HomeMy WebLinkAbout0037 SHAMMAS LANE - Health 37 Shammas Lane . `
Marstons Mills P -
_ 065 004006 _ \
' TOWN OF BARNSTABLE
LOCATION 3`} S)oe ,m A5 L.4,,3F SEWAGE# 2-6t9 - ZS k
VILLAGE M j�gSTcw5 M,LL-5 ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. Mor tj,?
SEPTIC TANK CAPACITY i I oog,
LEACHING FACILITY: (type) Troncb>5 (size) 31xa' �3a'L 206I
NO. OF BEDROOMS— � e��P@ 3'Xa'><3 2' f�
OWNERy1�
PERMIT DATE: '1 bx 1' COMPLIANCE DATE: g` fit
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 6%J c,r s 1 Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) NIA Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within �1
300 feet of leaching facility) N 19 Feet
FURNISHED BY ' A6LQ0w-)
Feac�< off, 5�
Pr
TOQLF
� 1b l
6 'x
t
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2ppliCation for Misposal 6pstem Construrtion VPrmit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System Xindividual Components
Location Address or Lot No. 3'1 `j NA"VAW-, Ua-3 6 Owner's Name,Address,and Tel.No.
M ,K, 11 a , M A �+�A0ut4+ +lA2el5
Assessor's Map/Parcel p (XS- Color- OO(Q
Installer's Name,Address,and Tel.No. Design 's Name,Address,and Tel.No. 609-s 39-,+9W
Type of Building:
Dwelling No.of Bedrooms 5 Lot Size !1 3, sq.ft. Garbage Grinder( ) ��A
Other Type of Building ►4 No.of Persons Z- Showers(1/) Cafeteria(
Other Fixtures LA..fA�e'l �. �L4ar,� S;rJk , �y�;�tc►.�
Design Flow(min.required) 7J c3C% gpd Design flow provided " 3 55 . Ro gpd
Plan Date 12�} , Number of sheets G Z. Revision Date J\)I A
Titlec�+QO`�2Q clew�iC J!t gl-M L,�Q�-ClC\2
Size of Septic Tank l LYb0 lko Qi(kST. Type of S.A.S. � - Ccecl C,5\�r���,t�� 3 8 I(2'x V
Description of Soil AZ T\ T—
Nature of Repairs or Alterations(Answer when applicable) "-?,a�k A-0 Vb n
,1.w 3�Az (V£w 9-0ax e 5�15 Z -t'es�c�►€s "3' xo1�x �a'
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 P "
Application Disapproved by Date
for the following reasons
Permit No. �OI �' Date Issued r 3 f—
No. aOI I ( Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Rpplication for -MispoSal .6pBtem Construction Permit
" Application for a Permit to Construct Repair Upgrade Abandon pp ( ) p pg ( ) ( ) El Complete System Individual Components
Location Address or Lot No. j`� �j Nq Owner's Name,Address,and Tel.No.
,M •t \I 1)s , MA �I� pP�t;rH +IA¢et5
Assessor's Map/Parcel p Co 5- Cho.+— 00(0 5 to tA t 1
Installer's Name,Address,and Tel.No. Design X3's Name,Address,and Tel.No. 5 -5 3q--JqW
MANN`2 aP���I�S 'F-Y +VQ E• SHAY
?.O. `6 R('5344?EF_ flA 02,4
Type of Building:
Dwelling No.of Bedrooms 7) Lot Size !-} 3 sq.ft. Garbage Grinder,( ) / P,
Other Type of Building No.of Persons Showers(1/) Cafeteria(l/)
Other Fixtures L-A JA-Me7'
Design Flow(min.required) 3 2>0 gpd Design flow provided 3 J • 0^2 U gpd r
i Plan Date 'a I Z,} 14 Number of sheets Revision Date to f A
Title �QoGQ� SQD .0 s4 5le-M
Size of Septic Tank 1 000 o.l\��e� ntic�ST. Type of S.A.S. F
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) �Qx -m !i> j C\
�+sST�L lilEw SAS "" 2 TQEYJCH�S 3 Xol�)c ;u 1
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed ,, Date
7 - 3�' � ��
Application Approved by r Date ;2 L/
Application Disapproved by Date
for the following reasons
Permit No. ��� 5I Date Issued
-------------------------------------------------------------------------------------------------------------------------'------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(x) Upgraded( )
Abandoned( )by —_IMp,1.40 y 3occokp�S
at 3�} ��MM A S LA+J E has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.g(Jlq''75( dated
Installer M fa r')N A t?V.-D Designer CA R M S r-�
#bedrooms 3 Approved design flow O gpd
The issuance of this permit shall of be construed as a guarantee that the systerrvw�fun 'on . de 'gned.
