HomeMy WebLinkAbout0086 STARLIGHT DRIVE - Health 86 STARLIGHT D'r
F
r.
TOWN OF BARNSTABLE
LOCATION SEWAGE.,#
VILLAGE
SSESSOR'S MAP&PRCELm ,60nA5d
INSTALLER'S
NAME&PHONE NO. W 14QA7 r/ P/k[Gg �
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type), �7pplXlts fIVr-11- (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE: G COMPLIANCE DATE:
Separation Distance Between the: V �-
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) f feet.
Edge of Wetland and Leaching Facility(if any wetlands exist
within 300 feet of leaching facility). feet
FURNISHED BY
OF
//0 f
4>
Ac3 � z/- O 9�3
Z
zj �
No. �W Fee QQ
THE ICROMMONWEALTH OF MASSACHUSET i S Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for T1oont *paem Con0truction VErmit
Application for a Permit to Construct( ) Repair�pgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Add ss or t No. �•rp Z / Owner's Name,Address,and Tel.No.7Z51*1UY
Assessor's M.ap/Parcel _-
Installer's Name,Address,and Tel.No. es' s N, d s a el.No.
6 r� n,�� �r .spy,¢�� oa�r�/ 5 � �--, �� `
Type of Building:
Dwelling No.of Bedrooms Lot Size Dd sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures y�
Design Flow(min.required) �V gpd Design flow provided6 i gpd
Plan Date Number of sheets Revision Date
Title �1
Size of.Septic Tank ���0 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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 H.90th. r
igne Date Q�
Application Approve Date V /
Application Disapproved by: Date �—
for the following reasons
Permit No. Date Issued (D v
----------__——_----------.�-----------------
..� �. -, -. y, .y,.�.."r„^F.....;;am-.M •�"1'-"r:. ,. -- #..,-++gym•-r+tfy.t,.w,6',+T.+•r'."'y-1't, _s -
No. .( �V C/V
Fee
` Entered in computer:
THE OMMONINEALTH OF MASSACHUSETTS r- er p
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2ppficatiou for >Mi5pd5al *pgtem Conotruction Permit
Application for a.Permit to Construct O Repair(LXUpgrade O Abandon O ❑ Complete System ❑Individual Components
Location Address or Lot No.Z6 -1 ej w Owner's Name,Address;and Tel.No. lvA
Assessor's Map/Parcel �� QQ .�.._. n 1
Installer's Name,Address,and Tel.No. f ! !�9/�//VFji;k-Desi ner's Name,Address and Tel.No. Q.
'�.r0 %'p.IIJT%/l G S7" 17et/.4- //�/¢ cs'vllcd
T�ype of Building:
Dwelling No.of Bedrooms Lot Size / sq. ft. Garbage Grinder ( )
? Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
'"Design Flow(min.required) O gpd Design flow provided S gpd
Plan Date Number of sheets Revision Date
Title
Size of,Septic Tank / / C7�� Type of S.A.S. Z0 /,fib/�P s
Description of Soil
Nature of Repairs or Alterationsf(Answer when applicable)
t
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.
iS g ed �� :i/ F� .9 1 Date `�/ ✓ y/
Application Approve rya \ �� I � Date .�,v
Application Disapproved by: Date W
for the following reasons
- F f
Permit No. r ? Date'Issued A (p Qj
THE COMMONWEALTH OF MASSACHUSETTS '
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (je-)"';Repa ed-( ) Upgraded ( )
Abandoned( )by n k/—~42_
at J/ TI�J 44 C H� e= /�"�',�, has been
{�constructed in accordance l
with the provisions of Tit1e.5.and the for D-isposal System Construction Permit No. dated {(}�
Installer Designer yy'\ S& �..5
#bedrooms r Approved design flow U ^_� J gpd
The issuance of this perm,ii--)shall notbe j'construedm w Ilue as a guarantee that the syste function as designed.f A{n
Date -��) f t 1 Inspector IV ,A F1qjaaw �
Not%� ` �� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
Migoaf *_ p5tem Con5tructiou Permit
Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon ( )
,Y System located at Cam, �c� � i�_ _I t 7 /W
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construrc�tio ylmust �e completed within three years of the da�'e°of this,perm\it.\
Date CJ r} In/0 Approved`by ,� J _ _
Town of Barnstable
'"E Regulatory Services
Thomas F. Geiler, Director
➢ABNBTABLL
9 MASS. Public Health Division
t63q. 1e
ply °' Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-362-4644 Fax: 508-790-6304
Installer & Designer Certification Form
J
Date: J °� Sewage Permit# Assessor's vlap\Parcel ld�
Designer: �J� ✓r�i✓� Pil-P� Installer: I lIkJ 44,n pt!w0�
Address: d,)y- co I Address: _
On was issued a permit to install a
(date) (Installer) ,
p �b ST&e- i.4 wT D tztye-based on a design drawn by
septic system at ,
(address)
►AAA aq- — dated
(designer) �1
1 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 an&or septic tank.
