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HomeMy WebLinkAbout0436 SANTUIT-NEWTOWN ROAD - Health ,�E_6 Santait-NeWtown Rodd Marstons Mills , - -- - A= 030— 132 i i i _`------- n 2c� v 4 + b � 'M2c�n� o� U r� i TOWlt OP BAJRNSTABL � WAGIE#. LC?CA,'X'iOMb SGt AS ESSOR'S MA.Y' VYLLAr�+:.�c. V4STALUR NAn9&PHONE NO. rtc TASK Acrcx . LA�CIi�Tt31�AC1f ,I'E"Y� �O tDF�3��OtJM[S BOWER OR OVMM P 1'1•�2A' +�01lgGIA1+TC 1DATE•.,....,� .-..�. S iarwou 8etviesn�ha : , A#nxitTkum Ad*u toclGmu�eifv+�te�Tablet the BattrnnofX.eanitin i�u,ihl l+cep Y tc�x 5u 1 Vtct aaici Lehi : pacatiry.1ty+wells ufst Pilvu '�a. i Y � ac within?AO feN oi.loli c qs fAc ). E t i��f t�/ t]{at► and Uac,,Mn� 11c�(If any wet.Wd5 exist w111utt' {IQ feet p let+cling fLail ac111ry D � ' o a �13 TOWN OF BARNSTABLE LOCATION 4 3 SEWAGE ASSESSOR'S MAP&PARCEL :30 INSTALLER'S NAME&PHONE LLC. E6g—1 -9377 SEPTIC TANK CAPACITY /0005 Gc t LEACHING FACILITY.(type) 40,AKIC 36NC .. W—20 (size) /1,5 -X o s r NO.OF BEDROOMS OWNER/149:c 1- / c ahcl VEffenq Fc, M J� recmevr4 PERMIT DATE: �]— (1 — ?.,o(� COMPLIANCE DATE: 7 I 7 /(A Separation Distance Between the: /✓® ®bSlerL. G Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility -at /30 P 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) p /°` Feet FURNISHED BY f a r y 13- A-a= 43 A-3= 5q-3° 0-3=4A.a A -4-3 a 3_4=5 �p A -5=47.'7 (3-5=60Y ® 4 5 vevJ � , No. P6 a^ sv Fee /616 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliLation for MispoSal bpstem Construction permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. t j3�,,5A/Jj'0( -PB4Mce 1 Owner's Name,Address,and Tel.No. P o N-. -Z, P-egr I%JA r of �5� Assessor's Map/Parcel 3 0 13�, y p o 'bp otw i GA Installer's Name,Address,and Tel.No. 67 -47-T&'j Designer's Name,Address,and Tel.No. Sic ;I"1'3-,03-7 VJGp$ ExJ1�l,�S Ckr, rY. � �i �. Type of Building: Dwelling No.of Bedrooms Lot Size 0 sq.ft. Garbage Grinder( ) Other Type of Building =,SjDk-%)-'1 4,L, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3() gpd Design flow provided 5 a — gpd Plan Date ;JU(-q l l ,10 Number of sheets Revision Date Title OL S4ur(.)rr - )JL 31=((2)0 P-ol m4ff-cong S k`u-S Size of Septic Tank i i Cop Cam Type of S.A.S. do 6L)Pig:?=US Description of Soil d O&SF, C q `t �P ) Nature of Repairs or Alterations(Answer when applicable) GWS' CLLA - (,CXM GYr �e 6R, 4- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by ` Date _ f Application Disapproved by Date for the following reasons I Permit No. got a Date Issued �' 1 �— No. � ) J� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplicatlon for ]Disposal *pstrm Construction 3dPrmct Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. l�3b 5�lJj'JfT.Ng�J7aJ Owner's Name,Address,and Tel.No. RD ,. N��1r� 1kvgr1 1A rAWIGK TtvsY Assessor's Map/Parcel 3 O 3 Z, M,K.: qU J lbTR GA Installer's Name,Address,and Tel.No. 5-OZ-477-2S71 .Designer's Name,Address,and Tel.No. 5�-a13-03-j 4A0t_ 1 t>sr SAS c1L<1 C. 81 . �t/.Ea[ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �Ct D�'l rf No.of Persons Showers( ) Cafeteria( ) Other Fixtures - Design Flow(min.required) 33n gpd Design flow provided gpd Plan Date 3U t,y l ,1U(}• Number of sheets Revision Date Title Sc4l�3tJ 1-C` W fl2Jj,'j�,1 o R.n N(,t �� S Af l C.L. Size of Septic Tank pry C 54LL A� Type of S.A.S. Description of Soil Ca= np 4kti" f ti Nature of Repairs or Alterations(Answer when applicable) OS19 ctI.)& (,(Xjp _Z'6 Dp -jK Date last inspected- i Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in a{ 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 Application Approved by ` Date :7-r( - l L Application Disapproved by Date for the following reasons Permit No. L9 O l :a I Date Issued :7'(f' �— ------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS t Certificate of Compliancr THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by 0(,O peen A bg-;=El XM4 Ul����� at q3G !_!1J'7)rr - IJfe)7taWl) P-*b has been constructed in accor ancP7•J with the provisions of Title 5 and the for Disposal System Construction Permit No. aGt ted Installer G�{{D(s�(�(�.»