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HomeMy WebLinkAbout0490 RIVER ROAD - Health 490 River Road Marstons Mills - _ A= 060-039 - -- - Town of BA•nstabie. P#_1 a H 7 Department of Regulatory Services • Public Health Division Date 342710 xeresr�, sib�q tee$ 200 Main Street,Hyannis MA 02601 3 wlFD Mft� �, Date Scheduled v Time Fee Pd. y o l { I Soil Suitahility Assesshient fog- Sewage isposal I CjI,Y!�✓� Q,L{Q� Witnessed By: m+LU t !i✓`. s Performed By: - i LOCATION & GENERAL INFORMATION Lxation P.ddress d � 17 Owner's Name �(> �Me Lo" PI 4 �O T q- T7�N S I�r�t u JS j �0vo .saw s g rc.�,•,�►+ �&. j�/,p,n S j M ; Address es , VA 221 v L Assessor's MaPtcel: tU 060/Q 3q j Engineer's Name Svc Da-W'L'1 M• �'� /N NEW CONSIRU�`i'ION REPAIR Telephone# 362-- 29 Z2 Surface Stones Land Use I�t-5���.�` �v Slopes(90) f Distances from: Open Water Body> Zoo Zoo Possible Wet 00 Area 7 t ft Drinking Water Well: ft i y too ft Pro � Line 7� y ft Other ft Drainage Way Property SKETCH: U^ 0 W` F (IV08 13AVa0 W 49 .50 a 50411 �y h� 4 a. �Y>� c`'i +i �� wto Y/ d O CYO U W - - �S• err Z l ASV W 00 4 Si ... co X I F_0L 1 d)�N` S \ LLJ U i N ( 3 \ i h O Parent material(geologic) act Depth to Bedrock Depth to Groundwakdr. Standing Water in Hole:' A i Weeping from Pit Face Estimated Seasonal Vigh Groundwater ��ry D) `ERMINATION FOR SEASONAL HIGH WATER TALE Method Used: in. Depth to Soll M0tths: In, Depth Clbserved standing in obs.hole: — in, groundwater AdJustment ft- Depth toiweeping from side of obs.hole: I AdJ,Groundwater I.eVCI Index Well# Reading Date Index Well level __ Adj.faatoC, .�� i PERCOLATION TEST Date )fie, Tip. Observation Time flt 9" Hole# Time at 6" -- Depth of Perc Time(9"-6" Start Pre-soak Time.@ _ ) ------ — End Pre-soak l0 . i Bate MinJInch Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(YIN) Original: Public;le'lth Division Observation Hole Data To Be Completed on Back— ***If percola#6n test is to be conducted within 100' of wetland,you must first notify the Barnstable C4#servation Dhision at least one(1)week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel bti f 4-0 A (�m-n1 Sam 10W, 3/ IV >a loci- 4011 E fP SaAd 10YR x 4-o`i_ l3Bu IMed Scud DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) q'' g M14 lu DEEP OBSERVATION HOLE LOG Hole# Depth from' Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten ra I Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No" Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? Q If not,what is the depth of naturally occurring pervious material? Certification I certify that on t D (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 require ( ining,expertise and experience described in 3,10 CUR 15.017 Signature Date Q:\SEPTIC\PERCFORM.DOC J fd TOWN OF BARNSTABLE LOCATION e r J SEWAGE # k` VILLAGE �0.r�5L°Di')S �� k ASSESSOR'S MAP & LOT 46P 03 INSTALLER'S NAME&PHONE NO. ✓��- �/a �P o E� c SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 94 9 n 2446BERGR OWNER i`iX a o�Ot�t�L PERMTTDATE: COMPLIANCE DATE: r 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 TOWN OF BARNSTABLE LOCATION SEWAGE# 7 VILLAGE ASS//ES''SOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. 00 SEPTIC TANK CAPACITY /z$00 LEACHING FACILITY:(type)/ (size) NO.OF BEDROOMS - OWNER PERMIT DATE: COMPLIANCE DATE: f Separation Distance,Between e: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Watek 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 R * 3 6?41 A No. ��C-) . Fee C THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes appliLation for is 05 '*pstem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) []Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and TeL No ��� Assessor's Map/Parcel�� Q `r► Installer's Name,Address,and Te_11�To. a Alt y7 ��,jZq�� Designer's Name,Address,and Tel.No� � �0 - _11z - Type of Building:Dwelling No.of Bedrooms Lot Sizea�u3sq. ft. Garbage Grinder( ) Other Type of Building �e5p No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank d Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of h. N Signed Date !