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HomeMy WebLinkAbout0588 ROUTE 149 - Health _ 5 8 8 Route 149 Marstons Mills A= 100-006-40 col V it I 7 4 � F No. 20 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for Misposaf 6pstem Construction Permit Application for a Permit to Construct( ) Repair�< Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S_$S Co`fu r.i(Coed(arc t yqq) Owner's Name,Address,and Tel.No. j?pq1 (vim41'5 MArsrovts &-i US Assessor's Map/Parcel /0 p — 00 1 S A✓�r b IInystaller's Name,Address,and Tel.No. I V— Designer's Name,Address,and Tel.No. $—e;g 27?6.7-1-7 C 2C-y C,�Y�•rht t� Lv+ ('ny Type of Building: Dwelling No.of Bedrooms Lot Size BLS,56 sq.ft. Garbage Grinder( ) T Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date `7— 5/ s 2a 1 ( Number of sheets Revision Date Title-5 8_9 Size of Septic Tank Type of S.A.S. lhnzOo C WC Description of Soil Nature of Repairs or Alterations(Answer when applicable) J `1, IODp ��/ AY W 0` /U-e,,d 7— Td 2S' A{C 3, !-IC CXt 3 1 14 —Zs i6'e-l-d Date last inspected: U 1n.1'C.y L aA Agreement: d 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__- 2S—'zot/ Application Approved by r Date Application Disapproved by Date for the following reasons Permit No. d 2 50 Date Issued 6-- l No.4 Fee THE COMMONWEALTH OF MASSACH ETTS Entered in computer: � S Ye PUBLIC HEALTH DIVIS.I:OU-TOWN OF BARNSTABLE, MASSACHUSETTS RpPlitation for BispoBar *pstem Construttion Permit ' Application for a Permit to Construct( ) Repair(< Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 5$$Caf„i r 2,,,,d CR r r c19) Owner's Name,Address,and Tel.No. Q, y / C _5 Nt/Jr}tony Assessor's Map/Parcel !0 o (, - O o 1: 5 A'M e Installer's.Name,Address,and Tel.No. 1)3 co.n roc.a,rc Sr- Designer's Name,Address,and Tel.No. Z 73 61 t-7 .--- (� 5 a cr c 71 l •n� �•,�tr ' Type of Building: Dwelling No.of Bedrooms L Lot Size /L 5,S!o y .- sq.ft. Garbage Grinder( ) ' Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures j Design Flow(min.required) gpd Design flow provided c/yc� gpd Plan Date � y - 2y 1 Number o sheets I , Revision Date Title ' ` j :98 Eo ll,. ( A d t i i j 1 z ),, Size of Septic Tank ! x' .s/f/� /0Q0 Type of S.A.S. STovri�`�44 Atc. 3 C NG Description of Soil r Nature of Repairs or Alterations(Answer when applicable) Ej( �r ti y ((SOU �el fi7".t T 2, /lJ 7- doA Ib '( 257) ,4te 3(;. / C L3G 3o Zd Date last-inspected: Uyi�C,✓tn�.,�n - 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. ;r}y Signed Date �' 25�-201/ Application Approved li y r Date' 7 ?G" t - Application Disapproved by _ Date j for the following reasons , i y 7 V f 7 n � 6" Permit No. �` � Date Issued 7�' - --------- - - _ - / - ? y THE COMMONWEALTH OF MASSACHUSETTS '— BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CEE�RTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(�) Upgraded( ) Abandoned( )by C„4ow.lam i d-- " 1�1i S() 0—(L. at 599 (,,W 6,24 /�� t y�{ 1 has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No. '2 a 5J dated - 6" Installer ( . !eA.) l)� , 1 L�-(/Or t� �-C� Designer #bedrooms Approved design flow and The issuance of this permit shal not be c nstrued as a guarantee that the system 411 fun d i• Date Inspector ---------------------------------------------------------------------------------------------------------------- --- -------- No. C;w �50 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction 3permit Permission is hereby granted to Construct( ) Repair O Upgrade( ) Abandon( ) System located at 5$$ CV and as described in the above Application for Disposal System Construction Permit. The applicant recognized nized 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. rf c !l -S Date , Approved by 8/03/2611 05:20 5082730367 ' 4t0371 P. 001/001 Town of Barnstable Regulatory Services Thomas F.Geiler,Director Public Health Division Mom. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508 790-6304 Date: �'7J �� Sewage Permit# 6)50Assessor's Map/Purcel Installer&Designer Certification Form Designer• SG E=f)cectoC, Too Installer. Cdeewide'_ F�,Ferpceses Address: 185I Ccanbcrcy 14,, U/0o Address: 153 Cornr oeffi Nt E051 WAf6navA, tjA 02538 MaShWe•, mA 02ioz19 Sob~2 7 3•03 7'l On aly " f� CptPLt,mtd�_ f:trYrf_ iSwas issued a permit to install a (date) (installer) septic system at 58.8 Go-tuck V_d ( Ake., !qq) based on a design'drawn by (address) C En gtneec i.,ng., Tv c-- dated Sulu 1 y 2011, (designer) ^` I certify that the septic system referenced above was installed substintally according to the design, which may include minor approved changes such as laterai relocation of the distribution box and/or septic tank. Stripout (if required) was ins;pcc:ted and the soils were found satisfactory. V I certify that.the septic system referenced above was installed with major changes (i.e. greater than.I 0' 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 certi ied as-built by designer to follow, Stripout(if required) ns ccted and the soils we found satisfactory. yr OF . JOHN L.6 CHURCnILL (Inst ler's Signature) IVIL 4160 . o P fesigner s Signature (Affix De bn i i� Here) ASE RETURN TO ARNSTABL)E PUBLIC HEAL DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT• BE ISSUED UNTIL BOTH THIS F'.)RM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC 11FA', 1'Fif DIVISION. THANK YOU. gAofficc lormAdesignerwrtiftaation form.doe Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 588 Cotuit Rd (AKA Rte 149) Property Address - Dennis Ekman Owner Owner's Name Q} information is Marsons Mills ✓ MA 02648 3-7-16 required for every page. City/Town State Zip Code Date of Inspection N 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. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification 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 ❑ Fails ❑ Needs F tion by the Local Approving Authority 3-7-16 Inspector's Signature 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 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. ****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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I oeXd VS J Commonwealth of Ma.ssachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 588 Cotuit Rd (AKA Rte 149) t Property Address Dennis Ekman Owner Owner's Name information is Marsons Mills MA 02648 3-7-16 :required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:'Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 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. 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 structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): e t5ins•3113• r Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a,broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipes) are replaced [] 'Y El El ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N '❑ ND (Explain below): E ❑ 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ��M s 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman r Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 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 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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. t5ins-3(13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection _Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments M SVB',W 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ' ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? El ® 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? ® ❑ 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 ® El approximation of distance is unacceptable) [310 CMR 15.302(5)) D. System Information r Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual). 4 f _ DESIGN flow based on.310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 3-2016 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons perday(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I�— Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 5 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract r ❑ Tight tank.Attach a copy of the DEP approval. . ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Maisons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"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.): Good condition. I Septic Tank(locate on site plan): Depth below grade: 14"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: 1000 gal I Sludge depth: 12" t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is Marsons Mills MA 02648 3-7-16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" 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 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to'outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: w ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts v Tale 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ` 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.