were determined: MSPr-�,j r'y Comments: (recommendation for pumping,condition of inlet and outlet tees or-baffles, depth of liquid level in relation to outlet invert, structuraFintegrity, evidence of leakage,etc.) �1 d GREASE TRAP: (locate on site plan) Depth below grad ._ Material of cons ction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions- Scum thickne s: Distance fro top of scum to top of outlet tee or baffle: Distance fro bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments (recomme dation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 P2ge7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C f SYSTEM INFORMATION(corrtimm4 Property Address: I�0`1 (�,d v�- ��+�� Owner: Date of knPection: -5-31,0'0 TIGHT OR HOLDING TANK: (Tank must pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: Material of construction:_concret _metal_Fiberglass_Polyethylene_other(explain) Dimensions: V y Capacity: foncrition Design flow: s/day Alarm present Alarm level: in working order:Yes_ No_ Date of previous pump Comments: (condition of inlet tee, of alarm and float switches,etc.) DISTRIBUTION BOX:— (locate on site plan) Depth of liquid level above outlet invert: Comments: (note-if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box, etc.) LSoC L. 4- C.L cf}2 PUMP CHAMBER: (locate on site pla Pumps in worfcin order:(Yes or No) Alarms in workin order(Yes or No) Comments: (note condition o pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Ptge8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Date of Inspection: .S_31—oe SOIL ABSORPTION SYSTEM(SAS) (locate on site plan,if possible;excavation not required,location may be approximated by non4ntrusive methods) If not located,explain: Type: leaching pits,number: I leaching chambers,number:_ leaching galleries,number:_ leaching trenches,number,length: leaching fields,number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) CESSPOOLS: (locate on site pla ) Number arid conf guration: Depth-top of liqu to inlet invert: Depth of solids I eL Depth of scum la er: Dimensions of ce spool: Materials of cons uction: Indication of grou dwater: inflow ( esspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of•vegetation, etc.) PRIVY:_ (locate on site Ian) Materials of c struction: Dimensions: Depth of solid Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ( 2tJae- I.JY- ` , A_ Ld s Owner: ni4ZI(A4,�Irn Daft of Inspection: s_31 -0 v SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Sire e? B 33r �i 3EF revised 9/2/98 Page 10of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM WSpECT10N FORM PART C SYSTEM INFORMATION(continued) Property Address: 1(0'"f [ Owner: Date of Inspection: 5-31-0 0 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 33 Feet Please indicateall the methods used to determine High Groundwater Elevation: ,'---Obtained from Design Plans on record Observed.Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) ?tr1ar 12apa�'*� `�" 4� -r(P.JAJ 2ecc�-�S revised 9/2/98 Page 11of11 ASSESSOR'S MAP NO. PARCEL v 0 7--0lO F-7-6 "LOCATIONZ��wm . SEWAGE PERMIT NO. VILLAGE N S T A LLER'S NAME A ADDRESS U � OleIAd ff 4-r 91412 R UILDE R OR OWNER 7, Jm l pi DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1 do CJ �d 319 u� �rb l v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,Y,:�......,"��,,, ,-e,-�..�..................... or R Application is hereby made for a Permit to Construct �"epair an Individual Sewage Disposal Syste5 at: Size Lo Type of Building t... .. -Sq. feet Dwelling—No. of Bedro Z Other Distribution box Dosing Percolation Test Results Performed by.- .. ....... ........ .....I ........ ... e.....1�1:2/ .1P__7........ Test Pit No. 2................minutes per inchilptih of�Test Pit................._ Depth to ground water........................ 0 Description of Soil.... ---'---'--- '---'-'''-''------'--'''---'-'---'------------- ''"'-_-_-. The undersigned agrees to install the uforcdescribed Individual Sewage Disposal System in accordance with the provisions of�I�I� �� S�� S itary` C�c— The n��s�o� ��b�u��so� mo�e the �m� � operatio tun il a Ce t*ficate of Compliance has been issued by the board f I I h rt - / . - - ---------' -.-----.. '-�"-----' '-",'-�-- -'-'-----'-~~��'--'--'--'---'v'-----'--------- -'-- --------�7a �--r---� Application Disapproved for the following reasons:................................................................................................................ ........................................................................................................................................................................................................ __Date Permit No. -- No- FizB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... ............................. Appliration for Phipaaal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct (-`)""or Repair an Individual Sewage Disposal System at: 12 .......... .......h ""y ............................ .. ....<. ------------------------------------------------------- 17 N�11 'Locatioi -7Ad�,`e S Z...................... ........ :.......................................... Owner 'ss _�/....�!.... .................................. Installer Address III Type of Building Size Lot_/'Z"`._`/`i�'��Q----Sq. feet U Dwelling—No. of Bedrooms......... .............................Expansion AttiqL(�') Garbage Grinderqo) PL4 Other—Type of Building ............................ No. of persons.........._.........._______ Showers Cafeteria P4Other fixtures ...................................................................................................... Design Flow_____..._._0 .............................gallons per person per day. Total daily flow._._ _2.t2.0.........*..............gmllons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width.__............. Diameter__-_--__-______- Depth................ Disposal Trench—.\Io. .................... Width.....____...._...... Total Length___..........._..... Total leaching area---------_---------sq. f t. Seepage Pit No--------------------- Diameter........._...._.___. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosin nk ........... Percolation Test Results Performed b ....... ......:jpate... .................................... Test Pit No. I................minutes per inch De th f Test Pit_...._..........__.. Depth 6/ground water..___----.___-___-_-_--. Test Pit No. 2................minutes per inch Depth of Test Pit.._____........._._. Depth to ground water.....------------------ ........................................................ m.............................................................................. 0 Description of ...... ..................... ....................................... ------------- .................................... U ... ----- .... ....................... ------- ........................................................ ........................................................................... ............................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable............................................................._............................... ........................................................................................................................................................................................................ Agreement: lank y t 0 ;De oi��es The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL-2, 4 of the State Sanitary Code— The undersigned further agrees not to place the system in operatioJI u tit a Cer,,*rica,e of Compliance has been issued by the board of health._ icati, f-7 Signed..................... ............. ................................ at ....................... C Ap ication Approved By--------- .............. ate Application Disapproved for the following reasons:.............................................................................................................. ......................................................................................................................................................................................................... Permit No.75..-------- ---_ ............... Issued---.------- ./.z57f!e------ ---- . ate te THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .1 r7............OF...Z .. ..................... Tatifiratr of Tomptiatta THIS, IS I TO CERTIFY, That; the Individual Sewage Disposal System constructed '--,--O-,r Repaired by....._ ........... ............................................................................................................. .,,I at 'taller, . ............. . .................................................... ......................1..�2........ -...... ...... .... ......... .. has been insmiled in accordance with the prsv4sions of ZZ��r of The�---- te Sanitary Cock, Id I d in the application for Disposal Works Construction Permit No....C-:>....L .....&.1 dated_----------- ........7--------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT !HE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................... ............................ Inspector--------- --- ....................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ✓ 0 F ............... ............ , .................................... No......................... FEE.................... Bispos!t Works Tonstr ton Pprrmff Permission is hereby granted........... .......� _1A ........................................................................ to Construct (--,-)5__or Repair an Individual Sewage Dispos4/�ystem �"I ( - ' at No..1 ...... zr�!...... ...................... Street lt_ Works Construction Permit N6`7_.��k_ Dated....... . ......... as shown on the application for Dispos2 ------------- ............................ Board of health DIAT E............ .................................. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 1 i t j t , 73 ` z. . : . � Li� y� 9z AL 1��-SI G-,N1 2�ATQ = 1 I! s I NCxLS ;=AM I:LY 3 SED1 =M , . -n4 t�Y P-;�� I lox 3' 33o G PD. G-, s pT I G " ,P, !�• - - . r -�- LLIL DISpO�L PIT -ti USE (1 ) Ca,4L F ^ r TJI D4ILY Fl-OVC1 _ p Ca. Pb . . ..; ;g,?1t+� i 4 . Tx�44-c'Ecot� 'c: i" ir\� 2 M,?N adz LE55 : �} .;oar Lj !�X>� �L7 -71 7/ 5 _ - Tye 7Z.o �p.� Nv , I INv $OX F.JC>•'rn� 7ae�✓,/, p 11 TN fig PT 1 G a BAX'ER Vt' -rA1.)K R! Mom. '• wrtN +� -tom✓ �4 Aik To l Y-x. • ° GC 7 %7 T It.. �, wash r aj 5 TO fJ 5 ,, >=�V � LZ 461 iLE No AL.S rzlvez : Qinc.G: 1 �Kt I FY T 1-ld-r 'T�-1>~ v Nan o N 5�-10 W N I STLV4;D"L�4 N I5"5U�zVt- I-1�zEofJ GOMiA-Y5 WITH TN•C- S1P�l aN� al.1i� ��ETgAGJ�C R�QVIR�M��tl'SDF THEE -r'avN N of Mor 11xATI2t:) W tTt- tW TE-}E FLDOD PLA►N. 9 (�l i TH 6 -MAW I.5 NOT g�S1=A oN a�! -1 � � � t>4c)VJ J 14L%IXGC)W 64OUQ;) Tnr='S Ai�UsH LOT L•INCM F Floor Elev. 78.8 P U� �_�tL D� � _ _1L �L T/V7— F3isish Grade II 76 5 t XY -RIM R--- Fin. Grade El. 76 f Exist. to Remain 0 DI AS RAVIII W 0 Die. RLSER TTlTT17T III TTTIIII M117 T77TTTlTTITTITTTTTI 1/8' to 1/2' !lashed Stone O 3" Thick INV EL 73.45" C y Cr^ dttn B'— - --- ti -73 c✓ 3/4" - 1 I/P' Washed Stone NV EL El. 74.00' INV EL INV EL INV EL -Sump 73. 78' `�;`:�. :: `'' _::`: �:::. Stage width Varies to 4' Max Exist to Remain 73.98' :s".st4�°: • : 2' a•a a+° 30 1/,2" Height °�a A 74.18' (xxst) 4 HOLE DISTRIBUTION BOX ; aepth a a-a° 90" Length ° a•a El. 71.45" with end caps 710,, 52 Cultec 330 - H 20 1000 GALLON SEPTIC TANK TO REMAIN PRECAST REINFORCED CONCRETE DISTRIBUTION BOX - 14� tir Install on a level el base PROPOSED INFILTRATOR TRENCH � a 1.0 �'� Minimum wall thickness = 2" (10' WIDE X 30' LONG) Minimum inside dimension = 12'" Design Da ta: g Outlet inverts shall be equal to each other and at �e Three Existing Bedrooms: �� 2 minimum below inlet invert. Bottom Observation Hole El. 66.0' Proposed System: The distribution lines froir the distribution box shall all have a U 3 X 110 gpd = 330 gpd Required Flow equal inverts as determined by flooding the distribution box to Adj. High Ground LOCUS x , No Garbage Disposal the height of the distribution line invert after all lines have a .. Use: Infiltrator Trench 30'L x 10'W x 2' Eff/Depth been sealed 1n place. Hater <El. 58' (Mapped) [30' + 30' + 10' + 107 x 2.0 = 160 Invert adjustments shall be made by filling with durable and Mill 4 nondeformable material permanently fastened to the line or Pond 30' x l0' = 300 reconstructing the lines until all Inverts are of equal elevation. v 460 x 0. 74 = 340 GPD Total Design Flow for New System 126 78 74,86 , 76 _ ®co ou{e WV L.O C' US' MAP •Y8 � Cp -- ' ASSESSORS DATA• Existing 1000 Gallon \ MAP 59, PARCEL 7-10 lank to Remain 75♦05' GENERAL CONSTRUCTION NOTES 1. All the workmanship and materials shall conform to D.E. P Title 5 29 � �'�' REFERENCE PLAN: and the Town of Barnstable rules and regulations for the subsurface �� 426 - 89 disposal of sewage. Pa do ,' FEMA DATA- ZONE "C" 2 At least one access port over tank tees shall be accessible — water fvithin 6" of finish grade, with anv remaining access ports brought -,� a 109'� ZONING DISTRICT.- RF to within 6' of finish grade. o' ,`� �� ; OVERLAY DISTRICT- 3. All components of the sanitary system shall be capable of ~ Deck EX7.15TING v ¢l ; GP & RPOD withstanding H--10 loading unless they are under or within 10 ft DWELLING 4 J167 p 7 .63' BUILDING SETBACKS of drives or parking. H-20 loading shall be used under- or Within 13 FRONT 30' 10 ft of drives or parking unless noted. Plastic equals may be f �� ' SIDE AND REAR 15' used in lieu of all precast units. 1 2p' _ 4, The excavator/contractor shall verify the location of all site b utilities prior to any exca va tion, and shall he responsible for all matters relating to electric easements. Shed `—Pro Existing C b osed ab P way q ,� V on blocks ti 10' x 30' Drive ' 5. Sewer pipes shall be 4 Schedule 40 PVC laid at a min. 0. 0,2 slope.72 6. Any masonry units used to bring covers to grade shall be �� ti �� , Infiltrator french _ -- mortared in place. - Pump and Remove 7. Finish grade shall have a minimum slope of 0. 02 ft per foot. LOT 1 36 Existing LP Se tic ZI - Grade Plan of Land \ � �� -- � '� � � For 14,480_tsq.ft. _ �1V62 5`I 36"F �_ -------- 150•39 74.�s 16 7 RIVER RIDGE DRIVE Soil Log TB E'1. 76. 0' In 0.. 72 Performed By. S. Doyle „01, GRAPHIC SCALE Marstons Mills, Massa ellusetts Date: February 10, 2005 ,S� 10.yr 312 Scale: I" = 20' Date: February 21, 2005 Perc Rate: <2 Min/Inch 4 " zo 0 o ao +o ko inu Prepared By- Stephen J Doyle And Associates js' I 10yr 4;`=1 ( 1N FEET' } � 42 Canterbury Lane, E. Falmouth, MA 02536 1 inch = 20 ft. �� Telephone: 5081540-2534 FINE IOyr 514 TO STEPHE"+ K'i t�q�, MED. L T� � r o LIEtiC•:pq.4N ► 1 ' � t 031559 ~•' � s tdO.23971 a� s a�' "4* y�4 ai -o��.a�."n•., c cQ'�~ - SAND , '4No sv�y� — » NO. DATE DESCRIPTION BY