Date �(0 Inspecto
---------------------------------I------------------------------------------------------------------------------------------------------
No. �oI L( 1 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
MispoBal *pstem Construction Permit
Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( )
` System located at HAMMA5 LA r-J E
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit. S
Date � ) I�- Approved b "�
pP Y
Town of Barnstable
Regulatory Services
.� Richard V.Scali,Interim Director
UAM• snsxsr�.e, •
Public Health Division
s6�A
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer&Designer Certification Form
Date: ' Sewage Permit# pl y'a.51 Assessor's Map\Parcel__n� —COcp
Designer: 0". Installer:
Address: OV \ � Address:
On '�j - �O(�ny RreCCguD5 was issued a permit to install a
(date) ( aller)
septic system at 3 ��\ n cg-s L}3 kA.C�*4ased on a design drawn by
(address)
dated
(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 compliance with the terms
of the INA approval letters(if applicable)
( taller s Signature} ''
esigner's Signature) (Affi l
gt� y,, flere)
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.
0-\Centir\T)ecicmer Certifiratinn Form Rev R-14-13 dor.
Town L/
of Barnstable P#
' Department of Regulatory Services
�►artaT,�r� . Public Health Division Date
MA&4
�pl r63p 200 Main Street,Hyannis MA 02601 ;
Date Scheduled— �� Time
. � � � Fee Pd.
_W
• • J
So►1l Sui bil�aty Assessment for Se fa i 4 c
Performed By: Witnessed By: ' I
LOCATION& GENERAL INFORMATION
Location Address . Owner's Name
MQ.(�CSc�S 1"►t''5►-�:e Address c�0.t't12
Assessor's Map/Parcel: ` co5 —z:)Z)LA_z--)n6 Engineer's Name � cS1r�Qt
NEW CONSTRUCTION REPAIR oTTelephone# 5a8-a9y---Lng
Land Use - � �t deci A-iA Slopes(% 3 Lc7 Surface Stones
Distances from: Open Water Body / ft_ Possible Wet Area—40_ft Drinking Water Well eft
Drainage Way 0 y zs t au ft Property Line �n ft Other ' ft
SIMTCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands fn proximity to holes)
rvc SQ S� I
2
J41
111L —'
_;> A C
z e v
_n
0C.)
rp
Parent material(geologic)�ywc.CC, ?ka t c, Depth to Bedrock /"I r4
Depth to Groundwater. Standing Water in Hole:.tlyOw-)p QJS P(a Weeping from Pit Fpee U%
Estimated Seasonal High Groundwater (rX
DE T RM_INATIO_N FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Obsery d standing in obs.hole: in. Depth to sell mottles, In,
Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level„ Ark,factor Ad<{,Groundwater'Level
PERCOLATION TEST Date,._� Thne,._�,
Observation
Hole# �. Time at 9"
Perc f o Depth
De Cat ��u
P 1) -'�U Time atG'
Start Pre-soak Time @ (m os Time(V-G')
End Pre-soak 10: 11
Rate Min./Inch , Z_a MP 1
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Sdil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling
(Stnucture,.Stones;Boulders.
onsistency,%Oravel)
o-(A 3
Ce- 30 G asi a tJ
Se)— C. Med-c a .5Y --( /j P ` Loo Ls?0
DEEP OBSERVATION HOLE LOG Dole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,% rav
IR
C� y.3o �; •
Med-Cocc-siz- 9.6y `+/-t Low- ca6b►es
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Con i to c . Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stottes;Boulders.
Cons' ten
i
Flood Insurance Rate Mau: ,
Above 500 year flood boundary No— Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No..V-*" Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervio material exist in all areas observed throughout the
area proposed for the soil absorption system? Y2 S
If not,what is the depth of naturally occurring pervious material?
Celctification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of EnvirAn—me'n—tal'Profe-bbon and that the above analysis was performed by me consistent with .
the required trainin ,exp r se a d e e ience described in 10 CMR 15.017.
' .Signature Date
Q:\S.EPT1CU1ERCFOAM.DOC
FRic
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/-.a wA ...........OF.....!!I .............................
Appliratiun for Diupuuttl Workii Toutitrurfiun Van it
Application is hereby made for a Permit to Construct (&,�' or Repair ( ) an Individual Sewage Disposal
System at:
l ...x s:.........-�...... ,..s _..__.................5--------------------- r ..........--.............
Location-Address •or Lot No.
•• .................................... . ............0 '7z 11/��-Es
a 4f..=-L/.I i f r Address
�dl/.Jf�l AL............ . ..........................................•. .........................................--
Installer Address 3 7��
d Type of Building 3 Size Lot.15r- .................Sq. feet
U Dwelling—No. of Bedrooms.......................:....................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
04 Other fixture
W Design Flow_______________.........._........._gallons per person per day. Total daily flow..........__33.v.._._:__......._.gallon
WSeptic Tank—Liquid capacity.�q!?gallons Length_-.._.6....._ Width.. 6..... Diameter................ Depth...
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No________ _________ Diameter......../Z...... Depth below inlet......
3'_S.._ Total leaching area__ ..sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by._.. ..................................................... Date..�Z,/ 3iy1 a .--------•--.
