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HomeMy WebLinkAbout0112 SPUR LANE - Health 11.2.Spur Lane — - - - Marstcns Mills _ A' 027-10A -'trot fic� - i t i �5 u . moor — �" ` � �-- VAC)'l E .. 1 } E t i —toa t"dO c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address owner Moses Joachim information fs Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 City/rown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way- Important: When filling outA. General Information out forms on the computer, use only the tab 1. Inspector. key to move your cursor-do not John Webby use the return Name of Inspector key. Belac Shores LLC ma Company Name 199 Rt 28 Company Address West Harwich MA 02671 Cityrrown State Zip Code 508-360-6922 S12987 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 03/17/2009 In ;ealtsh Signature Date Thtem inspector sha submit a copy of this inspection report to the Approving gy,to.; (Board of or DEP)within 30 days of completing this inspection. If the system is a sha seem or has a design flow of 10,000 gpd or greater, the inspector and the system owner shale ,_ tit the report to the appropriate regional office of the DEP. The original should be sent to thy,; m owner and Copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Us 6 Report(112 Sprr Lam Mmolm Mi1s MA)Jean krrWd•tK M ride 5 Offldal trepediwr Form:SU Sewage D osal System•Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 City/rown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: System was flowing properly, needs pumping as part of this inspection. System has no record of pumping on a regular schedule.Visable sights of maybe some over flow, d-box level and fluids flowing normal,signs of small roots, needs to be cleaned. 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 exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ 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): rFUe 5 Report(112 Spice Lane Marston Mtlla MA)Jean-aer e -03108 Title 5 OIfi681 Rupe(tion Form Stbwrfaoe Sewage Disposal System•Page 2 of 16 t- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 City/Town State Zip Code Date of Inspection ❑ broken pipe(s)are replaced ❑ obstruction is removed B. Certification (cunt.) B) System Conditionally Passes(cunt.): ❑ 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: 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 functioning in a manner that protects the public health, safety and environment: Title 5 Report(112 Spur lane M&Ston Mrlls MA)JaMaWard.03= Tide 5 OlficMI kwpftWh Form:Subsurface Sewage Disposal System•Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 City/Town State Zip Code Date of Inspection ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. B. Certification (cunt.) C) Further Evaluation is Required by the Board of Health(cunt.): ❑ 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Title 5 Report(112 Spur lane Marston WHO MA)Jean 3enwd-03= Title 5 OftW lrmpectlan Form s0mirtaoe Sewage DWOoeal Systern•Page 4 or 16 Commonweafti of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 City/Town State Zip Code Date of Inspection ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. B. Certification (cunt.) D) System Failure Criteria Applicable to All Systems(cunt.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes If the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure. criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply Tim 5 Report(112 Spur Lane Marston Wft NIA)JearAW sad.03008 Title 5 OffiQal krepedim Forth:Sobvaraw Sewage Disposal System•Page 5 or 16 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 Cityrrown State Zip Code Date of Inspection ❑ ❑ 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. C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. Title 5 Report V 12 Spur Lane Marston Wills MA)Jean4arrard•03M Title 5 Ofrraal kmpection Form:Subsurfaoa Sewage Disposal System•Page 6 of 16 Commonwealth of Massachusetts RIM Title 5 Official Inspection Form UVSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information ri Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 City/Town State Zip Code Date of Inspection ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Number of current residents: 4 Does residence have a garbage grinder? [ Yes No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? (D Yes ❑ No Seasonal use? ❑ Yes ® No 000, ) Water meter readings, if available(last 2 years usage(gpd)): 2008(2007(6060 00 Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commerciallindustrial Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft, etc.): Title 5 Report(112 Spur Lam Marstm Miffs MA)Jea kmard•03108 Title 5 Official 6nspection Forth:Subsaface Sewage Dispose System•Page 7 of 16 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 cityrrown state zip Code Date of Inspection Grease trap present? ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Tide 5 system? ❑ Yes ® No Water meter readings, if available: n/a Last date of occupancy/use: Date Other(describe): D. System information (cunt.) General Information Pumping Records: Source of information: 3/19/09 Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: 1000 gallons How was quantity pumped determined? meter Reason for pumping: To much waste in tank. 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/Aftemative technology.Attach a copy of the current operation and maintenanoe contract(to be obtained from system owner)and a copy of latest Me 5 Report(112 Spur Lam Marston Mile twq rem eermra•W= rift 5 Official kopettim Form:Subsurfew Sewage Disposal System•Pop 8 or 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 Cityrrown State Zip Code Date of Inspection inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known)and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 18„feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from.private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage, etc.): Building sewer in good condition Septic Tank(locate on site plan): Depth below grade: lot.feet Material of construction: ®concrete , ❑metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: years Title 5 Report(112 Spur Lane Marstm Miks MA) 9 •03W TWO 5 Official trispeCtm Form:Subsurface Sevrage Disposal System•Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information is owner's Name required for every page. Marston Mills MA 02364 03/17/2009 City/Town State Zip Code Date of Inspection Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) © Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 5'x5'x8' 1,000 gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 24" 6„ Scum thickness Distance from top of scum to top of outlet tee or baffle 2" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measured with tape D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Liquids in tank was level and flowing properly, tank needs pumping, no pumping has been done since installation of system. Grease Trap(locate on site plan): Depth below grade: fit Material of construction: ❑concrete ❑metal 0 fiberglass ❑polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle rme 5 Report(112 spir Law Maisimn Mfs ran)Jearv-�•03= rde 5 O fidel ktpeaon Forth:Subsurface Sewage Disposal system•Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 Cityrrown State Zip Code Date of Inspection Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): D. System Information (cunt.) Tight or Holding Tank(coat.