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HomeMy WebLinkAbout1042 RIVER ROAD - Health 042 River Road Marstons Mills A A = 045 - 030 - - -- TOWN OF BARNSTABLE LOCATION 0 L1 2 rt ur r Ir SEWAGE# VILLAGE s�«„q �I r� S ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.C-Aek_a,,'S b;rL ,JO FS 776 9 SK 3 SEPTIC TANK CAPACITY 1,5Gc I r LEACHING FACILITY:(type) ? ,5C b Cl IAtW&r, - (size) 3 K ✓Z NO.OF BEDROOMS OWNER 0CZ E'-t SIC PERMIT DATE: C7150 COMPLIANCE DATE: o / Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility V b (f 4Cbb-meet 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) r >� Feet FURNISHED BY �vf� ��0� Gorr 5U -. �0 3 s" , L f No. �1 v Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppfication for Disposal 6pstem Construction J)Efmit Application for a Permit to Construct( ) Repair(0/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot NOAOJ Z' 1 oe r •1 ( Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 3,,t 6 Installer's Name,Address,and Tel.No. S� r17 6 C�Ct 6 3 Designer's Name,Address,and Tel.No. L^y� I,� e m'In �'JG ti plij1°rF 12 L'�o rfi� f r� Ares D� TI pe of Building: ^c Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 141 gpd Plan Date 9 I q Number of sheets 2 Revision Date Title Size of Septic Tank l Sd� / Type of S.A.S. 2 500 Q 14 i/k 14A�('_c; Description of Soil 1M C S•g+� Nature of Repairs or Alterations(Answer when applicable) V\,eQ $P,1Ae V,t 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 gned Date Application Approved by - -" Date Application Disapproved b Date for the following reasons Permit No. 2,0I 9— �6Gf Date Issued_1 3�/;,;kP/� ' t r Fee g�� 4y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for i-Disposal 6pBtem Construction Permit Application for a Permit to Construct( ) Repair ), Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot Nofs !4 vr, f ;� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 6 `j 5 _ a _3 G ' 'I � k(i, � 1k a Installer's Name,Address,and Tel.No. E-o v Designer's Name Address,and Tel.No. /� �-'-�"-'- -Cti Jw' _ �� ��' ("— � ����s?�v_AC � .� Efld Type of Building: —.. ,Delling)No.of Bedrooms w Lot Size q 3 C sq.ft. Garbage Grinder(` ) Other Type of Building No.of Persons Showers( ) Cafeteria( Other Fixtures Design Flow(min.required) '2 ` "} gpd Design flow provided i ' gpd Plan Date t ! y Number of sheets j Revision Date Title Size of Septic Tank Type of S.A.S. 11, s.-,r 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 Health. Si ed 1 1_ Date i, " / Application Approved by Date 2a Application Disapproved by Date for the following reasons Permit No. ���y- ��{ Date Issued !9No_O-V0 9 -ram° --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(rd) Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N67 — -161 dated 13 Installer tlYj Designer #bedrooms _� Approved design flow A A( gpd The issuance of this permit sha 1 not be construed as a guarantee that the system will nc' n designed. Date v Inspector t , NJ ------------------------------------------------------ / ---------------------------------------------------- ------------------- No._oil' Fee `— �7 6 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit . Permission is hereby granted to Construct( ) Repair( 0) Upgrade( ) Abandon( ) System located at��} Q l 4 d4J�--�� f „�►� M11.1 .� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit.C,;7 Date C/ �� Approved by _ ��? �� Town of Barnstable 04 r Regulatory Services Richard V. Scali,.Interini Director • sanxsrAat,t:. 9q,A MASS. ���Q Public Health Division rFD"'iP�p Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 509-862-4641 - Fax: 508-790-6304 Installer&Designer Certification Form Date: t 6( Z.I cc� Sewa;e Perumit# 9 361 Assessor's Map\Parcel t S 6 3 Designer: u „�ee� ,� �lcrf�r 5 l�tC Installer: _ �6 Vic]an 5 C](CCAJcf Address: )2 1,V; Crb,;s Address: MA 6Z6,,41q On Q / ` t— ��^l 6,10W � LixC'4�was tsKued a permit to install a (date) (installer) septic system at j U 12 a t Uec R6 _based on a design drawn by (addre ss) r rt gQ�r r'j �1/CS t/LCs k I � dated (designer) /.I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in with the turnis of the I`,A approval letters(if applicable) (In aller's Signature) cNIL Rfl3l5j��� (Designer's Signature) (Affix Designe ere) 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. QP.Septi igner Certification Form Rev 8-14-11doe Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfll.The engineer did not supervise construction of the system.The installer assumes responsibitly=or all materials,workmanship,backfiiling to specified grades with proper compaction and setting risers,'covers as shown on the design plan. APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS i, LOCATION 4 fJ A, y`F NO. VILLAGE / l av-$ 7�o.*v 'ty1,'ll J DATE APPLICANT FEE /S ADDRESS �•7 � l� � �,r /f1//2,5 ,1 �k NO. (Q n-refundable) e ENGINEER /5 TELEPH JTE NO. DATE SCHEDU ED (Applicant' s signature) v_. • • • • • • • o • • o • • • • • • • o o o • • • • • • • • e • • o • • • • • • • • • • • • • • o • • • • o • • • • • • • • e i o • • • • • • • •Z55 o • • • • • . SOIL LOG SUB-DIVISION NAME p0"�J o P9'?