GZ %4"
Test Pit No. 1________________minutes per inch Depth of Test Pit_../._......_.____ Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x ............................................................
"67-7
Description of Soil-----......_b.. � � ..� ..............�f-----------------------.....-----------...-----------------------..........................
U ......_..�1 Gf7�---------=��-1�.............•..•......_..........------•----•-------------------•--------...-------------•---
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 iITL% 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee s by he oaL&f health.
Signed.....----•_... -- •_.. .." ..................... ..................... r�C1 ...-•--•--
Application Approved BY &..%�%' r:.. t. ---............................. ---- ..-•- ... f
Da£e
Application Disapproved for the following reasons:--------•---•------•-----------•---------------------------•----------------.....---•-•......------------••-•--
..................................
................. --.......
---
-----------
......
------------------------------------------------------
.._._......Date--------------
Permit No... .........----- _
Date
•o.��.......
No..�j.. Fss.. ��..:.�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......... lit/. .........0F..... -5T L e.............................
r
Appliration fnx Uiipusal Works Tonstmtivit rrrmi#
Application is hereby made for a_Permit to Construct (j,,y or Repair ( ) an Individual Sewage Disposal
System at:
Z...,...�J.......1M2ZS7D1,,S._.._.��.'/ems..................... 7: ! :...-----------••----•-•
����,- -��•- Location-Address or Lot No
----• 3 7 . ..---�f✓ r•-••.................................. . ............. �trT 7Z- /G�... L..._..- -----............._.............
ar Address
a _7"��. c0111 :11e.n............ ...••.....•••••-•...:_...........----......_........... ---....................-- •..............•--
Installer Address
Type of Building 3 ..
3 Size Lot.' _�._...7._..7.�r!......Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons............................ Showers — Cafeteria
G4 Other fixtures . ........
d
Design Flow................-�3.:._.................gallons per person per day. Total daily flow............. 3. ... ............gallons.
Septic Tank—Liquid capacity..�eaegallons Length..: "6 Width..!5.G.i.. Diameter................ Depth..........
x Disposal Trench—No--------------------- Width.................... Total Length................. Total leaching area...................sq. ft.
Seepage Pit No.........1......... Diameter........J;V'.. Depth below inlet.......s..... Total leaching area..z r..sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by... � �................ ... Date...f..z �al ' 6
.....................
,tea Test Pit No. I...!9� ....minutes per inch Depth of Test Pit.-. /.!!��' Depth to ground water...._............
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -----------------------------------•-------....--•-•-•----•-•-•----------•---------......._........---...........-••••-•--...-••---......-•-•-•--•-----------
p .. 6 LOiys�7 S�3-Sv,L �G /fig
i
Descriptionof Soil............. ...._... .� ..-------••--•-••....................................................
> �t� ........
•-------------
----........
•----------------._...............
--...........
.--------------------
W ....................------------------------------------------------------------------------------------------------------------------------------••--......---......_.........................--------
VNature 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 T IT LE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been-issu by the oard f health.
Signed.....v.:.. = S6 :.. ;-•............. ..��. ' ........._....
Application Approved By..... ... . _.�.._.1/v�1 ...... --- -------•...•---•-••..--. .... ".... ' .-•------
Dam
Application Disapproved for the following reasons:...........................................................................................................
.............................•-•-............` Date
-----� ..
•---..................-•••--------•....•--_.... ....................---•--------................................------...... ............_
Permit No....�...!-..........•--• ..1..........._.... Issued..........................
..................._.......»
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..................... OF................ -�r�??��,rS.T.f# ���..................
fUrfifirate of Tumplinure
THIS S T CERTIFY",-iatahe Individual Sewage Disposal System constructed (�r Repaired ( )
/ .U. _mil...............•-------.. ........------............--.--....
�? I t ter /� -1 at.--...... .. ........ .......,� 1�.. �.:1.... r.... ...... °... ......................................._.....__.._
has been installed in accordance with the provisions of TITLE 5 of T e State Sanitary Code de rib in.,the
application for Disposal Works Construction Permit No..�� '.( _ .._....... dated.-....-.�,.�..� .....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUA AN
EE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
� s o .r Y
DATE..........--•---•-•--------•----�---------�.(1............................ . Inspector............... ...................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
;7U l^/.i1/ ....O F..
No � � Fn.... ......
�is�n 1 nr � �nn�#��r#iun hermit
Permission is hereby granted....!. ......................4......................................................__--_
to Construct ( or/�i epair ( ) an Indi idual Sewa Disp Sys IL_L�7 at No.---- ,�`-------- 4-�f,F! ) J.... ........