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 anv component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
DA�YE�fEK �
(Installer's S'g�na re) 1140
1 Rfc�sTE ° p , D
S01 TAR�P�
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q:Health/Septic/Designer Certification Form 3-Z6-04:.doc
Town of BAl<nstable P#
Department of Regulatory Services
Publie.Health Division Date
"tea annis MA 02601
t6Jy. �e$ 20D Main Stree4 HY'. eft •
�ffD WU'l� r /loll
Date Scheduled - ' Time Fee Pd.— lot')
j
,Foil Suitability Assessment for Sewa e Di osal
Witnessed By:
Performed By:
LOCATION & GENERAL INFORMATION
Location Address'.�� tq�2t!1'�HT bf-(t/E Owner's Name f6D. �� 1��6 .
M, WN, M. Address
n ,�a✓' C2 �' `��
Assessor's Map/Parcel' IUG/4 I Eg'ineees Name '
Telephone# to
NEW CONS IRU� iYON REPAITt j
� %) 3GL- Z`i`Li
�� �1✓���L Slopes(go) , 4 S Surface Stones
Land Use q
o y i _ft Drinking Water Well > 2°� ft
Distances from: Open Water Body �• ft Possible Wet Area,: ' O
7 10o ft Property Line ft Other ft
Drainage Way -
SKETCH:(street name,dimensiotis'of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
1WELLINC
o , L
`\N TOp OF FNDN
s I EL = 5"-
I
\ L
\;30
\\ s L
31.25' �I
i
25.OJ
6 14
�Watcr
i Depth to Bedrock /Parent material(geglogie)Depth to Groundwa(er. Sta N I Weeping from Pit Face �. --
��A.
Estimated Seasonal Vigh Groundwater ' '
DtTERIVIINATION FOR SEASONAL kIIG13 WATER TABLE
Method Used: j i. it). Depth to soil moldw in.
Depth db$erved standing in obs.hole: - , in. oroundwnter Adjuattnent
Depth toiweeping from side of obs.hole: Adj-{actor,,,,. Adj- undwater LeVel
Index Well# � Reading Date Index Well 1evtl. ..
I
PERCOLATION TEST Date
Observation ---
Hole# `
D Time at6" .. —
Depth of Pere t� _
b 6� I Time(9"-G7 --- --
Start Pre-soak Time.6 -
�O12—
End Pre-soak
G 2-
Rate Min./Intl►
Site Suitability Ass0smenl• Site Passed
X Site Failed: Additional Testing Needed(YIN) —
Observation Hole Data To Be Completed on Back
Original:.Public Hedith Division
***If creole fiibn testis to be conducted within 100' of wetor to land,byou must first notify the
'
„_�.P..>~t� I A,icervation Division at least one(1)wedk prieginning.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
(USDA) (Munsell) Mottling (Structure.
Stones,Boulders.
Surface(in.) Consistency,
110
``3� Lo Sind to
Med. Sao 2.
DEEP OBSERVATION HOLE LOG Hole# 9--
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) -Mottling (Structure;Stones,Boulders.
Consistent %Gravel)
gu 14sa4 n iG 5;
,112r S
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
DEEP OBSERVA ION HOLE LOG Hole#
Depth from Soil Horizon Soil T cure Soil Color Solt Other
Surface(in.) (USDA (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. ra I
t
Flood Insurance Rate Man:
Above 500 year flood boundary No— Yes
Within 500 year boundary No- Yes
Within 100 year flood boundary No X Yes
Depth of Naturally Occurrine 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?
