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HomeMy WebLinkAbout0693 SANTUIT-NEWTOWN ROAD - Health 693 Santu it-Newtown-Road Marstons_Mills. A = 028 011 I TOWN OF BARNSTABLE. LOCATION G 9 3 �jc,,,JA VA)t-Vjl,,a,es,a T3 SEWAGE VILLAGE �ASSESSOR'SMAP&PARCEL 0!2e -�1 INSTALLER'S NAME&PHONE NCB JI ,�e'�Oft 9n1NC SEPTIC TANK CAPACITY 1:—: X 1 Sop LEACHING FACILITY: (type) c / n� (size) NO.OF BEDROOMS �' l ,,Jr. OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching fa i ility) Feet FURNISHED BY: /�.J r �3 ® l 3.�6 J7 3y'y C� I,J Oot- ID \I/ No. Y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Y 01ppfltation for -MI8p08al 6pstem Construction permit Application for a Permit to Construct( ) Repair(/pgrade'( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 0 0"L M:III M i1� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Do.)6kS A l fe);--oa ir,)r. S01B -400-7/S_1 Type of Building: 3 Dwelling No.of Bedrooms Lot Size 7`f,2_7© sq.ft. Garbage Grinder( ) Other Type of Building irrl eJi 1 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4 L-((0 gpd Design flow provided G/5-1, � gpd Plan Date"i y I CR Number of sheets Revision Date Title Size of Septic Tank S00 Type of S.A.S. _Cnp Qjc,10,�Clk-AM w 1/'5}t'z (! Description of Soil Nature of Repairs or Alterations(Answer when applicable) t Ny6�C,11 3 SOO CA U1\C",0 k-\-9,0 CWWAV% 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. Sign Date y Application Approved by Date Application Disapproved by Date for the following reasons Permit No: ^�/� Date Issued No.C/`�' f� � t�'Q�'�/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:—�-� YeB PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitatlon for Misposal *pstem (Construction permit Application for a Permit to Construct( ) Repair( Upg,,de ) Abandon( ) ElComplete System ElIndividual Components 4f Location Address or Lot No. Owner's Name,Address,and Tel.No. 4 Assessor's Map/Parcel Q a - 0 1fA, /V r j Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �o.�y\�.s f1- 1�to��� �c So$ -�4(?�1/�► ,�.�.5t•�rt✓rNg l.JviJcs 5�-�17�313 Type of Building: - 3 DwellingNo.of Bedrooms Lot Size� 71 :L 7® s .ft. Garbage Grinder q g ( ) Other Type of Building rCSI{�AJ�lGe' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Lj L Q gpd Design flow provided �/ , y gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. -gyp s Btce��(7A>cl mlc�(�w Y),sto r Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1 r.YakC4�� S00 CA 0-0 i AA) G -3 e v J o - \a 0 S\.2 W"s b ra C Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in i 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. Signe - Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. r/� Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( 41_� Upgraded( Pt�' ( ) Abandoned( )by 5°` �7y�4e�S jk 7 �"13 r"N at 'fit „%b;1} t3r o�,i 4p O") has been constructed in accordance / J h with the provisions of Title 5 and the for Disposal System Construction Permit Na�1 AD I' dated {y J Installer j�5 A -11 tic, Designer U 6C t. s #bedrooms (�` Approved design flow gpd The issuance of this permit shall not Ke co strued as a guarantee that the system will on as designed -7 . Date —1 �. '6 1/P �,r � Inspector "Jt�' - --------------------------------------------- ------------------- No. (p Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( 7 Up ade( ) T- Abandon( ) Systemlocatedat SP^JF0c4- A )rkzl, or,.) "Q C,(g���g �a�,` e, l 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: �I Provided:Construction must be completed within three years of the date of this permit. 1 Date 6 — �„ Approved by Town of Barnstable Regulatory Services Richard V. Scali,Interim Director • s�wsrneLe, y , � Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: ? ! Sewage Permit# .42ClG_ 22c, Assessor's MaplParcel Q Z O < Designer: nay,v1.z.z rt.+s 1 ` Installer: i4 18 ry.^J --- Address: t Z i.N;, C - lc� {Zc` 1 Address:►e t9Z�32 On C�r D .A . "-k- was issued a permit to install a (date) (installer) n septic system at �3 Ste'` '�' ��Va�W^ f wtbased on a design drawn by (address) 0 L L,n t—k£ f a dated- 4 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in co liance with the terms of the I1A approval letters(if applicable) y o PETER T. 4nstaller�sSip ature) � McENTEE CIVIL No. .35109 'USA������� (Designer's Signature) (Affix Desi Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASepticV)esiener Certification Form Rev 8-14-13.doe Assessing As-Built Cards Page 2 of 2 http://www.townofb,amstable.us/Assessing/HMdisplay.asp?mappar=047048&seq=2 7/8/2016 of� Town of Barnstable r#_ /SD I o Department of Regulatory Services Public Health Division a Date '2D e �, A t639• `e� 200 Main Street,Hyannis MA 02601 a rf0 MA't� ii (r1 Date;Scheduled ' Time d Pd. \ U U O Soil Suitability Assessment for Sewa& Disposal Performed By: 1 `+e S-�r' M(- � R 5 1 1 —Witnessed LOCATION & GENERAL INFORMATION Location Address 3 Sc✓\ Q.} Name � � �-� .1�';eu:.1't-t'J�,t ;\ 12. _Owner's 3-o Address qv VW . ►ti\,: i 1 S 1VA A- 6 , Assess;or's Map/Parcel: C'J " --(7 l Engineer's Name NEW gONSTRUCTION REPAIR )e Telephone# 4�S Land Use 5' 2-Slopes(3'0) Surface Stones Distandes from: Open Water Body2 1�U ft Possible Wet Area�ft Drinking Water Well Drainage Way�s4 ft Property Line S� —R Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands to proximity to holes) I 2 �7 — �Aa I � V%,4_ Parent material(geologic) U �� Depth to Bedrock "" (vim _ Depth to Qroundwater, Standing Water in Hole: Weeping from Pit FAae , ;� 132 Estimated Seasonal High Groundwater .y DETERMINATION FOR SEASONAL HIGH 'WATER TABLE Method Used: jDepth Observed standing in obs.hole: . ^ -.--In, Depth to soil mottles: n„In, ;Depth to weeping from side of obs.hole: , In, Croundwater Adjustment . ,ft. Index Well:# Reading Date: Index Well level AdI,factor,,,,,,,,, Adj,GroundwaterJAvei PERCOLATION TEST bate .