+e 461eCo J DATE Z- 4- �` TIME t(); E'XPANS,ION AREA: YES ✓ NO t_ cC*• ENGINEER TOWN WATER PRIVATE WELL t/ P, �. iMUQ BOARD OF HEALTH EXCAVATOR' r' SKETCH: (Street name,etc• ,dimensions of lot, exact location of test holes and � percolation tests, locate wetlands in proximity to test holes) NOTES : Q UV }�: 180 . 0d Guy- Z � Lru vS 7 E5 r6V PERCOLATION RATE: Z SINS /PO4 L �2-. �- D P - /a w-k L )'9 A__.-1 1� •� cJ J1^�h TEST HOLE NO: A. ELEVATION: TEST HOLE NO: " ELEVATION: 1 1 3 sbri sr>L 3 5 E 5 6 6 0 7 7 U 8 44 s 8 9 � 9 I 10 D 10 i 11 12 12 13 LQ6�V_ 13 14 14 15 15 -16 16 !.._SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING SREn:- ES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: i NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ; ORIGINAL: COMPLETED IN ENTIRETY BY P . E. AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT , P '-0-'vf ION sFk E--kLTH OF SSACH.-SF:—I—,S ExECUTIVE OFFICE OF EN4'IRONTVIENTAL AFFAIRS /�S ' DEPARTMENT OF ENVIRONMENTAL PROTECTION /,/-5 <.14*1 TITLE OFFICIAL INSPECTION FORM--N FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FOR-), I PART A CERTIFICATION Property Address o d oas S O 61 Owner's Name: c w�Owner's Address: ;� °v''Y { tv► tole � Date of Inspection: o - Name of Inspector: pl7e print)d k e(�.e Company Name: a ra�lc H �-7--- Mailing Address: cot Kr.:s. Telephone Number: ,S`V rYl 0�q! -- 8- 5 "� 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 DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 6 D� 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 ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address flow the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/1SP-000 page I R Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: I?i ,2 Owner: .. A 4 At.+ Date of Inspection: L /,2-3/gr' Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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 desZfta Conditional Pass" on need to be replaced or repaired The +stem,upon completion of the re repair,as appr d by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the f owing statements.If"not determined"please explain: The septic tank is metal and over 20 yeaseptic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfik failure is imminent.System will pass inspection if the existing tank is replaced with a complying septiroved by the Board of Health. *A metal septic tank will pass inspectionif it' structuray sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years d is available. ND explain: Observation of sewage ba p or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a b en,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health)• broken pipe(s)are zplaced obstrvcti(m is removed distri6utioti box is leveled or replaced ND explain: The s tern required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspec on if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I I OFFICIAL INSPEC a ION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 61p iecj� Owner: c�.eaG.l� Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determ' e if the system is failing to protect public health,safety or the environment. I. System will pass unless Board of Health determines in accordance with 310 R 15.303(1)(b)that the system is not functioning in a manner which will protect public health,saf v 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 wetl d or a salt marsh Z. System will fail unless the Board of Health(and P is Water Supplier, if any)determines that the system is functioning in a manner that protects the p tic health,safety and environment: _ The system has a septic tank and soil abso tion system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface ater supply. _ The system has a septic tank and S and the SAS is within a Zone l of a public water supply. — The system has a septic tank SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. ethod used to determine distance *"This system passes if t well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile or is compounds indicates that the well is free from pollution from that facility and the presence of ammo a nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are gered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DMOSAL STEM INSPECTION FORM PART.A- CERTIFICATION(continued) Property Address: /00 Rivv /C Owner: _ Gke,o Date of Inspection: L _ D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool o(,' 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'/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 _ -.4 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. 