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HomeMy WebLinkAbout0325 ROUTE 149 - Health 325'route.149 ! MarstonsMills .P -(A 079 034 1� m Commonwealth of Massachusetts Executive Office of Enviromnental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 .Tolui Gf�ci ' D.L.P. Title VS-eptie�,jnspector T i P.Q Box 2119- 1 9 Te le et, MA 0253E WILLIAM F.WELD 508) 5647680 Governor ARGEO PAUL CELLUCCI Lt.Governor OCT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 8 w PART A CERTIFICATION Property Address: 325 RT.149 MARSTONS MILLS MAP 79 PAR 34 Address of Owner: t Date of Inspection: 9129/98 (If different) Name of Inspector: JOHN GRACI JULEE SWANSON:BOX 883 MARSTONS MILLS MA.02648 1 am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name, Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected-the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In Title V Conditional) code 310CMR16.303.My findings are of how the system is yasses performing at the time of the inspection.My inspection does Need#ibmit r Evaluation By the Local Approving Authority not lmpty any warrantyor guarantee ofthelongevttyofthe F81IS septic system end any of Its components useful life. Inspector's Signature: Date: 9130/98 The System Inspector shall scopy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the.appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B. C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoMpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection, or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127/97) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 0 Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 325 RT.149 MARSTONS MILLS MAP 79 PAR 34 Owner: JULEE SWANSON:BOX 883 MARSTONS MILLS MA.02648 Date of Inspection:9129199 — Sew.acie backup or.breakout or hich.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: — The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. — The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. — The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded nr clogged cesspool. SAS is in hydraulic failure. (revised 04127S7) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 325 RT.149 MARSTONS MILLS MAP 79 PAR 34 Owner: JULEE SWANSON:BOX 883 MARSTONS MILLS MA.02648 Date of Inspection:9129199 D]SYSTEM FAILS(continued) 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 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 0427)97) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 325 RT.149 MARSTONS MILLS MAP 79 PAR 34 Owner: JULEE SWANSON:BOX 883 MARSTON$MILLS MA.02648 Date of Inspection:9129198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: ,c_ _ Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x The facility or dwelling was inspected for signs of sewage back-up. x _ The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)) (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 325 RT.149 MARSTONS MILLS MAP 79 PAR 34 Owner: JULEE SWANSON:BOX 883 MARSTONS MILLS MA.02648 Date of Inspection:9129198 FLOW CONDITIONS RESIDENTIAL: Design flow: 3W g•p•d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 4 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): nfa Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:U gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: nra Last date of occupancy: nta OTHER: (Describe) rde Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM WAS LAST PUMPED 1.5 YEARS AGO. System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: rda TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date Installed(if known)and source Information: 1974 Sewage odors detected when arriving at the site: (yes or no) No (revised 04117)97) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 325 RT.149 MARSTONS MILLS MAP 79 PAR 34 Owner: JULEE SWANSON:BOX 883 MARSTONS MILLS MA.02648 Date of Inspection:9129198 SEPTIC TANK: x (locate on site plan) Depth below grade: 1' Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age rde . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le'6^H5'7^w4'10^ Sludge depth:3" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness:1" Distance from top of scum to top of outlet tee or baffle:5" Distance form bottom of scum to bottom of outlet tee or baffle: 16" How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: Wa Date of last pumpingn- Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: vs-, Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction line•TOWN Diameter: nla Qe,mments: (conditions of joints,venting,evidence of leakage, etc.) (revised 00797) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add reSS: 325 RT.149 MARSTONS MILLS MAP 79 PAR 34 Owner: JULEE SWANSON:BOX 883 MARSTONS MILLS MA.02648 Date of Inspection:9f29198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n1a Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: n1a Capacity: n1a gallons Design flow: Na gallons/day Alarm level:_nra Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Na DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: LIQUID LEVEL WrrH80 0M Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) D$ox Is structurally sound PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_v« Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) Na (revlsed 04R7W) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 325 RT.149 MARSTONS MILLS MAP 79 PAR 34 Owner: JULEE SWANSON:BOX 883 MARSTONS MILLS MA.02648 Date of Inspection:9129198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: Na Type: leaching pits, number: 2-6'xs'LEACHPrrS leaching chambers,number:n1a leaching galleries, number: nla leaching trenches, number,length: Ma leaching fields, number, dimensions:n1a overflow cesspool,number:n1a Alternate system: rda Name of Technology.__rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY,THE PITS HAVE NOT BEEN MORE THAN 314 FULL. CESSPOOLS:_ (locate on site plan) Number and configuration: rUa Depth-top of liquid to inlet invert: nla Depth of solids layer: nra Depth of scum layer: nla Dimensions of cesspool: n1a Materials of construction: nla Indication of groundwater: nra inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Na PRIVY:_ (locate on site plan) Materials of construction: Iva Dimensions: Na Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Na (revised 04127197) .s i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 325 RT.149 MARSTONS MILLS MAP 79 PAR 34 JULEE SWANSON:BOX 883 MARSTONS MILLS MA.02648 9129198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) a � Ia � 0 0 AA A� 3� A 3`1 A 6 � Pay ! of 10 (revised 04)27197) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 325 RT.149 MARSTONS MILLS MAP 79 PAR 34 JULEE SWANSON:BOX 883 MARSTONS MILLS MA.02648 9120198 Depth of groundwater 10. Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS (revised04127197) Page 10 of 10 APPLICATION FOR SITE PLAN REVIEW LOCATION Business Name: Subdivision Plan �nc�lsbn Lak eS Assessor's Map # 0 ° Parcel# 03 ANR Plan Property Address: Site Plan OWNER OF PROPERTY APPLICANT Name: Name: ' ¢� Address: 3 2 , . Address: Telephoner — Telephone Fax 20— Fax 7 ARCHITECT/DEVELOPER/CONTRACTOR/ENGINEER AGENT/ATTORNEY Name: Name: A L= e Address: Address: Q SecaV.U- Telephoner Telephone a Q aL(, Fax Fax d-bc)y STORAGE TANKS(HAz MAT/FUEL OR WASTE OIL) ZONING DISTRICT CLASSIFICATION N 1 A District Overlays) 0 Existing Proposed Lot Area Sq. Ft. —Ac. Number Number Fire District Size Size Setbacks (ft.)� Above Ground Above Ground Side 3 7 4- ,S� Rear Cype& j�() Underground Undergro �j Contents Contents �`" er f Buildin s N O N E0 9 u IL-D L N C-T E sting hD�2, Proposed 4 0 : 20bb oliti n UTILITIES �- T F OR AREA BY USE Sewer- Public Private ize g Existing (sq.R) Proposed(sq.ft.) Water- Public Private Basement y S Electric - [g Aerial ❑ Underground Residential Gas - KNatural ❑ Propane Restaurant Grease Trap - ❑ Size gal _ � S °,n Retail Sewage Daily Flow * j4c u w''`+� 0g`pd' 4-4e,. Office Q - low o cA49 I5;2,o3 sko,>,^ as Medical Office PARKING SPACES CURB CUTS �`{0 vv% Commercial (specify) Required I Existing _ Wholesale (specify) Provided 2 + Proposed — Institutional (specify) On-Site To Close — Industrial (specify) Off-Site Totals 2 All Other Uses On ', Handicapped Gross Floor Area *GP or WP areas restrict wastewater discharge to 330 gallons per acre per day into on-site system. WN Of BN a�iEW Q:SiteP1an:SPRPG3—02/20/2002 i Old King's Highway Regional Historic District File# Approved? ❑ Yes [No o Hyannis Main Street Waterfront Historic District File# Approved? ❑ Yes Listed in National and/or State Register of Historic Places? ❑ Yes o Previous Site Plan Review File # Approved? ❑ Yes o Previous Zoning Board of Appeals File# Approved? ❑ Yes ❑No Is the site located in a Flood Area(Section 3-5.1) F(ooj Zee, C, ❑ Yes ❑No In Area of Critical Environmental Concern? Lt,,,,k v.o iv,r\ ❑ Yes ❑No Is the Project within 100' of Wetland Resource Area? (,c n tcc�.