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ® No Title 5 Report(112 Spur Lane AAaistoo MiDs IMU Jean-6ad-03I08 Title 5 Otfoal bspectim Form:Subsurface Sewage Dispr s System•Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane. Property Address Owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 Cityrrown State Zip Code Date of Inspection Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is level,water distribution to outlets equal, no evidence of any leakage. Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No D. System Information (cunt.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located,explain why: Type: ❑ leaching pits number: ❑ leaching chambers number. Title 5 Report(112 Spur Lane Marston MiNs MA)Jeerr Be wd•03M Title 5 Official Inspection Forth:Subsuface Sewage Disposal System.Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information rj Owners Name required for every page. Marston Mills MA 02364 03/17/2009 City/Town State Zip Code Date of Inspection ® leaching galleries number: 5 ❑ 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,etc.): D-box was flowing normally and did not see any signs of malfunction. D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Title 5 Report(112 Spur Lane Marston Mfs MA)J eemard-03M Tdie 6 Oftial tropection Form:subsurfew Sewage Dim System-Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 Cityfrown State Zip Code Date of Inspection Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): D. System Information (cunt.) 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. Title 5 Report(112 Spur Lane Marston Mills MA).lean-eertrerd•03= rifle 5 Official kupection Form Stbwface Sewage Dim system•Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address Owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 Cityrrown State Zap Code Date of Inspection A1<14 j 10s LAUft'1-,4Ar- Q - 1 _ a s f3 -2- - otq D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water. fleet+� Please indicate all methods used to determine the high ground water elevation: TAle 5 Report(112 Sp,a Lane Marston Mills MA)Aar►-�•03008 Tide 5 Official h spection Form:Subsurface Sewage Disposal System•Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 112 Spur Lane aka 105 Laurie Lane Property Address owner Moses Joachim information is Owner's Name required for every page. Marston Mills MA 02364 03/17/2009 City/Town State Zip Code Date of Inspection ® Obtained from system design plans on record If checked,date of design plan reviewed: 2/03 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Test pit files at the Board of Health Office ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Checked with Board of Health records. No records show any water encountered. See paper work in office prepared by Carmen E Shay Environmental P.O. Box 627 E. Falmouth Massachusetts 02536 Title 5 Report(112 Spur Lane Marston Mils AAA)Jean-Bernard-03108 Title 5 Official Iropechm Form:Subsysface Sewage Disposal System-Page 16 of 16 Permit Number: Date: Completed by: NIGH GROUND-WATER LEVEL COMPUTATION Site Location: pS L.cAngaE L.AN h/.M;\Xq Lot No. -mil Owner: _ �[3r`r�o �Z&hnGq Address: 1 a Spur L.e Contractor:_ Address: r.�oa Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date mo h/ y/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................. OSWater-level range zone..................................................... STEP 3 Using monthly report"Current Water Resources Conditions" determine current depth to water level for index well ............................ mo th/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 28) determine water-level adjustment ........................:................................................................. 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) ................................................ �4• t: Figure 13.—Reproducible computation form. 15 Sep - 20-01 13 :52 BARNSTABLE HEALTH DEPT 5087906304 P . 02 . srzs,oi :.NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. Y _ PERCOLATION TEST AND SOIL EVALUATION EXEIYIPTION FORM Cl ik-QY hereby certify that the engineered plan signer by r^e PA clztee , concerning the property located at _�1 — yiZtES S meets all of the t;uow.n, cntena- • This failed system is connected to a residential dwelling only. There are no -orvnerzia.1 or business uses associated with the dwelling. • T1 e soil is class!tied as CLASS 1 and the percolation rase is less than or equal to -rLnutes per inch. The applicant may use histoneal data to conclude th!s f3c: or may _onduc( -:)Wirninary tests at the site without a health agent present. • 'here :s no increase to flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen I' F--et 300ve the maximum adjusted groundwater table elevation. rAdiust the nun�.vate: table us in- the Frimptor method when applicable) Piease complete the following. �. Ynp o Ground Surface E!evation (using GIS information) G, W F;c vat:or, + ad;ustrnent for high G.W. Sy•4 1'FFFkStNCE BETWEEN A and B 33•lv S'61 ED Q DATE: a ----------- - NOTICE ' Basec..inort tre above ir.formadon, a repair permit will be issued for bedrooms a,.,rr.0 r `^ add!tional bedrooms are authorized in the future without engtneerec iar� C �yste^l plans. :tun:r.:0u XICdfA7 FORM 12 - PERCOLATION TEST lie Location Address or Lot No.: #105 Laurie's Lane COMMONWEALTH OF MASSACHUSETTS Marstons Mills , Massachusetts Percolation Test Date: 2/06/03 Time: 9:30 AM Observation Hole #: #� Depth of Perc 48" — 66" Start Pre-soak End Pre-soak Time at 12" Time at 9 Time at 6 Time (9-6") Rate Min./inch <2MPl Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Performed By: Carmen E. Shay Witnessed By: Waiver Comments: Would Not Hold 24 Gallon Presoak - <2 MPI ' Site Passed X Site Failed DEP APPROVED FORM 12/7/95 FORM 11 - SOIL EVALUATOR FOPi Page 3 of Location Address or Lot No.: #105 Laurie's Lane, Marstons Mills, MA Determination of Seasonal.High Water Table Method Used: Depth observed standing in Observation Hole: NIA inches 0 Depth weeping from side of Observation Hole: 156 inches (assumed) 0 Depth to Soil Mottles: None inches aGroundwater Adjustment: None feet Index Well