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ Nci* 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•°'r 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) = Type: ❑ leaching pits number: ❑ leaching chambers number ❑ leaching galleries number. ❑ leaching trenches number, length: ® leaching fields number, dimensions: 14'6"x25' ❑ overflow cesspool number: ❑ innovative/afternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach field in good working order with no sign of back-up into d-box or surrounding stone. 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 't 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 .1 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every Marsons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) - Site Exam: . ' ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ 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: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 588 Cotuit Rd (AKA Rte 149) Property Address Dennis Ekman Owner Owner's Name information is required for every MarSons Mills MA 02648 3-7-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 LA�1:' ' "l�i :S S . A;�StrSSW$MA:E'& LOT 0o d L� IPdSTAI.LW,5,1gAMEA.PHONE 140 5)EIr'I"1C TAN1 LC"A&CX zo N0.O BF,Doa>v�s DaR opt own, . 1 1t1►1$'TDA :w.. ... � ()M�iA1~YI�N ;IMF► .r._. . , ,� aep:ae�otz ,tstan�cc�Ev�eera tXae ire Maxims!m l }usted Gjvdit lwialet'� ble to tlac 9c�uom of Leaching l.7acilsty <_� .�w. ---.� .-.--�- Iv 4c;rdVAW Supply WWI .(ff-any violls exist 7�TIM aa:�it+ ai.wlthrn.2bo feet of leaching 'AcilftY) : — F�,cl�is iyi<'U�/et�ant9 a�l.Leacltintt 1~acx�f¢y(�f'sAstiy w�tlan�l5 ' ¢ E+�eq iv}tl+fi�3t10�c Pf leaoiii Puo}!i wA - u>i�4shCtl by_, . ._: . . 4 � .� � ��`� �- - �-a � G n � n � 3a �,�„ A � _ � - a � , ►� � � - o� � , y,, � - l: - 3 � � � . e TOWN OF BARNSTABLE LOCATION V*S-C t (,ems 1"2 SEWAGE# I7 ® VILLAGE /2f-1n, rI S ASSESSOR'S MAP&PARCEL (J U - [o"c'JC) 1 I INSTALLER'S NAME&PHONE NO. y?7 IZ77 SEPTIC TANK CAPACITY' _U P'-10 LEACHING FACILITY: (type),4jr Ore 310 (size) Zr NO.OF BEDROOMS OWNER b4A,L PERMIT DATE' 7 h/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility wo jo r/ 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 AZ 3`�•s �3 3 A. d� v 133 3q•Q BY �a Z . �f s�•� Ip to/7 H LOCATIONr... f:.� , SEWAGE PERMIT NO. VILLAGE _ A INSJA LLER'S NAME i ADDRESS ►� ��,�`f(�(;,.'���C'r f -;-- � `�? 4`�'/;fir. v . e I l D E R OR OWNER i DATE PERMIT ISSUED r DAT E COMPLIANCE ISSUED �_ � 1 3 / 13C��: nid r Town of Barnstable 4 Department of Regulatory Servict~; 1 Public Health Division ��200 Main Street,HYan o►ucla / ois MA 026 01 Date ---_.._ Date scheduled 7� Time_41— Fee Pd.l� Soil Suitability Assessment for Se age Dis o Pufmmedsy M(clnael ptrmenl�( is (_56 P sal Witnessed By: ].n Location Address S Bp L�IOC E I &GM..............L FORMATION d�} O Ro0� IyQ- O neesNam, (4e,, tAlSiDn t,, /M; 1t1 A Address 5 ?8 �V fiS ssessor a Ma 1 y 9 rst Nfs PfParai: i0g00(o1on( ft y / NEW CONSMUCTION I/ Engineer's Name Cop ;� � Pnse� .i JC Enyrnee:trf� 12EPAnt Telephone# SO -273-0377 Land Use' S1Sle ♦;cmtty daS,14n� Slopes --- (%) 0`2 Disaaces from _ �`---- Surface Stones — Open Water Body R Possible Wet Area — Drainage way — ft ft DrinI Water Well �_ft Property 7�_ft Other — f; SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests locate wetlands{n Proximity to holes) See ctNacl^ed Pl�rl Parent material(geologic) CUiu.45V) Depth to Bodrak Depth to Groundwater. Standing Water in Hole: — Weeping from Pit Pace Estimated Seasonal High Groundwater >12to,b,%S DETERMINATION FOR SEAS Method Use Drr�cl & ONAL ffiGH WATER TABLE d: Wu qtw� Depth Observed standing in obs.hole 7 12,(o In. Depth to Sall moUIW; IkPth to weeping ttmn aide of obs.hole: — In. Index Well# — ReadingDate•. —In,. GroundwaterAdiustment Index Well level — Adj.Factor --f. _ Adj.Groundwaterlevel,— Hnervation I PERCOLATION TEST bate�t3-It Time it/IM Depth orPrne T9meat6" Start Presoak Time® 1 c 0 2 f1 M l Time(9"•6") End Pro-soak I1.'0-7 A N — Rate MinJlnch G 2 Site Suitability Assessment: Site Passed Yes Site Failed e Additional Testing Needed(1'" :U Originel: Public Health Division Observation Hole Data To Be Completed on Back ***If percolation test is to be conducted within 1001 of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. QASEPTIOPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture FIOIe# i--�� Surface(In.) Soil Seil Color Soil. Other (Mansell) Mottling (StAu ftm 5tona;Bo,tlders. Y'12. A LS _ 1=iff "1 YC-3/1 r2-3a iOYt 5k 3& t26 C, — � DEEP OBSERVATION ROLE OG Depth from L soil Hrnizon Hole# 2 Surface Ca.) Soil Texture Soil Color Sail (USDA) Outer (Munson) Mottling (Struclum Stones,Boulders. a�y G S — rZ-3� t / — -rz c j-s ioY� S/b - - C's DEEP OBSERVATION HOLE LOG Hole#_ Depth from Soil Horizon Surface(in.) Soil Texture Soil Cola Soil (USDA) (Muaselq Mottling (StrontiumOther Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Otter (USDA) (Murrell) Mottling (Structure,Stones.Boulders. i Flood Insurance Rate May: Above 500 year flood boundary No_ Yes� Within 500 year boundary No_ Yes Within too year flood boundary No_ Yes Depth of Naturally OceurrinQ Leryious Ma erlal Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y�5 If not,what is the depth of naturally occurring pervious material? Certt— ific—ation I certify that on Z7"y (date)I have passed the soil evaluator Mattunation approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required.trainin e e ' e and ience described in 310 CMR 15.017. 4 Signature Date Q.-MPTICTERCFORM.DOC � - � No....... `- / FA--�.,o)__ � THE commowvvsALrn OF mAssuoHusszTa �� � �������� ' � � J\.������`��^~«-/ f BOARD' ~^ / [ ' ' ............ --��2��u)n...OFBarwtm ................................... �~�� �� ���«��lur«�4mwu� ��«� xmmw��x^xmoo� Works To*witrurtmwu» Prrxut»t C'I �q , ' '4r a Permit to Construct or Repair (�<) an Individual Sewage Disposal ystem at: ..........pa'a.............................. .................................................................................................. Location-Address 0�' -J._.2.-Q__ Zb--_C)......8al ............ ...Waj-6toaklZV!!�......................................... Installer Other—Type of Building ............................ No. c6 persons............................ 5bm~ero ( ) -- Cafeteria ( ) Other fixtures .' ~� -----_---'-.-.----_---_.----'_------.----.--_----------_------------- Design Flow............................................gallons per person per day. Total daily flow............................................ . Septic Tank—Liquid capacity............gallons Leocth-------' Wilth....... Diameter................ Depth................ Disposal Trench--No. .................... Width..--..----' Iotal Length.................... Total leaching area....................sq. {t. �Seepage Pit 24o'------- 1]�o��cc.------- Depth below inlet Totaluacuungarea_-.-----'sq. OtbccI)�a��bndoo box / \ I)ou�� tank �` ) �� ` ' ~ ' ~~ Percolation Test lleuoltu Performed by.......................................................................... Date...................1.4 ..................... Test Pb No. l................minutes per inch Depth of Test Pit'--------' Depth to ground water-'-_.---_. Test Pit No. 2L-------minutes per �c6 D�o8z c6 Test P�.-.-------. Depth tu ground water---.----_-. o4 � ' --'----'-'- --------. �� ofSo�------�������K��'���- ��,��-------.--------'----------------------------_ -'------'-`------------------`--`----------------`----'—`--'-------`----------------- ---.-------------------.---_.-..-_--------.-.-----.. �� I0utureofB 'roor �Jusa600x_z�onwervrhco uyy\�uble_.--.�'�������.��'..'���',�...........��'�x2�6�-~�....... ---'---'----'--'-----------------''-----------------------'------'---'---'---''----------'---'------- '-u'--'---' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with | the provisions of'LlILE 5 of the-State Sanitary Code—The undersigned further agrees not to place the system in � operation until a Certificate of Compliance has th5,�oard of health. Sign .... ..... A.- ... .-' -'.�°���&������ � ^�U »*" � Application Approved By........ ... ----------- ........................................ Date � bx ��x rxoxowx�-.--_---...-��-------_--------_.----------.----'------- � Application . . -----`-------`----------'-`----`-------`-------`---------------------------`--'—`-------- Permit No...... 9... .... F:cs............................. ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --'--.....OF..i............: Appliratiun for Disposal Works Tonstru.rtioat ' rrutit ''Application is hereby made for a Permit to Construct ( ) or Repair ( r ) an Individual Sewage Disposal System at: ................_............................................... ........................... --•-•-..........-•••--•-•..................•-•---••••............------.............•---.......... Location-Address / or Lot No. Owner i - t Address W Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..............................{.............Expansion Attic ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of persons............................ Showell YP g ---------------------------- P . ( ) — Cafeteria ( ) QOther fixtures .----•-------------------------•-•--.....--•--•------..----•.......---••••-•-•-------•------•-----•-------••-------. .......................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No....:................ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------------_... Diameter................ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by............................................................................. Date........................................ Test Pit No. I................minutes per inch Depth o Test.Pit_......_`:........- Depth to ground water......................... G4 Test Pit No. 2................minutes per inch Depth of Test Pit..............ti;_.. Depth to ground water........................ Description of Soil-•.................. .....:....:....:...... ...........................................................� r xr•--------...••-----•-----•--•--•-----------------------•-----. W .* .s f U Nature 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 LTT`. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Co pane hp b "'';;i ed by the-board of health. h.. Date ApplicationApproved By --•- .... ........................................................ ...................................... �t ...... =Date ..._._..__ Application Disapproved for the following reasons_____________ „ ......_ i' DatePermit No.......................................................... Issued-----•-•-•-•---• = Date-;; THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.........................I...................:./................................. (9rdifirttfr of Toutplianrr THIS IS TO CERTIFY, That the 'Inaividual Sewage Disposal System constructed ( ) or Repaired (.1) b _. ..._.....f.......�............. ---------------------------------------------------------- .. -.------•-••--•---•- ' Insta at ...--.-•---•�•-------------------•-*- •�=---- -----I---1/i—-•-- - .................................. - . has been installed in accordance with the provisions of TI 1 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated.-.............................................. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY -3�so " DATE+ r't r � J nfr tore ------•- -------- ---------- THE COMMONWEALTH OF MASSACHUSETTS ��• BOARD OF HEALTH :.!. ....:..........OF........................................... ............................ NO......... ..............___ FEE........................ iu�ro t lVi xku Tonu#rudion ranfit_ Permission is hereby granted....... . . ..... r fi ....................................... to Construct ( )—or Repair an-Individual Sewage Disposal,System d, .�.,/`,� .•. / •FYI � ,,y) I F as shown on t,a application or Disposal Works Construction j3'e me!s shown on�e ! o.. .. ._94.._✓......• Dated............ ... ....................... a - � . -------------------------------------------------------•-•----_r:::-•--------------------- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS • ..4 I T.O.F. EL.= 82.6'± PROVIDE EXTENSION RISER WITH INISH GRADE OVER D-BOX= 81.1'± 4"SCHEDULE 40 PVC MIN. SLOPE 1% FINISHED GRADE OVER BIODIFFUSERS= 81 .1' - 81.4' GENERAL NOTES CONCRETE COVER TO WITHIN 6"OF INSPECTION PORT WITH SLOPE @ 2% MIN. FINISH GRADE OVER INLET&OUTLET REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN 1• UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE RISER TO WITHIN 6"OF FINISHED GRADE 3"OF F.G. (ONE PER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL. 82.0 F.G. OVER TANK EL. = 81 ,5'± 5"DIA. OUTLETS) CODE AND ANY APPLICABLE LOCAL RULES. I /r I/ I I N MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER." 9"" IN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PIPE 36 36 TOP OF SAS/B O = PROPOSED 4" 9 M _ MAX a .w _.. . SYSTEM UNLESS OTHERWISE NOTED. (78.20 ) 3" 3"DROP MAX 3» 9" L - 2O�# PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2 DROP MIN - A " 7AAFF SLOPE JOINTS(TYP.) ELEVATION =78.20' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS 10" 4"PVC IN FROM 1.33' t 16" 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" SEPTIC TANK 4"PVC OUT TO 0.90' (TYP.) 10.75"(TYP) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY I5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. CONTRACTORCONTRACTOR SHALL 2" 6" 78,00' 77.10' laid flat 76.87' 2..875'(34.5")---I6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF //78.6T>> MIN. 78.50 (77.95 ) 77.77' S.0' )( ) (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES t78.13 ) 6"CRUSHED STONE ( ) (TYP.) 5'MIN. FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY 14.375 NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE REQ'D 25.0' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (TYP') 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 82.18' ESTABLISHED - - TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV= < 70.50' BIODIFFUSERS (END VIEW) ON THE CORNER OF THE EXISTING PATIO AS SHOWN ON PLAN. EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS OUTLET BIODIFFUSERS (PROFILE) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION (BY ADVANCED DRAINAGE SYSTEMS, INC.