Street Q
as shown on the application for Disposal Works Constructio e t �0 - Dated. ._... ........
d
DATE.... .. .. . ...V.................•--•--........._........._. Boa of ealth
FORM 1255 A. M. SULKIN. INC.. BOSTON
3� TOWN OF BARNSTABI.E
I,�)CA.TION (:�- o7 /y CcS A.,U _ SEWAGE #,`
VILLAGE Al/ 65 ASSbSSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.�t�d�07P
SEPTIC TA14K CAPACITY
LEACHING FACILITY:(t:ype) � (size)
NO. OF BEDROOMS PRIVATE -WELL QIt'PUBLIC W�=E
BUILDER OR OWNER �°7yST,
O DATE PERMIT ISSUED: _
DATE' COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes _ No
I,
v
� 2
� 04-
COMMON`WlEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL P OTECTIONT
_
RECEIVED
y yV
SEP 0 12004
TOWN OF BARNSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
GAF
Property Address: 3 6M -IRCEL, `0�� �®
Owner's Name: .OT _
Owner's Address: eq
Date of Inspection:
Name of Inspector:( ease print) �l'e4
Company Name: , a-,J i -k� t ( .S
m v�sper�
Mailing Address:
cb�c(
Telephone Number: -1UO C8
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 15340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date:
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.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not addr""6-how the system will perform in the future under the same or different
conditions of use. �
Title 5 Inspection Form 6/152000 page I
Page 2 of I I
OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 3
Owner:
Date of Inspection• Z
Inspection Summary: Check A,B,C,D or E!ALWAYS complete all of Section D
A. System Passes:
I have• of 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:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section n be replaced or
repaired.The system,upon completion of the replacement or repair,as approved by the d of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following ents.If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic (whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank ure is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as" ved by the Board of Health.
*A metal septic tank will pass inspection if it is stru sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is av • le.
ND explain:
Observation of sewage backup or out or frith stag water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, ed or uneven distribution box.System will pass inspection if(with
approval of Board of Health):
broken pipe(s)am
obstructkmisTemoved
distn-uti(it box is.Died or replaced
ND explain:
The system r quired pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
i 2
Page 3 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner:
Date of Inspection:
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 stem
is failing to protect public health,safety or the environment.
I. System will pass unless Board of Health determines in accordance with 310 CMR 15.3 (1)(b)that the
system is not functioning in a manner which will protect public health,safety and t 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 s marsh
2. System will fail unless the Board of Health(and Public Wa Supplier,if any)determines that the
system is functioning in a manner that protects the public h h,safety and environment:
_ The system has aseptic tank and soil absorptions tem(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water ply.
__._ The system has a septic tank and SAS an a SAS is within a Zone I of a public water supply.
_ The system has a septic tank and SA and the SAS is within 50 feet of a private water supply well.
The system has a septic tank an AS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well".Meth used to determine distance
"This system passes if thew I water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organi compounds indicates that the well is free from pollution from that facility and
the presence of ammoni itrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are tri ed.A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DSPOSAL SYSTEM INSPECTION FORM §.
PART.A,
CERTMCATION(continued)
Property Address: s L,0�
'_�``'
11111 ,0 -
�s
Owner-
Date of lnspeetion.
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for In inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Liquid depth in cesspool is less than 6'below invert or available volume is less than'/z 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 I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis.IThis system passes if the well water analysis,
performed at a DEP certified taboratory,for bacteria and volatile organic.compumids
indicates that the well is free from`pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equat to or less than 5 ppin,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
AID (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 s a facility with a design now of 10,000 gpd to 15,000
You must indicate either"yes"or-no"to each the following
(The following criteria apply to large syst in addition to the criteria above)
yes no
_ the system is within 4 feet of a surface drinking water supply
— the system is 200 feet of a tributary to a surface drinking water supply
— the syste located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone f a public water supply well
If you have ered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes"in ection D above the large system has failed.The owner or operator of any large system considered a
si ant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15. The system owner should contact the appropriate regional office of the Department.
4
Page 5ofII
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner:M ,
Date of inspectio :
Check if the following have been done:You must indicate"yes"or"no"as to each of the following:
Yes No
_ Pumping information was provided by the owner,occupant,or Board of Health
Were any of the system components pumped out in the previous two weeks
Has the system received normal flows in the previous two week period?
a 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?(1f 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
%thJ—affles 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
m intenance 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,$plan at the Baird of Health.
Q� Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)}
5
Page 6ofII
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: C�I &
Owner:
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual): _
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): O
Number of current residents:
Does residence have a garbage grinder(yes or no):'
Is laundry on a separate sewage system es or no). O[if yes separate inspection required]
Laundry system inspected(y s or no):
Seasonal use:(yes or no): - 4ON (401
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no): 10
Last date of occupancy:
COMMERCIALIINDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yesor no):_
Industrial waste holding tank present es or no):—
Non-sanitary waste discharged t e Title 5 system(yes or no):_
Water meter readings,if av ' le:
Last date of occupancy/ e:
OTHER(desc ' e):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no): 00
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)
_Tight tank —Attach a copy of the DEP approval
Other(describe):
m
Approximate age of all comp nents,date'jKtalled. if known and source of information:
Were sewage odors detected when arriving at the site(yes or no):�G
6
Page 7 of I I
OFFICIAL INSPECTION FORM NOT FOR VOLUIS7ARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C .