� Tlame,_mPe Observation iHole# '2- Time at 9" Depth of Perc Time at 6" r t Start Pre-soak Time Time(9"°6") ��. ... End Pre-soak t Rate Min/Ihch. M I Site Suitability Assessment: Site Passed �-L_ Site Failed: Additional Testing Needed(Y/N)_ Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conse>E vation Division at least one (1) week prior to beginning, Q:\SEPTIC\PERCFORM.DOC I �S DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoneg;Boulders. Consistency,%Gr vel 2 � DEEP OBSERVATION HOLr LOG Hole _ Depth from Soil Horizon Soil Texture Soil Color Soil 1 Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% rave i6 DEEP OBSERVATION HOLE LOG Hole#, Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistency, o Gravel) DEEP OBSERVATION HOLEE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Co si --------------- Flood Insurance Rate Man: Above 500 year flood boundary No— Yes .: Within 500 year boundary No Yes Within 100 year flood boundary No Yes.,,- L Death of Naturally Occurring Pervious Material I Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? — If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed'the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tra' ' ,expertise and experience described in 310 CMR 15.017. Signature Date 4'} f' Q:\SWTlCNPERCFORM.DOC YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and bet the Business Certificate that is required by law. DATE: U O I�-'' �{ �,n Fill in please: APPLICANT'S YOUR NAME/S: o n�� I 1v11�S BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number NAME OF CORPORATION: 5��� �� L-\<a,,.^ 7h��_ NAME OF NEW BUSINESS (-(e-tir C_h� W'^d"� L<<``^' TYPE OF BUSINESS ^�°� C ^ ' IS THIS A HOME OCCUPATION? YES NO I �/j--1) 1 (Assessing] ADDRESS OF BUSINESS �::h^ a w �°'^ �a S}r�s M�� MAP/PARCEL NUMBER O When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1: BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH MUST„OMPLY WITH ALL This individual ha$ been qr�n ,pf the permit requirements that pertain..to this type of business. WARDOUS MATERIALS REGULATIONI$ Authorizedf Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has n,infq(,i,ne(� the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: J � 1 IN 5 a �.. � a VN � o 3 ^ ao , o � o o w Liof - JI L i,5e� Town of Barnstable Health Inspector oFt Tp� Office Hours do . Regulatory Services 8:30-9:30 ; Thomas F.Geiler,Director 1:00—2:00 BAMSTABLM 1639. Public Health Division �0 ArF p �A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT - SEPTIC QUESTIONNAIRE 1. General Information: Size of Property: f" Z— j �D2 Address: M3 l(K9 W�1 Map Parcel Name: CSY\a(J� � Phone #: 56 2-o �3a�J 2a. How many bedrooms exist at your property now? Ll 2b. Are you planning to add any bedrooms? �/�/J If yes, how many? 2c. How many_bedr.00ms total-are-proposed-at-this-propert-y...(including the amnesty unit)? .2� d. Please include a copy of the floor plans for the entire property - showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. , 3. Is the d'welling-connected_to.publc sewer? YES or O If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE o OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? E ' 1 � -- 6. Is a disposal works construction permit on file? '=-YES o jr � NO-- 6a. If yes,how many bedrooms were approved according to this permit? r`-',` Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? 1 YES or 1VO t3 8. Is there an engineered septic system plan on file at the Health Division? YES poi RO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO --------------------7---------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY q2 — 107 N►: L 11(o Z ga4ES The Public Health Division has no objection to bedrooms at this property. Special Conditions: a k- Signed: Date: Q;/health/wpfil es/amnestyapp J 75 £ i• RO Az I i I I: i I i •i � : _ art' �� C�� -� Sit`D� � �-��or� � � � � � Lw i�' ��� '� 3' � �I ��� 4 a I CoMM - i ALTH OYNLASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA-IRS' DEPARTMENT ENT OF.ENVIRONMENTAL PROTECTION TITLE 5 OFFIGI A L INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL SYSTEM FORM PART A CERTIFI CATION Property Address: wog 7J z Q Owner's 1'iame. Owner's Address: Date of Inspection: O'J"104 Name of Inspecto%�� print} ,' Company Name: Mailing Addr ess: �. po Telephone Numb :. 77J9 CERTIFICATIO�i STATEMENi� I certify that 1 have personally inspected the sewage disposal system at this address and that the information repartee and complete as of the time of the inspection.The inspection was performed based on my below is true,accuratein of onsite sewage disposal systems. I am a DEP training and experience in the proper function and approved system inspector pursuant to Se,:tion 15.340 of Title 5(310 CMR 15.000). The system: V Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector-'$;Signature alth or The system inspector shall submit a copy of this inspection report z atshared system or has a desving Authority siign flow ooard of f 10,000 DEP)within 30 days of completing this inspection.If the system is Y apd or heater,the inspector and the systen owner shall submit the report to the appropriate regional office of the owner and copies sent to the buyer,if applicable, and the approving- DEP_ The original should be sent to the system authority. ?Votes and Comments %x**This report only describes conditions at the time of inspection.and under the conditions of use at that ' time.-This inspection does not address'how the system will perform in the future under the same or different conditions of use. Title.5 Inspection Form 6/15/2000 page I Page 7 of l I OFFICIAL INSPECTION FARM—NQT FOR-'VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL SYSTEM-INSPECTION FORY4 PART C SYSTEM.INFORMATION-(continued) Property Address: Owner: ' Date of Inspectio I �O BUILDING SEWER(locatz on site plan) A/ Depth below Fade: Materials of construction:_cast iron _40 PVC_other(explain): Distance-from private water supply well or suction line: Comments(on condition of joints,venting evidence of Ieakaae,etc) SEPTIC TANK �Z(locate'on site plan) Depth.below grade: Material of construction: ✓oncrere_metal_fiberglass—polyethylene other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) y Dimensions: ��'� k('o` k S Sludge depth: Distance from top of Judge to bottom of outlet tee or baffle: l ff Scum thickness: r// i Distance from top of scum to top of outlet tee or battle`. rt Distance from bottom of scum to bottom of outlet lee-or baffle:) How were ,dimensions determined: �1�� �1� I a Comments (on pumping recomrnen ations!inlet and outlet tee or baffle condition, structural integrity, liquid levels ?