Number: Reading Date: Index Well Level: Adjustment Factor: Adjusted Groundwater Level: NIA DEPTH OF NATURALLY OCCURING PERVIOUS MATERIAL: Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system: Yes CERTIFICATION: I Certify That on September 17, 2000, (date), I have passed the soil evaluators examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature: Date: c�- '�--0 3 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.: #120 Asa Meigs Road, Marstons Mills, MA On -Site Review Deep Hole Number: #1 Date: 2/6/03 Time: 9:30 AM. Weather: Sunnv, Cool Location (identify on site plan): Refer to Sketch Landform: Outwash Plane Position on Landscape (sketch on.back): Refer to Sketch Distances From: Open Water Body N/A feet Drainage Way N/A feet Possible Wet Area N/A feet Property Line 25' feet Drinking Water Well N/A feet Other DEEP OBSERVATION HOLE LOG Depth From Soil Soil Soil Soil Other Surface Horizon Texture Color Mottling Structure, Stones, (inches) (USDA) (Munsel) Boulders, Consistency, % Gravel 0" — 6" A P Sandy 10 YR None <5% Gravel, Friable Loam 3/2 Friable 6" -46" BW Loamy 10 YR 5/6 None <5% Gravel, Friable Sand Friable 46" — 156" C1. Med. - 2.5 Y 7/4 None Medium Sand, 25% r Coarse gravel, Loose Sand Parent Material (Geologic): Glacial Outwash Depth to Bedrock:None encountered - Depth to Groundwater: Standing Water in the Hole: None Weeping From Face: None Estimated Seasonal High Water Table_ 156" Assumed — No groundwater Observed DEP APPROVED FORM 12/7/95 FORM -11 — SOIL . EVALUATOR .FbF Page 1 of No.: Date: 2/6/03 COMMONWEALTH OF MASSACHUSETTS Barnstable , Massachusetts Performed By: Carmen E. Shay Date: 2/6/03 Witnessed By: Waiver Location Address or#105 Laurie's Lane Owners Name: James Falanga Marstons Mills,MA Address and #112 Spur Lane,Marstous Mills Lot# Map 27,Parcel 104 Telephone Number: New Construction : Repair: X OFFICE REVIEW: Published Soil Survey Available: No Yes Year Published:. Publication Scale: Soil Map Unit: Drainage Class: Soil Limitations: Surficial Geologic Report Available: Noa Yes Year Published: Publication Scale: Geologic Material: (Map Unit): Landform: Glacial Outwash Flood Insurance Rate Map: Above 500 Year Flood Boundary: No ❑ Yes a Within 500 Year Flood Boundary: No F-xl Yes a Within 100 Year Flood Boundary: No Fxl Yes a Wetland Area: None National Wetland inventory Map (map.Unit): Wetlands Conservancy Program Map (map unit): Current Water Resource Conditions (USGS): Month Range:, Above Normal ❑ Normal a Below Normal ❑ Other References Reviewed: USGS Topographic Map - DEP APPROVED FORM 12/7/95 TOWN OF BARNSTABLE i :LOCATION L r�i-CS SEWAGE VILLAGE ASSE R'S MAP&LOT INSTALLER'S NAME&PHONE NO. r__ Z_ SEPTIC TA4IK CAPACITY `�! ,2LL r—A,j0o�s�sf4- vU LEACH NG FACILITY: (typo) F�(���i�y.=•�,lTf�•ToI�S f /l .(size) NO.OFBEDROOMS BUILDER OR OWNER i J PERMITDATE: 7-ilGiO COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet { -Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility)• Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by oil LET a. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 59"C" C Y)C- Name of Owner I CkdCerGb S m r-"r-s b ,fin, �$ Address of Owner Date of Inspection: Name of Inspector:(Please Print) Y1 I am a DEP oved s m i e pect nt pursua t action 15.340 of Tide 5(310 CMR 15.000) Company Name: Mating Address: 4 p1� •1� �)r�brb�.�'� Telephone Number: CERTIFICATION STATEMENT I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection: The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails � - Inspector's Signature: Date: a r� �OC7{� The System Inspector shall su t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS RECEIVED S E P 2 8 2000 TOWHEOFBH DEPT.ARNSTABLE revised 9/2/98 Pagel of II A �� Printed on Recycled Paper f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: J(PV\rZ )iC ,_9 Mgr5�On3 Ownw: `( kA f e,1 Ta o Date of Inspection: s 9/ate/o INSPECTION SUMMARY: Check B, C, of A A. S STEM PASSES: 1 have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evfa-luat are indicate low. E7 ` h �COMMENTS: �n h�nl� c`7� B. SYSTEM COND NALLY PASSES: One or more syst components as described in the "Conditio completion of the re acement or repair,as approved by the ass" section need to be replaced or repaired. The system, upon and of Health, will pass. Indicate yes, no, or not determined , N. or NO). Describe basis determination in all instances. If "not determined", explain why not. The septic tank is tal,unless the owner o operator has provided the system inspector with a copy of a Certificate of Compliance(attached ' dicating that the nk was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether r not metal, i cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The sy am will ass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of He th Sewage back r breakout or high tatic water level observed in the distribution box is due to broken or obstructed pipe(s) or due to roken, settled or uneven istribution box. The system will pass inspection if(with approval of the Board of Healt . broken pipe(s)are rep ced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: L U r)'9- ) )YI A rS Owner: t'C,v.,r Date of Inspection: .1/ J'�—j( O O C. FURTHER EVALUATION IS REQUIRED BY THE B ARD C HEALTH: Conditions exist which req ' further aluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the a ant. 11 SYSTEM WILL PASS UNL BOARD F HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING A MANNER H WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cass of or privy is within 50 feet of s ace water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS T BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF Y)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THA ROTEC FS THE PUBLIC HEALTH AND SAFETY THE ENVIRONMENT: The system has a septic tank an oil absorption system(SAS)an a SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil a orption system d the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil abso ion sy and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorpti ystem and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well wa an sis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that fac" y and the esence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to deter a distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3oru SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ► ► 5 ��►� (i�Y, Owner: l C \",rd C5 S Date of Inspection: ci/2,/2 D D. SYS FAILS: You must)ndi to either "Yes" or "No" to each of the following: 1 have ermined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determin ion is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backu f sewage into facility or system component due to an ov loaded or clogged SAS or cesspool. Discharge o onding of effluent to the surface