�,,cJ,n Yes ❑No Site sketch-informal presentation Yes . ❑No Site Plan prepared,wet stamped and signed by a Registered PE and/or PLS. Yes ❑No Parking and Traffic Circulation Plan ❑.Yes 54 No Landscape Plan and Lighting Plan Yes ;❑ -❑No Drainage Plan with calculations and Utility Plan ❑ Yes ❑No Building Plans, (all floor plans, elevations and cross sections) ❑ Yes ❑No Note that all signage must be approved by Code Enforcement Officer at the Building Department Lot area in sq. ft. sq. ft r4`e—S Total Buildings) footprint clq& sq. ft. Gera K . Maximum Lot Coverage as % of Lot % GROUND WATER PROTECTION OVERLAY DISTRICT REQUIREMENTS' DISTRICT: Lot Coverage (%) Required Proposed Site Clearing (%) Required Proposed PRINCIPAL BUILDING ACCESSORY BUILDING(S) ❑ Yes XNo Number of floors�_ Height: ft. Number of floors Height: ft. FLOOR AREA: . . r FLOOR AREA: Basement sq. ft. Second sq. ft. Basement sq. ft. Second sq. ft. First ( sq. ft. Attic _ q. ft. First Sq. ft. Attic sq. ft Other(Specify 36'K ' S sq. ft. Please provide a b 'ef narrative description of your proposed p oject: ci • o � �,. , I assert that I have completed (or caused to be completed) this page and the Site Plan Review Application and th t, to the best of my knowledge,the inf ation submitted here is true. 0�1401 Date Printed Name of Applicant Q:SiteP1an:SPRPG4 02/20/2002 t _ DANIEL P.NEELON, ESQ. 5 EXPLANATION OF HOME OCCUPATION PLAN I am a business, business litigation and professional malpractice attorney presently practicing in Centerville. I am also a single, sole custodial parent of three boys, ages 11, 13 and 14.. As my sons go through their "impressionable" teen years, subject to peer pressure and a myriad of influences, I would prefer to be home as often as possible with them after school. I would also like to be able to work late when necessary without leaving my sons at home alone. Therefore, I need to be able to work out of an office in the home, but I also need a real, professional appearing office that is not just a spare bedroom. Anticipating any concern about a possible increase in traffic, please know that I only average 2-3 client visits per week in my own office. Because of the areas in which I concentrate, I do not have a "volume" practice. Many of my client visits occur in the clients' places of business around the Commonwealth (especially restaurant clients) or in the Boston office of the Boston firm with which I have an affiliation contract (Wayne, Richard & Hurwitz LLP). I also represent long-standing out-of-state clients who do not visit my office at all. ' Therefore, I do not anticipate that turning the garage into an office will cause any notable increase in traffic whatsoever on the already busy Route 149. Thank you for your consideration. t Sin ,I Daniel P. Neelon, Esq. is 1 y � c. A LOT 76 ;�0'00 - x . 66 1�56 00 s - _ - sus LOT 2 . e 0 �+ LOT 1 k ---6' 2- ;'gyp �� W tip /0 N �� e� �O. PARCEL E CD- a.,ee �P o RES ZONE.' "RF" This MORTGAGE INSPECTION plan is For FLOOD ZONE:' ':C" Bank Use Only TOWN: � ,5_7'OLY,S M!l�.S REGISTRY OWNER: LIR-W -&JUILF L S�NSON _ DEED REF: �'9�'f202 _ _ —BUYER: -8EFILVAN= _ _ _ DATE: 0_OB L2000 _ PLAN REF: �03 SCALE: 1" 50' -- FT. --- I HEREBY CERTIFY TO PJTBQLT_F N1�1Nf ___________________________THAT THE BUILDING MAIL YANKEE SURVEY SHOWN NAS AL. SHOWN ANDTHIS THAT ITS POSITION DOES PLAN IS LOCATED ONTHE-GROUND CONFORM lmwrrm i CONSULTANTS TO THE ZONING LAW SETBACK REQUIREMENTS OF THE ft3m 143 ROUTE 149 TOWN OF ---8,418VS-T.LIKC---_-___ ___AND THAT MARSTONS MILLS. NIA. 02648 IT DOES_AOT- LIE WITHIN THE SPECIAL FLOOD HAZARD TEL: 428-00-55 AREA AS SHOWN ON THE H. U.D. MAP DATED������_ FAX 420-5553 C0 aimimity-Panel a 2.50001 001.5 C :xu.:� n; r-�>~1 THIS PLAN NOT MADE FROM AN INSTRUMENT `g091 If,pp:11'(. :v \w lfffff;,v � F RVF.Y. NOT