4 Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than IbO 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_conponzds 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 a ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Ad (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 mast serve.a facility�Wideesigu flow of 10,000 gpd to 15,000 gpd- You must indicate either"yes"or"no"to each of the folio (I'he following criteria apply to large systems in addi ' to the criteria above) yes no the system is within 400 feet of urface drinking water supply _ — the system is within 200 f of a tributary to a surface drinking water supply — _ the system is located' a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a publi ater supply well If you have answered' s"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D ve the large system has failed.The owner or operator of any large system considered a . significant threat der Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The sy ern owner should contact the appropriate regional office of the Department. 4 Page 5 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: mj`, "?,<� Owner. Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? _ Has the system received normal flows in the previous two week period? A' Have large volumes of water been introduced to the system recently or as part of this inspection? _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up? �^ _ Was the site inspected for signs of break out? a _ Were all system components,excluding the SAS, located on site? _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum? 4 _ 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 _ 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)] 5 { Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address 69 iuo je-f � S Owner: G -e4 N Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 33D Number of current residents: .2 �h Does residence have a garbage grinder(yes or no): /w Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no):A0 Seasonal use:(yes or no):/10 Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no)a00 Last date of occupancy: C.W� COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.20� . gpd Basis of desi/available: eats/persons/ etc.): Grease trap s or no): Industrial wag to resent(yes or no): Non-sanitaryc ged to the Title 5 system(yes or no):_ Water meter *available:Last date of /use:OTHER(de GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no):Ltd If yes,volume pumped: gallons.--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM (Septic tank,distribution box,soil absorption system _Single cesspool —Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank `Attach a copy of the DEP approval Other(describe): Approximate age of all components, e installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): �C7r7 6 i Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /O 90 A r Owner: A4CC4(n _ Date of Inspection: 0 3� BUILDING SEWER(locate on site plan) . Depth below grade: _ 3 6 _ Materials of construction:_cast iron _�L40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: 0( (Iocate on site plan) Depth below grade: fps- Material of construction: #(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: lOUOc�'ctt Sludge depth: go Distance from top of sludge to bottom of outlet tee or baffle: 3� Scum thickness: cP a N Distance from top of scum to top of outlet tee or baffle: $ Distance from bottom of scum to bottom of outlet teeAr baffle: How were dimensions determined: NM 60 r Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): �// `� J e 'ftt,��C a� OataCs Ti c�Y TYrS i cep IP eo KJen GREASE TRAP:_(locate on site plan) Depth below grade:— Material of construction:_concrete_metal iberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of tlet tee or baffle: Distance from bottom of scum to ottom of outlet tee or baffle: Date of last pumping: Comments(on pumping re mmendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet inve evidence of leakage,etc.): 7 page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM {�INFORMATION(continued) Property Address: Oya 1RtUf.t- 1W Owner e, � S Date of Inspection: 3 o S TIGHT or HOLDING TANK: (tank must be p at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete I fiberglass_polyethylene other(explain): Dimensions: Capacity: a ns Design Flow: alIons/day Alarm present(yes /alarm Alarm level: orking order(yes or no): Date of last pumpin Comments(conditiod float switches,etc.): DISTRIBUTION BOX: K (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: eWCM 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.): ` 66x &Jct�s (e ve� ma c - w ��Nk Ito 61a el Gar Cum PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no):. Alarms in working order(yes or no): Comments(note condition of pump ch r,condition of pumps and appurtenances,etc.): Page 9 of I I OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: to V.1 o Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS):-A.(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number- innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): `x i s I I foo b w 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 in w(yes or na): Comments(note condition soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition o oil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.): 9 i Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: e(VeA PO q"A Owner: /,eo N Date of Inspection• 6 .. 