�s related to outlet invert, evidence of leakage,et J`A'' GREASE TRAP; (loca e on site plan) ' Depth below grade: Material.of construction:_concrete_metal_fiberglass__polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or bartle: Distance from bottom of scum to bottom:of outlet tee or bafr'le: Date oflast.pumping: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 WNW s Page 6 of I 1 OFFICIAL-INSPECTION FORM NOT'FOR VOLUNTARY:ASSESSMENTS V. SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION Fop-Ni I€ PART.C SYSTEM INFORMATION Property Address: U� Owner. Date,ofInspecti �1�y FLOW CONDITIONS RESIDENTIAL;---—. Number of bedrooms desig ( ten)- Number of bedrooms(actual}; �l DESIGN flow based on 510.0 15.203(for example: 11.0 gpd x 7#of bedrooms): V Number of current'iestdents Does residence Ihave garbage gander(yes or ao) /) Is laundry on.a separate sewage system(y s or no): lf yes separate inspection-required]" Laundry system. inspected(ye ,or no): }( Seasonal use: (yes or no): 0 Water meter readings;;if av ilable last 2 years usage 0J` le Sump.pump(yes or no):jyU. r Last date of occupancy: C OMMERCIALJINDUSTRIAL/�/o Type of establishment Design.flow(based on'10 CMR 15.203) gpd Basis of design flow(seats/persons/sgft,ett.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5-system'(yes or no):— Water meter readings, if available: Last date of occupancyluse: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information ®'� Was.system;pumped as part of the i spect on(yes;or no): If yes, volume pumped . gallons Haw 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 ofthe.current operation.and maintenance contract(to be obtained from system-owner) _Tight tank —Attach a copy of the DEP approval _.Other(describe): roximate age of all components, date installed_(if known)and source of inf rmation: Were sewage odors:all when arriving at the site(yes or. and .o f C OF ASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFF_AI:RS. �} DEPAR'I'1V ENT OF-ENVIRONNIENTAL PROTECTION TITLE 5 OFFICLA, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM FORM PART A CERTIFICATION Property,Address: cog 3 Owner's Owner's Address: — �&et&" Y "Aid*I./i'�2 4CL6T 0 Date of lrispeetion: � Name of.Inspec#or please e arint) Comp2nyName: VAC' Mailing.Address: Telephone Number:�6 9; `771 9 F3 99 " CD CERTIFICATION STATEMENT ' I.certify that I have personally,inspected the sewage disposal system at this address and`that the i•;;Iflbrmation-report c below is true, accurate and complete as of the time of the inspection.The inspection was perfonra� based o%my training and experience.in the proper function and maintenance of on;site sewage disposal systerns.'I am a DTP G. approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syste is w > Co. Passes C rn Conditionally Passes Needs Further Evaluation by the Local Approving'Authority Fails 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 m the system owner and copies sent to the buyer, if applicable, and the approving- authority. Notes and Comments ****This report only describes conditions at the.time oflinspection:an.d under the conditions.of use at that time..This inspection does not address`how the system will perform`in.the future under the same or different conditions of use. Title.5 Inspection Form 6/15/2000 page l Page 2 of l 1 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY:ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: U,� A: Owner: j Date of Inspection:'0ir W"A, /J. Jdoj�2 Irspection Summary:. Check A,B,C,D or E/ALWAYS complete all of Section D A. S stem Passes: I have not found an information which.indicates y that any.of the failure criteria described in 310;CMR 15.303 or in310:CNIR 15.304 exist. Any failure.criteria.not evaluated are indicated below. Comments: i - B. _ System Conditionally- Passes: One or more system components.as described in the"Conditional Pass" section need to;be replaced or repaired.The system, upon completion of the replacement or repair; as:approved by the Board of Health, will pass. Answer yes, no:or;rot determined(Y,N;ND)in the 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 rot)is structurally unsound, exhibits substantial infiltration or exfiltratiori or.tank failure is.imminent:System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. . ND explain; 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, set.ded or uneven distribution box. System will pass inspection if(with approval of Board.of Health): broken pipe(s)are replaced obstruction is removed distribution box.is leveled or replaced ND explain: The system required,pumping more than.4 times a year due to broken or obstructed pipe(s)..The system will pass.inspection if(with approval of the.Board of Health): broken pipe(s).are replaced obstruction is removed ND explain: a i Pa e'3 of 1.1 OFFICIAL:INSPECTION FORM -.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWA'GE.DISPOS:AL SYSTEM`INSPECTION FORM PART A` CERTIFICATION (continued.) Property Address: �(..l.A Owner: F Date of lnspectl� 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 2. System will fail unless the Board of Health,(and Public,Water Supplier, if any).determines that the system is'functionina 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 aseptic tank and SAS and the SAS is Within 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 supnly.well". Method used to determine distance "This system.passes ifthe well water analysis;performed at aDEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is.free from pollution from that facility%and the presence of amin_onia 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: 3. J Pape 4 of..l l OFFICIAL INSPECTTOIV:FORM.NOT FOR VOiLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE I)ISPOSAL.SYSTEM INSPECTION FORMS PART A. CERTIFICATIO (continued) P.roperty.Address: (.j ;B!r' Owner: Date of Inspectio .('s &e11J ;000 D. System Failure Criteria applicable to all systems: You must indicate"yes" or"no"to each.ofthe.following for all inspections: Yes No/ _C/ Backup of sewage into.facility or system component due to overloaded or cloQaed SAS.or:cesspool Discharge or pondin;of effluent to the surface of the ground.or surface waters due to an overloaded or cloased SAS or.cesspool Static liquid level in the distribution box above.outlet.invert due to an overloaded or.clogged SAS or cesspool . V Liquid depth in cesspool is`less.than 6"below invert or available volume is less than %day flow Required pumping more.than.4 times in.the last year NOT due to clogged or obstructed pipe(s).Number ' f times pumped yC Zy 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 cr,a.private water supply well.. Any portion of:a cesspool or,.privyis:less than.1.00 feet out ereater.than.50 feet.from a private water supply well.with.no acceptable water.quali.ty analysis..