- / L.LC Designer ;�� �o #bedrooms 3 Approved design flow © gpd The issuance of this permit shall of be construed as a guarantee that the system s si ed. Date Inspector ------------------------------- --------- No. c9ol ;� ! , ;Lx] Fee I THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Nsposal 6pstPm Construction permit Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( ) System located at 3� 56E W_fL4 I - tJ t%AJM&W 6J and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this perm t ' Date Approved by J4'W\ i I 7 f Commonwealth of Massachusetts ,. Title 5 Official Inspection Form bl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '» 9 p Y rY 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name - ' information is ✓ r0 required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection rye rya. 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. Inspector Information is% l3uo1- 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) am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally,Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-16-18 Inspector's Signat re Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ii, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement,or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 f .= Commonwealth of Massachusetts f.; Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced El ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to'protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 s Commonwealth of Massachusetts ,w Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) . ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is vkhin 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: - ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS.and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts l Title 5 Official Inspection Form i�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 436 Santdit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] Ej The system is a cesspool serving a facility with a design flow of 2000 gpd- ®' 10,000 gpd. 1:1 ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. _.. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply Lt5,n,p.d, El Elthe system is within 200 feet of a tributary to a surface drinking water supply ❑ Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well c•rev.7/26/2018• Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts a Title 5 Official Inspection Form ' i t Subsurface Sewage.Disposal:System Form -Not for Voluntary Assessments - >°J 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills '' MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components'pumped out in the previous two weeks? ❑ ® Has the system received 'normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) { ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site'inspected for signs of break out? ® ❑ Were all'system components, excluding the SAS, 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? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspedon Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 01 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 10-2018 Date t5insp.doc•rev.7t2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts 3 Title 5 Official .Inspection Form ll 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills - MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner--pumped 2013 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form R) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ . Tight tank. Attach a copy.of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2012 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): , Depth below grade: 24"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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 � ..., Commonwealth of Massachusetts ��. Title 5 Official Inspection Form i�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments :-y 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed b a Certificate of Compliance? attach a co of certificat e)e Yes No 9 Y p ( PY ) ❑ ❑ Dimensions: 1000 gal Sludge depth: 12" 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 s ' Commonwealth of Massachusetts r� Title 5 Official Inspection Form l,. fI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments T 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons II Design Flow: gallons per day Lt5in.p.doc-rev.7/26/2018. i Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts _ y Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town = State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): q Depth of liquid level above outlet invert 0 P 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. r t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >" 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) _ 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 20-ARC 36's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form II Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach field in good working arder and empty at inspection with no sign of back-up into d-box or surrounding soils. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 cam` Commonwealth of Massachusetts ;w Title 5 Official Inspection Fora i,.l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts ;w Title 5 Official Inspection Form i i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate.where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately B �'9 ....... A. 71 Aa t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 r s Commonwealth of Massachusetts 1� Title 5 Official Inspection Form i,i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10, 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 10'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts p, Title 5 Official Inspection Form iI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 436 Santuit Newtown Rd Property Address Regina Ellena Owner Owner's Name information is required for every Marstons Mills MA 02648 10-16-18 ' page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding'Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15 Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 7/17/2012 02: 17 5082730367 :1307 P. 001/001 Town of Barnstable Regulatory Services �. Thomas F. Geiler,Director BARN6TABL1t :MA88 Public Health Division . �'0r6'659..4►`°� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Officc: 508.862-4644 Fax: 508-790-6304 Date: I " 20 ' 2®�Z Sewage Permit# 7-1 I Assessor's Map/Parcel 011 132 Installer&Designer Certification Form Designer: P5G En�tt�eari�n�, Tv-)G Installer: CaecL:ide- EnFerQrfse-S, L.L-C- Address: 25y CcQnbe;ty rirhw / Address: fo d2(. 3 , On 2�j— ��- �AAWl - -3 was issued a permit to install a (date) I (installer) septic system at w31' '540'rulr- NG-u+ N R°gd based on a design drawn by (address) �L' L-ct�;<iee�i,lal ; ThG. dated (designer) l certify that the septic system referenced above was installed substantially according to Elie design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. �T i certify that the septic system referenced above was installed with major changes (i.e. greater than I lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations- Plan revision or certified as-built by designer to follow. Stripout(if req nspected and the soils were found satisfactory. ,<�of ki qt, JOHN 1.. c4r " JR. (It staller's Sign re) GIVIL ' No 41507 ..r esigner's S.ignattir (Affix esi �e s Amp Here) PLEASE RETURN 10 BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. y lullirc IimnslJr,igndrecnilicntian I-orm.du� Town of Barnstable P# 75 Departiment of Regulatory Services ""14 _ Public Health Division Hate "a�/� D >,� rED NUtt�,� 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. 66 . , Soil'Suitability Assessment for S e Disposal Performed By: iCme� � ,ELT,GSe Witnessed By: LOCATION& GENERAL INFORMATION , Location Address T�rD c7dCn"& J JVf( .W� kV P.�Owner's Name (4 tcK tijo+ LI.Was P '-�, "10f9S'C't^)S bk f i_L� Address L Co (30MG 140P001) Die. Assessor's Map/Parcel: 013 / d'R'V(CL6j 4_4 f'3� Engineer's Name � 7 F 1G C-ngtY1L'E'iCrI NEW CONSTRUCTION REPAIR._ Telephone# vL�7 7 50 6-2-73-0 377 Land Use: st"Aie- fowui4 dlue(Icrla Slopes(%) 2'- 5 Surface Stones Distance9,from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line 710 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) See- a0 C1A, Parent material(geologic) dub-UOMn Depth to bedrock u Depth to Groundwater. Standing Water in Hole: 7 138 bS S Weeping from Pit Face Estimated Seasonal Hlgh Groundwater ? t 31,`1e9s DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Off ec+- OoSu02VOO Depth Observed standing in obs.hole: 130 In, Depth to soil mottles] In. Depth to weeping from side of obs.hole: in, Groundwater Adjustment Index Well# r, Reading Date: Index Well level _-_„ Adj,factor � Adj,Groundwater Level,,9 PERCOLATION TESL' bate 7-5-•12 Time >o 111 Observation ' Hole# Time at 9" T ^ Depth of Perc y 811 Time at 6" Start Pre-soak Time @ J 0 /o do Time(9"-G") ' End Pre-soak X'/6 AH Rate Min:/Inch Site Suitability Assessment: Site Passed Yes Site Failed: Additional Testing Needed(YIN) AJ Original: Public Health Division Observation Hole Data To Be Completed on Back------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LO'G Hole# 2- Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other Surface(in.) :(USDA] (Munsell) Mottling (5tructire Stones;Boulders, 1� to w.