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE ©© (� ®(�v ! ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TO THE DESIGN ENGINEER. r D I S T R I t�U T I `o'N E3`.'l\ DETAIL 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM PERC NO. 13345 APPROPRIATE AUTHORITY. INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS art EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. # C.S.E.APPROVAL DATE: Oct. 1999 DATE: July 13,2011 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. Q ,d , .; xi TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE y MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ELEV TOP= 81.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ... - - a. 4 ►r'. ' - • ; ELEV WATER= <70.50' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). Cn� ��"' CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN r �'; _ � - -_ � �=� _ �: �.�� PERC RATE <2 min./inch =` SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK t a = DEPTH OF PERC= 36"-54" �I , 0 16. PROPOSED PROJECT IS LOCATED WITHIN: M TEXTURAL CLASS: 1 ASSESSOR'S MAP 100 PARCEL 6-001 m MAP 1011 a ❑/Hiw ❑/Hiw ❑iH w ❑/Hiw UP 35A � o � O S' OWNER OF RECORD: L. BERYL LEWIS PARCEL 61-001 � tf Am '' 0" 81.00' ADDRESS: TRUSTEE OF THE 588 COTUIT ROAD NOMINEE TRUST Fill 588 COTUIT ROAD ;W y �3 � ' 4" 80.6T MARSTONS MILLS, MA 02648 Benchmark o . - .. A Loamy Sa=' nd Patio Comer / s 5` / ` I Z E 12" 10Yr 3/1 80,00' FEMA FLOOD ZONE C Elev. =82.18' / ��, ` ) CO � 39$pA +• �` tr�� Loam Sand COMMUNITY PANEL# 250001 0015 C Approx. M.S.L. • , 44 B 10Yr 5/6 / \ • " } ++ " 78 00' 17. DEED REFERENCE: DEED BOOK 10802, PAGE 328 36 \ - ' • ` ` =" . , // = Pei 18. PLAN REFERENCES: P.B.376 PG. 78 ti t • ' // 54 76.50 / 81f - ( GARDEN . 2.) P.B. 347, PG. 50 Bj 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. r - Med.to Coarse Sand 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY ' "' C 2.5Y 616 AS-BUILT D-BOXY/r� ' ` �_' ° FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY (5/o gravel) FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. #588 V (loose) (� EXISTING 4 4-BEDROOM n� LOCUS PLAN Q DWELLING TP 1 Cr �cy� TOF = 82.6'± 81.0'�� 8 0 ` SCALE: 1"= 1000' 126" 70.50' No Mottling, Standing or Weeping Observed DESIGN DATA TEST PIT DATA LEGEND G 182'_ �S � �--AS-BUILT INSPECTION PORT WITH PERC NO. 13345 N ACCESS BOX TO GRADE (TYP OF 5) INSPECTOR: Donald Desmarais, R.S. 50x0 EXISTING SPOT GRADE MAP 100 ' `� - 50 - - EXISTING CONTOUR NUMBER OF BEDROOMS (DESIGN) 4 EVALUATOR: Michael Pimentel, E.I.T.ET PARCEL 6-001 � AS-BUILT TOTAL 25 ARC 36HC (#3616BD) H-20 Oct. 1999 50 PROPOSED SPOT GRADE 165,964 S.F.± tv _ a r ��QJ BIODIFFUSERS IN A FIELD CONFIGURATION DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E.APPROVAL DA 3E 2011 Cj DATE: y r0 PROPOSED CONTOUR O J TOTAL DESIGN FLOW 440 GAUDAY TEST PIT#: 2 DESIGN FLOW X 200 % = 880 GAL/DAY ��H�W EXISTING OVERHEAD UTILITIES T ELEV TOP= 81.00 SHED \ USE PROPOSED 1,000 GALLON SEPTIC TANK ELEV WATER= <70.50' W W EXISTING WATER LINE 41 \ 82� PERC RATE_ GAS EXISTING GAS LINE QP �� INSTALL 25 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) DEPTH OF PERC= 1- TEST PIT LOCATION TEXTURAL CLASS: 1 SYSTEM CAPACITY EXISTING 1,000 GALLON SEPTIC TANK (125.0')(4.8 SFFLBF)(0.74 GOAUSQ.FT.)UPLINGS)(4444.0 GAL. LEACH N.74 IG DAYGPD AS-BUILT 4"SOLID SCHEDULE 40 PVC PIPE 0" 81.00 Fill ss3° AS-BUILT SWING-TIES SCALE: 1"=20' 4" Loamy Sand 80.67' ❑ AS-BUILT DISTRIBUTION BOX TOTALS: A DESCRIPTION HC-A HC-B TOTAL NUMBER OF BIODIFFUSERS: 25 12» 10Yr 3/1 80.00' AS-BUILT ARC 36HC(#3616BD)BIODIFFUSER(H-20) ' 1 / TOTAL NUMBER OF COUPLINGS: 0 Loamy Sand SEPTIC TANK COVER IN(1) 35.5' 19.0' TOTAL LEACHING AREA: 600.0 B 10Yr 5/6 (96.87') ACTUAL ELEVATION "AS-BUILT" SEPTIC TANK COVER OUT(2) 34.5' 27 0' TOTAL LEACHING CAPACITY: 444.0 MAP 100 / Rom• DATE BY //��A��P++P'D. DESCRIPTION