SYSTEM INFORMATION(continued)
Property Address: :T-7S —
G, u� Vlki
Owner: VIIA4A=
Date of Inspectio t
BUILIDING SEWER(locate on site plan) .
a - .
Depth below grade:
Materials of construction:_,-_cast iron _1( 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: tX (locate on site plan)
Depth below grade: , 7r
Material of construction: !X concrete_metal_fiberglass Tpolyethylene
_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: [oU0 ^tau\
Sludge depth: N
Distance from top of sludge to bottom of outlet tee or baffle: tZ 0
Scum thickness:
it
Distance from top of scum to top of outlet tee or baffle: ba
Distance from bottom of scum to bottom of utlet tee or bfie:
How were dimensions determined: ,/ �/
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity;liquid levels
as related too tlet invert,evi ence of leakage,etc.) JJ
ft`
GREASE TRAP:_(locate on site plan)
Depth below grade:_
Material of construction:_concrete etal fiberglass . Polyethylene_other
(explain): �
Dimensions:
Scum thickness:
Distance from top of scum t op of outlet tee or baffle:
Distance from bottom of um to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pu g recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outl invert,evidence of leakage,etc.):
. 7
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: , oq [,Cc
Owner:
Date of Inspectio
TIGHT or HOLDING TANK: (tank m pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concre metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: Qallons/day
.Alarm present(yes or no
Alarm level: farm in working order(yes or no):
Date of last pu?' on
Comments(co of alarm and float switches,etc.):
DISTRIBUTION BOX: / (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: �11
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.). /
6 arc CAA25 L evil of K c�-fs 4 f W CA A6 's i� ti �C�����,
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no
Comments(note condition of p chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of l i
OFFICIAL. INSPECTION(FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE ]DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: _:rod
Owner:
Date of Inspectio . C./
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
/C—leaching pits,number.
teaching chambers,number.
leaching galleries,number.
leaching trenches,number,length:
leaching fields,number,dimensions:.
overflow cesspool,number
innovative/alternative system Type/name of technolog5r
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
ka-5 A-
0Z es
LL a �H
V4A
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 groundwate flow(yes or no):
Comments(note con ' on of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
/O�
Materials of construction:
Dimensions:
Depth of solids:
Comments(note conditi of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address- 57v
Owner:
Date of Inspection._
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
64A M WL �D
3°
' yy1
7a
Page I 1 of I 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:
SITE E h
Slope J v b
Surface water
Check cellar P�
Shallow wells No
Estimated depth to ground watereet
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 hi h ground water elevafio:
Ln r&t t'l 0
. Il
l
t
*NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C.
INLET TEE TO BE INSTALLED IN D-BOX
10' min. from Grade over septic Tank - 99.00 Schedule 40 PVC
Existing Foundation house to septic tank Provide Risers if necessary LEACH TRENCHES CROSS—SECTION (2 TOTAL)
TOP OF FOUNDATION = ELEV. 100.00 to bring Septic tank covers D-BOX cover must must have riser and be
y within 6" of finished grade within 8 In. of finished grade Finish Grade = Elev 96.00
Grade over D-Box -96.00
4' PVC(CAPPED)INSPECTION PORT TO BE I PVC (CAPPED) BE WITHIN
PORT G BE
INSTALLED AND TO BE WITHIN 3' OF GRADE
INSTALLED AND TO BE WITHIN 1 13' OF GRADE
3 HO Top Of System = ELEV. 93.50
S 0.02 S=0.01 or"Greater DIST. BOX S-.005 , 31-V wide 10'APART 3'-0'wide
S-0.01 Or Greater 4'Perforoted P.V.C. V-//tY-1/2' washed Stone Or Approved Filter Fabric
25' EXIST.
EXIST. PIPE � 0 1000 GAL. 75' ;�124* Invert Etev.=92.84 z•or 1/e'-t/V
FROM EXIST. FOUNDATION _O o Ln SEPTIC TANK i` r04 � 15' 3 4 1K"Wormed Stone a Or pileswashed w Stone
tc p / Bottom of Leach Facility Elev.= 90.84
Cn r�i M
rn Gas Baffle rn rn 0) 32' w a
CONCRETE FULL (l H-10 II II II PP
Note: All leach(Ines to be capped at ends w/PVC cape. 5' PROVIDED
N >
m a 6 in 3/4"-1 1/2" v a� >y _ Bottom_of_Test Hole 2 Elev.=84.00 3/4--t 1/2-Washed ston
w compacted stone LEACH TRENCH compacted.tan.
(2 TOTAL) •perforated Sat 40 P.V.C.pip
_Z
6 In.of 3/4"-1 1/2" NOT TO SCALE
compacted stone NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE
2 FOOT EFFECTIVE DEPTH FOR LEACHING TRENCH
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE SYSTEM PROFILE
Not to Scale
2-18" DIAM. ACCESS MANHOLES
6 PERCOLATION TEST ALL OUTLET PIPES FROM THE
DISTRIBUTION BOX SHALL BE qTLE
.