%'Gravell Y8-130` G C, s 2-S7 `% — 5 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture s Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ins %Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sol!Texture Soil Color Soil Other' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistenczG DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon 'Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. y Flood Insurance Rate Man:, Above 500 year flood boundary No— Yes . . Within 500 year boundary No Yes Within 100 year flood boundary No. ✓ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �e's If not,what is the depth of naturally occurring pervious material? Certification I certify that on D'2� 9 9 (date)I have passed the soil evaluatoroexamination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and exper' nce described in�10 CMR 15.017. is Signature Date 7��0�1Z Q:15.EPTiC1PERCPORM.DOC FINE T°w� Town of Barnstable Regulatory Services Department > RARNRrABLE, "A9. i6gq. Public Health Division ,0 ArfD MAC A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO May 17, 2007 Regina Ellens 40 Butte Woods Drive Oroville, CA 95966 Dear Regina, I am writing in regards to the new rental ordinance. We did receive payment to register the rental unit, however there was no application enclosed. A letter was sent to your attention on March 28, 2007 with an application requesting it be completed and returned, however none was returned. Please fill-out the enclosed application and send to the Health Department at: Town of Barnstable Health Department 200 Main Street Hyannis, MA 02601 If we do not receive this appl_.ication by the end of June, we will issue $100 a day non-criminal citations for failure to comply. Respectfully, Caitie Barrett Health Division/Rental Program Coordinator 508-862-4072 Direct Line COMPLETE /N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. (A' D. Is delivery address different from item 1? El Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No i j ^ 3. Service Type ' -(� Certified Mail ❑Express Mail ❑ Registered ■Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number TI ;fir 7003 168Oi-0004'!5'458 4579 i;� (rransfer from service label) PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 1 I' UNITED STATES ��� ,QQ TAL E. 1,G ��.x... s.� ,� E • Sender: Please print your name, address, and ZIP+41in�`f box• I I � t I Qc/,fi Town of Barnstable "I Health Division �'"'"� 200 Main Street I Hyannis,MA 02601 I I I I Hiss11 lisill ii1111111i111'11'I1i1M ''yy yy jj Nyy 111111j{1 111i11f11111/)) I �s /-lo butte GU�ac�o fir. ����rte✓- �D rd�l P(Ns Gve r`c c�/ve o� a. ce1-7�i fief' Z4M7e aca tech //��c:ey l7. r),zrm G. ''appl�CR FcL, bUt hd� no f �,�l�e� subse - &Gaz Us, .L�m s d ��,o s �t ���" f� /S /C��J Qr? c�ncl !is cbs7 0( J- �tz�/� l`en 7` Ala -"l U-C S Sl�l ce (.U� ,b d✓�G� l t l 6,06 Gar�'✓�-7` Oj� `� is aU.- /'�l s _ q, 9 — b a-7 46 /oarn , b ✓7 vQ/ c/ ov) � q �l tG�e�� `�v� ---coU�'� � o lan yer- MODIMs' /ifnf C?, year 601?e"o tAe- '' l ll, h ose/7'a l/mod n 9r?a 6l6. 7'a u� _ l// GUd r-k- p cv- r-ca Uses /ec, f to m ayrtG s - z cos -Fof(7 ve✓� �oo6d Pl—j p �d k es 2, 2Z3 o 00 a fin Aucz 1 l far fncvl-�--I- = 3 3 . o cv incfcases 14 zoo-7- Gee e�uc�� e�seo i n c. � ��k Cek cep of s o O1- -�cz q 0c� tell u� .� /'h us 7- vl6 per� l of Z r"M7 SP./1f• 1lrn ar/so 44 r 74h� A ��f n oUr Cori pv�liG GI�c / Gi � � fDc��-�n� q ��f �/rY,'c -� of✓�r ���� �n� p'cr��/��r����' ��rssa�� of sev-P� n�-�'ingn��s, 1� vn d�s��r n� f�� I eases per- -f� /s oi•�r'i� nce, /�7q-5-50.5 ®r Ghat° ��r7an�� . �v � ' �h�� �/✓�'f vc5. " %/n%� ���� �/Ue /r fG� is l�ayse�ol�' — ��.vG see /ors c�n�1 ��e�i 9raro/�Grv�G��c Guh�� Ile f eat 0 � A6/s -the 5 og- S6 z • 6 y /1 U m s 1�s fc� �Iz2e /.r��r, cr✓� y s-fo/y CsamC� JaC-1s 0)/? . / o ! is �, �oUr �vz�o/r��' �o !/ass � '' s�e s��ol• ''C,u`�y ��"f y°�, �-� i a)d�-� sPn fitie �� otf Fi 174 GIB /�/vsfiG� fic7 aP� l'yees �� Gt 7cPn-�,/y G�SG/'lb�d, � a✓� n� � �h� ogles �rlJs��7� f/2e j0✓�jnle,�l'I.S .�vP P o✓-� �' � voficc�f �a ,� 1✓�crcgses ana° r►o� dlsyv.rb��' fh� �I-�i���a, �es f �o �ocJ l ,,' O CAT ION S SEWAGE PERMIT NO. .'w/al�i VILLAGE /1 v/f GAG o l INSTALLER'S NAME i ADDRESS JOHN A. AALTO BACKHOE SERVICE 156 Wainut Street West Barnstable, Mass. 02668 R U I L D E R OR OWNER � v %w rw� Ad DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED r � II v 0 1130 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............. n//�........OF....... `.s�.