of the ground surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level i the distribution box above outlet inv t due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspo is less than 6" below inver r available volume is less than 1/2 day flow. Required pumping more th n 4 times in the last ear NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorpti System cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is wi in 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is i in a Zone 1 of a public well. Any portion of a cesspool or priv is within 0 feet of a private water supply well. Any portion of a cesspool or p vy is less-than 00 feet but greater than 50 feet from a private water supply well with no acceptable water quality ana sis. If the well he been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile or anic compounds, am onia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" t each of the following: The following criteria apply to I ge systems in addition to the criter above: The system serves a facility ith a design flow of 10,000 gpd or great (Large System)and the system is a significant threat to public health and safety and the a ironment because one or more of the folio 'ng conditions exist: Yes No the system i within 400 feet of a surface drinking water supply the syste is within 200 feet of a tributary to a surface drinking wate supply the syst m is located in a nitrogen sensitive area llnterim Wellhead Prot ction Area- IWPA)or a mapped Zone 11 of a public water pply well) The owner or operator any such system shall upgrade the system in accordance with 310 MR 15.304(2). Please consult the local regional office of the Departme t for further information. revised 9/2/98 110gr4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ) )?\ S-?1n r Owner: Date of fntspection: Check if the following have been done:You must indicate either"Yes" or"No" as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been•Teceiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this Inspection. �L> _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. N _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components,excluding the Soil Absorption System,have been located on the site. _ The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example,Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)1 _ The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5of11 . 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Prop"Address: ( 1�. S P v'r f c,v%Q, Owner: t.,-- grl-�s s Dace of Inspection: J 0-0 FLOW CONDITIONS RESIDENTIAL: Design flow:- g.p.d./bedro m. Number of bedrooms(design): Number of bedrooms(actuagz Total DESIGN flow 1330 Number of current residents Garbage grinder(yes or nol: b Laundry(separate system) (yes or no):,� If yes,separate inspection required Laundry system inspected ( as or no) Seasonal use(yes or no):-19 Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or no):,jj[7 Last date of occupancy: r,. ,re,n•b COMMERCW INDUSTRIAL- Type of establis ant: Design flow: qpd (Based on 1 03) Basis of design flow Grease trap present:(yes or Industrial Waste Holding Tank pr : (yes or no)_ Non-sanitary waste discharge the e 5 system:(yes or no)_ Water meter readings,if liable: Last date of occupy OTHER:(Describe) ast date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection:(yes or no) i�((D If yes,volume pumped: gallons Reason for pumping: TYPE qP 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) i/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date Installed(if known)and source of information: Sewape odor detected when arriving at the site:(yes or no) 'y revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ( �� S�U'r CnY1¢. f WGn�of� 5 M M5 Owner: l„ kAC C- Date of Inspection: li BUILDING SEWER- (Locate on site plan) Depth below grader( Material of construction:_cast iron A`PVC other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting, evidence of leakage,etc.) SEPTIC TANK: .-I (locate on site plan) p Depth below grade: Material of construction:_concrete metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 52 Sludge depth: 3 Vz Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: a „ Distance from bottom of scum to bottom of outie�to o baffle: ( /� How dimensions were determined: T�J �6-t , Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) GREASE TR (locate on site. 1 Depth below grade: Material of construction:_c crate_metal_Fiberglass _Polyethylen _otherlexplain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee affle: Distance from bottom of scum to bottom of outlet affle: Date of last pumping: Comments: (recommendation for pumping, condition inlet and outlet tees or es,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 . Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a PART C SYSTEM INFO)RMATIO,rNy((continued) Property Address: 1,� l>�L•/L � 11 S Owner: LCA n Date of Inspection: ur 1 `^b`75 TIGHT OR HOLD TANK: (Tank must be pumped prior to, or ime of,inspection) (locate on site plan) Depth below grade: Material of construction:—con cr metal_Fiberglas _Polyethylene other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in orking order:7 Yes_ N Date of previous pumping: Comments: (condition of inlet tee, ndition of alarm and float switches,etc.) DISTRIBUTION BOX:--)kl (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note.if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order:(Yes or No Alarms in working order(Yes or No) Comments: (note condition of pump chamber, co ition of pump nd appurtenances,etc.) revised 9/2/98 Page 8of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ( I �j��••✓ I c.,r f G„r S Fo,S I I S finer= Laor,�I QT S Date of k apection: /a7/moo SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not locate ,explain: nn n Type: leaching pits, number:L leaching chambers,number:_ leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Alternative system: Name of Technology: Comments: (note condition of soil,aip�ns of by raulic failure,level of ponding, d p soil,condition f ve tion, etc.) CESSPOO (locate on site an) Number and conflg ation: ")epth-top of liquid to let invert: Jepth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool mus a pum des part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of p ding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, na of hydraulic failure; vel of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9of11 I • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C SYSTEM INFORMATION(continued) Property Address: IV, 6'f"✓ 1""- Owner: (ln1.YL0 i3rw-0,5 S Date of hupectkm: o)ho)0-0 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) on p-oLal:D Cflt►a-c�' SI.Ai? _ — Lnt7 G9u�oJ s PT)L i qnr Ux EC t3 Ic", , 1`3 -71(� " 13 =40' revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(c