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required training,ex�p�er/ti�se and experience described in 3.10 CMR 15.017.
Signature G" Date
Q:\.SEPTICIPERCFORM.DOC
rj TOWN OF BARNSTABLIE
.t?srA 1ClO1V `✓(r� cu l� i� �t' '. SEWAGE #
QLAGEAdZll s /uJ Z S ASSESSOWS MAP & L,OT
NS T I,ER'S NAME&PHONE NO.
;EPTIC TANK CAPACITY n 0
.EACHING FACILI'I" : (type) (size)
40,OF'BEIDROOMS
MILDER OR OWNER ° CI A 4 ' L e
'ERMITDATE:` .M.. _-COMPLIANCE I'AJE:
'Wparation Distance Between the:
vlaximurn Adjusted Groundwater Table to the Bottom of Leaching Facility eet
Irivate Water Supply Well and Leaching Facility (if my wells exist
on site or within 200 feet of leaching facility) eet
sdge of Wedand and Leaching Facility(If any wetlands exist
within 300 feet qf leaching facility) _feet
--urnished by . w� ti r �� � �
p
A-C-37' 410 9
A _
,6Ld
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments
86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. 51-75
A. General Information
1. Inspector:
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Services
Company Name
29 Atwater Dr
Company Address
E. Falmouth MA 02536
City/Town State Zip Code
508-495-0905 S13971
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and th 9 the" ,
information reported below is true, accurate and complete as of the time of the inspection.Tie inspection
was performed based on my training and experience in the proper function and fa`intenaQ of one site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section P15.340'of
Title 5 (310 CMR 15.000).The system: �!' CO '
❑ Passes ❑ Conditionally Passes ® Fai s v=
❑ Needs Furthe Evaluation by the Local Approving Authority
C
10-6-08
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
e: 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.
1gewo
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syste •Page 1
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
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 pipes) or due to a broken; settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15
Commonwealth of Massachusetts
W Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M y 86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-96.6-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
-
every page. City/Town State Zip Code Date of Inspection , 4.
B. Certification (cont.)
B) System Conditionally Passes (cont.): q
❑ distribution box is leveled or replaced
ND Explain:
= R ❑, 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 t
❑ 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 mannerwhich will protect public health,
safety and the environment:
'' ` ❑ Cesspool or privy is Qthin 50 feet of,a surface water
E Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
�. v
I'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:
tp ,• . ,.;.< 4. ,�{' ,, ❑ ' ,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.
a ❑ 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.
t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ 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
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1h da flow
Y
❑ ® 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.
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface-Sewage Disposal System Form -Not for Voluntary Assessments
86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
_
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.): -
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 CM 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑,. the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a'tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes"in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5insp official document-03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done.You must indicate "yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® 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.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CM 15.302(5)]
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
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: 0
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? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: 4-08
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water.meter readings, if available: .
Last date of occupancy/use: Date
Other(describe):
t5insp official document•03/08. - TTRIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
w W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
y 86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1=800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: N/A
Wass stem pumped as art of the inspection? ❑ Yes ® No
Y P P P P
If yes,volume pumped:
gallons r
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
1975
Were sewage odors detected when arriving at the site? ❑ Yes ® No
t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15
Commonwealth of Massachusetts
F Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
'
every page. City/Town State Zip Code Date of Inspection
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.):
Good condition
Septic Tank(locate on site plan):
12"
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
--------------------------------------------------------------------------------------------------------------------------
Dimensions: 1000 Gal
Sludge depth: 12'
Distance from top of sludge to bottom of outlet tee or baffle 20"
Scum thickness 0
Distance from top of scum to top of outlet tee or baffle 6
Distance from bottom of scum to bottom of outlet tee or baffle 16"
How were dimensions determined? Tape
t5insp official document•031D8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and,outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank in good condition.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural Integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
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):
t5insp official document-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.) -
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
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert N/A
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.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes . ❑ No
Alarms in working order: ❑ Yes ❑ No
t5insP,official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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:
2
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Both leach pits had evidence of failure with stain lines above inlet inverts.
t5insp official document•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
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.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
D. System Information cont.
Y (cont.)