[This system passes if.the well water analysis, performed at:.a DEP certified laboratory; for coliform bacteria and::volatile organic compounds indicates that the..well is free from pollution from that:.facility and the.:presence.of ammonia nitrogen and nitrate nitrogen is equal.to or less than 5 ppm, provided that no:other failure criteria are,triggered.A.co.pyof the. an2lys8..must:be.attached to. this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria.exist as described in 310,CIvIR 15.303;therefore-the system fails. The.system owner should contact the Board of Health to determine what will be necessary to.correctthefailure. ' E. Large_Systems: To be considered a large system.the system must serve a.facility-with a design flow.of 10,000 gpd to 1.5,000 gpd- You must indicate either"yes" or"no"to each of the following: (The following criteria apply to large.systems.in addition to the criteria above) yes no 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 ILof 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 signi... nt.threat.under Section E.or failed under Section D shall upgrade the system in accordance with.3.10 CMR 15.304.The system owner should contact.the appropriate regional office of.the Department. Paae 5 of I OFFICIAL JN.SPECTION FORIM NOT FOR VOLUNTARY ASSESSMENTS SURSURYACE SEWAGE DISPOSAL- SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Own er: Date ofinspectio .. aj� '�jQ�,L jf t Check if the following have.bien done.You must indicate "yes"or"no" as to each of the followin_: Yes No —bl Pumping.infoi rination was.provided by the owner, occupant, or Board of Health LZ Were anv of the system components pumped out in the previous two weeks ? - /_ Has the system received normal flows in the previous two week period ? V Have larze 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? V 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/eba"les or tees, material of construction, dimensions, depth-of liquid,.depth of sludge and depth ofscum _ 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: YeKno r Existing information.For example, a plan at the Board of Health: _ Determined in the field:(ifany of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15302(3)(b)1 5 Pace of 11, OFFTCIAL I3tiSPECTIONTORM-I�I.OT FORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE:DISPOSA.L SYSTEi'✓✓Y Ilti,SFEC CIOiti FORM PART.-C SYSTEM,,INF.ORNIATIO Property Address::C06? ( Owner: Date;of Inspecti FLOW CONDITIONS RESIDENTIAL Number of bedrooms.(design): Number of bedrooms (actual).- DESIGN flow based on 310.C1*v1 15.203 (for example: 11.0 gpd x r of bedrooms),: � Number of current residents:. Does residence have a garbage grinder(yes or na): Is laundry.on.a separate sewage system (ygs or no.)_�.[if yes separate inspection required] Laundry system inspected(ye .or no): Seasonal use: (yes or no): O. Water meter readings; ifav ilable(last2 years usage (gpd)): 0 Sump.pump (yes or no):/ Last date of occupancy: yea, COMMERCIAL/INDUSTRIAL /0 Type of.establishment: Design flow (based on 310 CMR 15.203): gpd Basis of"desian flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings;if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORI4:IATION Pumping Records Source of inforination: Was system pumped as part of the i spection.(yes or 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) y _Tiaht tank _Attach a copyof the.DEP approval _.Other(describe): roximate age of all.components, date installedw(if known).and source of in- rmation:. Were sewage odors.detected when arriving at the site(yes.or no)fkh) ' 6 Pace 7 of 1'*I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM PART C SYSTEM-INFORMATION,(continued) Property Address: Owner: Date of Inspectio APZ BUILDING SEWER(locate on site plan) A10 Depth below trade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments (on condition`of joints;venting, evidence of leakage, etc,):: SEPTIC TANK.: (locate on site plan) Depth.below grade: Material of construction: V concrete_metal_fiber-lass_polyethylene _other(explain) If tank is metal list age: Is age conrirmed by a Certificate of Compliance(yes or no): _(attach a:copy of certificate) Dimensions: )(6,191 Sludge depth: Distance from top of 3 ;udge to bottom o-outlet tee or baffle: ! . Scum thickness: fl Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet lee or baffle: How were dimensions determined:. Comments (on.pumping recommen a� tions; i� nlet and outlet tee or baffle condition, structural integrity, liquid levels s related to outlet invert,evidence of leakage,et ): '�, ,� ^ e GREASE TRAP ; i locate on site plan) l�L/z�C,� Depth below grade: Material:of construction: concrete_metal_fiberglass polyethylene_other (explain):: Dimensions: Scum thickness: Distance from top of scum to.toga of outlet tee or bathe: Distance from bottom of scum to bottom:of outlet tee or baffle: Date of 1ast.pumping: Comuents (on pumping reconmendatiors, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 . Page 8 of I OFFICIAL..INSPECTION FORM=NOT FOB:Y:OLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INEORAIIATION(continued) Property Address: �,(9 } AZI+ Ownerr Date of Inspectiod/ TIGHT or HOLDING TANK: (tank Must be pumped at time of inspection)(loc.ate oa.site plan) Depth,below grade: Material of construction: concrete metal fiberglass polyethylene other(explain).:: Dimensions:" Capacity: gallons Design Flow: gallons/day Alarm present.(yes or no):. Alarm level: Alarm in working,order(yes for no): Date of last pumping: Comments�(condition of alarm and float switches, etc.): DISTRIBUTION BOX: t/ (if present must be opened (locate on site.plan) Depth of liquid level above outlet invert: Comments (note if box is.level.and distribution to..outlets ual,.any evidence of solids caryover, any.e.viaence of eakage into or o �ofbox,�e -.),.. � PUMP CHAMBER:.A(locate on site plan): Pumps in working order(yes or no): Alarms in working order(yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Page 9 of I I OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM"INSPECTION"FORYI PART C . SYSTEM INFORMATION (continued) Property Address: ,� C9 509 Owner: Date SInspecti SOIL ABSORPTION SYSTEM (SAS): t/ {locate on site plan, excavation not required) If SAS'not located explain why: T � ._.. 7leaching pits,number:_ -leaching chambers,number: leaching.galleries, number: leaching trenches, number; length: ochina fields,number, dimensions: verflow cesspool, number: innovative/alternative system. Type/name of technology:" Comments(note condition ofsoil. signs of hydraulic failure, level of ponding., damp soil, condition of vegetation, al e f CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and con i_uration: th Dep =top of liquid to inlet invert: Depth.of solids layer: Depth"of scum layer: Dimensions of cesspool: 0_k�, Materials of construction: Indication of-groundwater.inflow(yes or no): . Comm"ents (note conditiorrof soil_; signs of hydraulic failure, level of ponding, condition of vegetation, etc' PRIVY:ALO (locate or, site plan) Materials of constriction: Dimensions: " Depth of solids: Comments (note condition of soil; signs of hydraulic failure, level of ponding, condition of vegetation; etc.): C� ` 1 Z ✓/ram oc/ kd�, � &0- 9 Page 10 of.11 OFFICIAL;INSPECTION.FORM--.NOT FOR VOLUM.F-ARY A,SSESSMENT.S SUBSURFACE SKWAGE DISPOSAL SYSTEM INSPECTION FORT PART C. SYSTEM INFORI�/IAT ON (continued) Property Address: 3C Owner: Date of Jnspection _af!. 11 a SKETCH OF SEWAGE DISPOSAL SYSTEM. Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 1100 feet:Locate.where.public water supply"enters the building. 0 ' 3lcxA�C O ebb �a 0,00c) 00c) � f Page 11 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:f119 �,�„� Owner:Qei � Date of Inspectio 0(0 SITE EXAM Slope Surface water Check:'cellar Shallow wells Estimated depth to ground water fee: Please indicate (check)all methods used to determine the high ground water elevation: Obtained from.system design plans on record-If checked, date of design plan ieviewed: 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 USES database-explain: You must describe how you established the high ground water elevation: 5'ell e4l. , . 11 Permit Number: Date: ' Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Lot No. Owner: E �_ Address: a Contractor:- Address: STEP 1 Measure depth to water table tonearest 1/10 ft. _............................................................................: :Date_ month/day/year STEP 2 UsingMter.-Level`Range Zone -= and Index.-Well Map locate site and determine: ✓ � Z5 3 Appropriate index well.................................................... OB Water-level range zone ..................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to _.... Water level for index well .......r................... l� / _.: -:,.,,.._:..,.,_.,._.......... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth 'to water level for index well (STEP 3), and-water-level zone (STEP 213) determine water-level adjustment ................................................... ►-� STEP 5. Estimate depth to high water -by subtracting the water- IQvel adjustment (STEP 4) from measured depth to water level at site (STEP 1) ..................................:........... Figure 13.—Reproducible computation form. 15 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECT10. JAN 21.200 row 3 IV TITLE 5 HFgL rH DE,6 �F OFFICIAL INSPECTION FORIVIR-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM . PART A CERTIFICATION Property Address: ®� MAP Owner's Name: _ .Owner's Addres :(ALPARCEL CIS Ve _...�,�...._�.... LOT Date of Inspection: Name of Inspector: (please print) -'T. 9) v0100I1 Company Name f, _ (Q�) G. Mailing Address: .C� .Telephone Number: 5jr -7-2/• 9392 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of,the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I.am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CM'R 15.000). The system: Passes Conditionally Passes Needs burther Evaluation by the Local Approving Authority: . - Fails 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. - J Notes and Comments � -L 4 i 1 ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/20.00 page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:C / U l " 1.11 Owner: Date of In pection: 3 Inspection Summiary: Check A,B,C,D or E/ALWAYS complete.all of Section D A. )ystem Passes: I have not found any information which indicates that any`of the failure criteria described in 310,CMR 15.303"6r in 3.10 CMR 15.304 exist.'Any failure criteria not evaluated are indicated below. Comments: i0 JP'.r 7 B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair; as approved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for the following statements. If"not determined"please explain. 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 exfi'ltration oraank 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 indicatin-that the tank is less than 20 years old is available. ND explain: Observation.of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken;settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more,than*4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: . 2 Page 3 of 11 OFFICIAL.INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of In .pectiori. 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 2. System will fai: 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 I Page 4 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 0 Al Owner: .Date of Ins ection `-3, 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 — V Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or I// clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an:overloaded or clogged SAS or / cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number / of times pumped ►/ Any portion of the SAS,cesspool or privy is below high ground water elevation. _ .V 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. id/ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates.that the well is free from pollution from that fa6lityand the:presence..of ammonia nitrogen and nitrate nitrogen,is equal to or less than-5 ppm,provided that no other failure criteria Aare triggered. A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct`the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10;000 gpd to 8,000 gPd• You must indicate either"yes"or"no"to each of the following:. (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply — i 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. .4 Page 5 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Cp 9 Owner: Date of In pection. Check if the following have been done. You must.indicate"yes" or"no"as to each of the followine: 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? vl'_ 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 7 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: Yes/no Existing information. For example,a plan.at the Board of Health. __ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 r, v Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -PART C SYSTEM:INFORMATION Property Address:&! Owner: Date of I spection U FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):--� Number of bedrooms(actual): DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence.have a garbage grinden(yes or no)• Is laundry on a separate sewage system (yes`or no✓ if yes separate inspection'required]., Laundry system inspected(yes or no Seasonal use: (yes or n4' Water meter readings, if available(last 2 years usage (gpd)):01 1q3 V Sump pump(yes or no • Last date of occupancy: COMMERCIAL,%INDUSTRIAL, /,," Type of establishment`..) Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap.present'(yes or no):— Industrial Waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the in pection(ye or no If yes, volume pumped: gallons--How was quantity pumped determined? Reason'for pumping: TYPE OF SYSTEM --LA- eptic tank, distribution box, soil absorption system Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval _Other(describe): Approximate age of all compone ts, d e i stalled(if known)and source of information- Were sewage odors detected when arriving at the site.(yes or n° 6 Page 7ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEW AGE DISPOSALS a SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: C� Owner: .� Date of Anpe-ction: 3 03 BUILDING SEWER(locate on site planl� Depth below grade: Materials of construction:_cast iron 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: Z(locate on site plan) Depth below grad�s� i Material of construction: _metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:20.G' X (o' k ig ' Sludge depth: Distance from top of sludge to bottom of outlet tee.or baffle: y Scum thickness:1 /' - I i - Distance from top of scum to top of outlet tee or baffle: I , Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined• Comments(on pumping recommendations,Inlet and outlet tee or baffle condition,structural integrity, liquid levels related to outlet invert,evidence of leakage, etc:): . y i� Q GREASE TRAP: cate on site plan) Depth below grade:_ 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert, evidence of leakage, etc.): 7 Page of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION(continued) Property Address:. (P :�4-- U� Owner: Date of In pection: ! _�c) TIGHT or HOLDING TAN 1; t(tanl: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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must'be opened)(locate on site plan) Depth of liquid level above outlet invert:�to Comments(note if box is level and distriequal, any evidence of solids carryover, any evidence of akage into or-out of box te.): PUMP CHAMBER(locate on site plan) Pumps in working order(yes or no): Alarms in,working,orde.r(yes or no):" a Comments'(note condition of pump chamber,condition of pumps and appurtenances, etc.):+ 8 I Page 9 of 1 I OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner Date of Inspection. 3 SOIL ABSORPTION SYSTEM (SAS):_/�(Iocate on site plan,excavation not required) If SAS not located.explain why: TYPe leaching pits,number: leaching chambers,number: Leaching galleries,number: leaching trenches, number, length: leaching fields,number,dimensions: _overflow cesspool,number: % innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, �i /2 it . 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 or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY ocate 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.): 9 Page 10 of 1 l OFFFCIA.L INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C, SYSTEM INFORMATION(continued) Property Address: Owner: i v Date of In pection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two.permanent reference landmarks or benchmarks. Locate all wells within 100'feet.Locate where'public water supply enters the building. tom►' " O 0\ O 10 f Page I 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: ,41 . Date of In ection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check).all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: 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: , S 11 s Permit Number: Date: Completed by:' HIGH GROUND-WATER LEVEL COMPUTATION Site Location:-/ye, /"I�'�5 /1S j//ot No. Owner: Address: Contractor:_ Ar. Address: Notes: STEP 1 Measure depth to water table J to nearest 1/10 ft. .............................................................................. .Date I /✓�`3 2 month/day/year -.a STEP 2 Using Water-Level Range Zone and Index Well Map locate site and cetermine: OAppropriate index well.................................. ..lJ.i/ OWater-level range zone ..................................................... STEP .3 Using-monthly report"Current Water Resources Conditions" determine current depth to water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) Q' determine:water-level adjustment ........................................................................................... v �. STEP 5 Estimate depth to high water by subtracting the-water- level adjustment (STEP 4) from measured depth to water • level at site (STEP 1) .....................................:........................................................................ Figure 11-:-Reproducible computation form. 15 100 Ll l r tr'f f� � � i�Z✓ ... TOWN OF BARNSTABLE LOCATION 1&IZ3 SEWAGE # VILLAGE ASSESSOR'S MAP & LOT 6=� --O// INSTALLER'S NAME & PHONE NO. e&A7— fPFF SEPTIC TANK CAPACITY LEACHING FACILITY:(type) /,�') (size) &X/0 r NO. OF BEDROOMS `7 PRIVATE WELL'OKE6LC WATER BUILDER OR OWNE /�s0 J �sLl�l1 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �G �� '��. ~ `� � ?. �. ---- v� Q �y� I r a No... .2 .........:....... -"- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H E A LT Ibrq$table ion pROVEO TOWN OF BARNSTA LE ',at,� Appiiratiun for Mupuual Works Tonutr '# Application is hereby made for a Permit to Construct ( ) or Repair (< an Individual Sewageoposa System at: ...��,z�'.3_......_ ........................ ....-----•�. ...................�..e!� �......6o�(o S f`.... -• ................. ----- o tt - d ss or Lot No. - ... Ownys ddress Installer Address U Type of Building Size Lot_42..aW_ Sq. feet Dwelling—No. of Bedrooms......................,_....................Expansion Attic ( ) Garbage Grinder ( ) a�_l e of Building ersons____________________________ Showers Other—T yP g --=---------------•--------_ No. of P ( ) — Cafeteria ( ) dOther fixtures .....................--------------------------------.--..-----------------------------------------------.._...._...---------•..._---•---........._.. w Design Flow....................�aS..........gallons per person per day. Total daily flow_________ ....................gallons. WSeptic Tank—Liquid capacitA—__gallons Length._Z7Fs Width_..:..... Diameter________________ Depth................ Disposal Trench—No_ ____________________ Width______i,_._._------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.........../...... Diameter.....