w \ontired) Property Address: �) 'j 1P I'll' �,+�, , ��., h a, rn.l 1 S Owner: Dots of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM �heck ape rface water Cellar Shallow wells r M� Estimated Depth to Groundwater J, Feet V{ r' j-lr— Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole,basement sump etc.) -Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records �C1 Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) lS Pti<.'jzaes revised ,9/2/98 Page tlof11 OWN OF BARNSTABLE t� L'OCA: ?N SEWAGE # Z--) *3--7526� VILLAGE � ASSEW(R-'S MAP & LOTO INSTALLER'S NAME&PHONE NO. �;✓ �— SEPTIC TANK CAPACITY LEACHING FACILITY: (type) lh L��xl�`t�,U��''t�ys (size) `�rl`��1�376 NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: a. 2-I l G 1i 63 COMPLIANCE DATE: 2 ( � Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �-- -�� ^ �-� ( j. ��� � o � 1" �- �/ . ��� ��-� �f� � ' �a, �y No. FEE s`�O COMMONWEALTH OF MASSACHUSETTS Board of Health, MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) - ❑Complete System Individual Components. Location I wS L M , 1 Is Owner's Name Map/Parcel# AP Address 1.N a ��� M, ( ��ls Lot# —4'(a Telephone# sae— Installer's Name Designer's Name ? ` Address AddressMA R Telephone# -48— 3\b__ `` Telephone# _0-+ �Z> i Type of Building � �S't't QN Lot Size Q 0 sq.ft. Dwelling-No. of Bedrooms —,`00r-Q.Q_ C,3> Garbage grinder (� Other-Type of Building IVO`12 No.of persons ?—Showers V,Cafeteria Other Fixtures (_Q),IC'� iL �c�'�t'CCNk . lr:.A�'L�t�... Design Flow (min.required) 3!s�> -, gp Calculated design flow— Design flow provided 334•S gpd Plan: Date Number of sheets Revision Date Title C J ,SkM Q�—CV Description of Soil(s) 4m. '7�CA-1 Soil Evaluator Form No. ���`'6- Name of Soil Evaluator CktK6r-lS Y Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS ,ZrJD`d(1 GZ C,C" so C\ . /NST/�N/Nc The unders'gned agrees to install the above described Individual Sewage Disposal System in visions of TITLE 5 and further agr es t no to place m in o . ation until a Certificate of om\p'ance hJs b' tit! o J ealth. st Signed _ VA- DateTRr/`v��J/S�pFR� rove.5� Z f jv�o� Al ��Fp N WR�Tj/S'F Inspec tions FEE 'A COMMONWLALT14 Of MASSAC14USETTS r f S.C 1'r, G��P MA.Board o Health, • APPLICATION FOP DISPOSAL. SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) RepairX Upgrade( Abandon( - ❑Complete System\ dividual Components ~ Location b S L fl Ulc�1 LlJ. , !" M I'S Owner's Name �, ,V--, {� Map/Parcel# M�-A? c;t Address 5 r U� LC4--Lq M, M, „ Lot# 1-(p9 Telephone# Installer's Name C Designer's Name w Address M 1 Address 3-3 Telephone# _ L\8 - 3�b Telephone# u _Q- 9(a x v` Type of Building Lot Size r20,�y d sq.ft. Dwelling-No. of Bedrooms Garbage grinder (K))A Other-Type of Building IV O`1P No.of persons Showers �,Cafeteria (l/� Other Fixtures C. C h-O-C., nuC 6 Design Flow (min.required) b `, gpd Calculated design flow D. � gpd Plan: Date f' : b� Number of sheets Revision Date Title k 1 t C "� V';> �2 Description of Soil(s) C (t�, � Soil Evaluator Form No. Name of Soil Evaluator A�,M c r- S"0Y Date of Evaluation w U 3 DESCRIPTION OF REPAIRS OR ALTERATIONS � N , c,-, The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place th s m i ys en o eration until a Certificate of o'm1p'ance has been issued by the Board of Health. Signed /� I Date V Q Inspections s � No. Z003-'fib / �T��T m �¶�T FEE 50 ® �1� VV T �� i1t�� �itJtlJ����� Board of Health, ,��; MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( �)(Repaired (Upgraded ( ),Abandoned ( ) by: D S f h / / S at / 1 has been installed in accordance witA the pr vis'ons of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application N,.7-00 3- 0!0`7' da ed 2 f C 3 Approved Design Flow (gpd) Installer i _ , zr Designer: 6y Inspector: Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. ZOO 3' 067 t FEE 50 Board of Health, 12 MA. ➢ ISPOSAL. SYSTEM CONSTRUCTION PERMIT MIT Permission is hereby ranted to; Construct Repair( Upgrade( an indhidual sewage disposal s _ Yg ( ) p (( pg (t ) ,I Abandon( ) stem g P Y at 1 L6, l o �i ��l f l 'S as described in the application for Disposal SysterriV Construction Permit No. 200 3^0V7, dated' Provided: Construction shall be completed within three years of the date of this e it. local ns must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Z (U CJ 3 Board of Health r i TOWN OF BARNSTABLE LOCATION " L li CS SEWAGE # VILLAGE A ASSE R'S MAP & LOT INSTALLER'S NAME&PHONE NO. f-a✓ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER a. PERMITDATE: COMPLIANCE DATE: 2 J i Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I � r � 1 , FORM � 11 - SOIL • EVALUATOR FORK Page 1 of No.: Date: 2/6/03 COMMONWEALTH OF MASSACHUSETTS Barnstable , Massachusetts Performed By: Carmen E. Shay Date: 2/6/03 Witnessed By: Waiver Location Address or#105 Laurie's Lane Owners Name: James Falanga Marstons Mills,MA Address and #112 Spur Lane,Marstons Mills Lot# Map 27,Parcel 104 Telephone Number: New Construction : Repair : X OFFICE REVIEW: Published Soil Survey Available: No ❑ Yes ❑ Year Published: Publication Scale: Soil Map Unit: Drainage Class: Soil Limitations: Surficial Geologic Report Available: NoF7 Yes 17 Year Published: Publication Scale: Geologic Material: (Map Unit): Landform: Glacial Outwash Flood Insurance Rate Map: Above 500 Year Flood Boundary: No ❑ Yes a Within 500 Year Flood Boundary: .No Fx_1 Yes Within 100 Year Flood Boundary: No a Yes ❑ Wetland Area: None National Wetland. Inventory Map (map Unit): Wetlands Conservancy Program Map (map unit): Current Water Resource Conditions (USGS): Month Range: Above Normal ❑ Normal [i] Below Normal ❑ Other References Reviewed: USGS Topographic Map DEP APPROVED FORM 12/7/95 FORM 11 - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot No.: #120 Asa Meigs Road, Marstons Mills, MA On -Site Review Deep Hole Number: #1 Date: 2/6/03 Time: 9:30 AM Weather: Sunny, Cool Location (identify on site plan): Refer to Sketch Landform: Outwash Plane Position on Landscape (sketch on back): Refer to Sketch Distances From: Open Water Body N/A feet Drainage Way N/A feet Possible Wet Area N/A feet Property Line 25' feet Drinking Water Well N/A feet Other DEEP OBSERVATION HOLE LOG Depth From Soil Soil Soil Soil Other Surface Horizon Texture Color Mottling Structure, Stones, (inches) (USDA) (Munsel) Boulders, Consistency, % Gravel 0" — 6" A P Sandy 10. YR .None <5% Gravel, Friable Loam 3/2 Friable 6" — 46" Bw Loamy 10 YR 5/6 None <5% Gravel, Friable Sand Friable 46" — 156" C' Med. 2.5 Y 7/4 None Medium Sand, 25% Coarse gravel, Loose Sand r Parent.Material (Geologic): Glacial Outwash Depth to Bedrock:None encountered Depth to Groundwater: Standing Water in the Hole: None Weeping From Face: None Estimated Seasonal High Water Table 156" Assumed — No groundwater Observed DEP APPROVED FORM 12/7/95 FORM 11 - SOIL EVALUATOR FORM. Page 3 of 3 Location Address or Lot No.: #105 Laurie's Lane, Marstons Mills, MA Determination of Seasonal High Water Table Method Used: ❑ Depth observed standing in Observation Hole: NIA inches ❑ Depth weeping from side of Observation Hole: 156 inches (assumed) ❑ Depth to Soil Mottles: None inches ❑ Groundwater Adjustment: None feet Index Well Number: Reading Date: Index Well Level: Adjustment Factor: Adjusted Groundwater Level: NIA DEPTH OF NATURALLY OCCURING PERVIOUS MATERIAL: Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system: Yes CERTIFICATION: I Certify That on September 17, 2000, (date), I have passed the soil evaluators examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR 15.017. 