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.
No �
k 10
8C4 Q,DL�_- _e r 1 �
0 i
q 7-7 fr
7� - � J
t5insp official document-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
l
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
86 Starlight Dr
Property Address
Fannie Mae (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Marstons Mills MA 02648 10-6-08
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 20'
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site(abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
® Checked with local excavators, installers- (attach documentation)
® Accessed USGS database- explain:
You must describe how you established the high ground water elevation:
USGS maps show groundwater at greater than 20'.
t5insp official document•OWN Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
It�t' � ��� SEWAGE PERMIT NO.
VILLAGE
INSTALLERS NAME de ADDRE_SS
BUILDER JR Off
�►vid c �Izn�
DATE PELT ISSUED
DATE C010MIANCE ISSUED
l
� _.. •r°'
44= �
r
_ - 410
1 coo �
No.$ :.. .. FEsA.... ..00...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1 ........................._.T..own......OF...Barnstable..
Appliration for Disposal Works Tonstrurttun itamit
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System at:
..86 Starlg(� .. ra.. xoxls.,.?�11.1; a Q28
......... ..............•----------------....................._..-------•-----........---
Location-Address or Lot No.
....David Barne.Y_..---•---••---••-----•-----•--•-----------------------•--------- .6... tax].�gki ..I27�,�,..xlaxstQns__. Owner Address
a ..... & B Cesspool Service..........-............................... .............
Installer Address
dType of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms......................3...................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building .............................. No. of persons.........._.�'.............. Showers — Cafeteria
P4 Other fixtures -----------------------••-------
d -------•------------------------------------
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length________________ Width---------------- Diameter________--__.--- Depth................
x Disposal Trench—No. .................... Width................... Total Length.....................Total leaching area-------_............sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
14 Percolation Test Results Performed by.......................................
-------------------------------
Date........................................
a
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-------_................
Li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -•-•--------------------------•------_._...._..._--.._-_---•-----•--•---------••-••••-------•--------••................ ......_..._.._---------•------_----
ODescription of Soil------•--sand .......-•-----------------------------------------------------------------------------------------•---------
x
w
UNature of Repairs or Alterations—Answer when applicablenstallatio __of-•a._1-,000-_gal]oa-.fie-� St,
stone packed leach it (overflow_.
•--•-•..............•--•-----------------------•----.....------------------------------------------------..........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TTTLi, 5 of the State Sanitary Code— The undersign urther agrees not to place the system in
operation until a Certificate of Compliance hasj�b q�n�iisss�sued by the ar o icalth. `
Signe ............ . ....�.... ��1� . ........ 1---Val.....----
f y
Application Approved BY ----�J�� 7�D�/.......-•--••--
Date
Application Disapproved for the following reasons-------------------------------------------------------------•.-----------------------------------._......_...._
...................................................... ---------••-------------------------•--•------------•------.......-•------•--------------•••-•-•••--•••-•---•-•---------•----••-•--------••-•----
Date
Permit No.---81-•---•---
.....------•------------------------ Issued-.-------71._.R-,/$1..............................
Date
No.$l-................. FE:$.$...5..00...........
r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........................................o .. ...Bainstable-•-•--..--------------------•---..........................
Appliration for Disposal Works Tonstrurtion jhrmit
Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
••-86 Starll�Yrt_-nr,_-Marstons,Mlls,._•0264$
Location-Address or Lot No.
.-David_Barne�r- .......................................................... 86 Starlight.-D :.... 9? 2
_._..
Owner Address
a A& B Cesspool Service 128 Bishops:Terrace,,..Hyannis_...02601.....-•--•---
Installer Address
Type of Building Size Lot.... ......... . .....Sq. feet
Dwelling—.No. of Bedrooms........................3
.................... Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons...........�______.__.__._ Showers ( ) — Cafeteria ( )
dOther fixtures .------••--------------•-------.....------------•..........-------------------•-------------------•-•---------------------...---------.....-•--.----••
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area___-_-.-..-.------sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
~' Percolation Test Results Performed by........................................................................... Date........................................