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 wat er ter supply enters the building. �d1q� 3� Page11ofIt' OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: r Owner: Date of Inspection:I&V.&� SITE EXAM Slope q 45 Surface water 0'0 Check cellar ' v-> Shallow wells 00 Estimated depth to around water c2.5' 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) Accessed USGS database-explain: You must describe Ghow you established the igh ground water elevati n: it Any ;. LOC TION SEWAGE PERMIT NO. y VILLAC I N S T A LLER'S NAME i ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED D DATE COMPLIANCE ISSUED � � �3 R I I,L L (C ~ Noi. G�---- t Fps..../.... _..........:... THE COMMONWEALTH OF MASSACHUSETTS oit��D� BOAR® OF HEALTH .................. ........................O F..........................................----------------......---..-_................... Applira#ion for Dhipaii al Warkii'Towitrurtion ratnit Application is hereby madefor a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at- I ion-Address or t No. ...--------(!�,.91�`r ....._ ZAiI ..........-•----......-•----.....-//UG!_ � ��+�.. /4d,1 i11C �r _. Owner �J /� A. e s W C. 1 � �1 ? _�r .. ........................... .......... ail fJ €r....dt. t .............i... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...................¢�..___......_.__.._..Expansibn Attic ( ) Garbage Grinder ( ) Other—T a ype of Buildin g _�� a�__. g --No. of persons.........V................ Showers ( j ) — Cafeteria ( ) P4Other fixtures ............. -----••------•-•------------•-------------------•••••-•••••--•-••••••-•......•....--••••-•.......... W Design Flow.................................. ........gallons'per person per day. Total daily flow____.__..-_.._33.2..................gallons. WSeptic Tank—Liquid capacity).4�aL2.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. �. Seepage Pit No--------------------- Diameter.................... Depth below inlet........:........... Total leaching area..................sq. ft. Z Other Distribution box ( v) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' ----••••••••--------------•----.._..•--•-•••---•...•---•••••••••••-•-.......-••..-••-•-•-------••••.......................................................... O Description of Soil.........................LQ.,51xiev...�t.,f ..........747.-?.....L 3 p-----------------------.......................... --------------------------------------------------- �Q�v -e U ...... /✓�----------- ', TP..----- _ �?...-------.....-•---•--------.....--...._ U x ----•-••••-•----------------------------------------------------•---••-•--•---...-----•,oO�V.6•--JA"."A- - ......----------------------------------- ................................ U Nature of Repairs or Alterations—Answer when applicable.---:_.__________________111�:>�......5 ,f._���...................___. ------------------------•----------------------------------------------------------------------•-••••---•---•-------------------------------••••-••--•----------------------•••-••-•-•-•--..........•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i1TI11 5 of the State Sanitary Code-The undersigned further agrees not to pl/11,em in operation until a Certificate of Compliance has been issued by he board of health. Application Approved By----- --- • ••....... ..-•-•••-•••-•••-•----......-•-•••--••....•.....................•-- ....................D a t e... Application Disapprov d f r following reasons--------------------------------------------------------------------------------------------Da .............. :° ...... -- -----------------•------••-----------.----------•-----•---•-------------•----------------------------------------------------------------------- Date PermitNo......................................................... Issued_....................................................... Date t No9j.— FEB ..............*.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................ ........._OF..................................... Appliration for Dhipniial Workii Toustrurtion Vamit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal- System at: ............................... .............................. ........................................................... .Ion-Address I No j 6 V 0 'A ...... ....... .......... A Owner ............ ...... .. .. ............. ... .......................................... e. ............ieA ,A................................... .......................... .... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................... ..................Expansion Attic Garbage Grinder '4 114 Other—Type of Building ovf persons.........V............... Showers Cafeteria ............Other fixtures ... . ........................... --­------------................................ .................... Design Flow............................................gallons per person per day. Total daily flow..............33.Ii;.7.................gallons. 04 Septic Tank—Liquid capacity. gallons Length................ Width........___.._._ Diameter_---_.__-____- Depth_....___._...... Disposal Trench—No..................... Width.___...__...__._._.. Total Length_____.__._._:__.._._ Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter..........;_._...... Depth below inlet___.__.___.......... Total leaching area,.................sq. ft. Z Other Distribution box ( L- . . Dosing tank ( ) Percolation Test Results Performed by-------*.............................*..........*......................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit._......_._....._._. Depth to ground water.._...__..____.._.._.__. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...___..._..._...._._... 04 .......................................................................... -------------------------3- ----------------------------------------------- 0 Description of Soil_____________________..... ..........iX413� .................................................. W - 4.. #V U .........................................................wahz4ej.......... .............. .......iw.,?............. ................................ ...... -------------------*------- .............................................................................. -14. /-------------------------------- U Nature of Repairs or Alterations—Answer when applicable._.......................A10 ........................................ ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT 1E 5 of the State Sanitary Code—The undersigned further agrees not to place the sysitm in operation until a Certificate of Compliance has been issued by tpIse board of health ig ............ Date Application Approved By___.._ ;_� ..... ......... . ................................................................... ........................................ Date Application Disapprov f r h following reasons:................................................................................................................ 0( 1 ...VW. .. ...................................................................................... ............................................ ZZ .................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS -BOARD OF HEALTH ..........................................OF..............................................................I...................... rdifiratr of Tautpliatta T�He�s TO C TIFY, t the Individual Sewage Disposal System constructed (4_�®r Repaired by.... ..... .............. ... . ... ...................... ......................................................................................................................... Install at................. ..........3---­------- . .. . ......... ............................ .................................................................... .......... .............. has been installed in accordance with the provisions of TIT Pvle fr) of hy ate Sanitary Code do in the application for Disposal Works Construction Permit No.__._t.#..........I. ....... dated---- ---- ---------- ----- ................ r tl 'g --------- 141-ZY .. ...... ..... - ----------------- following reason,.------ tfTIFY, at theldv�. ................ . ........ . .... ----------- ---------- ------ 'c .11 THE ISSIJ NCE OF THIS "CERTIFICATE SHALL NOT BE CONSTRU D A GUARA EE THAT THE SYSTEM Vlll IWC;ION SATISFACTORY. DATE..... . ...0 ...................................................... Inspectortor ........... ...................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... ...................OF..................................................................................... FEE._...A................. *, r�kii nstrudion prrmit , ,-E Permissioni!>eeby gprted........... ............I..................................................................................................... to Constructof,f r 1 Repair an al Sewage Disposal System 09 at No.-- 1. ­_Qvi.................................................................................... ..... ....... .................. Street as shown on the application for Disposal Wor s Construction Permit No______________ a __1. .......................... ....................................... ....... . ......... ................................. 0 DATE.......................... B 0 alt ..................................................... FOAM 1255 HOBBS & WARREN. INC., PUBLISHERS LEGEND a N EXISTING CONTOUR s ` x 100.98 EXISTING SPOT GRADE 0 cK F Rood POND j —w EXISTING WATER SERVICE a WATER SURFACE EL.=77.1 ° —6.H-V1 OVERHEAD WIRES --UGV1— UNDERGROUND WIRES <o�e 3 F O ^ / TEST PIT ° o� BENCHMARK ? LOCUS O�i�e y0 rq) S River R LOCUS MAP NOT TO SCALE + 79.66 oc \ + 80,f 39 / I / + 83.40N/ LOT 3 25,430 ±SF \ ; + 8 57 + \ \ + 86.06 8 72 + / V Lf) ' 87.30 86/ C5 \ 86.7 + 0 � N , / +'88:53 87.