�/v....... Depth below inlet.....j(a ....... Total leaching area..................sq. ft. Z Other Distribution box (G'14 Dosing tank ( ) Percolation Test Results Performed by................................ Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fit Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ �+ -------------------------------------•--------------___--------- •--••••--•----------•••••--•-----------••-••---- O Description of Soil------------ =ems_.._._ ."; ��---L.VlC. s �� c e. !�--�--4;��............. �. x w UNature of Repairs or Alterations—Answer when pplicable_.__ffs& �a S CE •- PC)....1,0 , .� ----•---� d ? �_ :..arc....f.........t'doG `,�i w����'��•-----• greement: e undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation.until a Certificate of Compliance h e iss b e bo rd f ealth. Signed .............. �-- - -- - ------------------------------ ---.----------. ....- Dat ApplicationApproved By ............ ....-.----- ------------------------------------_.----------....--.....-...---- ------ Date Application Disapproved for the following reasons- ----------- --------------------------- -- --- ----------------------------- -- ---------------- ---------------------- -------------------------------- ------------------- -- ------- ------------------------------------ ------------------------------------------------------------------------------------ -- -- ------------------ -- ---------------- Date PermitNo. ......... --...V e_77---------------------- Issued ................. ---- ---------------....------------------- Date No ?... / ?... �- U// \ F�$....`..��.... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' TOWN OF BARNSTABLE App iratilan for Elhipmal Workii TowitrurtUarilirrmit y _ Application is hereby made for a Permit to Construct ( ,) or Repair an Individual Sewage Disposal�a System at ._.._.. _____ dr ___________c.................... ..........----.--._>__...jAj.........._...........`.......(._..---._................................ Location- ess or Lot o. ..--•---•------------------.....__.............----..........------•---...... -• ----•------------••-•-----•....._....••-•--....__.._..---•-••-------------..._............._----- Owne Address ��,. �l-� way �o ��,. _I« Installer Address Type of Building Size Lot_________� DdC�� _________________S q. feet �`k 1 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons____________________________ Showers � YP g --------•----•-•------------ P ( ) — Cafeteria ( ) Other fixtures -------------------------- ----------------------------------•---------------•--------------------------------- •---------------------- W Design Flow....................... ...._____..gallons per person per day. Total daily flow___________--? d .... ....................gallons. WSeptic Tank—Liquid capacity4 gallons Length___ Width....S_....... Diameter________________ Depth................ x Disposal Trench—No.........i........... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------------ ----- Diameter......Zv_...... Depth below inlet...... ......... Total leaching area..................sq. ft. Z Other Distribution box (P) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water......................... 04 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ -•-----•---------------------------------•-•••---•-----_.. O Description of Soil------------d_-. ..........C)*W-A� SGiQ--�/c - ./� --``.�-4.r�lU x ......._.. --------•------••-•••---------•-••--•------------------................................ U .....-•--------------•-------•-----------------.._...--•-•-----.........._..---------•••--....-----•-------------------------••------------•---- UW ----------------------------------------------------------------------------------------------------------------------------------------------------•------_---•---••---•---•--•--- . ) Nature of Repairs or Alterations—Answer when pplicable._____--4dX''`I'6'0� ` �_____`' Ly S L _. U` f��� ��«/ . ._ od `s ............ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has.been is�suedA y,�the board�©fhefalth. Signed - - � t...../�/ J .'".`. .................... 1"�- Date Application Approved By �9e, .� --w� F_.' -__3_--..-g ............. 2.................._.....-....-'---.............................-----------------... Date '- Application Disapproved for the following reasons- -------------------- ------------------------------------------ ------------------------------------------------------------ ---------------------------------------------- -- --------------------------------------------- -------------- ------- ----------------------------------------------------------------------- --------------------------------------- Date PermitNo. ------ f------- n...�-- -- ---------------------- Issued . ... a .................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�er#tfteate of C�otrtialial t.ce THIS IS TO CERTIFY, That the.lndiv_idual Sew. e Disposal Sy tem constructed ( ) or Repaired ( ) by .....--- U%r./' LOn.1S ................................................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......I���..-....�.o..7...... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. r' n - Ti� DATE------------------------- ------------------------l.. / ?--�------. Inspector . pn I. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� ID TOWN OF BARNSTABLE &� _---- No._._.,,...-.....?... FEE........................ ,�5� aka A97 CaAu� _" r Permission is hereby granted ____-------•---- --------------------------------------------------------- to Construct ( ) or Repair ( )/an I divi ual Sewage Disposal System atNo......................................................... � lvz"Fi M-0 -•-------------•--------------------------------------•-••-------------------...----------•---•---••---•-..__............. Street as shown on the application for Disposal Works Construction Permit No ___ Dated.......................................... �J - t --• . ------- DATE. Q............................................. Board of Health FORM 38808 HOBBS&WARREN.INC.,PUBLISHERS �9 F 'w1 / LOCUS N I I Long Pond 0 y , Long Pond \��� z EOV -� 152 w C 50.50 50.33 ��. - o� O Eso 3 EDGE OF POND E1_-v--___�- _-_-_--_-cJ -_---_- e6 vl 6, ��,L� LOCUS MAP NOT TO SCALE I - ' 01� � -- LEGEND J i I ��- q�� 1 \\\ x 100.98 EXISTING SPOT GRADE 99 -- EXISTING CONTOUR -W EXISTING WATER SERVICE -G EXISTING GAS SERVICE -0.'H.l+� '- OVERHEAD WIRES -U UNDERGROUND WIRES POND' ti 71.06 \ t 7 OF 2 TEST PIT ' EDGE -SPKT.....•• r� y BENCHMARK .....