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HomeMy WebLinkAbout0013 ROSELAND TERRACE - Health 71 13 Roseland Terrace (Marstons Mills) A= . '11 Commonwealth of Massachusetts 103~h2v?- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ? 13 Roseland Terrace Property Address Baker i. Owner Owner's Name ' information is required for Marstons Mills Ma 02648 8-26-19 every page. City/Town State Zip Code Date of Inspection ' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. Inspector Information 151� y /_p forms on the computer,use Douglas A Brown Inc only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.O. Box 145 Company Address Centerville Ma 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify'that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 8-26-19 s ec a re Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts ' Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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: At time of inspection this system met or exceeded all minimum passing requirements. This report can not predict the future performance under the same or increased usage. This report is not to be used for bedroom count determination. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structural) sound, not leaking and if a Certificate of Y 9 Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1; V 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; v 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/20111 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments aL 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Cont. If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS lo cated on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 t Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: This system consists of a septic tank (probably original ) and a new d-box and 2 500 gallon leach chambers that were installed in 2016 there is also a leach pit that was left in place as well. Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: 2017---------297 2018----------303 gpd. We did not enter the house so we could not verify that there is no garbage grinder. This system is not designed for use with a garbage grinder. Sump pump? ❑ Yes ❑ No Last date of occupancy: currently occupied t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts it? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: appears to be 1000 gallon Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I always recommend pumping at time of transfer and every 2-3 yrs there after for maintenance. This septic tank is functioning properly. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c Commonwealth of Massachusetts �v Title 5 Official Inspection Form 1 I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: tank and pit appear to be original. leach chambers were installed in 2016. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 r • Commonwealth of Massachusetts ,�-p Title 5 Official Inspection Form j' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4� u � 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): box looked fine at time of inspection l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c` Commonwealth of Massachusetts �. = ,P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal 0 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.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.cloc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 cam, Commonwealth of Massachusetts ,4? Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: no g.w encountered at time of perc. feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed. 8-2016 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: I ' You must describe how you established the high ground water elevation: design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts �v 1'i4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,•v 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): one chamber was opened and had about 4 inches of standing water at time of this inspection with no signs of failure or surcharge. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑, Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; •v 13 Roseland Terrace Property Address Baker Owner Owner's Name information is required for Marstons Mills Ma 02648 8-26-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System SAS locate on site Ian, excavation not required): p Y ( ) ( P If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 TOWN OF BARNSTABLE LOCATION SEWAGE# aO(&- (2DC,,- VILLAGE dVlu n6 A4AI ASSESSOR'S MAP&PARCEL 1(33-12-0. INSTALLER'S NAME&PHONE NO; SEPTIC TANK CAPACITY = �( LEACHING FACILITY:(type) p (size) NO.OF BEDROOMS OWNER Bak_,eC PERMIT DATE:T�� J[, COMPLIANCE DATE: Separation Distance Between the: A7040---Ctf—fefC. 