�� .............................. Appliration for Disposal Works Tons rnrtion Prrutit Application is hereby made for a Permit to Construc t (v)-or Repair ( ) an Individual Sewage Disposal System at: /V6�✓Tuy. / /Ls � �' .........•---..---••-•-•-•--.....___ - - -.- W Location-Address or L -t No. c S� i -------------------------------------------------- .............................................A --,�---s.------------------------. , G � or ress Installer Address Type of Building Size Lot.__ b6d....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures .................................. Design Flow W .................... `.. gallons per per day. l dail 3 gallons. Septic Tank—Liquid ca acit ,L4 ._ allos Len th_A K`... Wdth . Diameter................ Depth..S_�"/. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.--_____------------------ Diameter........f?:!._. Depth below inlet.... ... Total leaching area.. f.__sq. ft. Z Other Distribution box ( ) Dosing tank ( ) _ aPercolation Test Results Performed by..... ........ Date___'�v7...�. a Test Pit No. 1 ._ ..._.minutes per inch Depth of Test Pit...Z _....... Depth to ground water...... .............. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .................................... ................. O Description of Soil----...D �. Pyau d>1. ... czi "� B- --------••- -------------- - . . •-----------•-----........................................... 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 TITLi- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a ertifica ompliance has been i ued by the ar of health. SignedI�... '.. . ....'.....................---........ Date Application Approved BY------- .....---�---,-�--� -•---------•-•--•--- _Q D ite Application Disapproved for the following reasons:................................................................................................................ ................•---•------•-----------------------------•--•-------------•------•------•-------.........-----•---------•----•---••-------••----...-•••-•-------•------••••--••--•------•-•-----------•- Date PermitNo......................................................... Issued....................................................... Date No. '."SI '7 Fs�_t............_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................1n/,.!fit..---.....OF......- �'° /. T. '1,3L. .................................... Appliration for Disposal Works Toustrnrtinn rumit Application is hereby made for a Permit to Construct (L,4 or Repair ( ) an Individual Sewage Disposal System at: ............. i2w s.... *GLS.... ....................................t�-----------------------------------------• Location-Address -or Lot No. 5.--...--••--.....-•-•------------------------•----. ........----••-•-(�-ST�?Z I//G LLr ���5.._............_._....... ........ --- --- -- .... �----••- Owner ......................•-•------.Address Installer Address Type of Auilding Size -----Sq. feet �-, Dwelling—No. of Bedrooms__..._....3..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of pers'bns............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------••-••---• -•••--••---•-••-•••-----•-•---....•-•.•-••-•--•------•---••--•-------•-----•---•--•----------•---••---•-•....-••-•-•...............•• W Design Flow.................. ................gallons per person per day. Total daily flow.............25.,v...................gallons. WSeptic Tank—Liquid capacityLo9_;>..gallons Length._6..Z.".... Diameter________________ x Disposal Trench—No..................... Width................_... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......../.......... Diameter......./Z__'.... Depth below inlet....LJ....... Total leaching area..z .A ...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by....L�W ...<-:.... _________ Date.. . �//!�%•!_ aTest Pit No. 14..Z-.._._minutes per inch Depth of Test Pit..45-4......... Depth to ground water.... .............. PL4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------•---•----•--.......................------..........------........----•...._.................................................................. O Description of Soil------- _......11!�gD &1--7 V' s1,354k..................................................2a' ...........Sl...... W x ---------------------------------------------•---------------.....