1 Signature: Date: FORM 12 - PERCOLATION TEST Location Address or Lot No.: #105 Laurie's Lane COMMONWEALTH OF MASSACHUSETTS Marstons Mills , Massachusetts Percolation Test Date: 2/06/03 Time: 9:30 AM Observation Hole #: #1 Depth of Perc 48 — 66" Start Pre-soak End Pre-soak Time at 12" Time at 9 Time at 6" Time (9-6") Rate Min./inch <2MP1 * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Performed By: Carmen E. Shay Witnessed By: Waiver Comments: Would Not Hold 24 Gallon Presoak - <2 MPI ' Site Passed X Site Failed DEP APPROVED FORM 12/7/95 Sep - 20-01 13 : 62 BARNSTABLE HEALTH OEPT 5087906304 P . 02 sn�,ot \C)TICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. _ PEKCOLATI.O:N 'TEST AND SOIL EVALUATION EXEMPTION FORM rJ hereby certify that the engineered pian sio ec by me uz;ee concerning the property located at _LOS _ y2.tES L.N• .1 meets all of the tcl:ow Ong c�tena • This failed system is connected to a residencial dwelling only. There Lire no .orunercial Or business uses associated with the dwelling. • 7r� soil is class:;,.ed as CLASS l and the percolation rate is less than or equal to -rt_autes net inch. The applicant may use historical data to conclude this Fac: or may :onduce pre:im,:•,ar% tests ac the sire without a health agent present T her`: :s no increase in !low and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen 1 iecc acinve the maximum adjusted goundwater table elevation. ,Adjust the ;r�unc .ya:er tattle using the Frimptor method when applicable) Please complete the following: �. fop Grouno Surface E!evation (using GIS informauon) t� \�Y' ;coat:or, ad;ustraent For high G.W. ._59 4 _ �'_FTTRE�t:F.. 6ETWEEi� A and B 2(3VED __. QATE: -- - -a -_ -- NOTTCE was c �,t.n e above . Formation, a co, oair permit will be issued For 5edr^.oms ddtuonM bedrooms are authorized to t`te future wi:houc en;tncerec plans _ -- — Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: `p5 121FS LP4.3 1\S Lot No. Owner: ,�p{�QS �Q,�n�Gt Address: Contractor: Stla&_ ut�olt� Ip��F��Address:--E_x,y(!-��— M Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date mo h/ y/Year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... OWater-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to .S�}•a water level for index well ........................... mo th/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) �. determine water-level adjustment 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) ................................................ �. I!; Figure 13.--Reproducible computation form. 15 CARMEN E. SHAY (508)-548-0796 ENVIRONMENTAL SERVICES, INC. P.O. Box 627,East Falmouth,MA 02536 February 12, 2003 RE: Certification of Title V Septic System Installation: Residential Property— 105 Laurie's Lane, Marston Mills, MA Dear Sir or Madam: On February 10, 2003, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at 105 Lauries Lane, Marston Mills, MA, based on a design drawn by Shay Environmental Services, dated, December 28, 2002. XX I Certify That The Septic System Referenced Was Installed Substantially According to the Plan I Certify That the Referenced Above Septic System Was Installed With Changes but in Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow. The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is Required. If you have any questions, please do not hesitate to call the undersigned at (508)-548-0796. Sincerely, CARMEN E. SHAY ENVIRONMENTAL SERVICES, INC. jw"00ACFI;;. S i.A�,/ C en ay, R.S., C.S. President `SgNt7Kn`p ,�,. tlr.......... FHE COMMONWEALTH OF MASSACHUSETTS BOARD OF: HEALTH -•1 .......... .l0 uJ_..............OF-.-.. c..r.Y... �c`.b.l'..' _................................ ,Y liration for Dinpniial ork,i C�onarurtion 1hrmit P� Application is hereby ma for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ^n �� �_ ULY �Q In S`-- -- �r�e �_ �CA,)_').. ---------- --->rS �,�••-_,!v!1�� _ {l_1. ................ ................ - --•--• ---A.....- g ------------------ - //4' z Location-Address ry� or Lo o. ---------------SV.:°-----�.lL'�!1P � ....................... -------------------------------- �'1�4!-l�r_-5 = W Ownez Address Installer Address Type of B Size Lot__ `�_;__l,_J_Q.....Sq. feet v Dwelling— No. of Bedrooms----___-__-Z------------------_----------Expansion Attic ( ) Garbage Grinder ( ) I!� w Other—Type of Building ---------e�----------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures --------------- ------------------------------•------- ••---••------•----•-------•--------------•--••---•-----••--............•-••--•--•-----•-•--•- W Design Flow----------------- 57------------------gallons per person per day. Total daily flow---_--...--•-._3-30.................gallons. R: Septic Tank—Liquid capacity_10-OO.gallons . Length--------7--____ Width...._...?_---_- Diameter---------------- Depth_.... ....... f w isposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. it No------------k-------- Diameter-_--_._-_$------- Depth below inlet................. Total leaching area__� _-_I_.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by `c:Na.K 12_��.._. +. L��N+�_yPr _..__ Date..__ _....................... n Test Pit No. I-----24.2:_minutes per inch Depth of Test Pit.......!P_1------ Depth to ground water.N!4lrP.----ereo.un4`orp� Test Pit No. 2----------------minutes per inch Depth of Test Pit.------------------- Depth to ground water-.----_-------------_- ----------------------------------------------------------------------------------------------------------------------------------------------------------•-- 0 Description of Soil---- ...... ------------------------------------ �4 -! --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable............................................................................................... -------•-----•-----------------------------------•---------•-----.......----------••••-••-••----•••-••••--•---•-----------------------------------------------•-•-------------------------------------- Agreement: 11 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITTUI 5 of the.State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. d------ ................................