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 tC 13 Ro On Sr7�►$ h 1-30 a-33 I — risr.r our-1- - 'D -17 C OJT- 1-7 3G C No. 2 Ib—��� Y Fee ( v - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppfication for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(&4Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (' Owner's Name,Address,and Tel.No. Assessor's Map arcel p I ller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 5 1 xX�a�_i_.�c 5�3"`t00 7 t5 7 �rJ i Neet i^FV ps Type of Building: Dwelling No.of Bedrooms Lot Size l9', j7131 sq.ft. Garbage Grinder( ) Other Type of Building}fc�,� No.of Persons—' Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `g gpd Design flow provided 3 y�. 7 gpd Plan Date /2-' /S Number of sheets y Revision Date Title Size of Septic Tank Type of S.A.S. J Q^� qC.\�a H-\6 &t' d, tj q',5t jc Description of Soil Nature of Repairs or Alterations(Answer when applicable) r15¢C J N P:•y U 10 OK 6A U 2 SC 0 .Gd /G" J Cj 66M6P j C_1 57"C)L-NC [•J G Alcaw x 2S x j e/r4 Gc Show-3 n^� 0��� 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. Signed Date !G- Application Approved by Date �� —/ fo Application Disapproved by Date for the following reasons Permit No. C9 1b__ d Date Issued z. »... y No. Ito—b6� Fee ! `� f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: w: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS Yes 2pplication for Disposal 16pstem (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. Mars}ors Mai s� Ror� 1�{crfre �,v�� i ker Assessor's Map/Parcel .2.2 In taller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. J o r Ls Type of Building: 1 Dwelling No.of Bedrooms r ' Loi SizeA0,0 �. r s .ft. Garbage Grinder 7 q g ( ) Other Type of Building�P�iC�R�I a,�1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) ` t gpd Design flow provided 3 , Plan Date IQ_- 13 J S. Number of sheets 'Zb Revision Date Ti Size of Septic Tank r5 4--1.., Type of S.A.S. �. SCo AG`�O }�- t� r C W Ll Description of Soil Nature of Repairs or Alterations(Answer when applicable) fG I.- iv P w C) to OX G N U 2 S a) G /L ChGM�C'r� us y r o /2 .R X ZS X 1� 4/(�4 rc Sao jr'S nnl n � 1 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 ,r'1 Compliance has been issued by this Board of Health. Y ,� Signed - Date Application Approved by Date Application Disapproved by Date for the following reasons i Permit No. 1 OJ6 Date Issued ' I --------------------------------------------- ----------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by c/�4� 7&r r� at-/5J2 §'14ac.i e has been constructed in accordance with the provisions of Title-5 and the for Disposal System Construction Permit No.��l�i dated Installer ,A G I✓ Designer #bedrooms J Approved design'flow and gpd The issuance of this permit shall not be construed as a guarantee that the system will Finnctio as designe Y C Date / /��/ 4 Inspector / ----------------------------------------------------------------------------------------------------------------------------------------- No. Fee ( "l/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Disposal 6p$tem ConBtCUction 3permit Permission is hereby granted to Construct( )/ Repair( ) Upgrade( ) Abandon System located at fi- /G Gf' /l�G/t ^ c JCS 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-� l Date ' 1 I ir(V Approved by 1 Town of Barnstable Regulatory Services } Richard V. Scali,Interim Director BAWS ABM ; MAS& Public Health Division qj i639. �@ A Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 1 1 `t 1 l Sewage Permit# Z� Assessor's Map\Parcel 03—t Z,Z . Designer: M�6r�,���T,6 1,_ , Installer: � As - 3�a..0 f► 4►'t L Address: 1 Z 14,)-. Cro c s�7,Qkok R4 Address: P 0 • 1Ra x 14 5 a rQS}r�aLe . N1 t� 6 Z 6 Lf y vi je r v.t UL ►�1 i& Zfo 3 2 On/n//l6 P,A-,Ara 0 n L, was issued a permit to install a (date) (installer) septic system at i IZOS e 1 ci,Kt{ !err _ r?,M; S based on a design drawn by (address) dated /Z s (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 co Hance with the terms of the IAA approval letters (if applicable) ��P� MgS�9c�G II o PETER T. s (Installer's Signature) o M C�VILEE No. 35109 SW (Designer's Signature) (Affix DesigRN440W 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:iSepticlDesigner