TO BE USED FOR FENCES. ETC. C� A Cam./o F F I c-E. FR o --------------- w ^ry�1 � ® Q~� �7 N O 7 o > ui N Z Q Z pep ! , pn- O L�.fl V ZLU M Z=C=u W to c Ck- El �.6, l.O l`nc�Q l,vS o►Z- !. t4 C — LOT 76 ' �� rt` fO 1 O O � 1 a� � �jZ•-LLl= t. � tY. 6 6JG _ sus LOT ,2 s i w N LOT 1 o �'__ __f�. �s O ti PARCEL E �� y 10 �`b SITE P Aft 0 4 0: 2004 L—Es ZONE- "RF" This MOR GA R P TOWN: Al�S1'OV BI k lUseoonl FLOOD ZONE.' DEED REF: �'9A1,6? — _ — R �'BR ,/U� W. S�XSo y _ DATE: 06 0_L2000 —BUYER: -EE�ILV,4N PLAN REF: 203 —SCALE: 1" 50___FT. I HEREBY CERTIFY TO E'-4TBQLT_FSl1V1�1cY� __— SHOWN ON THIS PLAN IS LOCATED ON THE GROUND ROUND HE DASD YANKEE SURVEY SHOWN AND THAT ITS POSITION DOES ____ CONFORM CONSULTANTS TO THE ZONING LACY SETBACK REQUIREMENTS OF THE "amm TOWN OF 6L4L _T.�B E 143 ROUTE 149 `-- 4--------------AND THAT [T DOES-Q- - LIE WITHIN THE SPECIAL FLOOD HAZARD MARSTEL MILLS.28- eta. 026 t8 :AREA AS SEio�YN ON THE H. U.D. MAP DATED TEL -�28-00�5 C0 unity-PinPI 2.50001 001.5 C Fa\ 420-5553 THIS PLAN NOT MADE FROM AN INSTRUMENT i'��`i• �. CIF: lf�(I[ Tti-P(� SURVFY. NOT TO BE USED FOR FENCES. ETC. 2B0�1 /F ®Boise Cascade Double 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SP Floor BeamT1301 Dry 12 spans No cantilevers 1 0/12 slope October 26, 2016 13:44:51 BC CALC®Design Report Build 4516 File Name: House Co Neelon Job Name: Neelom Description: Designs\FB01 Address: 325 Route 149 Specifier: ilm City, State, Zip: Marstons Mills, MA Designer: Customer: The House Company Company: Shepley Wood Products Code reports: ESR-1040 Misc: -- - . _ —�--------3 I — IF IF IF IiF 11F IF L —_—' 08-01-00 _— —_�---^- W -- —_ 06-05-00 M BO B1 62 Total Horizontal Product Length=14-06-00 Reaction Summary (Down/Uplift) (Ibs) Bearing Live Dead Snow wind Roof Live BO, 3-1/2" 685/51 1,093/0 1,563/0 B1, 3-1/2" 1,687/0 2,906/0 3,994/0 B2, 3-1/2" 567/132 748/0 1,185/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf.Area(lb/ft^2) L 00-00-00 14-06-00 20 10 07-06-00 2 Unf.Area(lb/ft^2) L 00-00-00 14-06-00 20 10 02-00-00 3 Unf.Area(lb/ft^2) L 00-00-00 14-06-00 15 30 15-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 4,167 ft-Ibs 43.3% 115% 8 03-04-15 Neg. Moment -5,185 ft-Ibs 53.8% 115% 13 08-01-00 Neg. Moment -5,185 ft-Ibs 53.8% 115% 13 08-01-00 End Shear 2,056lbs 37.1% 115% 8 00-10-12 Cont. Shear 3,225 Ibs 58.2% 115% 13 07-04-00 Total Load Defl. U531 (0.177") 45.2% n/a 8 03-09-12 Live Load Defl. U999(0.113") n/a n/a 23 03-09-12 Total Neg. Defl. U999(4021") n/a n/a 8 09-06-01 Max Defl. 0.177" 17.7% n/a 8 03-09-12 Span/Depth 13 n/a n/a 0 00-00-00 %Allow %Allow Bearing Supports Dim.(L x W) Value Support Member Material BO Post 3-1/2"x 3-1/2" 2,779 Ibs n/a 30.2% Unspecified B1 Post 3-1/2"x 3-1/2" 7,166 Ibs n/a 78% Unspecified B2 Post 3-1/2"x 3-1/2" 2,062 Ibs n/a 22.4% Unspecified Notes Design meets Code minimum (U240)Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary(1") Maximum total load deflection criteria. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8"were ignored in the results. Fastener Manufacturer:TrussLok(tm) Page 1 of 2 ®Boise Cascade Double 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SP Floor BeamT1301 Dry 2 spans No cantilevers 1 0/12 slope October 26, 2016 13:44:51 BC CALC@ Design Report Build 4516 File Name: House CoNeelon Job Name: Neelom Description: Designs\F7B01 Address: 325 Route 149 Specifier: jim City, State,Zip: Marstons Mills, MA Designer: Customer: The House Company Company: Shepley Wood Products Code reports: ESR-1040 Misc: Connection Diagram Disclosure - b —d---a•— Completeness and accuracy of input must be verified by anyone who would rely on a output as evidence of suitability for T — C • on building articular application. desiut gn based properties and analysis methods. ' �— ' • Installation of Boise Cascade engineered wood products must be in accordance with current Installation Guide and applicable a f building codes.To obtain Installation Guide or ask questions,please call a minimum=2" c= 3-1/4" (800)232-0788 before installation. b minimum=4" d =24" e minimum= 1" BC CALC®,BC FRAMER®,AJSTM ALLJOIST@,BC RIM BOARD-,BCI@, BOISE GLULAMT"^ SIMPLE FRAMING Calculated Side Load =225.0 Ib/ft SYSTEM®,VERSA-LAM@,VERSA-RIM PLUS@,VERSA-RIM@, All