& • x 89,17 J� 8-,70 �� OF MASS x .5( f?OPANE 8 .3 // 2 P OPANE + 90 �/ q�9 90,03 PROPANE o PETER T. x S PRO cn � McENTEE jOLE,4NT(/ / /3 88.1 + 00 CIVIL91.36 No. 35109 DECK -- U'• REGIS(�� c�.n_ , 1 L fir'. + x 9317' 92,40 WALKOUT \� �.34� o EXISTING I I \ :rn HOUSE(#1042) \o T.O.F.=95.9t 93.74 Tp I / pRON• IBM rn COR./APRON .� 94.83xDECK 95,36 ' EL.=95.36 / 94.35 TIP GRAVEL x 94.91 `moo.>.:-':.._DRlVEWi4Y:: 95.63 -�TP-1 95.54 95,43 N 0 O 96 `` , 96, �l 96 80 _ 98.72 +51 PROPOSED S.A.S. 97.46 97f5�) 2-500 GALLON CHAMBERS DEADP E 98,41 :':!O.. SURROUNDED W/4' STONE .:.,:.:N. x 98.76 L�I46' 97.51 INSTALL VENT EXISTING SEP17C TANK PK SET TOP OF TANK, EL.=92.73 98.34 EDGE OF INV.(OUT)=91.4f 97.85 PAVEMENT 96,47 97.20 EXIS7 ,NG LEACH ]�PUMP VE-R PUMP, FILL WITH SAA NDAND ABANDONROA D OWNER OF RECORD SROCZENSKI, KEITH PARCEL ID: 045-030 MAR RIVER ROAD MAR RIVER MILLS, MA 02648 Engineering by: SCALE DRAWN JOB. No. PROPOSED SEPTIC SYSTEM UPGRADE FLAN Engineering Works, Inc. 1"=20' P.T.M. 222-19 1042 RIVER ROAD, MARSTONS MILLS, MA 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 8/9/19 P.T.M. 1 of 2 Prepared for: Keith Sroczenski, 1042 River Road, Marstons Mills, MA 02648 1 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:91.00 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S.A.S. AND SET TO 6" OF FINISH GRADE. PROPOSED D-BOX PROPOSED S.A.S. INSTALL WATERTIGHT RISER & PROVIDE ONE ACCESS MANHOLES TO WITHIN 3" COVER SET TO 6" GRADE OF FINISH GRADE FOR INSPECTION PURPOSES T.O.F.=95.9t CHARCOAL . F.G. EL.=95.0t F.G. EL.=95.4t F.G. EL.=95.6t F.G EL.-96.Ot VENT fMAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 42' L = 5' ® S=1� (MIN.) p S=17 (MIN.) 4"SCH40 PVC 4"SCH40 PVC 6" oo 10"I " 6 B6aaaB8 J�� INV.=911.4± BBa96a6 EXISTING 48' LIQUID aaaaaaa LEVEL 4' 4.8' 4' GASINV.=90.77 PROPOSED INV.=90.60 EFFECTIVE WIDTH = 12.8' • • •• • ... : . .. . • D-BOX INV.=90.50 (FIELD VERIFY) EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-20 RATED NOTES: TOP CONC. ELEV.= 91.6t 1 CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BREAKOUT ELEV.=91.00 INV. ELEV.=90.50 No CrI 6363010 61,3 00 INVERTS, PRIOR TO INSTALLATION. MB90 0 666663 aa.B aaaaa 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE BOTTOM ELEV.=88.50 ON A MECHANICALLY, COMPACTED -SIX INCH CRUSHED 4' 2 x 8.5'=17.0' V . ( ) PERVIOUS MATERIAL STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 4' MIN. OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION 4) CONTRACTOR SHALL INSTALL A GAS BAFFLE ON THE OUTLET TEE. BOTT. OF TP, EL.=84.5 ESTIMATED GROUNDWATER 3/4" To 1-1/2" DOUBLE EL.=77.1 (POND SURFACE) WASHED STONE SEPTIC SYSTEM PROFILE 3" LAYER OF 1 DOUBLE WASHED HEED STT ONEE (OR APPROVED FILTER FABRIC) SOIL LOG HOUSE(#1042) DATE: AUGUST 9, 2019 (REF#TPT-19-103) FRONT DECK SOIL EVALUATOR: PETER McENTEE PE(SE#1542) WITNESS: DAVID STANTON R.S. HEALTH AGENT ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH 60.4' N 011 ,_ 95.5 q 0 95.0 011 _S ND 4/2 OAM 94.0 A FILL 12 6 ,�low, 1 95.0 B 6" SANDY LOAM S.6' PROP. 1 10YR 4/2 S.A.S. 1 SANDY LOAM 93.5 18" 1 10YR 5/6 B 92.5 36" SANDY LOAM C1 10YR 5/6 �'L5 91.5 42" PERC C'32'/50" SEPTIC LAYOUT M-C SAND M-C SAND 2.5Y 6/6 2.5Y 6/6 GENERAL NOTES: 84.5 132" 84.5 126" 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. NO GROUNDWATER, PERC RATE: <2 MIN./IN. ("C" HORIZON) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS REFERENCE PERC P-125, JAN 14, 1981 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: -310 CMR 15.405(1)(b): 1) A 3' variance to the 3' maximum cover requirement, for up to 6' of max. cover. S.A.S. shall be H-20 and vented. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN CRITERIA DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING NUMBER OF BEDROOMS: 2 (APPROVED FOR 3 PERMIT#83-241) FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN SOIL TEXTURAL CLASS: CLASS I ENGINEER BEFORE CONSTRUCTION CONTINUES. DESIGN PERCOLATION RATE: <2 MIN/IN 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. (0.74 GPD/SF LOADING RATE) 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF DAILY. FLOW: 220 GPD (DESIGN FOR 3 BEDROOMS, 330 GPD) THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF DESIGN FLOW: 330 GPD HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. GARBAGE GRINDER: NO 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS .74 GPD/SF AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE EXISTING SEPTIC TANK: 1250 GALLON CAPACITY DIRECTED BY THE APPROVING AUTHORITIES. PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY USE 2-500 GALLON LEACHING CHAMBERS IN SERIES THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE TOTAL AREA:..............................................................471.2 S.F. INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) - 348.7 GPD 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. Engineering by: SCALE DRAWN JOB. No. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. N.T.S. 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