SET LEVEL FOR AT LEAST 2 FT. CONCRETE COVER
�r �``r '-`''-"'j''—'—' +�• Date of Percolation Test: JULY 3, 2014 ..:f_:..
a.f • ''"' I�.' - - 3 - 5' :;.:..r.;a. 2'Test Performed By: CARMEN E. SHAY, R.S., C.S.E. KNOCKOResults Witnessed By:DONNA MIORANDI (Barnstable BOH) _EXCAVATOR: Shay Env. Svcs. ; - s ' tz INLET
ou rPercolation Rate: Less Than 2 MPI ® 30" a
THE ACCESS COVERS FOR THE SEPTIC TANK. Test Hole Test Hole 1$S" 4" - SCH. 40 Te 1,754
DISTRIBUTION BOX AND LEACHING COMPONENT
•--r r rrs' �^ — SET DEEPER THAN 6 INCHES BELOW FINISHED No. 1 No. 2 PLAN SECTION CROSS—SECTION
. " GRADE SHALL BE RAND TO WITHIN 6. OF
STEEL ^E .•O ~• .~ FINISHED GRADE. DEPTH SOILS ELEV. DEPTH SOILS ELEV.
STEEL REINFORCED PRECAST CONCRETE 0 96.00 0 96.00 3 HOLE H-10 DISTRIBUTION BOX
PLAN VIEW INSTALL TUF-TITE GAS BAFFLES OR EQUALS Sandy Sandy
Loam Loam
3-24" REMOVABLE COVERS
11 10 17R 3/2 10 YR 3/2
a• q• >•.. 0"- 6" AP 95.50 0"- 6" Aa 95.50 PLOT PLAN
. L ....1
3' min clearance
Loamy Loamy
6• min. 13' INLET" Sand Sand
---T'i2_min. Inlet to outlet V min.
-Uquid level t4 OUTLET6"- 30" 10 YR Br'e g3.50 6"- 30" 10 YR B''8 93.50 OF PROPOSED SEPTIC SYSTEM UPGRADE
10'min. ' h
E g '• a'-0" min. Med. Med. PREPARED FOR
ae.eam. : Liquid depth Sand Sand 2.5 Y 7/4 2.5 Y 7/4 E L I Z A B ET H H A R R I S
AT
30"-144" C, 84.00 30"-144" Ct 84.00
$ D •, ..s: •. .. .. . '4'�-10 :•-' • 37 S HAM MAS LANE
CROSS SECTION END—SECTION ASSESSORS MAP 065, PARCEL 004-006
TYPICAL 1000 o SCALE
SEPTIC TANK MARSTO N S MILLS , MA
NOT TNumber of Bedrooms: 3 Equivalent to 330 Gal. Day 330 Gat. Day per Title V �---��
Design Calculations Garbage Grinder: No OF MA
g ��N ss9 PREPARED BY:
Leaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) c� n•\ �/ /Septic Tank - 2 x330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank.
Perc #1 ARMEN E. ,sHl-1 Y
�� l\
� L
SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch Depth to Perc: 46" to 58" NA 1 ENVIRONMENTAL SERVICES
Proposed Leaching Trench Dimensions: 2 TRENCHES TOTAL-3' Wide by 32' Long by 2' Depth Perc Rate= 2 MPI r�. 1 �'
Groundwater Not Observed �o P.O. BOX 1576
Bottom Area: 0.74 gal/sq. ft. x 192 sq. ft. = 142.08 gallons No Observed ESHWT GIS-T MASHPEE, MA 02649
Sidewall Area: 0.74 gal./sq. ft. x 288 sq. ft. = 213.12 gallons ADJUSTED H2O Elev. = None °= SANITA��'���
Providing: = 355.20 gallons ---�' TEL/FAX : 508-294-7498
Use: 2 TRENCHES — 321 by VW x 2'D EACH SCALE: N/A SHEET 2 DRAWN BY: CES DATE: JULY 24, 2014
ROJECT#37 SHAMMAS L FILENAME: 37SHAMMAS.DWS SHEET 2 OF 2
i
� � 39 GENERAL NOTES
37 Shemmaa Wey Merrton... p [D
1. Contractor is responsible for Digsafe notification, Verification of Utilities
and protection of all underground utilities and pipes.
2. The septic tank and distribution box shall be set
37 Shammas Way level on 6 of 3/4"-1 1/2' stone.
90 �6 v o 3. Backfill should be clean sand or gravel with no
ti Q11 stones over 3" in size.
�6 4. This system is subject to inspection during installation
X 83D qn 4b ( by Shay Environmental Services
1 t)� 28" Jr 1
5. ��T
he contractor shall install this system in accordance
with Title V of the Massachusetts state code, the approved plan
and Local Regulations.