Certification Fonn Rev 8-14-13.doc I Town of Barnstable P# VIA I tie Department of Regulatory Services �. x BA MASS.LE, Public Health Division Date_11- L 9 1679• 200 Main Street,Hyannis MA 02601 ArfD MAt a Date Scheduled: U 13 Time Fee Pd. _ Soil Suitability Assessment for Sewaag,e Disposal Performed By: ���1�[ �✓1/�� �� I�YZ Witnessed By: LOCATION & GENERAL INFORMATION I Location Address /3 IzoSe14hd TeAc--( Owner's Name -Pn,�,d ,LzQ k-e— M M `115 /3 c � Address Assessor's Map/Parcel: 3 —/ZZ Engineer's Name $0ekY—MCC4K-2, I NEW CONSTRUCTION REPAIR � \ Telephone#SQ F-737-4 Land Use R -SF J."4Q Slopes(%) —Z Surface Stones l ! Distances from: Open Water Bo>_1q#__ ft Possible Wet Area 73�O° ft Drinking Water Well'?t$0 _ft IL ees Dra t ma-g N�lar ft Property Line �3-0 h— ft Other ft i -- ( SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) o j I /TOtT� i I t ! Parent material(geologic) Depth to Bedrock N/ 'C Depth to Groundwater: Standing Water in Hole: -J1A Weeping from Pit Face t 5 Estimated Seasonal High Groundwater 1 3 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: _in. Depth to soil mottles: _ Depth to weeping fro m side of obs.hole: in. Groundwater Adjustment _ ft. Index Well# Reading Date: Index Well level Adj.factor _ Adj.Groundwater Level PERCOLATION TEST Date_ _ Time Observation j Hole# Time at 9" _— �P Depth of Pere -�^^ C ( 22 7(T Time at 6" j -- i Start Pre-soak Time @ L Z Time(9"-6") End Pre-soak SOt 13 ✓` �tC-�t� ttCZ11 qd e Cd^S`S h Rate Min./Inch Z- W I i Site Suitability Assessment: Site Passed 34 Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland, you (must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. i q\SEPTIC\PERCFORM.DOC �4 DEEP.OBSERVATION HOLE LOG Holm# t Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. i _ OnSIStCrtcy,%Gravel�'1yGi C G'oGrS,clvic� 2S�C(m�t( _ 16 ogv-e-1 DEEP OBSERVATION HOLE LOG Hole:# z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stones,Boulders, — Cons' f;nsv,% raven— 3 2 Sl_ to yrZ Z—&6 6 C Z arse��� Z�s.'�CSC -- - � r . DEEP OBSERVATION HOLE LOG Hole#Soil Texture Texture Soil Color Soil Other De th from Soil Horizon � P Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _ onsistency.%Gravel)�— I i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling —(Structure,Stones`,Boulders. . i I Flood Insurance Rate Map: Above 500 year flood boundary No— Yes i Within 500 year boundary No � Yes Within 100 year flood boundary No A Yes Dlenth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout tho a�ea proposed for the soil absorption system? eS If not,what.is the depth of naturally occurring pervious material? I Certification I certify that on `r (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent:with the required trainin ,expertise and experience described in 310 CMR 15.017. Signature Date \SEPTICTERCFORM.DOC 30N ; -. � � SEW A G E" P.E RMIT, N0. . VI L.L:AG E I N S T A L L-E'R';S N A M ij_ A D D'ROE lJ B�1�&-D =R OR OWNER Di1'TE PERMIT ISSUED DATE COMPLIANCE .1SSU.ED j ► ` �. y. .t ! � �.. '♦ r« a a. " � _ t .. � w. t "' , `�� .. r �'�u � y.. ..... r,,. % � � K� �- ©. .., '1 ,�� � i ,;�,, �1 `�: � � �, ', r .• `, No....... S.... ... F�$............`a_............ -t'THE COMMONWEALTH OF MASSACHUSETTS BOARD O HE N.-i t:TH _ ............. �'......OF.......... Applirafiou for Disposal Worko Tons tiun amit Application is hereby made for a Permit to Construct (X)` or ;Repair ( ) an Individual Sewage Disposal Sys ...... .....•--.... ................................ ►. ...........•---- ---. .......;.. - •Locatio dress or Lot No. ....... �....... �?.Ml.. :... can ................................... ............. � ►_...�.�L'� O ner ^ n Address a ............ -�r- '-�--•---.. ..�t�t. .--------••---••--•------•--- ---••--•��c�......DC:�---.....�.�..1!L�!� ��..---•--•--------- Installer. Address Type of Building Size Lot_.690j_._U----A.Sq. feet Dwellin . of Bedrooms---------------- -----------------------Expansion Attic-�-�-- Garbage Grinder�� Other—Type of Buildirrg--D-. .-____-__-.- No. of persons............................ Showers ( ) — Cafeteria ( ) QOther�fi ures ------------------------------------------------------------------------------------------------------------------------------------------------------ W Design Flow 1.....E_61----------------------------gallons per person per day. Total daily flow.......ZU).......................gallons. WSeptic Tank Liquid capacity UDD..gallons Length................ Width-................ Diameter................ Depth................ x Disposal Trench—No. .................... Width :........._...... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........I_.......... Diameter......Y-_------_- Depth below inllet.........4....... Total lea gj ea._ P� .�....sq. ft. Z Other Distribution box ( ) Dosingtank,l,�(, ) 4/✓ S-s a- 7�'' `" 1-4 Percolation Test Results Performed by.,__V-_' G......`..... ------------- Date..k5=--.a Zf............. ,aa 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........................ ---------•- .... ......_.._.. y� :._ ..}... -------•------ O Description of Soil.......6--` .v-. . �... .- 7_-1 z..t..-----.... -.............................................................................................................. W ---------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------•---..... UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITiE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by-the. board of health. igned- -•--•--------------------•--------------•-.................... ------------------- Date? Application Approved By------- 1%�n`�? S..y. 1 ...--- ... �.' ' --------------------- Date Application Disapproved for the following reasons:----•----------•---------------------------------------•----.........------•---------------------------------- •-•------------------------------------------•-......----------------........--------------------------•------ I Date PermitNo.................................... Issued..... ----•-........................................ Date 7 NO...--- S,l---- r 4 Fss.... �?... t THE COMMONWEALTH OF MASSACHUSETTS f BOARD H EA T . ....OF..... .... . " Appltrtt#ion for Uiipusttl Works Tonstrnrtia tt Veirmit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal Sys t: ... .- _ .......' + .. ........... ............••-••-.........._...... ----------..... .......----.....---•-- Locati A dress or Lot No. ner Address Installer Address Type of Building Size Lot._ �p.._ :! ..Sq. feet Dwellingpoe go. of Bedrooms................ -----------------------Expansion Attie Garbage Grinder aOther—Type of Bui ----------------•-- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fptures -------•-•-••-- ••-----•-----------••--•••••••---•--..---••-•--•-•-------•--•-•--••• ......................... W Design Flow........66---•••.......................gallons per person per day. Total daily flow:......e�,;..d........................gallons. WSeptic Tank l Liquid capacity).S ..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Widt .................. Total Length......._ Total leaching area._ sq. ft. } Seepage Pit No....... Diameter.._' _........... Depth below inlet......... ► .._.. Total lea i ea.ts _. _.._sq. ft. Z Other Distribution box ( ) DosiUtank Percolation Test Results Performed by. yl .x............ .-_---------- Date..4 '=`! a.'.' ' '------_-. Test Pit No. 1................minutes per inch Depth of Test Pit...V............. Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......._................ • � .---- _,�'✓.u�����----1--- + -1, VOW Description of Ss'i l- . .. . =n -""- ..7!t-•- F'F -----------------•--------------------•---•--.....----- •-••-••-•-••......... -•------ x --••---`"" �-----1 ----- --- 1 --------------------------------------------------- --•----------------- ... ............... ------------.-- U Nature of Repairs or Alterations—Answer,,when applicable.............." ----......-•---------•--------------•---...........................------...........------•-------------.....--------•-----------------------,..------------....--•-•--•-------------------.........•--• Agreement: r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. x , . igned./.. ........ .................................................................. ................................ Dat Application Approved By.. y . r"�' ........ !1_"� r _ '._.. Date Application Disapproved for the following reasons:.................................................................................,............................... ....----••••--•-•••........--••••-•--••••..........--•----••....-•..................•••-.._._..-----•----'-•---•-------•--•-•--••••-•---•...•------•-----•-----•------=--••--......--•-•--••-------•---- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEA T O F. .......................... i.. .... .... Trrttf iratr of f�untplittnrr THVIO Y, hat the Individual Sewage Disposal System constructed ( -or Repaired ( ) by-- at.....' .--e- ......----•-. ........................... ---. stauer '_ �i�Y """. - i � .........