DISTRIBUTION BOX(3) 31.0' 39.0' NOTE: "AS-BUILT" SEPTIC SYSTEM PARCEL 6-002 INSPECTION PORT(4) 22.5' 50.2' EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE PREPARED FOR: INSPECTION PORT(5) 33.5' 58.7' DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED Med.to Coarse Sand "AS-BUILT" �AS_B U I LT" CAPEWIDE ENTERPRISES DRAINAGE SYSTEMS, INC. ON OCTOBER 3,2003(LAST MOIDIFIED C 2.5Y 6/6 JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. (5%gravel) PLAN (2 (loose) LOCATED AT (1 588 COTUIT ROAD (RTE. 149) HC-B (3 MARSTONS MILLS, MA 02648 #588 NOTES: EXISTING 011 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC 4-BEDROOM e�� 126" 70.50' SCALE: 1 INCH = 20 FT. DATE: SEPTEMBER 12, 2FEE SYSTEM COMPONENT. DWELLING C/i-A N of P��s o �0 20 ao ao FEET TOF- 82.6'± q No Mottling, Standing or Weeping Observed ��� Sqc 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED Ti0 � yGsF� PREPARED N LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS RESERVED FOR BOARD OF HEALTH USE �ONN JC ENGINEERING, INC. PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT 1a 3 O�ORc L CONSISTENT WITH TEST PIT DATA. Also? 2854 CRANBERRY HIGHWAY 5) EAST WAREHAM, MA 02538 P HC-A �4A °A F cisz 3.) LOCUS PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION OVERLAY SITE PLAN (4 508.273.0377 DISTRICT AND THE ESTUARINE WATERSHEDS. SCALE: 1"=20' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.2029 T.O.F. EL.= 82.6'+ PROVIDE EXTENSION RISER WITH INISH GRADE OVER D-BOX= 81 .1'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER BIIODIFFUSERS= 81 .1' - 81.4' GENERAL NOTES SLOPE @ 2% MIN. CONCRETE COVER TO WITHIN 6"OF REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OVER INLET&OUTLET ACCESS BOX TO WITHIN FINISH GRADE RISER TO WITHIN 6"OF FINISHED GRADE 3"OF F.G. (ONE PER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 82•0'± F.G. OVER TANK EL. = 81.5'± 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. I 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. PROPOSED 4" 36"MAX.I36 MIN. AX. TOP OF SAS/B.O. = 78.43 EXISTING 4" PVC SEWER PIPE �� " ' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE SYSTEM UNLESS OTHERWISE NOTED. 6�3" 3"DROP MAX L __ 20��. PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2"DROP MIN 3 9 MIN.SLOPE(d 1% JOINTS(TYP.) ELEVATION =7$.43' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" 4"PVC IN FROM 1.33' 11 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" * �.F SEPTIC TANK 4"PVC OUT TO 0 90, (TYP.)777 10.75"(TYP) 16 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 79.6 _ O LEACHING FACILITY 1 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. " " CONTRACTOR CONTRACTOR SHALL OUTLET TEE 78.67� MIN. 6 78,rjQ' 78.00� 77.1 O' (laid flat) 2.875'(34.5")�-1 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF 5.0' (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6"CRUSHED STONE (TYP.) 5'MIN. 14.375' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY REQ'D NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 25.0' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 82.18' ESTABLISHED TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 70.50' BIODIFFUSERS (END VIEW) ON THE CORNER OF THE EXISTING PATIO AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS (PROFILE) 9• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION (BY ADVANCED DRAINAGE SYSTEMS, INC.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TO THE DESIGN ENGINEER. 'CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING ` • TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM PERC NO. 13345 APPROPRIATE AUTHORITY. INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS � � �,,�� *� �-� EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT DRIVES OR TRAVELED WAYS IN WHICH CASE -� THEY SHALL WITHSTAND H-20 LOADING. • C.S.E.APPROVAL DATE: Oct. 1999 w DATE: July 13,2011 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. Pond TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE r MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. / ELEV TOP= 81.