-•-----------------------------------•-•- - •...... ..----•••. ApplicationApproved B ••---• -- -----------••---------•••-•-•-•--•-•---------•---•-•••-•-•-•-----•-•-•••----- Date Application Disapprove r t f ollowing reasons:---------------------------- --•--•-----------•---•------------------------------------------------•-•----- - ----------------- .-- ---------------- ----------•-----------------•-------------- Date No '` - gyp F$s....... -- - THE COMMONWEALTH OF MASSACHUSETTS >'• { BOARD OF HEALTH , �0 ...... ........ .--...... . fir on fur• bripmat ' , urk.s Tonstrurtion pt:Ott# 'A lication is;hereby',made for,a Permit to Construct . or Repair an Individual Sewa a d5is osal PP Y (� P ( ) g P , System a't_^^ v�C /, 1 'J ..K`:•� - SR ,:. {: .�o.?.Q UI r_..Y�Q �•.... -•-- ... O N.____k�Ykc.....-__.�-•=•c_YSio-0 ....J.7A1J•: � Location-Address or Lo o. , ��/� III` �•�n 1�1 t1 A 1n {r\ ____ :.....�1sL1..9C'. .�� '�' a.... tAC�'1PS!!\�_ _______________________ _______________________ ......_...:.l;Y]..l`�___.s.�_...... .t.�7G!Ys.��717H.� .1 F r �' Owner Address 1 � lostaller .. \-----•----••--"..."Address .............. Dwelling ATo: of B , Q Type.of Building Size Lot.: .�__Q _O,:__Sq.'feet M edrooms.__-.__._.. .............Ex Expansion Attic Garba a Grinder `04 l •Other—T c of Buildiu ............. _..__._ No. of persons........... Showers Cafeteria Q' Other .,fixtures .: ' ' _.gallons per person per day. Total*daily flow_______________ + W Design ':Flow -: .-_. .... g P P P Y Y 33 0_. __ gallons td Septic Tank Liquid!capacity_101)Cl.galIons Length........7..... Width........ Diameter................. Depth !Ai.:, Y W isposal'Trench 'Jo ......... Width.................... Total Length.................... Total leaching area_ sq'ft No. ...• Diameter_____.... .__._. Depth below inlet_ .... •""••"• Total leachingarea �.L._:..sq- ft Other Distribution-.box ( ) ' . Dosing tank ( ) Percolation.Test Results Performed by- «N a.B�_��.___F .!.R3�!�14�-4t�.._-. Date.... $._�_1.g.-S 3 n Test-Pit No ].._.:L..�:_minutes per inch Depth of Test Pit.......!. ......... Depth to ground water NNAn9__-.erCo'nf0r- N !' •,,�� : .w Test Pit No. 2.::.::. :.:minutes per inch Depth of Test Pit____________________ Depth to ground water.......... i.' x . .C) Description of Soil �.� a St ..............................................- - c r .te.�. - .: y W U _ Nature of Repairs or Alterations Answer when applicable........................................................... ,. . e, Agreement The undersigned agrees to,install the aforedescribed Individual Sewage Disposal System in accordance•:'with ' 1 ' the provisions of TITU ' .5 of the.State Sanitary Code— The undersigned further agrees not to place the system in operation until-a Certificate of Compliance has been issued by the board of health. •-•••••••-" _ •_••----•:...............•""•"""._...-"-"••--"- """•"-/�Dtale _- ...... ... ` i APPhcation Approved B .._ - _: .1Appltcation Disapprove r t allowing reasons__________________•____--_________-_..__.._.___-___..._.__.___._._. .____ _ _ ; - c Date Permit No -_. Issued._.. .........................l ; Daze r r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r. • r , t ...................... ] �PrIifiratr of �lQ lintire „ i I k RTIFY, That the Individual Sewage Disposal System constructed or Repaired b . , --- -••- .. - `., Installer - r r ...._S1�at. GCr =-(�f .. - - 1. application for Disposal `rdance with tl'e rovisions of T-Tim j of The State Sanitary Code s desc ed in the has been'•installed in acco Yorks Construction Permit No _ dated.. , -' THE ISSUANC •, OF THIS CERTIFICATE SHALL NOT EE CONSTRUE A �lt TEETFIA'I• THE SYSTEM WI , F TION SATISFACTORY. .� DATE l Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0F F7�' • F r' t5 to 1 r 5 (SMuitrlF.tflrlltt rrtttt Permtsston,1 e an -•--"-_....._•• ---••-• .................... , j t to Constru. pa ) a 'ldual Sewage Di osal System t at No :.. ... __ '} 'as shown on the apTHlion for Disposal \'arks Constru Permit No...___ ..... Dated_ j,:. a y ' Board of ------------------- -------------- Health DATE J FORM 1255 'HOSIA & .WARREN.:ANBC:. PUBLISHERS - 7 1 -- �� ioz 7t? LO CA IO �i ,. S E W A G E PERMIT No. VILLAGE MC4"Vcr,°5 mill , INSTALLER'S NAME & ADDRESS 'o ll s 8 U I L D E R OR OWNS DATE PERMIT ISSUED DATE COMPLIANCE ISSUED `��� 1 0 ga� 00 l v i ' a� l� Ii cd ACTION - SEWAGE " -SEPTIC TANK - - "D" BOX - - LEACH TOP OF FDN \ r Z g •!�-•IrMOVG AU- 5. (MSL)# ��'� A Ai�aT'A��GI= GK 1G1 Av+r rr tC7 2,.OF 1/8T0 42" GhrTtR� L_J.- J--1 7>ii A>J':a w1 i\WASHEDSTONE l r e, P J^rvr:'co �b IN.. tb OUT - OUT- 4"TN- ' , ` C\ SEPTIC 's,r I R., .y `. ��l' •,r-��"" •.i'� �Z '�� I• .. t'' ��' TANK I ��� 41\-' ELEV. ELEV. ELEV. ELEV.. Lo ELEV. ELEV. _ O �.._ o�t.u' - LLI , v �fm \\ �1 ' OF 3/4"-11/2' WASHED STONE z Y \\\ s \ !t V TEST DOLE LOG TEST BY T'�+,t2��a,>.„y K. "�1=v. •�. :i 6.G�i�..7'�t' �.ca..t� . \ /'! �•/ \�O f � 1 �, ,�ti'- '�' t`"---' .j' fit`'' , WITNESS1 TEST DATE /'l DESIGN BEDROOM HOUSE .` , \ !' �j-- �'. T.H. # 1 2, T.H. # '/ 4�`{. ``\ /,, ELEV. ELEV. NO ' i .,��' \ \ ` - 1 CSC. _ 1 4-7 ` DISPOSER DISPOSER �^, _� - PERC RATE MIN/IN. L� ✓J/`J J \` " t-.4aA,wq �••'�u. sn,_ i' i FLOW RATE (GAL./DAY ) SEPTIC TANK 4`'S 4b" a .V i REQ'D SEPTIC TANK SIZE _ LEACH FACILITY - '- i SIDE WALL f x � �, ` ._(?• ) = _ G/D. wt- z s f l cti� BOTTOM — ----- =--I � �' ) - --_ _ __ G 1D. \o TOTAL r� t� Cn A.•v. - �T_'' 1, � `..�� .��e� 'l� - _."• rij� � _..•ri`\ � USE: ----- �f=' LEACHING r�I i __ \ \, '.r.~ r.,.��t�,• ':. �.% C"`•'�.�.�./t 2a{5-E -'f' r'_____.___ �� �" r - WATER ENCOUNTERED NOTES: (UNLESS OTHERWISE NOTED) " 1. DATUM(MSL)L TAKEN FROM---P. n 2. MUNICIPAL WATER .....,....................AVAILABLE ` � Qf c Col 3. PIPE PITCH: 1/4"PER FOOT 4. DESIGN LOADING FOR ALL PRE-CAST UNITS: AASHO -44 8 , \ 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. Gl� ARNE GJ; �� NE H �r� 0---DISTANCE AS CERTIFIED 6. PIPE JOINTS SHALL BE MADE WATER TIGHT {t 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. cie UJALk W GIVCIVILI HEREBY CERTIFY THAT THE BUILDING SITE PLAN STATE ENVIRONMENTAL CODE TITLE 5 `-' I _p�b'i S �" �.1 SHOWN ON THIS PLAN IS LOCATED ON THE 2-`Cvu.�.� oc A3wS'1Ahs.lTz B•C.�t• O ,' GROUND AS SHOWN HEREON &THAT IT_. (LOCUS: L � �� I��c� i�F1G.tats r"T '� JDFGt �� "140 CONFORM TO THE ZONING BY LAWS OF THE > \ y RCI2 v+t.��i-+_ Ct.GssE 'C410► tc7'-tom �r�6*= c E/�Ga,t (h�' `ra►lGi �111LL S)S?(��'lly �31. MASS p"-•Mg:;I,_,w r L5' v,-�l/,.Ncr- -T,= AI�-CSw✓ wL1�_ @ IZ�' �C713Ac�_. \ /VD SL) -_ -_- -_ 7 TOWN OF £4 �- �✓ REG.PRO NGINEER WHEN CONSTRUCTED. DATE �, � Z-7-z- 9 'tx, 'fi. -^r" « xrtciu SGilt_s C� :x*+,w -Tc> wvw-E.2 'I}ai3�2= . REF: rr tS r_ n�Icc t3Y"tuT� Ctii�a�►., c�+ar e.