- ° _`::'.....fir% ,• ----- has been ins alled ' accordance with the provisions of T "' r of The State SanitaryCode as"described in the application for Disposal Works Construction Permit No. ...___. dated .lQ .... ............... ,. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT_BE CONSTRUE® AS A GUARANTEE THAT THE SYSI TEM WILL FUNCTION SATISFACTORY. DATE-.`........................................................;---•-••-----...... Inspector...................................................................................... ; - THE COMMONWEALTH OF MASSACHUSETTS gx ' N BOARD O HEAL f. f9 ! _OF ... E..._... , w"4 No........................: FEE........................ Kits 01i nr notrudion firrmit Permission ' reby anted...... ..__:. to Const u I ) R it ( ) an Indi ri Sewage vosystz_ Street as shown on the application for Disposal Works,Construction Pgfqt No.__ _ .... Dated.._; .!!4......................... .__..... ..._.f...................•••------- — DATE.......... Board of Health •�s - 7••••••......•- ------------------ -- FORM 1255 HOBBS & WARREN.,INC.. PUBLISHERS t r_ l.,`.L:._ �L1,A%\1 L� �� T.7C�✓1C 1 ''7 NC =� �� `�,C��'�`1 �R � l s. •;c �As<•z.�c'.ir car{l+.lt��lL. � � .-„-j � mat t_�4 t:Law 110 4 3 = SSC) 4.P.v ..C:F-T lc -r4" C = 33C7.r (:�D % = L Cj 6.P.D ,� 1 JSPOSAL PlT - tJSE t00c, GAL . P-MEWALL AME.A tcj0 S t=. r lc� SF' 31C 2.S S 7'S G.P.D. 0 $c!T r oAA TOTAL TJ SS16Q = c� ► r X 425 G..vD. O �� Sq,� � ► ToTQL- UA•lL.,-( FL10W = 33C? 6.PD. i PE"aZGDI.ATIOLJ t2eTlr �",u 2M t u' otz L>~�5.� ��,p+ TAyt ' i s VEST Tor FNa =►oo.o In Icy, d"Ape 4 I r>oo 1�1V •i� 4'pp Vlsr; 1w. GALtp . r -sox 4G.� Snc i SU9.�o/L. ,� ►TA w. ' loco ICl �N�. tw '�, caaCad CPAL. QGL. sA.va 96.E G r�� PIT WAs►.tao CEQTt F 11~L7 p L.bT' Pt.._.Q.i•.l Paro =1L•I✓ loGr'►T►o� M A,,Q.s-rar.�S t�,9 !,.s_��' I G C tz-r t V=-{ T i-!A?' T 1-1 r-- t=o u N v ATl a N,51-lava►J Go&1 PL YS 'W{TIA TNT:.: 51 DE LI -1E-_ LOT 13 Auk r>ET0ACIG V'C4UICGAAEWTs OP Ti4C "r0 W►..! OC= S A Q h1 $T A.G3 i._E. JoL.f.�'N �'��G y �G ¢/ PATC tZEGtS t _jZC.D 1.AWo 5UeVa%.(o Tt-I,I'S PL.AW IS LIOT B SCV OW A.W 05TC,IZvtL.t..G o &(A5S, ti.lrst"�Jt✓lC:l.!i >tJF_./C`{ Tl{E. c�FG"SErr, 514Gl Lr-> !�}7Pt_i GA.F�JT'i�:✓r U,I- U��Gr) T-u ter.-_rr.QMt%4 1..O-C l_l titeS j--�> •..�'P� �n� ' �' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ' RECEIVED MAY29Z001 TITLE 5 TOWN OF BARNSTABLE HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNT SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 13 Roseland Terrace Mars tons Mi s, MA Owner's Name: Sophie Church Owner's Address: Date of Inspection: 41_ Name of Inspector: (please print) Wi 1 1 i am E_ - Robinson Sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA Telephone Number: (5 0 8) 7 7 5—8 7 7 6 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: 1- The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Heatth~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 approv—Mi g 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 how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - - _ PART A CERTIFICATION(continued). Property Address: 13, ResefaTdTer-r-as-emills Owner:.., Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sys �m Passes: (/ I have not found an information which indicates that an of the failure criteria described in 31 y y ocMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Co ments: B. Sy tem Conditionally Passes: ne 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 s,no or not determined(Y,N,ND)in the for the following statements.If"not.determined"please explain. septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, xhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing is replaced with a complying septic tank as approved by the Board of Health. *A meta septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indica ' that the tank is less than 20 years old is available. ND ex ain: bservation of sewage backup or break out or high static water level in the distribution box due to(broken or obstruct pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval f 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 inspe ion if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: ' Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 13 Roseland Terrace Marstonbs Mills Owner: Sophie Church Date of Inspection: /— 1-6 1 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 fail' to protect public health,safety or the environment. 