-----------•------------------------------------------------------------------------------------------------------------------------- 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until Certifi f Compliance has been Oued by the oar_4t of health. ----------------•---••-•-•--•..--,.Signed- = s,r gy .�Dat . - ..........APPlication Approved BY . te A Application Disapproved for the following reasons:--•-----------------------------------------------------------------------------•---------------------------•... -•.................................................•--------....----•-•-------------------------.........._...............-------•--------------•--------------------------------------------------•-•--. Date PermitNo................................................... Issued....................................................... Date t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........�. %/.............OF......�i!!L (S.T. � .............................. (9rrtifirtt#r of f�ompliFaurr � THIS IS TO CERTIFY, at the Individual Sewage Disposal System constructed (�or Repaired ( ) by... _ ._ � .. A---44- ----•----••----------------...--------------...----------•---- , -•----••--•----•--..............----•-•-•--•----•-.. . at...................................................................................................................................................................................................... has been installed in accordance with the provisions of TL' f The State Sanitary Co _a� esc d in the �� application for Disposal Works Construction Permit No........... dated.......•......... D__.._........._._.._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................1 ..._.... ..................................... Inspector.....------ . .......------ --•-----. .......-- •........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD�?OF HEALTH .............T..t� ///...........OF......1/Lt�� /ST .................... F E.... N ............. E ........................ Disposal rks nstrur#ion umit Permission is hereby granted.................... ---... ....... to Constru%t. or�,R.�p�ir��i n i u e age Disposal System. atNo.-•................II----....................-----...-------•--•----•--......--•-----..............---.-------------------------•----•--------•---------------•---------------•----------••-----...... I Street 6 t'•7 as shown on the application for Disposal Works Construction Permit No......... d............... mi�ll.._...... ram. .................................................. ................................................ ....................................... Board of Health DATE........... -.�-.1��._opp--.J. --• FORM 1255 A. M. SULKIN, INC.. BOSTON SNErr Z of Z vieers EZ� 6y3 Loy-�G 88 J SL'yT1 f PgoPosED wAyz�� RTtL a OGd •SQ? GY �- 1 / 64' 6 Z' Lo 7- tit oA-' UDCATION ,!`�/aRSTonJS !�J/GLS r. 1 SCALE . / „�s.�. . . . DATE PLAN REFERENCE 7^/G LoT ' <i KE! LEY " I CERTIFY THAT tHE ... ..... SHOWN ON THIS.PLAN 19 LOCATED ON THE GROUND AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF WHEN CONSTRUCTED. DATE . . . . . ... . . . .. REGISTERED LAND SURVEYOR T Z a F Z f i L. ��.v.�. . . ... . ` P TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 4"CAST IRON 12"MAX. nT 12"MAX. OR SCHEDULE 40 4"SCHEDULE 40 P.V.C.(ONLY) P.V.C. PIPE PIPE - MIN. EACH LL PITCH 1/4'PER.FT PITCH I/4 PER.FT. PIT � . PRECAST o INVERT a LEACHING c EL..�I,Bg.. INVERT INVERT e . PIT OR e'. SEPTIC TANK DIST. w EQUIV. e INVERT EL.-�r<-J�4. . BOX EL ? ,/6 .•: /000 GAL. INVERT jSva INVERT 3/4"TO II/2 U.EL 5Z33 EL SS6. a �►: WASHED w STONE • �—►tom—W D I A. DIA,----�,e'vco��rar�zrD PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE THY. TIME.g--3o A� , oN. . T cob// /. S: , BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ENGINEER ELEV. . .G/./o. . . . ELEV. . . . . . . . . . . WooD�/f�`1 jr ;� DESIGN DATA : NUMBER OF BEDROOMS . . . . . . . io TOTAL ESTIMATED FLOW 33o GALLONS/DAY BOTTOM LEACHING AREA //3:� SQ.FT. /PIT/,•p•D. SIDE LEACHING AREA . . . S0.FT./ PIT/3Z9. C,RD, Co/t1SC GARBAGE DISPOSAL (50% AREA INCREASE) TOTAL LEACHING AREA SQ.FT a" Csz,48/o PERCOLATION RATE 771-1*!.n^1-. MIN/INCH LEACHING AREA PER PERCOLATION RATE . 