/ r Application Approved by c Date Application Disapproved by Date for the following reasons Permit No. �Lo 1,U 01 f Date Issued (e3 f No. � � - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �UQBLIC-HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for IBtlo� Y 6pstem Construction 3permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel r Installer's Name,Address,and Te_1..No.uo,V /G.t47 DY/f (F Designer's Name,Address,and Tel. /i p/ — Type of Building: ' `'ti Dwelling No.of Bedrooms Lot Size q.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets r Revision Date Title Size of Septic Tank " /Qop Type of S.A.S. Description of Soil Nature of Repairs or Alterations Answer when applicable)p ( Date last inspected: Agreement: - The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of "tth. Signe�� Date Application Approved by Date - C. Application Disapproved by Date for the following reasons Permit No. U V r ( � Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS ' (Certificate of Compliance r f THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(vJ� Upgraded( ) Abandoned( )by !VIIIAA-4 at U has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,A 0/0 `b(b dated y—/3` r Installer Designer #bedrooms _ Approved design flowtt 3 3 gpd The issuance oft s per fit shall not.be construed as a guarantee that the system winfuncbn as designeDate �� (] Inspector / lt.1. ------ "- -=----------=-- - _ = = ------------- - = --------- gU ----Fee --- �d _1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Disposal *pstem Construction 'permit ,Permission is hereby granted to Construct ) Repair ) Upgrade( .)-I-- Abandon( ) System located at /s' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with r Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this perntj Date �� Q Approved by Town of Barn stable .� Regulatory Services Thomas F. Geiler,Director • BARNSTABLE, °ASS. Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 503-362-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: ' W ZU Sewage Permit# f1 Assessor's MaplParcel Designer: ►-,Ie A � E/" installer: �/�/� Z 6ell� Address: 0 Address: i�A57- S�WVW)Gg A4, 0Z537 1- On �� �� ) / /�` was issued a permit to install a (date) (installer) septic system at Z 6� based on a design drawn by (address) Y-Y'e✓', 6e- dated (designer) J41 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Of y (Installers Signature) 1 V �NITAIt�p� � .�Zl '�b esigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 346-adoc j Town of BArnstable. P# Department of Regulatory Services Public Realih]division Date 200 Main Streeh Hyannis MA 02601 3 Date Scheduled a v Time_ 6 Fee Pd. ,foil Suitability Assessment fog- Sewage isposar Performed By: l� ! Witnessed By: d'`�t pL�O�C�ATION & GEN]ERAL INFORMATION _ l.rcatioa P.dd ess b ti"vr`t �� i Owner's Name Fs�' �ML, l,oMj M I4 &r►7. YV l&asTo J S AI 11,s, MA Address j,L A"n). VA 221 v Z M. Assessor's MapP�tcel: D60D/0 Engineer's NatneDaWA 1 NEW CONSIRUOON REPAIR '` I Telephone# S06 %I--,2ec1 7-2 Laud Use InF.JJTI A'L Slopes(40) Surface Stones ",K Distances from: Open Water Body> Zoo ft Possible Wet Area ----too ft Drinking Water Well ft Drainage Way y o� ft Property Line 7 y ft Other ft SKETCH:c so U� O O OV08 13AV60 W V2 / a 49 — o +� SO4'11 N 4 �c 5 • .y !7 � O 1 n n . . F W `` /—_- 2.!1�\``•lam`\ 6 C5 -H n u Qf Q to w— u O [Y W U _ a S. r1 �Z' lS ASV SS 00 m i W Uj OJ / L j 0 t i �uL( RS"I Depth to Bcdroek .. Parent material(geologic)� i1 � /� - IIL1 i Weeping from Pit Fact..-. (_...r....----- Depth to Groundwater. Standing Water in Hole: to i P g Estimated Seasonal High Groundwater t `D DtTERM NATION FOR SEASONAL HIGH WATER TA]3LE Method Used: C, ;f cosww15 s -N i tj/A jr.. Depth Observed standing" obs.hole: /2-7 1 in. Depth to Spll t110ttles: i ; in. otoundwnter Adjustment Depth tolweeping from side of o hole Ad.Groundwater LeVel Index Well# Reading Date:� Index Welt level s Act.fai toY,,� - j PERCOLATION TEST Date-)� T��'_____. Observation Time at 9" �- ------ Hole# ¢� o� Time at b" ....- -- Depth of Perc Time(9'�6") -------- _ Start Pre-soak Time.@ -- ; End Pre-soak L Z^�" !\„[.fir•. I Rate MinJlnch C• X Site Failed; Additional Testing Needed(YIN) site Suitability Assessment: Site Passed • Original:.Public k;elth Division Observatiot Hole Data To Be Completed on Back y — ou must first notify the ***If percolalyibn test is to be conducted within 100' of wetland, Barnstable C4#servation Division at least one (1)week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel ()t'- 14' A, l0Y 3/ l41! 