•w 70.05 4 •� \ l z Tm 70.85 z i a• 1 \'`� rn•• i i....y...... 1 1 1 i PARCZL ID:\\\ 028;011l 0 /4,2701 S)F, t 69.33 -7 41 f C) U1CP EX. SEWER FRdM COTTAGE ' I ( �' BENCHMARK-2 BN i \ I CORNER/MASONRY STEP 74. 73 a Tp_TP-2 \��'� ,��' i EL.=75.B3 1 ' SLEEVE SEWER WITJA r 10 OF WATER SERVICE ,7 `- 4 7125' r f BENCHMARK-1 : 7.e ` CORNER/WOOD STOOP 7 s 73.03 EXIST. SEWER i EL.=74.30 0 /' FROM HOUSE � rAb D o +J EXISTING LEACH PITS0 TO BE PUMPED, FILLED WITH ° 7 60 75.43 V1'1 76.78 SAND AND ABANDONED, OR .y ° ° TB 2 , 76.8 REMOVED. 2:7o Z: - '.B PATIO 7 86 EXISTING SEPTIC TANK �;. 76.32 EXISTING72 �_ 3Q•,._.;.:�; TOP OF TANK=72.24 72.97 I HOUSE(#693) 76.3 INV. OUT =70.90f T.O.F.=75.6t �s.b . ) �' �. . 75.36�. 73. 75.40 7� �� 76.15 73.23 �� 74,31 a.37 74.69 74.81 \2- 75.15 1 PROPOSED S.A.S. (vented) 73.41 74.20 1 \ 73.56 '. 0 11 \ 1.t.' 74.67 1 \\ I I \ \Q3.. D STONE,DRIVEWAY' :;:. 6.4 . 4.83 U__" 3 E-MT 174.19 - J - X 74.37 75.20 74.41 76 0 i 76.4 -76 co up ;... x 78.36 x 76.40 76.60 CATCH BASINS` edge of pavement 76.31 76.46 77.35 75.91 10 OF MgsJ9��G N 34'52'58" E o PETER T. SANTUIT- NEWTOWN ROAD McENTEE o CIVIL `n No. 35109 FG/STE� �� OWNER OF RECORD MILES, JONATHAN D & DANIELLE I 693 SANTUIT-NEWTOWN ROAD MARSTONS MILLS, MA 02648 Engineering by: SCALE DRAWN JOB. No. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1"=40' P.T.M. 134-16 12 West Crossfield Road, Forestdole, IMA 02644 DATE CHECKED SHEET No. 693 SANTUIT-NEWTOWN ROAD, MARSTONS MILLS MA (508) 477-5313 6/14/16 P.T.M. 1 of 2 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL:70.0 FOR A DISTANCE OF 15' AROUND THE PROPOSED SEPTIC TANK PROPOSED D-BOX PERIMETER OF THE S.A.S. INSTALL RISERS & COVERS OVER INLET AND INSTALL WATERTIGHT RISER & PROPOSED S.A.S. OUTLET. SET TO 6" OF FINISH GRADE. COVER SET TO 6" OF GRADE. PROVIDE ONE ACCESS MANHOLE TO WITHIN 3" OF FINISH GRADE FOR INSPECTION PURPOSES. T.O.F.=75.6t F.G. EL.74.0t CoHARCCOAL VENT F.G. EL.=75.0t F.G. EL.=73.0t F.G. EL.=73.0t ( ) MAINTAIN 2% GRADE (MIN.) OVER S.A.S. L = 36' L = 7'(MAX.) ® S=17 (MIN.) I S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 6" � -H1 . = L==150 0"I " as O as 14" 6 98Ba96B EXISTING 48" LIQUID aaaaaBa TWO INLETS LEVEL ADD INV.=70.17 PROPOSED INV.=70.00 4' 4.8' 4' 1) HOUSE GAS BAFFLE D-BOX EFFECTIVE WIDTH = 12.8' • . .• INV.=70.90 2) COTTAGE INV.=69.50 EXISTING SEPTIC TANK 3-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-20 RATED NOTES: TOP CONC. ELEV.=70.1 t 1 CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BREAKOUT ELEV.=70.00 aaaa INV. ELEV.=69.50 aaaa INVERTS, PRIOR TO INSTALLATION. eases aaaaa ease aaaaa 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE BOTTOM ELEV.=67.50 fm . ON A MECHANICALLY COMPACTED SIX INCH CRUSHED 4' 8.5' 4' STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 4' OF NATURALLY OCCURRING VARIES-REFER TO SKETCH 3) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL 4) CONTRACTOR SHALL INSTALL AN APPROVED GAS 5' MIN. SEPARATION TO G.W. LEACHING SYSTEM SECTION BAFFLE ON THE OUTLET TEE. NO GROUNDWATER, EL.=60.50 - (VERIFY SOILS TO EL.=62.5.5 AT TIME OF INSTALLATION) 3/4" TO 1-1/2" DOUBLE WASHED STONE 3" LAYER OF E3D TO , SEPTIC SYSTEM PROFILE DOUBLE WASHHED STONE (OR APPROVED FILTER FABRIC) N.T.S. GENERAL NOTES: SOIL LOG 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. DATE: APRIL 29, 2016 (REF#15,010) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL EVALUATOR: PETER McENTEE PE(SE#1542) OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE WITNESS: DAVID STANTON R.S. HEALTH.AGENT LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW: -310 CMR 15.405(1)(b): ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH 1) A 10' variance, S.A.S. to cellar wall, for a 10' setback. 71.6 A 0" 71.5 0" 2) A 3' variance to the 3' maximum cover requirement, for up to 6' of max. cover. S.A.S. shall be H-20 and vented. SANDY LOAM SANDY LOAM 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 71 1 10YR 4/2 71 0 10YR 4/2 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE B 6" B 6" DESIGN ENGINEER. SANDY LOAM SANDY LOAM 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 10YR 5/6 10YR 5/6 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 69.1 30" 68.8 32" ENGINEER BEFORE CONSTRUCTION CONTINUES. C1 C1 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM (BARNSTABLE G.I.S.t). SILT LOAM SILT LOAM 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10YR 5/3 10YR 5/3 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 67.6 48" 67.7 46" HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. C2 C2 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. E PERC 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. MED. SAND 46"/64" 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 2.5Y 6/6 MED. SAND AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 2.5Y 6/6 DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 60.6 132" 60.5 132" THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. PERC RATE <2 MIN/IN. "C" HORIZON 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS NO GROUNDWATER ENCOUNTERED IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). EST. GROUNDWATER AT WATER SURFACE EL.=50.5f 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE " INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. O DESIGN CRITERIA f- __25,0'--� m NUMBER OF BEDROOMS: 4 PROP. S.A.S. �� 3 house + 1 cottage (future connection) TI BOTT. AREA I ' SOIL TEXTURAL CLASS: CLASS I N DESIGN PERCOLATION RATE: <2 MIN/IN M = 428.8 SF `-1 I (0.74 GPD/SF LOADING RATE) N r J'0 o DAILY FLOW: 440 GPD I I ad o DESIGN FLOW. 440 GPD 1 L--; GARBAGE GRINDER: NO I--12'8 o LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF 12.2'--I S.A.S. .74 GPD/SF PERIMETER=92.6' I EXISITNG SEPTIC TANK: 1500 GALLON CAPACITY 1 g SAS DIMENSIONS PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS 14.4' USE 3-500 GALLON LEACHING CHAMBERS IN SERIES SKETCH 34.9' SURROUNDED BY 4' DOUBLE WASHED STONE-ALL SIDES PROPOSED EXISTING SIDEWALL AREA: 92.6'(PERIMETER LENGTH) x 2'(EFF. DEPTH) = 185.2 SF S.A.S. H01SE(#693) BOTTOM AREA: 428.8 SF(BOTTOM AREA) = 428.8 SF , TOTAL AREA:.................................................................................... 614.0 SF SEPTIC LAYOUT DESIGN FLOW PROVIDED: 0.74 GPD/SF(614.0 SF) = 454.4 GPD Engineering by: SCALE DRAWN JOB. No. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. N.T.S. P.T.M. 134-16 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. 693 SANTUIT-NEWTOWN ROAD MARSTONS MILLS MA (508) 477-5313 6/14/16 P.T.M. 1 of 2 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632