\ 6. If, during installation the contractor encounters any
soil conditions or site conditions that are different
from those shown on the soil log or in our design
a � \ installation must halt & immediate notification be
sD L 0 made to Shay Environmental Services
90 78� �w` ' � ` �"' "T' �o. LOCUS MAP 7. No vehicle or heavy machinery shall drive over the
SHED `Dp, \ septic system unless noted as H-20 septic components.
HED \ 3 SR HOUSE FLOOR SCHEMATIC 8, Install Tuf—Tite gas baffles or equals on all outlet tee ends.
(Description Provided By Owner) 9, All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes.
to I e moo \ 10. All solid piping, tees & fittings shall be 4" diameter
N a � EXISTING Schedule 40 NSF PVC pipes with water tight joints.
g2 FAILED GARAGE 1st FLOOR 11. Municipal Water is Connected to ALL OF The Abutting
3- 3- LEACH PR —
Properties Within 150 Feet.
ESISTING \ 1 THE PROPERTY LINES ARE APPROXIMATE AND
ASPHALT J each Living COMPILED FROM THE SURVEY PLAN BY SAGAMORE SURVEY ASSOCIATES
v DRNEWAY -- i
9� 3 • �m :. 3 SLAB Room ENTITLED: "Certified Plot Plan of Lot 14 SHAMMAS LANE Marstons Mills, MA"
o A FOUNDATION ( Kitchen Dining DATED: OCTOBER 9, 2004
w TEST HOLE �1 = DECKft
# + Room
EST LE (� AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
b — Bath
p #37 —"—MunicipoF-Water.Line.. _ _, I Bedroom THE SEPTIC SYSTEM INSTALLATION.
i
1 droom TEST HOLE �2 3 HOLE —H10 EXISTING B
EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE
ELEV.- 96.00 D—BOX O 3 BEDROOM PORCH Bedroom NOTE
� 1 1 e : ANY STRIPPED OUT SOIL CONTAINING LEACHATE
c HOUSE FROM THE EXISTING CESSPOOL/LEACH PIT TO BE DISPOSED
o ,y 1 OF AS PER BOARD OF HEALTH SPECIFICATIONS.
EO 0 gal. DECK Full Foundation 11
Septic Tank W
NLET TEE To BE IN STALLED M 0-eo% V
96 sd.ama a PVC
k I w PLOT PLAN
71t11 3 OF PROPOSED SEPTIC SYSTEM UPGRADE
LOT #14 o PREPARED FOR
PROJECT BENCH MARK 43,778 Squarc Fact
TOP OF B U D TIOSSUMED) 0 E L I Z A B ET H H A R R I S
AT
37 SHAMMAS LANE
j ej911, I a ASSESSORS MAP 065, PARCEL 004-006
240.00' MARSTO N S MILLS MA
S 89,0 13' 55" A
PREPARED BY:
,r N E. ,SHA Y
-i
r ENVIRONMENTAL SERVICES
A �f:f P.O. Box 1576
0 20
40 50 =�Y\ S % i MASHPEE, MA 02649
'r r" o= rb TEL/FAX : 508-294-7498
SCALE: 1 "=30' DRAWN BY: CES DATE: JULY 24, 2014
SCALE: 1"=30' ROJECT#37 SHAMMAS L FILENAME: 37 SHAMMAS.DWG SHEET 1 OF 2
i � _
•°°°°�•r8 e�, GENERAL NOTES
ro 37 Shammas Way Marston... Q m
1. Contractor is responsible for Digsafe notification, Verification of Utilities
and protection of all underground utilities and pipes.
2. The septic„tank on j distri ution box shall be set
' 37 Shammas Way level on 6 of 3/4 —1 1%2" stone.
3. Backfill should be clean sand or gravel with no
stones over 3 in size.
C6 z 4. This system is subject to inspection during installation
N 83,0 fe' ze^ °1b I by Shay Environmental Services
5. The contractor shall install this system in accordance
h with Title V of the Massachusetts state code, the approved plan
and Local Regulations.
\ 6. If, during installation the contractor encounters any
soil conditions or site conditions that are different
from those shown on the soil log or in our design
i installation must halt & immediate notification be
r ,r 3D CT7 / O made to Shay Environmental Services
90 '' �o. LOCUS MAP 7. No vehicle or heavy machinery shall drive over the
septic system unless noted as H-20 septic components.
SHED \ 3 BR HOUSE FLOOR SCHEMATIC 8, Install Tuf—rite gas baffles or equals on all outlet tee ends.
+P (Description Provided By Owner) 9, All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes.
t,� Ro • 10. All solid piping, tees & fittings shall be 4" diameter
S's EXISTING Schedule 40 NSF PVC pipes with water tight joints.
g2 Faro 'per• GARAGE 1st FLOOR 11. Municipal Water is Connected to ALL OF The Abutting
3' 3' O LEACH PR -
- � � Properties Within 150 Feet.