4oit 8 W , lov s o DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other = Mott, (Structure,Stones;Boulders. Surface(in.) (USDA) (Munsell) — — — �—-' Consistenc %Gravel Q3 Y if it DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Hori on Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten ra I Flood Insurance Rate Map: Above 500 year flood boundary No Yes _ Within 500 year boundary No" Yes year flood boundary Yes No Within]OOy _. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? Q If not,what is the depth of naturally occurring pervious material? Certification I certify that on 10 (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 require , fining,expertise and experience described in 310 CMR 15.017 Signature Date lv Q:\.SEPTIC�PERCFORM.DOC Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6115/2000. Inspection forms may not be altered in any way. A. Certification �� o Important: When filling out 1. Property Information: computer, the Q O \``v�� + _/f1. /rl LLr com uter,use 4 %A i�Jp� only the tab key Property Address n R A to move your A L+ A O� J 9� V cursor-do not � --- use the return Owner's Na`� key. �3 T u rn b k i ro R t N e. RA Owner's Address A.-t-il,c- k /Town C' �' State Zip Code w J`:",: Date of Inspection: d.� Date 2. Inspector: Name of Inspector Company Name Company Address PL © 2366 City/Town I State Zip Code I -1,8t - AS4 - �Sas- 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 the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of A'-site — sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340�of Title 5(310 CMR 15.000).The system: Passes `7` ❑ Conditionally Passes ❑ Fails -< ❑ Needs Further Ev uation e Local Approving Authority Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving uthoritf-($oardn of Health or DEP)within 30 days of completing this"inspection. If the system is a s ared 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. t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 1 of 16 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) '�`f 10 R yve A- R- Property Address y s4©:,j m�u� _ _ mom. o2c��cr3 City/Town State Zip Code AL 4-6 6 A--S Pc)Q N - lam` — l`�I ® -' Owners Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) S�found I have not 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: NB) 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: t5insp.doc•1!/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Ii Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) RA Property Address .I[1 ,j M % Us 42�{8 ity/Town State Zip Code Owner's Name Date of Inspection 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 ❑ 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: 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 t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 4 A. Certification (cont.) Property Address in by%z 4-o^j MLl.L _ /tr'1 O ZCo 45 City/Town State Zip Code. Owner's Name Date of Inipedlion fk+ ) Further Evaluation is Required by the Board of Health(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 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: t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 r Commonwealth of Massachusetts Title 5 Official Inspection Form v Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) VQ`ye- R� Property Address City/Town State ZipCode Owners Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ p( 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 Y2 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. ❑ �K' Any portion of a cesspool or privy is within a Zone 1 of a public well. El well. 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 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 No ❑ Q/ The system fails. 1 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. . t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form. Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) Sao t�t�� Property Address yY1 ky s-1-ati LLg 11U 02(v 4 8 City/Town State Zip Code Owner's Name Date of Inspection 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"rid'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 ❑ El Area 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. t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist jq 90 Property Address C1 AAM-�O A m LLLA o z c0 4 9 City/Town State Zip Code Owner's Name Date of Inspec ion Check if the following have been done.You must indicate`fires"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? ElHave 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? 0' ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? bd ❑ 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(3)(b)] t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form Co System Information Property Address M A-\,s-�aN A n 2 y 8 Cityrrown State Zip Code Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder? ❑ Yes VNo Is laundry on a separate sewage system?[if yes.separate inspection required) ❑ Yes KI"No Laundry system inspected? N A ❑ Yes [/No Seasonal use? El Yes 8 40 Water meter readings,if available (last 2 years usage(gpd)): Sump pump? ❑ Yes 93"N4o Last date of occupancy: Commercial/industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.fL, 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: Last date of occupancy/use:. pate Other(describe): t5insp.doc•11M04 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 it Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) Property Address City/Town State Zip Code &L ArGG / 3-SNulv- -t 9-o s- Owner's Name Date of Inspection General Information Pumping Records: Source of information: '` (D�-O"Aj Was system pumped as part of the inspection? ❑ Yes VNo If yes,volume pumped: NA gallons How was quantity pumped determined? A-)A. Reason for pumping: MA 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) ❑ Tight tank.Attach a copy of the.DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes 2*'No t5insp.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 I r Commonwealth of Massachusetts Title 5 Official -Inspection Form Not for Voluntary Assessments it 15� Subsurface Sewage Disposal System Form C. 'System Information (cont.) Property Address AIMS s City/Town State Zip Code Owner's Name Date of Inspection Building Sewer(locate on site plan): — O Depth below grade: feet Material of construction: y]cast iron 40 PVC ❑other(explain): Distance from private water supply well or suction line: A) feet Comments(on condition of joints,venting;evidence of leakage, etc.): Septic Tank(locate on site plan): 1000 Depth below grade: feet Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: Aj A years Is age confirmed by a Certificate of Compliance? (attach a copy of El Yes No certificate) Dimensions: X 14140 a K 94 a Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness f l Distance from top of scum to top of outlet tee or baffle t Distance from bottom of scum to bottom of outlet tee or baffle t ` How were dimensions determined? �Tci � 4%,4A,4 5 t5insp,doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form r ' Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) Property Address City/Town State Zip Code Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, li id levels as related to outlet invert, evidence of leakage, etc.): %-&VIA 4e4k. Po M PAI'Ue, ryF��r�A ' e--e S-A,N NV G py Le ram,� AjA Grease Trap(locate on site plan): MA i Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 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): t5insp.doc•11 J2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 f Commonwealth of-Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cunt.) qo R VA, Zr Property Address M, C)2 to $ City/Town State Zip Code A�G 4S 0G, Owner's Name 'Date of Inspection A) Tight or-Holding Tank(cunt.) Dimensions: Capacity: gallons Design Flow. gallons per day Alarmpresent: ❑ Yes ❑ No Alarm level: Alarm in Working order. ❑ Yes❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Distribution Box(if present must be opened)(locate on Site plan): t Depth of liquid level above outlet invert Comments(note if.box is level and distribution to ouflets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etG.): t4=LL. )L;l:�' C�3�ie C AV-�-vj sir- -- /V es o Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No Alarms in working order: Yes ❑ No t5insp.doo•11/20l)4 Title 5 official Inspection Form Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title-5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form. n Co System Information (cunt.) RkveAr- Property Address 02(o�� City/Tewn : State Q Zip