TrussLok screws may be installed from one side of multiple ply VERSA-LAM beams. VERSA-STRAND@,VERSA-STUD®are All TrussLok screws may be installed from one side of multiply Versa-Lam beams, trademarks of Boise Cascade wood Connectors are: FMTSL338 Products L.L.C. f ®Boise Cascade Double 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SP Floor Beam\F1302 Dry 1 span No cantilevers 1 0/12 slope October 26, 2016 13:44:37 BC CALC®Design Report Build 4516 File Name: House CoNeelon Job Name: Neelom Description: Designs\F_B02 Address: 325 Route 149 Specifier: jim City, State,Zip: Marstons Mills, MA Designer: Customer: The House Company Company: Shepley Wood Products Code reports: ESR-1040 Misc: BO 11-06-00 61 Total Horizontal Product Length=11-06-00 Reaction Summary (Down/Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 230/0 157/0 B1, 3-1/2" 230/0 157/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf.Area(lb/ft^2) L 00-00-00 11-06-00 20 10 02-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 1,026 ft-Ibs 12.3% 100% 1 05-09-00 End Shear 327 Ibs 6.8% 100% 1 00-10-12 Total Load Defl. U999(0.101") n/a n/a 1 05-09-00 Live Load Defl. U999(0.06") n/a n/a 2 05-09-00 Max Defl. 0.101" n/a n/a 1 05-09-00 Span/Depth 18.3 n/a n/a 0 00-00-00 %Allow %Allow Bearing Supports Dim.(L x W) Value Support Member Material BO Post 3-1/2"x 3-1/2" 387 Ibs n/a 4.2% Unspecified B1 Post 3-1/2"x 3-1/2" 387 Ibs n/a 4.2% Unspecified Notes Design meets Code minimum (U240)Total load deflection criteria. Design meets Code minimum(U360)Live load deflection criteria. Design meets arbitrary(1") Maximum total load deflection criteria. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8"were ignored in the results. Fastener Manufacturer:TrussLok(tm) Page 1 of 2 I f ®Boise Cascade Double 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SP Floor BeamT1302 Dry 11 span I No cantilevers 1 0/12 slope October 26, 2016 13:44:37 BC CALC®Design Report Build 4516 File Name: House Co_Neelon Job Name: Neelom Description: Designs\FB02 Address: 325 Route 149 Specifier: jlm City, State,Zip: Marstons Mills, MA Designer: Customer: The House Company Company: Shepley Wood Products Code reports: ESR-1040 Misc: Connection Diagram Disclosure t� - b d ---a• Completeness and accuracy of input must —� be verified by anyone who would rely on a output as evidence of suitability for • • . particular application.Output here based c on building code-accepted design properties and analysis methods. • �— • • Installation of Boise Cascade engineered wood products must be in accordance with e current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum =2" c= 3-1/4" (800)232-0788 before installation. b minimum=4" d=24" e minimum= 1" BC CALC®,BC FRAMER®,AJSTM ALLJOISTO,BC RIM BOARD-,BCI®, BOISE GLULAMT'" SIMPLE FRAMING Calculated Side Load=60.0 Ib/ft SYSTEM®,VERSA-LAM®,VERSA-RIM PLUS@,VERSA-RIM®, All TrussLok screws may be installed from one side of multiple ply VERSA-LAM beams. VERSA-STRAND®,VERSA-STUD®are All TrussLok screws may be installed from one side of multiply Versa-Lam beams. trademarks of Boise Cascade wood Connectors are: FMTSL338 Products L.L.C. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR Z w DEPARTMENT OF ENVIRONMENTAL PROTECTIOON M j MAP 7 PARCEL I � LOT e - TITLE 5 OFFICIAL INSPECTION FORM;—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 325 RT. 149 MARTSONS MILLS 02648 M79 P34 Owner's Name: JULIE SWANSON j Owner's Address: BOX 883 MARSTONS MILLS MA. 02648 Date of Inspection: 2/12/04 RECEIVED Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS MAR 0 5 2004 Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 TOWN OF BARNSTABLE [—HEALTH DEPT. Telephone Number: 508-564-6813 FAX 508-564-7270 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 inspectii n. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I aim a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 'MR 15.000). The system: i X Passes _ Conditionally P sses _ Needs Furth valuation by the Local Approving Authority Fails i Inspector's Signature: Date: 2/12/04 The system inspector shall submit opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti n. 