B%ISTINC \ THE PROPERTY LINES ARE APPROXIMATE AND
BZ KGB ASPHALT Both COMPILED FROM THE SURVEY PLAN BY SAGAMORE SURVEY ASSOCIATES
94 3 m : 3 , SLAB DRIVEWAY Living
— — oom ENTITLED: "Certified Plot Plan of Lot 14 SHAMMAS LANE Morstons Mills, MA
` FOUNDATION Kitchen Dining DATED: OCTOBER 9, 2004
TEST HOLE #1 z DECK Room AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN
ELEV.- 96.00
IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
c !87 "— — —►dunk:ipoi-water.Line.. _ — _ Bad' Bedroom THE SEPTIC SYSTEM INSTALLATION.
TEST HOLE #2 3 HOLE —H10 BRISTlNc I EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE
ELEV.- 96.00 D-BOX O 3 BBDROOM PORCH Bedroom Bedroom NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
o aoaSB FROM THE EXISTING CESSPOOL/LEACH PIT TO BE DISPOSED
ti I OF AS PER BOARD OF HEALTH SPECIFICATIONS.
EXIST. DECK Full Foundation II II
1000 gal.
Septic Tank
Sd�iiau TEE TO
P E ursrwm INo-eox
w 96 PLOT PLAID 3 OF PROPOSED SEPTIC SYSTEM UPGRADE
LOT #14 I o PREPARED FOR
PROJECT BENCH MARK 45,773 square Peet E L I Z A B ET H H A R R I S
TOP OF FOUNDATION S2
ELEV. = 100.00 (ASSUMED) W AT
i
o 3 SHAMMAS LANE
e' ASSESSORS MAP 065, PARCEL 004-006
240.00' I 11
MARSTO N S MILLS MA
S 89D 13' 55" lI ( F�`���==-
p rs1�y; `� PREPARED BY:
o C4 R1fEY E. SHA Y
6 5 ! ENVIRONMENTAL SERVICES
o.
0 20 40 50 ��o P.O. Box 1576
GIs MASHPEE, MA 02649
• SANI
' TAE'" TEL/FAX : 508-294-7498
fl
SCALE: 1"=30' , SCALE: 1 "=30' DRAWN BY: CES DATE: JULY 24, 2014
ROJECT#37 SHAMMAS L FILENAME: 37 SHAMMAS.DWG SHEET 1 OF 2
Al
TOP OF FOUNDATION
o CONCRETE COVER
CONCRETE COVERS
. , i
N "0 4"CAST IRON r '7"P77Z7r
12 MAX. 12'MAX. ,
M OR SCHEDULE 40 4"SCHEDULE 40 PVC-(ONLY)
P.V.C. PIPE PIPE- MIN. LEACH
� PITCH I/4'�PER.FT PITCH 1/4�PER.FT. PST
PRECAST
° l\ -J LEACHING
`INVERT INVERT . a ..c.
INVERT IT OR
- P \� b�
°•, SEPTIC TANK EL../aia,3� BOX•DI
ELy ?.,7. ' : >_ EQUIV. / 3Z
INVERT /000 GAL. INVERT-
EL.
o; /oo,SZ INVERT ,• hi ww 0• �:% 3/4"TOIV2'
EL. .9:...
u- �. WASHED
w STONE
/8 --�'--6'DIA.
o• , . �--- /Z' DI A----r-I a�✓ v.vrL
PROFI LE OF GROUND WATER TABLE per +
SEWAGE DISPOSAL SYSTEM
NO SCALE
SOIL LOG WITNESSED BY :
DATE TIME. . ... . . . . .. T�. G4`^?•¢"^� BOARD OF HEALTH
TEST HOLE I TEST HOLE 2 S�/ 1�1CoB/ ENGINEER T.QsvC O ' Q
ELEV. /03,70 . ELEV. .. .. .
ToP 78 -
.norsug�so. DESIGN DATA
Q
ez,ioo- 7o NUMBER OF BEDROOMS '3 . . . . . . . . . 'Op
TOTAL ESTIMATED FLOW . . 33o GALLONS/DAY -J
�� BOTTOM LEACHING AREA ��'3: . SQ.FT./PIT1C.P,D- Y.
CA
, `jL or- 7t 1
.SIDE LEACHING AREA . . . . . . . . SQ.FT./ PIT/3Z�.g G,�D• , / �o
_
GARBAGE DISPOSAL .'Yql C.(50% AREA INCREASE) Ir
TOTAL LEACHING AREA SQ.FT / �� oa '
PERCOLATION RATE �5. . .. . . ? o MIN/INCH
LEACHING AREA PER PERCOLATION RATE 1� . SQ.FT./eR,,P-
_r/o WATER ENCOUNTERED No O
NUMBER OF LEACHING PITS .
APPROVED . . . . . . BOARD OF HEALTH
�"aL" S7Z n e
DATE. . .
AGENT OR INSPECTOR
o� EDWA��
K I LEY
. 26100 9 .
�`1�l STa�/s• • i`1i GG 5 ���'�'�t L�'�v
PETITIONER