Code owner�s.Name .:. .Date of Inspection TJ A c Comments(note condition of pump chamber,condition of-pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: Tom' leaching pits number. t ❑ leaching chambers number. ❑ leaching galleries number ❑ leaching trenches number,length: ❑ leaching fields 'number,dimensions: ❑ overflow cesspool . . ritimper. ❑ innovative/attematroe system Type/name of technology: ' Comments(note Condition of soil,signs of hydraulig:failure,level of ponding,damp soil,condition of vegetatio},etc.): t5insp.doc•11rAm ? Official InspeWm Fomt Subsurface Sewage Dispose System- Page 13 of 16 • Commonwealth of Massachusetts Title 5 official Inspection Form �w-VNot for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 4qO KL:r42A- QA Property Address City/Town State Zip Code Owner's Name Date of Inspection l� 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.): Privy(locate on sit6plan): 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•11/2004 Title 5 Official inspection Form:Subsurface Sewage Disposal System Page 14 of 16 } • 1 Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) g,.v�, RA Property Address /Yl A 4 O Z!o _ $ Cityfrown State Zip Code Owners.Name Date of Inspection. 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. �s 1 � � 9 ! _ r { f I I ; I . I t5insp.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form IN Not for Voluntary Assessments � Subsurface Sewage Disposal System Form C. System Information (cont.) "It Property Address rC4 ��Q A 0 z Cityrrown State Zip Code -AA- A-AM 0rQS- fie- -1-®s Owner's Name Date of Inspection Site Exam: Slope , Surface water Check cellar Shallow wells a Estimated depth to ground water: 1 -3 ar 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: G c� Sv rY o y tiAJ t5insp.doc• 11/2004 Title 5 Official,Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 TOWN OF BARNSTABLE ^?.00ATION 'V JD I v C2 T?p_ SEWAGE # • Q0 VILLAGE�'J S 7IOA) /li115 ASSESSOR'S MAP LOT p d INSTALLER'S NAME & PHONE NO. 0619 C V 3 SEPTIC TANK CAPACITY 19A LEACHING FACILITY:(type) ::Q�27 (size) — 3 NO. OF BEDROOMS _7 PRIVATE WELL OR PUBLIC WATT BUILDER OR OWNER DATE PERMIT ISSUED: DATE . COLIPLIANCE ISSUED: j VARIANCE GRANTED: Yes No �C 1 t _ c� �. 36 y� � SSESSORS NIAP NO: -'RR CEL NO... No. FEB_�L THE COMMONWEALTH OF MIASSACHUSETTS BOARD OF HEALTH LkOi i-6L VIP ..,T O.W_n.....................OF....... ... . .. ........................ .. .. ....... Applirafti i u for Mqpaoal i Do rki i To utitrurti o n PrIr Application is hereby made for a Permit to Construct or Repair (%,-I an Individual Sewage Disposal System at: ..................... ... .................................................................................................. To M PNJO Loqation-Address or Lot No. ........................... ........................5.1:.M. ....... ................................................................................................. oo C , c ..& ddress InstcIer . . j ��( Address Type of Building Size Lot............................Sq. feet U oms...VD.D (?2I......................Expansion Attic ((\)/)A Dwelling—No. of Bedro Garbage Grinder ((\)A 04 Other—Type of Building %9R<lt............. No. of persons_.Rf?u.r............. Showers Cafeteria dOther fixtures WWA§_�M_/ . ........................................................................ 7 Design Flow.................�5.....................gallons per person per day. Total daily flow..............OQ.....................gallons. 9 Septic Tank—Liquid capacity_1_9ftqt..gallons Length..k.(a Width_'!,.Aq'.. Diameter................ Depth.5............. Disposal Trench—No................. ... Width_....____....__..... Total Length._._.__............. Total leaching area....................sq. ft. Seepage Pit No.-____.__I.......... Diameter...J--- ---------- Depth below inlet.....S6.'!......... Total leaching area..;4�......sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by................................NVA------------------------------- Date........................................ ,4 Test Pit No. I................minutes per inch Depth of Test it___.__._..........._ Depth to ground water..__...___...._......__. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..._...___......._.._... Rr' ........................................................ -----------*­-----------------------------------------------------*------------- 0 Description of Soil......... .................................................................................................................................................... �4 U ......................................................................................................................................................................................................... .....................................................................................................................................::....... --------------------------------------------------------- U Nature of Repairs or Alterations—Answer when a plicablel�Xi_4o��5----- ..+.t ....f)*.+5-----W.7- _..().......h—R.j2�C...D....Dpx.................................................................................. ...... ... ... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate 06Corapliance has been issued by the board of health. -------------------------------- Z/i Z"R2........ Application Approved B ................. ..... ....... ppi ....... Date Application Disapproved for the following reasons:.........................................................:.................................................... ........................................................................................................................................................................................................ Dat 0, Permit No........................................... ............................... . S.... Issued........... ............. Date t No.� -�. t F.R$. .S THE'COM`M.ONWEALTH OF MASSACHUSETTS 7 l r 'i.frk ir'�i BOWR® HEALTH TDB F gAjist� b Lc - : ................................................. Appliration for Bh4pos ai Works Tontrurtion 1hrmit Application is hereby made for a Permit to Construct ( ) or Repair (✓) an Individual Sewage Disposal System at 4Qo ►elver C . I� arsforI5 M Lis .............. - ......_.._....-.............----------------...........•...•....... .......------------------------------........-----------------------------------............•••••. Torn -R Q c ,out�Elddress -SCL m e_ or Lot No. ...............r.�...,.."..._'...._..... /1 ►( ... /.........--_-------/-....................------..............---....------------..... ............. a -O(.�t Dt t/LDwr�i c) In c- 1 C.�(/\i tt l'stt rn ess f1 &rW D-L .. ........ ...............................................---<---J---------------•---- .. .. '\J 1J._t�.l�......._...... Installer Address Type of Building Size Lot----------------------------Sq. feet 1-1 Dwelling—1\.o. of Bedrooms.......... ................Expansion Attic (NhA Garbage Grinder (QJA p.1 Other—Type of Building _...w - ..._.. No. of pers ns._._.��-_-___- Showers ( I ) — Cafeteria ( ) a' Other fi ures -----. ----Y1 -� �S.'1--tJLl.dk1 QJL. W Design Flow..........._5............................gallons per person per day. Total daily flow..............�3...................._._gallons. N S i 04 Septic Tank—Liquid capacity g .gallons Lengthl.�-- .'... Width.._.. D. ._ Diameter________________ Depth...._..g_'�.... Disposal Trench—No..................... Width_..�............... Total Length......__....i7...... Total leaching area....................sq. ft. Seepage Pit No........I........... Diameter------[Z._....... Depth below inlet_.....b....._.... Total leaching area...Z—W......sq. ft. Z Other Distribution box (✓) Dosing tank ( ) �' Percolation Test Results Performed by.............................. ---J-A•-•----••--•----------------•---- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------_............ Depth to ground water__________-.-___-----___ a O •� Descr�ipt�t'o�n of Soil.................... -�--------------------------------------•-•----•--•------------------------------------------------------------------...........---- V . ••----•---•-•----•---•------------••-----•--•-----------•--••-•-•------•---•-•-••-------------------•-•--••-•••....•-------•------•-----•••------•--•----•-••.........--•------------- W --------------------------------------------------------------------------------------------------••----•----- :.. x U Nature of Repai>s r Alterations—Answer when applicable......E. t h__ C�................................ ......m me.�.... ?-iaQ. ?� W.l� -h.....►'1D...fi�?1c....�------. .---$6X-................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT'La: y g g p y 5 of the State Sanitary Code— The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has ben ' sued by the board of health. �(.' 121 ed.. . • .. ........................................................... �r..._ Application Approved By.................................... --- ------------ -----•-•-------- -------- ---------- -------------- Date Application Disapproved for the following reasons:.............................................................................................................. -................ 2 I•^ � Date PermitNo........................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH b......... oF...........T'j GIJL YLS tZ� �A.................... (IrrtifirFa#r of Tautpliatta THIs 1 TO CER,�lu That the Individual Sewage Disposal System constructed ( ) or Repaired (✓S at--•---------=•••=•-- - _�---�---r------�j-.---•-----v 1,Wr5-----stall------ -----------------------•-------.-•---•-----•--------------------------- has been installed in accordance with the provisions of j/oV41_j tJ ate Sanitary Co c of in the application for Disposal Works Construction Permit No.__.....'"`"................'.....JJ...... dated_............................................... TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. � ) DATE....... - /.Z:_.. ...... -•-•---- Inspector....................................r---------•----------------------------•-•----. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I f 2 oll�. ........ ....OF........................� -s....---- b.JL-----------........ ta �- No......................... FEE........................ Eliavoua� orkv 'Wonwtr ton �eruti Permission is hereby granted............... Db&� b L� In ---------------------•----------------•---••--• ....... ----..... ............... .---•---------- •----•--.-••-- to Construct ( ) or pair (✓) an Ind'vid al Sewa a Di sal S s em at �vo. ----- ��..,-vl?r '�?�• N�...,�,rs�s- �. 1 L s 2 - Zf Street /ram Z. as shown on the application for Disposal Works Construction P .....::::....... d.::._____.__....._.....---............. ----- DATE------- .................................. Board of Health ------------------------- ------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS TOWN OF BARNSTABLE LOCATION_ gD l�i V e,2. i�� SEWAGE # VILLAGE I. . S /Off. /�l1�/J AS MAP & LOT 0� INSTALLER'S NAME 6z PHONE NO: a�/� CO y3 • SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WA'TE BUILDER OR OWNER o f?a z DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No {f e O D.�. i r . i a az a 39 j MARSTONS MILLS QO LOCUS U) N S77.51, PARCEL ID: wAKEgY 40.,E 061/004 226.36 ��p LO LO PARCEL ID: TBM: TOP COR OF RET. WALL 060/039 ELEV.=54.08' GIS± AREA=49,523f LOCUS MAP FENCE LOCUS INFORMATION ABUTTING PLAN REF: 545/41 PARCEL ID: ^ ^ TITLE REF: 20747/66 N h 50 �� p�2 PARCEL ID: MAP 60 PAR. 39 060/001 M� —_ I E Q ZONING: "RF" h rP-1 I� Q FLOOD ZONE: "C" 24 LoC O COMMUNITY PANEL: 250001-0015-C DATED:08/19/85 X TOP of I TANK SEPTIC SYSTEM ' ELEV. I REPAIR PLAN = i Q ,. a 50.14 I #49 I I LOCATED AT: -; TCF= DECK ; ' 1 490 RIVER ROAD 56•27' MARSTONS MILLS, MA. PREPARED FOR `~ wgLKWgy Q �, `. I, .ii, FEDERAL HOME LOAN / / I MTG. CORP. !k AWN ' 9 P' APRIL 10, 2010 SCALE: 1"=30' o �\ Existing Leach rt a (Note 10) 52.0 1 30" P1 E ��� OF MASS AR M. .36.14' n 55 k 16,7; Uo No. 1140 _ , 5775140.,F - -- - ; - / cr 'PFCI$iE��� RI VE _ SgNIT 0R * CB/D ' e� ' at Inep Port q R� UPOLE 852�9s DARREN M . MEYER, R. S. \ 82� P. O. BOX 981 ' EAST SANDWICH , MA. 02537 (508)362- 2922 A SHEET 1 OF 2 J#1239 NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:47.89 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER � OF MqS OUTLET AND SET TO 6" OF' FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. �*Q, Jq�y F.G. EL.=50.Ot F.G. EL.=52.0-50.0t F.G. EL: 53.5f F.G. EL: 53.89(MAX.) DA E s I R L = 10.. ± 9" MIN COVER/ N , ® S=1% (MIN.) 36" MAX COVER L = 70' L - 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) ® S=1% (MIN.) 0 S=1% (MIN.) �TF 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC SANI TA�\�`� t0" 14 H . 6 11.3" TO INV.= 49.23 a8"uvw0 INV.