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. i Notes and Comments SYSTEM PASSED TITLE V INSEPCTiION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****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. Titles 5 TncnP.rtinn 17nriri F/1 5/'J(nn 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 325 RT. 149 MARTSONS MILLS 02648 M79 P34 Owner: JULIE SWANSON Date of Inspection: 2/12/04 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: SYSTEM PASSED TITLE V INSEPCTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a I Page 3 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 325 RT. 149 MARTSONS MILLS 02648 M79 P34 Owner: JULIE SWANSON Date of Inspection: 2/12/04 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the envir.omnent. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank ar.d 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 ar.d SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank ar.d 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 325 RT. 149 MARTSONS MILLS 02648 M79 P34 Owner: JULIE SWANSON Date of Inspection: 2/12/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NOT IN THE,LAST YEAR PER OWNER. X Any portion of the SAS, cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. a Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 325 RT. 149 MARTSONS MILLS 02648 M79 P34 Owner: JULIE SWANSON Date of Inspection: 2/12/04 Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period 9 _ X Have large volumes of water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up ? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site X _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and depth of scum`? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems" The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 325 RT. 149 MARTSONS MILLS 02648 M79 P34 Owner: JULIE SWANSON Date of Inspection: 2/12/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)):A* L�I a(�C� Sump pump(yes or no): NO 11 Last date of occupancy: n/a 0 U Flo S,�b COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft;etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: NOT IN THE LAST YEAR PER OWNER Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons-- How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components, date installed (if known)and source of information: 1974 Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 325 RT. 149 MARTSONS MILLS 02648 M79 P34 Owner: JULIE SWANSON Date of Inspection: 2/12/04 BUILDING SEWER(locate on site p.an) Depth below grade: 18" Materials of construction:_cast iron _40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting, evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 12" Material of construction: Xconcrete_rr_etal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 10"11 Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: l" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIOING PROPERLY. RECOMMEND PUMPING EVER'TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): n/a 7 Pap 8of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 325 RT. 149 MARTSONS MILLS 02648 M79 P34 Owner: JULIE SWANSON Date of Inspection: 2/12/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches, etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): D-BOX IS STRUCTURALLY SOUND. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 325 RT. 149 MARTSONS MILLS 02648 M79 P34 Owner: JULIE SWANSON Date of Inspection: 2/12/04 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 2 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments note condition of soil signs of hydraulic failure level of ponding,dam soil condition ( g y p g, p on of vegetation,etc.): THE LEACH PITS ARE STRUCTURALLY SOUND-SYSTEM SHOWED NO SIGNS OF FAILURE AT TIME OF INSPECTION.THE LEACH PITS HAD I OF WATER IN THEM. BOTTOM IS AT 8' CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): n/a 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 325 RT. 149 MARTSONS MILLS 02648 M79 P34 Owner: JULIE SWANSON Date of Inspection: 2/12/04 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. W ,CIL t3 C ' AA a L A� '30 AL Si f5c So 150 �n Page 11 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 325 RT. 149 MARTSONS MILLS 02648 M79 P34 Owner: JULIE SWANSON Date of Inspection: 2/12/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked, date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established she high ground water elevation: GROUNDWATER DETERMINED BY HAND AUGER- 10+FT. Zls--Q+ vAq TOWN OF BARNSTABLE LOCATION SEWAGE # ViU.AGE - S +t`n��IS ASSESSOR'S MAP & LOT _ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �Q LEACHING FACILITY: (type) R���"ts� Q t r (size) �• NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ` Feet Furnished by S• a cc. 1 r A6- 5l D 4qif THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH OF......... .0. . . ....7 ................ Apphration for Di!ivasal Workii Ton5#rnrtion Pprutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: � ' ..--- -------------------------------------------------------•----------.....` ---- .................................................... Location•Address or Lot o. A1.rta'1er!r . ..................•----•------.._...._......Address...Address ..r dType of Building Size Lot__S ts_f9®__-____Sq. feet Dwelling—No. of Bedrooms................-3..._......__..._.___.Expansion Attic ( ) Garbage Grinder (1e) Other—Type of Building ---------------------------- No. of persons--------6----__-_-----_- Showers (I-) — Cafeteria ( ) Q' Other fixtures ------------------------------ -- W Design Flow...........................670----------gallons per person per day. Total daily flow--------• 0/w-------------------.-gallons. WSeptic Tank—Liquid capacity-/PA©gallons Length---------------- Width------------.-.. Diameter---------------- Depth_-.---_------. x Disposal Trench—No-____________________ Width.................... Total Length.................... Total leaching area-------------.------sq. ft. Seepage Pit No-------Z......... Diameter_..6.A.a.... Depth below inlet.................... Total leaching area.__'-/Q_.;Z-__sq. ft. , z Other Distribution box (X) Dosing tank ( ) aPercolation Test Results Performed by._ t7 T�slrt�__-s✓ !! __--_______________________ Date----------------------------------- Test Pit No. 1________________minutes per inch Depth of Test Pit--.- ......... Depth to ground water------------------------ riq Test Pit No. 2----_-________minutes per inch Depth of Test Pit.................... Depth to ground water--.---_.--_--_-----..... 9 ------------------- -----------------------------------•-------------------------------•....---..................----------------------------------------- ODescription of Soil------------?Fi"c--- `' ` --•----•---•-•-•--•--•---•----................................................ ------------------------------------------ ............. ...... ....--•-----•---.......---•----------- W -•------- ••-------------_------- T fST......../ 4-L� '------d�sl L�'�--------- '�� !' .. - .............. .........._....-----•----- 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 Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in 1 operation until a Certificate of Compliance has been issued by the board of health. Signed- -••---------•-----------....-•-----...-•-........----............................... ---! --a-- --------•--...-- Ca Date rk ApplicationApproved By---- = '--•-•-••-•--•-•------------------------------------------------- --........... Date Application Disapproved for the llowing reasons:--------------------------------------------------------- -••--•-•--••---••••••••----•-----.....---------------- .. •-•-••-•--•--•--••----------•---•--••-••--••••------•--------•-----•-•••••••--•----•-•-••---••-•----•-•---------------------------------------•----------------•-----------------.........•----•-------- Date Permit No....A/.- 3 U Issued. f Date -7 �' � No..- •- ..�� _ � ss..... d. ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD CHEALTH t A pliration -fur :41-4puml Works Towifrurfiun Vrrutif Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal. System at: ...... .......................�u ' ..................................................... Location-Address �D or Lot No. --------------------------------•-•---....... 'I 64�fF6 +F+6• iiLlw.r---- .--------.....----•--•-•--........................... wrier Address W 4 Installer Address Type of Building Size Lot---,�"'�r.���.......Sq. feet Dwelling—No. of Bedrooms------------------3......................