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, APPROX. LOC. OF EXISTINGZNG PIT TO BE .. . a g ELEV WATER= <70.50' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). CESSPOOL TO BE PUMPED AND _3 ED w/CLEAN, . PERC RATE_ <2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN CO FILLED WITH CLEAN COARSE � ������ � - - Q r` ABANDONED r O SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. SAND, IF NECESSARY a DEPTH OF PERC= 36"-54" � O� 42 y 16. PROPOSED PROJECT IS LOCATED WITHIN: m TEXTURAL CLASS: 1 ASSESSORS MAP 100 PARCEL 6-001 M / MAP 101 OWNER OF RECORD: L. BERYL LEWIS a / ❑ i/W ❑/H/W ❑/f W ❑/H/W UP 35A LOCUS PARCEL 61-001 '� ,^ t 0" 81.00' ADDRESS: TRUSTEE OF THE 588 COTUIT ROAD NOMINEE TRUST o Fill 588 COTUIT ROAD o 4 / 4 * _ I " Loamy Sand 80.67' MARSTONS MILLS, MA 02648 Benchmark -�. A Patio Corner, o / S��o I ZONE 2 �)' �r 12" 10Yr 3/1 80.00' FEMA FLOOD ZONE C Elev. =82.18 J � CO ` 3 3s5►0^F ,' !f` if B Loamy Sand COMMUNITY PANEL# 250001 0015 C Approx. M.S.L. 2 a� \ o' 39.E „ ii �� Q tit 10Yr 5/6 17. DEED REFERENCE: DEED BOOK 10802, PAGE 328 � �; ; " � . �� , ►� ,• � Ef � 36" _ 78.00'Perc 18. PLAN REFERENCES: - `f' , • /l 54" 76.50' 1.) P.B. 376, PG. 78 - 81 y Cd RDEN ` 11t 2.) P.B. 347, PG. 50 LF 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. 77" Med.to Coarse Sand � �1 ROP D-BOX F��i t� ��. •.--'• C 20. PROPERTY LINE INFORMAT'ON IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY o ti� r Ra 1 { (5/o gravel)c _ a t o FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY (loose) FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. #588 1 { �� EXISTING mac, �0, \ Q` 4-BEDROOM �131 LOCUS PLAN OQO ry�� ELLING �82.6'+_ 11.01 T 2 /OF � SCALE: 1"= 1000' 12681 70.50' &� �D � -_81.0' PROPOSED INSPECTION PORT WITH No Mottling, Standing or Weeping Observed ACCESS BOX TO GRADE (TYP OF 5) e C3 r�y� �' TO BE UTIOL ED IN TH SI DESIGN DESIGN DATA TEST PIT DATA LEGEND PROPOSED TOTAL 25 ARC 36HC(#3616BD) H-20 O 2 BIODIFFUSERS IN A FIELD CONFIGURATION PERC NO. 13345 o J INSPECTOR: Donald Desmarais, R.S. 50xO EXISTING SPOT GRADE MAP 100 ' ��� NUMBER OF BEDROOMS (DESIGN) 4 EVALUATOR: Michael Pimentel, E.I.T. - - 50 - - EXISTING CONTOUR PARCEL 6-001 , C.S.E.APPROVAL DATE: Oct. 1999 165,964 S.F.± �� DESIGN FLOW 110 GAUDAY/BEDROOM DATE: July 13,2011 1­501 PROPOSED SPOT GRADE O4 �` TOTAL DESIGN FLOW 440 GAUDAY TEST PIT#: 2 --t;r- PROPOSED CONTOUR AI DESIGN FLOW X 200 % = 880 GAUDAY ELEV TOP= 81.00' EXISTING OVERHEAD UTILITIES SHED USE PROPOSED 1,000 GALLON SEPTIC TANK ELEV WATER= <70.50' EXISTING WATER LINE PERC RATE_ FQP� ti INSTALL 25 - ARC 36HC #361613D BIODIFFUSERS H-20 GAS EXISTING GAS LINE DEPTH OF PERC= �O \ ' SYSTEM CAPACITY TEXTURAL CLASS: 1 TEST PIT LOCATION / �h $/T 2� (TOTAL L.F. OF BIO'S&COUPLINGS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD (125.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 444.0 GAL. LEACHING/DAY 0" 81.00' � Q Q EXISTING 1,000 GALLON SEPTIC TANK 4' 1ll 80.67 1 PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE / ss6o23s3, TOTALS: A 1 F Loamy 10Yr 3amy Sand SWING-TIES SCALE: 1"=20' TOTAL NUMBER OF BIODIFFUSERS: 25 12" 80.00' 0 PROPOSED DISTRIBUTION BOX TOTAL NUMBER OF COUPLINGS: 0 B Loamy Sand 0 PROPOSED ARC 36HC(#3616BD)BIODIFFUSER(H-20) HC-1 HC-2 TOTAL LEACHING AREA: 600.0 DESCRIPTION 10Yr 5/6 / BIODIFFUSER CORNER(1) 29.2' 42.0' TOTAL LEACHING CAPACITY: 444.0 / REV. DATE BY APP'D. DESCRIPTION MAP 100 BIODIFFUSER CORNER(2) 43.5' 48.7' NOTE. PROPOSED SEPTIC SYSTEM UPGRADE PARCEL 6-002 BIODIFFUSER CORNER(3) 52.1' 70.5' EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FRtOM THE BIODIFFUSER CORNER(4) 41.0' 66.1' DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER PREPARED FOR: "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO ADVANCED C Med.to Coarse Sand CAPEWIDE ENTERPRISES DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST MODIFIED 2.5Y 6/6 JANUARY 11, 2011). TRANSMITTAL NUMBER=W000052. (5%gravel) (loose) LOCATED AT HC-1 (2 588 COTU IT ROAD (RTE. 149) #588 ?.0, MARSTO N S MILLS, MA 02648 NOTES: EXISTING (1 SCALE: 1 INCH = 20 FT. DATE: JULY 14, 2011 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC 4-BEDROOM 3) 126" 70.50' SYSTEM COMPONENT. DWELLING �'�j-A o 10 20 ao 80 FEET TOF - 82.6'± No Mottling, Standing or Weeping Observed IN THE LOCATION OF THE PROPOSED gTiO � s LAN OF�qs c 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS �,�P sq� PREPARED N LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS RESERVED FOR BOARD OF HEALTH USE PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT � JOHN L. Gs� JC ENGINEERING, INC. CONSISTENT WITH TEST PIT DATA. CHURCHILL JR. � 2854 CRANBERRY HIGHWAY CIVIL HC-2 P NO.41807 EAST WAREHAM, MA 02538 3.) LOCUS PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION OVERLAY SITE PLAN s cr E 508.273.0377 DISTRICT AND THE ESTUARINE WATERSHEDS. SCALE: 1"=20' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.2029 I