1. yytem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the s stem is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. Sy tem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syste 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 s rface 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 front a pri ate water supply well".Method used to determine distance ** is system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bact ria and volatile organic compounds indicates that the well is free from pollution from that facility and the esence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failu criteria are triggered.A copy of the analysis must be attached to this form. 3. Oth 3 Page 4 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 13 Roseland 'Terrace Marstons Mills Owner: Sophie hurch Date of Inspection: r 0 D. System Failure Criteria applicable to all systems:. Yot4mjW indicate"yes"or"no"to each of the following for all inspections: Yes No _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private wager 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)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. La ge Systems: To be c nsidered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You mus indicate either"yes"or"no"to each of the following: (The follo ing criteria apply to large systems in addition to the criteria above) yes no th system is within 400 feet of a surface drinking water supply _ th system is within 200 feet of a tributary.to a surface drinking water supply _ the ystem 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 an wered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Secti D above the large system has failed.The owner or operator of any large system considered a significant.thre t under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The Sys em owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 13 Roseland Terrace Marstons Millc Owner: Sophie Church Date of Inspection: 4/— `l— G 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 II _/ Were any of the system components pumped out in the previous two weeks? l/ Has the system received normal flows in the previous two week period? t/ Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _V_ 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)J 5 Page 6 of 11 ` OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 13 Roseland Terrace Marstons Mills Owner: Sophie Church 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): — Number of current residents: u. Does residence have a garbage grinder(yes or no):k Is laundry on a separate sewage system(yes or no):ii.o [if yes separate inspection required] Laundry system inspected(yes or no):_k Seasonal use:(yes or no): /v 0 Water meter readings,if available(last 2 years usage(gpd)): 2000 32,000 gal. Sump pump(yes or no): 0 1999 45, 000 gal. Last date of occupancy:. COMN ERCIAL/INDUSTRIAL Type of establishment: Design low(based on 310 CMR 15.203): gpd Basis oj design flow(seats/persons/sgft,etc.): Grease rap present(yes or no): Industr. 1 waste holding tank present(yes or no):_ Non-s itary waste discharged to the Title 5 system(yes or no): Water eter readings,if available: Last to of occupancy/use: OTH) R(describe): GENERAL INFORMATION Pumping Records Source of information: A Was system pumped as part f the inspection(yes or no):fir) If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPZOF 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 or no):�L d 6 Page 7 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 13 Roseland Terrace Marstons Mills Owner: Sophie Church Date of Inspection: 4/—c J—0 l BU DING SEWER(locate on site plan) Depth elow grade: Mater is of construction:_cast iron _40 PVC_other(explain): Dista ce from private water supply well or suction line: Co ents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: /11 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: t� Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: d Scum thickness: 6 �. 