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building __________________________•- No. of..persons........ep................ Showers (.A) — Cafeteria ( ) Other fixtures ---------------------------------------------------- W Design Flow_____________ .........dU......___gallol6Ae�erson per day. Total daily flow._______�gGd_____._.___._.__..__.gallons. WSeptic Tank—Liqu capac.*v_/4ozogallons Length.......:....... Width-:-.:-.:..__.... Diameter-...__ _ _ _- Depth--_.-_--_-.----- xDisposal Trench—No. -------------------- Width-------------------- Total Length_-_______--__--_...'Total leaching areaL.1.a_.,2s-------sq. ft. Seepage Pit No..................... Diameter--__-___-_-__-_--__ Depth below inlet/.C�t____........ Total-leaching area.--_-------____.-_sq. It. z Other Distribution box ( ) Dos' ► ar Ttl Sv�YuE aPercolation Test ResultjWe F.We># d4y----------------------------------------------------------•---------------- Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-..-_-:..__--_-__.--. - (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-_.-.____--_.-_-----. �+ ------------------------------------------------------ ................................................... 01 Description of Soil.•-------.............................................................. x fG----------1�--'rr---- U - ---------------------------------------- W ----- - ---- 1"EST e�....... v�+ tit I.�c t ----- ----•----�- i, U Nature of Repairs or Alterations.—Answer%ruhentappli6 ble:_-------------- --------------------------------------------------------------------------- . -------•-------------------------•-------------------..-_-_----. ---------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—,.The.undersigned further agrees not to place the system in t '� operation until a Certificate of Compliance has been issued by the boaro of health Signed ......• .•... I i /. _?« 7—ir him Application Approved BY---------- = ------------------------------------------------- .................... `1 ' Date Application Disapproved for the ollowing reasons:---------------------------------------------------=........................................------.............. ---------------------------------------------------------------------------------------------------------....-------------------•-------------•-.---------------------------------------------------•-••. Date Permit No......l�-'....................................... Issued........ 73-I....................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :1.............. .10 140� ...........OF..............eA.A.,o'4..1.r#.. t '-................................... "'rrrfifirafr of Tu1ltphaurr TI�-YS IS T C TI 'at the Individual Sewage Disposal System constructed (1E) or Repaired ( ) byI ....4 ?�..-------- ---- Installe ,,�• �*f'/VCs ,��Sr ��' .f�1� 1 = } ice - kl/GCS at ..... .4�_r ....../ -------------------------------------------------------------------•-------------------- has been installed in accordance with the provisions of Article X The State Sanitary Code as descried in the application for Disposal Works-,Construction Permit No. _:::_ •z ................. dated...-_-f-_,36..'.7 _._.>......__...._. THE ISSUANCE OF THIS CERTIFICATE SHALL N T BE CONST,RUED"AS A GUARANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. Y ;A. ' k Inspector__ DATE_: - ...................•- :.: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF--'HEALTH �. ............... u..................OF.......1, .. •fxs_,f'�.xt No.....- -ff----------- FEE.... QU Bi-spuuul Varifi Cftan l�r'Lrff�1111 Prrntit � __ Permission is hereby granted_._.. (i_ _____ __._ _. _.._. _._ .......................... to Construct ( ) or Repair an Individual Disposal System >P • 'r49 atNo. ••--•---•-----•---. ...................................................................................... Street"' •"� /t 75 as shown on the application for Disposal Works Consfructton •r No. Dated.................. —. W.M�a_ealthealth DATE... _ _ ;/ / ' ' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS , 1 10/15/2015 -Al -411 15' i —=------- -- -- ----- o - U - N p 14'-9" —+ � N Ll D o 0 ,0 0 N �— - - - - - - GLST ' a) Q O vi 0 M Ll ! 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