W
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
(r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ••••-•-••-••-•---------•--••--•---•-•------•---------•------•-•.....-••-----••••......------•.......---••...------••--•-•--•-•------•.....................•--
O Description of Soil.........sand
x
W
.........................................................tevltrat (--A -••- n •---- lic --installation.........................................0gln.........................
cast
V Nature of Re airs or Alterations—Answer hen applicable...............................................t.._....... ............�......................
stone a ked leach it overflow .
------------------------------------•------•-----•----------------------•-.......------------.......----...-•---------------------------------------------------------------------.......•-----•••...._.
Agreement:
The undersigned agrees to install the aforedescribed: Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issued by the b and of health.,
r 1 t dF/
Signed.!' G fit }' ......_'�z..'. {._y�::.f'.--------------------------------
Application19 $l
/Approved BY --- -� ........................................7/ �t81
Date
Application Disapproved for the following reasons:............................................................................................................. l
.............................................•-
Date
.....................................
Permit No.....81.................................•------------- Issued.........7/ 9/83.
Date
� r
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
......................T own........O F..........Barnstabl.e................................................
%rrtifiratr of Tontplianr
I I IF hat I iv dual wa e Disp al S tem st ( ) or Repaired (X )
14 - deQp9§Fi'e Ice, � $is ops lyle ce, ` yan RSO I� ti l
by •...............................••--......------••...--•-------•----•-•--•---•--•--•-•-----•--..----•••--•-•-•---•....------------------------••-•--•--•----------...............---------••-•-
at
86 Starlight Dr.---
, Marstons Mills 02618sta-11eiDavid Barney
---• -----•------•--•••• •-•••-• - -------------------- --••-•--•-•- •----••-•-------• -----•--•••- .............. =
has been installed in accordance with the provisions of di IZ 3�&4l'he State Sanitary ft(lMdescribed in the
application for Disposal Works Construction Permit No----------------------------------------- dated---.._____.77_.---------------------------------
:
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WIL9L/ l NCTION SATISFACTORY.
DATE. Inspector.................. .............................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
81- ,l� Town ..... $ 5.00
No......................... FEE........................
;Disposal Works Tonstrmflon rrmit
A & B Cesspool Service, 128 Bis ops Terrace, Hyannis 02601
Permission is hereby granted.."finn ....,,D ,$,y ------ ---•..............................................
to Con uc�t Indi ij eV�Gc�Fc's 1—pbs l s�Yle
rat No -•----•-•-••--•--• -- y
Str eta°
as shown on the application for Disposal Works Construction Per it 1 ....... Dated...........74 9/81....._........
;......: -•-----•-- ------
a� Board of Health
DATE......................7�--91�1-•---••-•------•----•-----------------...� ,✓''
t
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
00
_ ,° OF 4 0�4.
COMMONWEALTH OF MASACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET BOSTON MA 02108(617)292-3500
TRUDY COXE
Secretary
ARGEO PAULCELLUCCI DAVID B.STRUHS
Commissioner
Governor
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 86 STARLIGHT DR MARSTONS MILLS, MA 02648 L62
Name of Owner MADIGAN
Address of Owner: 6 ASHMORE DR.WORCESTER MA.01602
Date of Inspection: 417100
Name of Inspector: JOHN GRACI
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636
Telephone Number: 608-664-6813 FAX 608-664-7270
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 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:
X Passes
_ Conditionally Passes
_ Needs Further Evalua' n y the Local Approving Authority
Fails
Inspector's Signature: Date:419100
The System Inspector shall su it a copy of this Inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection.If th 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
"The inspection Is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My
Inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its components useful life"
THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING THE SYSTEM NOW AND MAINTAINED EVERY TWO YEARS.
revised 9/2198 Page 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 86 STARLIGHT DR MARSTONS MILLS, MA 02648 L62
Name of Owner MADIGAN
Date of Inspection: 417/00
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evalua'
are indicated below.
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.
Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all Instances.If'not determined",explain why not.
n& The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliai
attached)indicating that the tank was installed within twenty(20)years prior to the date of the Inspection;or the septic tank,
whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.Th
system will pass inspection if the existing septic tank Is replaced with a complying septic tank as approved by the Board of Heafl
Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructed pipe(s)or di
to a broken,settled or uneven distribution box.The system will pass Inspection if(with approval of the Board of Health).
broken pipe(s)are replaced
_obstruction is removed
_distribution box is levelled or replaced
Ala The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection
(with approval of the Board of Health):
_broken pipe(s)are replaced
_obstruction is removed
revised 9/2/98 Page 2 of 11
i�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 86 STARLIGHT DR MARSTONS MILLS, MA 02648 L62
Name of Owner MADIGAN
Date of Inspection; 417100
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
_ Conditions eAst which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety
and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a
surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well,
The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 50 feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm,Method used to determine distance NH(approximation not valid).
3) OTHER
n/a
revised 9/2198 Page 3 of 11
s
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 86 STARLIGHT DR MARSTONS MILLS, MA 02648 L62
Name of Owner MADIGAN
Date of Inspection: 4I7/00
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
_ I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is
identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
X Backup of sewage Into facility or system component due to an overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool.
_ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
_ X Liquid depth in cesspool is less than 6"below invert or available volume Is less than 1/2 day flow,
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped a.
X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone I of a public well.
_ X Any portion of a cesspool or privy is within 50 feet of a private water supply well,
_ X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,
ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must Indicate either'Yes'or"No"to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and
safety and the environment because one or more of the following conditions exist:
Yes No
X the system is within 400 feet of a surface drinking water supply
g the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone it of a public water supply well)
The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.30412).Please consult the local regional office of the
Department for further information.
revised 9/2198 Page 4 of 11
i�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 86 STARLIGHT DR MARSTONS MILLS, MA 02648 L62
Name of Owner: MADIGAN
Date of Inspection: 4/7/00
Check if the following have been done:You must Indicate either"Yes"or"No"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health.
X _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.
Large volumes of water have not been introduced into the system recently or as part of this inspection.
X _ As built plans have been obtained and examined.Note if they are not available with N/A.
X _ The facility or dwelling was Inspected for signs of sewage back-up.
X _ The system does not receive non-sanitary or industrial waste flow.
X _ The site was inspected for signs of breakout.
X _ All system components,excluding the Soil Absorption System,have been located on the site.
X _ 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:
X _ Existing information,For example,Plan at B4O,H,
X _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)t 5.302(3)(b))
y _ 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 5 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 86 STARLIGHT DR MARSTONS MILLS, MA 02648 L62
Name of Owner MADIGAN
Date of Inspection: 417100
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g.p.d./bedroom
Number of bedrooms(design): 3 Number of bedrooms(actual):
Total DESIGN flow: 330 gpd
Number of current residents:4
Garbage grinder(yes or no):NO
Laundry(separate system)(yes or no): NO If yes,separate inspection required
Laundry system Inspected(yes or no): NO
Seasonal use(yes or no): NO
Water meter readings,If available(last two year's usage): n/a gpd
Sump Pump(yes or no): NO
Last date of occupancy: Na
COM MERCIAL/iNDUSTRIAL
Type of establishment: Na
Design flow: n/a gpd(Based on 15.203)
Basis of design flow:n/a
Grease trap present:(yes or no): NO
Industrial Waste Holding Tank present:(yes or no): NO
Non-sanitary waste discharged to the Title 5 system:(yes or no):NO
Water meter readings.if available: n/a
Last date of occupancy:n/a
OTHER: (Describe)
n/a
GENERAL INFORMATION
PUMPING RECORDS and source of Information:
n/a
System pumped as part of inspection:(yes or no):NO
If yes,volume pumped n/a gallons
Reason for pumping:n/a
TYPE OF SYSTEM
X 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)
1/A Technology etc.Attach copy of up to date operation and maintenance contract
_ Tight Tank Copy of DEP Approval
Other:n/a
APPROXIMATE AGE of all components,date installed(if known)and source of Information:
1981 PERMIT 81368
Sewage odors detected when arriving at the site:(yes or no): NO
revised 9/2198 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continuid)
Property Address: 86 STARLIGHT DR MARSTONS MILLS, MA 02648 L62
Name of Owner MADIGAN
Date of Inspection: 4/7/00
BUILDING SEWER:X
(Locate on site plan)
Depth below grade: 18"
Material of construction: _ cast iron X 40 Pvc other(explain)
Distance from private water supply well or suction line: n/a
Diameter: 4"
Comments: (condition of joints,venting,evidence of leakage,etc.)