3 SOFT. No. _WATER ENCOUNTERED NUMBER OF LEACHING PITS .6!V,6 Al'T A/i77-/ APPROVED . . . . BOARD OF HEALTH. . . )ATE . . . . . . . . AGENT OR INSPECTOR a��p119 OF MgsJ Zo T d. ✓� C.3 ` STE PETITIONER /Z�CP�/ f n/ES /(/ '>x✓ 6�y ��tt n' 4"SCHEDULE 40 PVC MIN. SLOPE 1 % PROP.4"VENT WITH CHARCOAL - G E N E p /� L I�OT E S T.O.F. EL.= 72.1 '±' FINISH GRADE OVER D-BOX= 69.3 ± FILTER TO ABOVE GRADE FINISHED GRADE OVER BIODIFFUSERS= 68,3 69.3 f�,/`1 PROVIDE EXTENSION RISER SLOPE u@ 2%MIN. INSPECTION PORT WITH-\ WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN 3"OF 1• UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL F.G. (ONE PER OUTER ROW) CODE AND ANY APPLICABLE LOCAL RULES. FND. EL.= 71.2'± F.G. OVER TANK EL. = 70,6'± 5"DIA. OUTLET(S) 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE i t DESIGN ENGINEER. 4.57 MAX.PROPOSED 4" 3.73' MAX• 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL �_E�I�.,T ILIG 4,_ r r EX I �_- - - --- -_- -3 SCH.40 PVC (SEE NOTE 21) (SEE NOTE 21) TOP OF SAS/B.O. = 64,73' SYSTEM UNLESS OTHERWISE NOTED. -DER F'IPE T14f' ! SEWER PIPE4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 3"DROP MAX - �.I. ELEVATION =64.73' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A j6" 3" 2"DROP MIN .SLOPE@1% L - 21 _ PROVIDE WATERTIGHT 40 MIL GEOM MBRA10" 4"PVC IN FROM ! JOINTS (TYP.) 1174_71 .33' nl(TYP) 16" E NE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 9.1. SEPTIC TANK 4"PVC OUT TO (TYP.) THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. _ - LEACHING FACILITY 0'90� oCONTRACTOR TO PROVIDE `s ' . 5. SLOPE ALL SOLID PIPE AT 1.0 /o MINIMUM. SPECIFIED DROP BETWEEN 12" 6" 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL ' 64.30' �--63.40' laid flat 2.B75`(34.5")_- SHALL VERIFY SIZE 48" VERIFY CONDITION OF OUTLET TEE 64.57 MIN. 64.40 ( ) (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES ; GAS BAFFLE 5A' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS 4 PVC TEE 6"CRUSHED STONE 11.5' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH EXISTING SEPTIC AND REPLACE AS } 513 OVER MECHANICALLY (T'P') R MIN. TANK NECESSARY f COMPACTED BASE 25 0 REQ'D AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (TMP') 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 76.00, _-- - -- - ' TO BE INSTALLED ON A LEVEL STABLE ' ESTABLISHED ON A NAIL SET IN A 14"PINE TREE AS SHOWN ON PLAN. -____ ---�� -� --- _.__ BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 58.17 BIODIFFUSERS (END VIEW) 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 INFILTRATOR SYSTEMS;, INC.) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW c �+ ©�+ r� 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CONI RACTORTOVE IFYEXISTI��GELEVAIFI��NPRIOR SEPTIC TANK PROFILE H-20 DISTRIBUTION BOX DETAIL ARC 36HC ( 3616 D) BIODIFFUSERS (H-20) TO THE DESIGN ENGINEER. TO ANY"st`•'ORK& N' � 1,r�_V ENGINEER IF D€FFIwfiF4,T. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. , ?rc, „ r ., , _ TEST PIT ®A-1'1>, 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING O " + i I- ii A REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM .,.° PERC NO. 13683 APPROPRIATE AUTHORITY. G ..- INSPECTOR: Donald Desmarais, R_S. i 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS ACM EVALUATOR: Michael Pimentel, E.I.T. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE * II THEY SHALL WITHSTAND H-20 LOADING. C.S.E.APPROVAL DATE: Oct. 1999 ±L Jul 5 2012 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND FINES. � * DATE: Y BL , ;� EXIST, 1,000 GAL. S P!IG TANK ; ZONE 2 AI~�,. , '`-, yc' TEST PIT#: 1 CONTRACTOR SHALL REMOVE ALL LOAM SUBSOIL AND UNSUITABLE W � T C SE li'§!�..€QED II`�i T=i{� t"�.F:S9Gi`� �t MAP 30 `-f '� r � ��� � Q" 14. WHERE REQUIRED, Q MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. 1 y ELEV TOP= 69.00 REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, PARCEL 131 � � `' � �' + •' 1 ELEV WATER= <58.17' � FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). W __80- -� �' -`� ff -, PERC RATE_ <2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. W l a * > ' • DEPTH OF PERC= 48"-66" 16. PROPOSED PROJECT IS LOCATED WITHIN: MAP 45 _ ( k LOCUs TEXTURAL CLASS: 1 ASSESSOR'S MAP 30 PARCEL 132 / M PARCEL 46 1 OWNER OF RECORD: NICK ELLENA& R. ELLENA,TRUSTEE OF THE NICK ELLENA cc 315 40' 0° 69.00' & REGINA ELLENA FAMILY TRUST AGREEMENT 0 } _ 72 ° A Loamy Sand ADDRESS: 40 BUTTE WOODS DRIVE " 10Yr 3/1 ! 