1 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botorn of outlet tee or baffle: How were dimensions determined: p P,6, -- 7-* Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leaka e,etc.): X GREASE T P:_(locate on site plan) Depth below gr de:_ Material of cons ction:_concrete_metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from tol of scum to top of outlet tee or baffle: Distance from bo torn of scum to bottom of outlet tee or baffle: Date of last pum ing: Comments(on mping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to ou et invert,evidence of leakage,etc.): 7 Page 8 of]] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 13 Roseland Terrace Mars tons mi is Owner: Sophie Church Date of Inspection: Z-1-V ,7 1 T HT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Dep below grade: Mate ial of construction: concrete metal fiberglass_polyethylene other(explain): Dime lions: Capa it ,: gallons Desig Flow: gallons/day Al present(yes or no): Al level: Alarm in working order(yes or no): Dat of last pumping: Co ents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: 'y (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: _ Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUM CHAMBER: (locate on site plan) Pump in working order(yes or no): Al in working order(yes or no): Co ents(note condition of pump chamber,condition of pumps and appurtenances,etc.): i 8 f Page 9 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:13 Roseland Terrace Marstc)ns Mi 1 1 G Owner: Sophie c'h rch Date of Inspection: tf,-Git-o SOIL ABSORPTION SYSTEM(SAS): t/(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.): , o� CESS OLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number nd configuration: Depth- p of liquid to inlet invert: Depth of olids layer: Depth of um layer: Dimensio of cesspool: Materials f construction: Indication f groundwater inflow(yes or no): Comments note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: .(locate on site plan) Materials of onstruction: Dimensions: Depth of soli s: Comments( ote condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addresl3 Roseland Terrace Marstons Mills Owner: Sophie Church 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. �LJ -27 37 � 3 � I 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 13 Roseland Terrace Marstons Mills Owner: Sophie Church Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 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: �bserved site(aburting property/observation hole within 150 feet of SAS) hecked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must desc *be hkv you established the high ground water elevation: I1 �. x 10 _ -gg --EXISTING CONTOUR N y J102A1 x 100.98 EXISTING SPOT GRADE 101.00� '^ W EXISTING WATER SERVICE LOCUS / x \ CB w -8/-/, W`OVERHEAD WIRES ere�O°d / 100.33 1�� x 3 2.82 O t TEST PIT J J x 5 edge 101.54 'V BENCHMARK now on 101:16 �•--� � LEGEND � v Lakeside Dr 98:53 li 4 0 o coo o / I x x ) 0.82 100,59 J / x 98,78 l / 99.51 / �'� O l / � `S 6 � 100,17 �oJ � a ° ° �Pond l l 0 98.09x x 100.78 00630% / LOCUS MAP J 49 9 F / NOT TO SCALE x 99.92 9 �� 98.87 x� 01.17 / GENERAL NOTES: , 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL Z' 100.36 1 98 87 x 101.18 '100,44:,: > ; ,'< . :,:.,:;. 99.37 BOARD OF HEALTH AND THE DESIGN ENGINEER. x \• ' r ;' : :;. '''. •.',',:' :: TCHBASIN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS N 31 I- 12.8--I g 79 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ��'" LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: I ,... 99.15 101,20 ., : `;''` `:' //' -310 CMR 15.405(1)(b): O fQ, ,`:,;� �i'• t;:,;: ::,; `, t;.'r:. 1) A 10' variance, S.A.S. to cellar wall, for a 10' setback. 0cn x �tri•. '� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 101.21 N� ;::`� -�� DRl1/EWAY:::':`:':`;;. :, x 100: TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE TP-21 gyp' 10 EXISTING O�cy / DESIGN ENGINEER. 99,96 �a. '� x HOUSE 13 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING .: / FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN �:.', .. '•. :' � 99 28 T.O.F.=102 541 101,40;..;';.' =:.:,`':'`,'-..•..;.:• ':';.:•.,'. '- '. TP-1 \ "_' .J ;'r. 1p 8 ENGINEER BEFORE CONSTRUCTION CONTINUES. x 101,17 \ 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 99.71 _ 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 0TORTHE OR OWNER TO NOTIFY THE\ /� 99,77 HEALTHO FOR CPROPER INSPECTIONS DURING CONOSTRUCTON.BOAR OF B 101.35. . 100:/70 10 :0 DECK 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. \ 99A 10 .44 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 101,36 x 100,36 ( GARAGE 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS x 101.33 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 1 99.71 ) 102.01 DIRECTED BY THE APPROVING AUTHORITIES. / lv 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY C THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING \ 99,86 x x x p� CONSTRUCTION. 