THE SYSTEM HAS TOWN WATER.
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 12"
Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other
explain: n/a
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO
Age: n/a
Dimensions: 1000G L 8'6"H 6'7"W 4'10""
Sludge depth: 4"
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: 3"
Distance from top of scum to top of outlet lee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
How dimensions were determined: MEASURED
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.)
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING NOW EVERY TWO YEARS TO PROLONG
THE SYSTEM'S USEFULL LIFE.
GREASE TRAP: _
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other
Explain: n/a
Dimensions:n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle n/a
Date of last pumping: n/a
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.)
n/a
revised 9/2/98 Page 7 of 11
s
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 STARLIGHT DR MARSTONS MILLS, MA 02648 L62
Name of Owner MADIGAN
Date of Inspection: 4/7100
TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other
Explain: n/a
Dimensions: n/a
Capacity: n/a gallons
Design flow: n/a gallons/day
Alarm present: NO
Alarm level:N/A Alarm In working order:NO
Date of previous pumping: n/a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n/a
DISTRIBUTION BOX:_
(locate on site plan)
Depth of liquid level above outlet invert: n/a
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage Into or out of box,etc.)
n/a
PUMP CHAMBER: _
(locate on site plan)
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NO
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
n1a
revised 9/2198 Page 8 of 11
J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 STARLIGHT DR MARSTONS MILLS, MA 02648 L62
Name of Owner MADIGAN
Date of Inspection: 4/7/00
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods)
If not located,explain:
n/a
Type:
leaching pits,number:(2)1000 GAL 6 X 6
leaching chambers,number: (nla)n/a
leaching galleries,number: (n/a)n/a
leaching trenches,number,length: (n/a)n/a
leaching fields,number,dimensions: (n/a)n/a
overflow cesspool,number: (n/a)n/a
Alternative system: n/a
Name of Technology: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE LEACH PITS ARE STRUCTURALLY SOUND AND ARE FUNCTIONING PROPERLY.ONE PIT WAS FULL,THE OTHER PIT WAS EMPTY.
CESSPOOLS: _
(locate on she plan)
Number and configuration: n/a
Depth-top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer. n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
PRIVY:
(locate on site plan)
Materials of construction: n/a Dimensions: n/a
Depth of solids: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
revised 9/2/98 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 STARLIGHT DR MARSTONS MILLS, MA 02648 L62
Name of Owner MADIGAN
Date of Inspection: V7/00
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)
pec�C o R
A
(DO (Z)c
A� �a
31
37�
ya
revised 9/2/98 Page 10 of 11
J
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 86 STARLIGHT DR MARSTONS MILLS, MA 02648 L62
Name of Owner MADIGAN
Date of Inspection: 417/00
NRCS Report name: n/a
Soil Type: n/a
Typical depth to groundwater: Na
USGS Date website visited: n/a
Observation Wells checked: NO
Groundwater depth: Shallow_ Moderate_ Deep_
SITE EXAM _ Slope T
_ Surface water
_ Check Cellar
_ Shallow wells
Estimated Depth to Groundwater 12 Feet+
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
Checked local excavators,installers
X. Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
UGSS MAPS AND CHARTS-12+ FEET
revised 9/2/98 Page 11 of 11
-LOCIQTION : 5EWo,GE PERMIT UO.
1P1S QL, ER 1 &INAE .� ADDRESS
BUILDER 5 Q l� E DRESS
-OAAL -
pL�TE PERMIT ISSUED �'2- — —`
D ATE CONAPLI W-ICE ISSUED - �h_� ��
�� ,
t
��
s
P ���
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE��T"
P-4-- .
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at:
Location-Address or Lot No.
Installer Address
Type of Building Size Lot-=Pxg------------------Sq. feet
a.
Z Other Distribution box Dosing fank
---'------------------------------------------------------------------------------------------- ........................................- .........-
Agceeoxoz : -
The ou6eraiguo6 agrees to install the aforcdoucribcd Individual Sewage Disposal System in accordance with
thcyrovisiouoofArticloXIofHeStatoSunitaryCode- The undersigned further agrees not mplace the system in
"pe^^""" until ^ Certificate "` Compliance-has
been is,�ued y the board of ea t
-----_-
ate
Apyickiou Approved Dy- ��20L _-.--�---_--' '��,���~�����-�����..... '
- "="
Application Disapproved for the ƒoDozw�q7reasons:-----------_----.---------'--_-----._................