4" 68.67' ORVILLE, CA 95966 PROPOSED H-20 / a # DISTRIBUTION BOX Loam Sand FEMA FLOOD ZONE C / ^ `�' A / B y COMMUNITY PANEL# 25000 001 `c � - - � w - _ � 10Yr 5/6 1 5 C Ljjo N o / UV 17. DEED REFERENCE: BOOK 9570 PAGE 318 48" 65.00' , 3 N ? /' TP 2 TP1 LtNE �cP �sQ �. ' d Perc 18. PLAN REFERENCE. P.B. 349, PG. 76 2 / #436 _- _ z 69xx0' 69x0' TREE LINE k ,, 66" 63.50' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. / EXISTING C PROPOSED TOTAL 20 \ 3-BEDROOM Q cr ' + * ''' ^� 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY �( ARC 36HC #3616BD) .; DWELLING � SHED ( _ �� _ f - ��'"� � ';N �� ;«. "t`,, � ��: ; _;.:; � FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME/�fY LABILITY ' co S BIODIFFUSERS (H-20) IN ? ' i,, �.,' "� f Coarse Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. TOF = 72.1'± RET.WALL r; A FIELD CONFIGURATION - '°" �"� +� `' �,� C 2.5Y 6/6 w W WOOD N PATIO ° :" (5%gravel) 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE ....U,�:, fF �: " -'' APPROVALS ARE REQUESTED FROM 310 CMR 15.221 (7): RET.WALL (1.) A 1.57'WAIVER(3A0-4.57')FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. _ GAS (2.) A 0.73'WAIVER(3.00-3.73')FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. GAS GAS GAS ` ( �� PLAN 7/H/V _ l GRAVEL DRIVE / \ �� �p� _�--�ROP,OSED INSPECTION PORT LOCUS PLA V H14 �\ \ WITH ACCESS BOX(TYP OF 2) �� /H/V �i p��) DECK \ T2� i SCALE: 1"= 1000` 130" 58.17' / Hiw 6 ~� o/H/w ❑� 1 �- \ PROPOSED 4" PVC VENT PIPE; No Mottling, Standing or Weeping Observed Hew GUY'WlRE a -74 '"� EXACT LOCATION PER OWNER MAP 30 DESIGN DATA TEST PIT DATA U.P. #33A LEGEND I < _E�t; T. I_ECI�IIG T�; EE PARCEL 132 PERC NO. 13683 \ PUMPED, FILLED wl C'L EAN 55,059 S.F± INSPECTOR: Donald Desmarais, R.S. TREE (TYP) SAND &ABANDO iNI ED EVALUATOR: Michael Pimentel, E.I.T. _ � 50x0 - EXISTING SPOT GRADE Benchmark NUMBER OF BEDROOMS (DESIGN) 3 50 EXISTING CONTOUR Nail in 14"Pine C.S.E.APPROVAL DATE: Oct. 1999 Elev. =76.00' DESIGN FLOW 110 GAL(DAY/BEDROOM DATE: July 5,2012 --� 50 PROPOSED CONTOUR X--X X _X X_ Approx. M.S.L. TOTAL DESIGN FLOW 330 GAUDAY p/H/W EXISTING OVERHEAD UTILITIES _ TEST PIT#: 2 GAUDAY ELEV TOP= 69.00 X )( _ DESIGN FLOW X 200 % = 660 , FENCE x-' -�x �Q �/ W EXISTING WATER LINE USE EXISTING 1,000 GALLON SEPTIC TANK ELEV WATER= <58.17' GAS EXISTING GAS LINE PERC RATE_ ` DEPTH OF PERC= TEST PIT LOCATION S�� INSTALL 20 - ARC 36HC (#3616BD) H-20 BIODIIFFUSERS -36'3g"E TEXTURAL CLASS: 1 EXISTING 1,000 GALLON SEPTIC TANK 380•00• �...-� MAP 29 SYSTEM CAPACITY PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE PARCEL 30 (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0" - 69.00' (100 0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL. LEACHING F DAY A Loamy Sand ® PROPOSED H-20 DISTRIBUTION BOX 4" 10Yr 3/1 68.67' SWING-TIES SCALE: 1"=20' TOTALS: ® PROPOSED ARC 36HC(#3616BD)H-20 BIODIFFUSER DESCRIPTION HC-1 HC-2 TOTAL NUMBER OF BIODIFFUSERS: 20 B Loamy Sand 10Yr 516 TOTAL NUMBER OF COUPLINGS: 0 BIODIFFUSER CORNER(1) 49.5' 38.7' TOTAL LEACHING AREA: 480.0 48" 65.00' BIODIFFUSER CORNER(2) 58.3' 49.4' TOTAL LEACHING CAPACITY: 355.2 REV. DATE BY APP'D. DESCRIPTION BIODIFFUSER CORNER(3) 48.0' 62.1' PROPOSED SEPTIC SYSTEM UPGRADE NOTE: BIODIFFUSER CORNER(4) 36.8' 54.0' PREPARED FOR: EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE HC-2 DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER Coarse Sand CAPEWIDE ENTERPRISES "MODIFIED APPROVAL FOR GENERAL USE" ISSUED TO INFILTRATOR C 2.5Y 6/6 SYSTEMS, INC., DATE OF ISSUANCE OCTOBER 3,2003(LAST MODIFIED (5%gravel) MARCH 14, 2012). TRANSMITTAL NUMBER=X235253. LOCATED AT 2) SPECIAL NOTES: 436 SANTUIT-NEWTON ROAD #436 (1 11.5' 35.4 EXISTING MARSTONS MILLS, MA 3-BEDROOM 1.) MAGNETIC MARKING TAPE SMALL BE PLACED ALONG THE TOP EDGE OF DWELLING N HED EACH SEPTIC SYSTEM COMPONENT. 130" 58.17' �� t� SCALE: 1 INCH = 20 FT. DATE: JULY 11, 2012 TOF = 72.1'± 0 10 20 40 80 FEET /."��N OF l�lAs p12.6' 2. CONTRACTOR SHALL VERIFY( SOIL CONDITIONS IN THE LOCATION OF THE No Mottling, Standing or Weeping Observed � s��y , JOHN L. PREPARED BY: PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT RESERVED FOR BOARD OF HEALTH USE CHURCHILL JR. JC ENGINEERING INC. DATA SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF ivil (4 (3 HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. 4180 2854 CRANBERRY HIGHWAY HC-1 F �`S - �' EAST WAREHAM, MA 02538 DECK 3.) PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION s SITE PLAN 508.273.0377 OVERLAY DISTRICT AND THE ESTUARINE ZONE WATERSHEDS. Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.2264 SCALE: 1" =20'