101,79 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS EXISTING LEACH PIT ) 100,62 �� x 1( � Gov, IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND TO BE PUMPED, FILLED WITH / Q LOT 13 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). SAND AND ABANDONED 20,072±SF -0 OF MAs 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE Is, A� �Q� s9� INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 59.12, oo' PARCEL ID: 103-122 ' o� PETER T. yG� 13.' THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND EXISTING SEPTIC TANK s8% McENTEE NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. TOP OF TANK, EL.=98.08 F x 101:68 /��\ o CIVIL N 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC INV.(OUT)=96.75f(VERIFY) � SHED No ' / / SYSTEM COMPONENTS NOT SHOWN ON THE PLAN /, Gl S BENCHMARK x 102,14 PROPOSED SEPTIC SYSTEM UPGRADE PLAN OUTSIDE COR./BULKHEAD 13 ROSELAND TERRACE MARSTONS MILLS, MA EL.=102.04 FNc� � � �31, � � Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. BAKER, DAVID C & Engineering Works, Inc. 1"=20' P.T.M. 243-15 TABITHA R 9 g 13 ROSELAND TERRACE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. a MARSTONS MILLS, MA 02648 (508) 477-5313 12/3/15 P.T.M. 1 of 2 NOTE: FINISH GRADE SHALL NOTBE PROPOSED 5 SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE S A. . INSTALL RISERS & COVERS OVER INLET PERIMETER OF THE S. 35.21 AND SET TO 6" OF FINISH GRADE. PROPOSED S.A.S. PROPOSED D-BOX PROVIDE ONE ACCESS MANHOLE TO WITHIN 3" 12.8'-� 229 INSTALL WATERTIGHT RISER & OF FINISH GRADE FOR INSPECTION PURPOSES T.O.F.=102.54t COVER SET TO 6" OF GRADE F.G. EL.=99.6t F.G. EL.=99.7f P6' F.G. EL.=99.5t F.G. EL.=99.7f Q i• p, MAINTAIN 2% GRADE (MIN.) OVER S.A.S. N N i o I, TING L =wz 27' L - 5' , l Cr Fj 6 ti 2 HOUSE(i 13) ® S=1% (MIN.) ® S=1% (MIN.) Z ,��' O l!l 4"SCH40 PVC 4"SCH40 PVC ! / 27 $� T.D,f =ft72;$¢f 14" 6666666 EXISTING 48" LIQUID amaaaaa LEVEL GAS BAFFLE I!EF!FEC 4.8' 4' INV.=96.27 PROPOSED INV.=96.10 INV.=96.75t D-BOX IVE WIDTH = 12.8' EXISTING INV.=96.00 EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP CONC. ELEV.=96.8t BREAKOUT ELEV.=96.50 SEPTIC LAYOUT NOTES: INV. ELEV.=96.00 ®aaa 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE aamaa mamma ease mamaB ME) INVERTS, PRIOR TO INSTALLATION, BOTTOM ELEV.=94.00 4' 2 X 8.5'-17.0' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' MIN. OF NATURALLY OCCURRING ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL EFFECTIVE LENGTH = 25.0' Ea STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE GROUNDWATER LEACHING SYSTEM SECTION ®®®® ® ®®® ®®®®®® ® ®®®® 33" 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTT. OF TP, EL.=88.3 — Of ®®®®®® ® ® ® ®Ea 4) CONTRACTOR SHALL INSTALL A GAS BAFFLE ON 3/4" TO 1-1/2" DOUBLE N > ®k0-®®®® ® ® THE OUTLET TEE. I WASHED STONE ? 3" LAYER OF 1/8" TO 1/2" DOUBLE WASHED " SEPTIC SYSTEM PROFILE (OR APPROVED FILTERTONE FABRIC) 102 SOIL LOG 4" KNOCKOUT DESIGN CRITERIA 20" DIA. COVER DATE: OCTOBER 23, 2015 (REF#14,861) NUMBER OF BEDROOMS: 2 SOIL EVALUATOR: PETER McENTEE PE(SE#1542) SOIL TEXTURAL CLASS: CLASS I WITNESS: DAVID STANTON R.S. HEALTH AGENT 4" KNOCKOUT 4" KNOCKOUT 58" DESIGN PERCOLATION RATE: <2 MIN/IN ELEv. TP- 1 DEPTH ELEV. TP-2 DEPTH 0 (0.74 GPD/SF LOADING RATE) 100.0 A 0" 99.8 A 0" DAILY FLOW: 220 GPD SANDY LOAM SANDY LOAM 4" KNOCKOUT 99.5 10YR 4/2 6., 99.3 10YR 4/2 6„ DESIGN FLOW: 330 GPD 8 B GARBAGE GRINDER: NO SANDY LOAM SANDY LOAM 500 GALLON CAPACITY, H-10 LOADING LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 975 10YR 5/8 30" 97.1 . 10YR 5/8 32„ CHAMBERS C C .74 GPD/SF L PERC EXISTING SEPTIC TANK: 1000 GALLON CAPACITY COARSE SAND COARSE SAND 24"/42" N.T.S. PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS 2.5Y 6/4 2.5Y 6/4 j USE 2-500 GALLON LEACHING CHAMBERS IN SERIES 10% GRAVEL 10% GRAVEL PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 94.5 C 66" 94.3 C 66" 13 ROSELAND TERRACE, MARSTONS MILLS, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. COARSE SAND COARSE SAND Prepared for: D.A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. 2.5Y 6/6 2.5Y 6/6 Engineering by: SCALE DRAWN JOB. N0. TOTAL AREA:........................... ...............471.2 S.F. DESIGN FLOW PROVIDED: 0.74 GPD SF 471 .2 SF = 348.7 GPD 88 5 / (3 C" HOR3Z 138 Engineering Works, Inc. NTS P.T.M. 243-15 / ( ) PERC RATE <2 MIN IN. I ONS) REF. PERC 5/22/78 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. NO GROUNDWATER ENCOUNTERED (508) 477-5313 12/3/15 P.T.M. 2 Of 2 -- 103 13 &-S6Z,4kp1 -r6kx� �Arz <l-C -ME 5tA.N�Poh h o « _ c z cc-- CS n _ . .........-- ) go 64 � C. Cx/ nk)& 3q 3 '�- _...... C i i