=48.98 INVERT LEVEL PRDOBOXEO 3 ROWS OF 5 UNITS AT 6.25'/UNIT + 0.75' WEDGE = 32.0'/ROW GAS BAFFLE INV.=47.80 INV.=48.0 DB-3(H-10) INV.= 47.50 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1,500 GALLON SEPTIC TANK RESTORE VEGETATIVE COVER GENERAL NOTES: EXISTING SEWER OUTLET BACKFILL WITH CLEAN PERC SAND 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL TO TOP OF CHAMBERS BOARD OF HEALTH AND THE DESIGN ENGINEER. NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS PIPE .INVERTS PRIOR TO CONSTRUCTION OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=47.89 LOCAL RULES AND REGULATIONS, EXCEPT AS NOTED BELOW: GRADE ON A MECHANICALLY COMPACTED SIX INV. ELEV.= 47.50 INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 46.56 - 310 CMR 1 (1) (B): EXISTING SUITABLE 1) A 3.OFT. VARIANCE IANCE FROM 310CMR15.221(7) TO ALLOW LEACHING 70 BE 310 CMR 15.221(2) 2.83' MATERIAL 3) REPLACE EXISTING 1,500 GALLON SEPTIC TANK 5' MIN. ABOVE BOTTOM OF 6.0 FT BELOW GRADE VS REO'D 3 FT. (H20/VENT PROVIDED) T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 3 x 2.83' = 8.49' WITH 1500 GALLON SEPTIC TANK IF FAILED, 3. THE .SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR DAMAGED, OR LESS THAN 1,000G IN CAPACITY. (6.14' PROVIDED) USE 3 ROWS OF 5-160OBD H2O TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 4) INSTALL INLET & OUTLET TEES AS REQUIRED ADJ. GROUNDWATER EL.=40.42 - ADS BIODIFFUSER UNITS-NO STONE DESIGN ENGINEER. W/ CONTOURED WEDGE 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN SEPTIC SYSTEM PROFILE ENGINEER BEFORE CONSTRUCTION CONTINUES. TYPICAL SECTION 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. N.T.S. HAS. 5. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF DESIGN CRITERIA SOIL LOG THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF NUMBER OF BEDROOMS: 3 BR P#: 12887 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.EXIST.(PROP IS IN ZONE II/WELLHEAD PROTECTION DIST.) DATE: APRIL 12, 2010 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 8. PROPERTY IS LOCATED IN A ZONE OF CONTRIBUTION. DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DAVE STANTON, BARNS. BOH 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY DAILY FLOW: 110 G.P.D/BR. Elev. TP- 1 Depth Elev. TP-2 Depth THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING DESIGN FLOW: 330 G.P.D. 50.0 A p" 52.0 A 011 10. EXIST. LEACH PIT TO BE PUMPED, CRUSHED, AND FILLED PER TITLE V. GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) LOAMY SAND LOAMY SAND PROPOSED SEPTIC TANK: USE EXISTING 1,500 GALLON CAPACITY 10YR 3/2 10YR 3/2 1 1 . NO WETLANDS WITHIN 150 FT. OF PROPOSED LEACHING 48.84 B 14" 51.25 a 9" 12. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING LEACHING AREA REQUIRED: (330) = 445.94 S.F. LOAMY SAND LOAMY SAND 13. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT .74 10YR 5/8 10YR 5/8 DISTRIBUTION BOX: 3 OUTLETS (MINIMUM) H2O LOADING 46.67 14. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR PRIMARY S.A.S. C1 40" 49.84 C1 26 THE USE OF A GARBAGE GRINDER USE 3 ROWS OF 5 - 16" ADS 16008D BIODIFFUSER H-20 UNITS-NO STONE 15. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION MED. SAND MED. SAND CONSTRUCTION. AND EXTENDED 0.75' W/ CONTOURED WEDGES 2.5Y 7/4 2.5Y 4/7 PERC ® 48.0 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) PROPOSED SEPTIC SYSTEM SITE PLAN (BIODIFFUSERS) 15 UNITS x 6.25 LF x 4.70 SF/LF = 440.63 SF (CONTOURED WEDGE) 3 ROWS x 0.75' x 4.70 SF/LF = 10.58 SF 38.50 138" 41.0 132" 490 RIVER ROAD, MARSTONS MILLS, MA TOTAL AREA = 451.21 SF PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Mike Dedecko DESIGN FLOW PROVIDED: 0.74GPD/SF(451.21 SF) = 333.89 GPD > 330 GPD req'd TESTHOLELLE #I- Engineering by: Surveying by: SCALE DRAWN GROUNDWATER OBSERVED AT 127" EL. 39.42 DARREN M. MEYER, R.S. ArecDougell Survey NTS D.M.M. • 1, Darren M. Meyer, R.S., CSE, hereby certify that 1 am currently approved by MADEP pursuant to 310 CMR 15.017 INDEX WELL: SDW-253 ZONE: B PO BOX 981 (508) 419-1086 to conduct soil evaluations and that the above analysis has.been performed by me consistent with the LEVEL: 46.8 ADJUSTMENT: 1.0 it. DATE: CHECKED EAST SANDWICH, MA 02537 SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. ADJUSTED GROUNDWATER AT EL. 40.42 508-362-2922 04/13/10 D.M.M. 2 Of 2