�ea Y�ora�lri,G ��satr.,s Ct�ro �'.t.. 5 Y• A�>L41 �atu�Y own ciw eI'���/ee rl�g PREPARED FOR: T I� _ CIVIL ENGINEERS �^ BOARD OF HEALTH LAND SURVEYORS REG. LAND SURVEYOR CONTOURS (EXISTING)-----•------- -, ^, 1 �Y SCALE' ,4 r (PROPOSED)-0--0--0-0- APPROVED DATE MA Yarmouth&Orleans,MA DATE _ _�...+..•-y �----may,_ I SECTION _ VENT PIP ( 4 f A A 1 zooa / VE E O least 2 inches toll l0 min. from . ) ALL T - NOTE. ALL PIPE5 ARE TO BE 4 SCHEDULE 40 P.V.C. Schedule ounE aBOX SMALL THE hose ,to septic tonk 46 PVC •/Chorcow odor FBter PROFILE VIEW OF ADDITION TO LEACHING SYSTEM tasTRIBUTaN Box sHALI BE , Existing Foundation _ SET LEVEL FOR AT LEAST 2 FT. t2 CONCRETE COVER Septic took covers mutt De 3'-041/8 - 1/2 Washed Peostont G/q_ +. Within 6 in. of finished yroda KE$Y ROAD N ' Grade over Septic Tank - 98,25 Crode over D-Box - 98.00 —{rode o.er SAS -98.00 3/4 to 1<1/2 Washed Crushed Stont , 3 - S"OUTLET dO - •w +.. 2 A KNOCKOUTS rf , . \ '^ .'15.5 OUTLET 12" INLET �d r-F S 002 3 HOLE H-10 . , a 6 t r DIST- BOX 3' Moximum Cover 6" w Top o1 SAS - Eiev x 94.50 .- EXIST_ Sx•O.Ot ar Cicala t z EXIST, PIPE X 10 N 1,000 GAL. �. S= 0.01" per foot . /5.S' O d N 4" - SCH. 40 Te FROM EXIST.FDUNDATION Effective Depth - L75' V�P, �{ KJ w � . SEPTIC TANK o a H-10 fl..«r.. N N ° 5 Units e 6' - 30' PLAN SECTION CROSS-SECTION �s c�0 f 3 3, a t7i A 3 CONCRETE FULL FatAlOAT 4) 11 a O 1 _ J v rn o $ 30 SIT SPUR x ri LANE SZ SYSTEM PROFILE ; . 6 in of 3/4'-1 1 n'_ o, o, 36 3 HOLE H 10 DISTRIBUTION BOX l Not to Scale c compacted stone > d Y 9 Effective Length NOT TO SCALE c > d 4• a' ; LOCUS MAP c c m i2.5 - " SOIL ABSORPTION SYSTEM (SAS) GENERAL NOTES 6 in.of 3/4"-1 1/2' c i0' .. compacted stone - Effective Width m GULTEC MODEL 125 <H-10 LOADING)/ SHOREY PRECASTE 1. Contractor is responsible for Digsafe notification H9ltsm_sS_IeQI fict 99-------- (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes. NOTE OVERALL HEIGHT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 12- 2. The septic„tank and distribution box shall be set level on $ of 3/4"-1 1/2 stone. 3. Bockfill should be clean, sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation by Carmen E- Shay -- Environmental Services, Inc. 5_ The contractor shall install this system in accordance PERCOLATION TEST with Title V of the Massachusetts state code, the approved plan i Regulations, �� LOT 68 6. If, during installation the contractor encounters any Date of Percolation Test. FEBRUARY 6, ;2002 � � g Test Performed By CARMEN E. SHAY, R.S., C.S.E. soil condlitions' or site conditions that ore different Results own on the soil log or in our design Excavator:t Roberts BSe vt cl Services Barnstable B.O.H.) S installation must -halt & immediate notification be p 6�7 PROJECT BENCH MARK made to Carmen E. Shay Environmental Services, Inc. Percolation Rote: - Tess Than 2 MPI � ��, Off, TOP OF FOUNDATION 7. No vehicle or,heavy machinery shall drive over the _ ) P Y unless hated as H-20 septic components. ELEV. 100.00 Assumed septic s stem Test Hole p i 8. Install Tuf Tite gas baffles or equals on all outlet tee ends. NO. 1 ' - Lines shall be 4" diameter Schedule 40 NSF PVC pipes. 9. All Distribu On DEPTH SOILS ELEV.I \6 t 10. All solid piping, tees & fittings shall be 4 diameter 0 9s.00i / Foilea�� Schedule 40 ',NSF PVC pipes with water tight joints. Loamy Leach 'Pit'• 11. Municipal Water is Connected to The Residence and Abutting Sand TEST HOLE #1 D-Box SHED i Properties Within 150 Feet. ,o YR 3/2 120' ELEV.= 98.00 t t 0"-6' A, 97,50 / � , �� THE PROPERTY ,LINES ARE APPROXIMATE AND Loamy i ' COMPILED FROM THE SURVEY PLAN GENERATED BY Sond // 1�ir EXIST. 1000 go[ \ DOWN CAPE EGINEERING, -OF BREWSTER, MA +,; i;t'>' Septic Tank ,o YR 5/6 / Y-`ti?,t ,.,•:; 5_! . ENTITLED PLAN OF LAND OF WAKEBY ESTATES, MARSTON MILLS, MA" LOT #74 6'O DATED MAY 1 1973, 6"- 46" 94.00I O AND 1S NOT INTENDED TO BE A' SURVEY PLOT PLAN Medium � 4.-,.. ,;r.S'o'�-�'-.,�.T!f I . OJ Sand cc VENT/PIPE �_� nJ IT SHOULD BE USED FOR N0 PURPOSE OTHER THAN ------ THE SEPTIC SYSTEM INSTALLATION. J / t L- ' EXISTING LEACH' PIT TO BE PUMPED & FILLED IN PLACE. ---- ----- DECK , ,I / i � NOTE- ANY STRIPPED OUT SOIL- CONTAINING 'LEACHATE q S P 'Cl 7 FROM H EXISTING A �J I EXISTING � 0 THE_E S G LEACH PIT 'T4 BE DISPOSED Or' T S t yr AS 'PER BOARD OF HEaI H SPECIE CAT,ON�.t 3 BEDROOM V f `. D� HOUSE Per t a c \ f Depth to Perc: 48 to (di °J , �1 LEGEND Perc Rate= Less Tho 2 MPI t� �� 7 Groundwater Not Observed cO ` \ LOT #69 , M No Observed ESHWT p �\ ADJUSTED H I None t 20,040 Square Feet +/- I PORCH �tQ DENOTES PROPOSED D 1US ED 20 E e . o i C h� r SPOT GRADE x 104.46 DENOTES EXISTING `` ' SPOT GRADE 9Fa o 1 PL PROPERTY LINE o0 QA, 96P 0 PROPOSED CONTOUR 166.94' - o S 87c1 52' 55 E' — — — — - -97 EXISTING CONTOUR g -- ----- DEEP TEST HOLE & ly 2-18" DIAM ACCESS MANHOLES ----__--------------------= �_ ' PERCOLATION TEST LOCATION 8. ------ �.. - 6 FOOT STOCKADE FENCE (40 FOOT RIGHT OF WAY) l � 1 `* THE ACCESS COVERS FOR THE SEPTIC TANK, 1� _- —.-- DISTRIBUTION BOX AND LEACHING COMPONENT IZID J OUTLET SET DEEPER THAN 6 INCHES BELOW FINISHED GRADE SHALL BE RAISED TO WITHIN 6" OF FINISHED GRADE. P LOT P LAN -;• INSTALL TUF-TlTE GAS BAFFLES OR EOUALS i � :.. �. "...:. .�.. .- ..,.. .� .. OF PROPOSED SEPTIC SYSTEM UPGRADE STEEL REINFORCED PRECAST CONCRETE PLAN VIEW PREPARED FOR 3-24" REMOVABLE COVERS MR . J A M E S FA LA N G A AT 4' 105 LAURIE' S LANE 3- min clearance T 8' inn. 13- • ME7 ' -- ---T tr min. inlet to outlet MARSTONS MILLS , MA ^�- uQuid level ouneT t0" inn t i4',,,e C - L L I- 5' -7' i n Calculation s -_ _- A ,. Des gs 4'-0' min. ^� PREPARED' BY: ro.seM. '• Liquid depth - o Number of Bedrooms- 3 Equivalent to 330 Got./Day (330 Got/Day Min, PeC:Title 1) Is - r 9 •xr ,• .. Garbage Grinder: No i �r.o• <: .� ;, .� •. � - I Minimum n Per Title V � •�. , ,:� E. r`^r TyT/� Y ,, •. Leaching Capacity Proposed 330 Ga./Day nimum (MI e t e ) /.� �17�1►l L 1 ►' .L • AJ l l!1 l Septic Tank 3 x 330 Gal./Do = 660 USE 1.500 GAL. Septic Tank. . :. . . . .... . Y 0 20 40 50 I ENVIRONMENTAL SERVICES, INC. '` -to" SOIL ABSORPTION 'AREA: Using percolation rote of <2 min./inch Bottom Area 0.74 gol/sq. ft. x 360 sq.' ft. _ 266.4 gollons ;K, c END-SECTION P.O. BOX 627 CROSS SECTION ' sdewatl Area: 0.74 got:/sq. ft. z 92 sq. ft. = 68-08 gallons F . i 4 gallons t. r:� EAST FALMOUTH, MA 02536 Providing: 334. 8 go lons ;. s . . `re��>/ > �.,•�. TEL FAX 508 548 0796 . . . SCALE. 1 20 ,H � SEPTIC TANK Use: (5) CULTEC MODEL 135 UNITS, HAVING A 1 EFFECTIVE DEPTH, ;> , USE EXISTING 000 GALLON 0 E SCALE: 1 =20 DRAWN' BY: CES DATE: -FEB. 7 2003 I TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, 'AND OF WASHED STONE ' NOT TO SCALE N N N T UNDER. o THE ENDS. 0 STONE U DE . _ PROJECT SD391 FILENAME. SD391 PP.DWG SHEET 1 OF 1 -