----- --`' ----------'----'---`-`----------------`--
. Z�_ ��
------------------' -- - -'''
4-8
No
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
,;, of`.�t..(. ...._......OF._ <------ / �f: .. �4�.: �
Appliratinn -for Disposal Works Tonstrnrtinn Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: `
r ------------------------
Location-Address or Lot No.
------•... . /-._.L..7.. �=:fit ''� =-------•-•---------•--•-- ..........................................................................................................._
.. Owner Address
Installer Address r�}�
UType of Building Size Lot•_r :._____-___-Sq. feet
�-, Dwelling—No. of Bedrooms.............A..............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons.--___-_-______-_-.___--___- Showers ( ) — Cafeteria ( )
P I Other fixtures --•------------ -------------
W Design Flow.............,?__.# ______-___--____-_gallons per person per day. Total daily flow-____y c w'r_--_---_-_----.--.-_.gallons.
WSeptic Tank—Liquid capacity)fr2±_gallons Length................ Width................ Diameter........-------- Depth.._.-.--_-_---
x Disposal Trench—No------ Widtli...-Z.. ------ Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No..................... Diameter*....................
Depth below inlet.;X.............. Total leaching area. t. ,_..sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date----------------------------------------
Test Pit No. 1----------------minutes per inch' Depth of Test Pit-.-__--_-_--_____. Depth to ground water_.._____..__-._.-..-._..
f� Test Pit No. 2________________minutes per inch Depth of Test Pit.................... Depth to ground water__.___-_-_-.--._-r--. .
-----•---- ----I��----� a , , !, ��r a_s. ....�-d Racay�./f sr z
D Description of Soil---•--- - _` ....� -'� ��R.��a�.f7r�:� � -�
------------------------------
W
V 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 Article XI 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.
ri ,F X
Sign •. . ........................
iDate ! o
Application Approved By---= ---- - /-� / �; f!�-------�' � = =3 ; ��`.
. _. { - r Dater .._..
Application Disapproved for the following reasons:-------------L'................................................................................................
......................................•-----•-------•---•••------------•••-•---•-.......-----•--•-------'------------................... .......--•--•----------•-•--•------------._.......-------.•----
Date
` Permit No.........
--- ------------------•--•-•--........ Issued......................-.................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
i�i.................0F......... . t.. Fi�... r•r.+" id '• .
QVIrrtifiratr of Tnmplianr
THIS IS TORTIFY That the Individual Sewage Disposal System constructed ( A 'or Repaired ( )
aby---- F����--- --•-----'- -.-----
Installer
at t r y r -, `� - �Pt.-j ° E ,/ ,;> � �;(� f i� " LS: -.---•-•------.
-
has been installed in accordance with/,(he provisions of Article XI of -ie State Sanitary Code as described in the
application for Disposal Works Construction Permit No-----------e aZI-_ ............. dated_._/., ..,:.. :_=-.. :---------
THE ISSUANCE OF THIS CERTIFICATE SHAD NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
r v n O F *. r r'i,.1+ t f .s f -----------------
> c........... .. .... t
No.-----•. ----------•- FEE.-- .....
Binvnsttl Wor ,i TTnnstrnrtion rprmit
Permission is hereby granted.................... `-...............=..............................................
d.
to Construct ( or Repair , ) an IndlvMual wage D spgSal Syste
at No._� '^ �, ..x ..._,:1 :--= � `a = �r.... y I� q
i,- ,.�.f---•• -Ef'° :aL.-_ ,e.r,�yr,-i-. .r✓r'«..-t+ `-€ `*?-„ Street `'+�` --- j�..- -e ` ............... .-
ermit No,__ .y f Dated_,_a�
as shown on the application for Disposal Works Construction P /� j�.,ds_� ..� --:14
-.� '------7_l-_-.....
�a 7�O -Ya ord of Health
DATE. ................. ...........................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
No......................... Fmc..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-.. ........... _---------------OF.................................................. .......
AVVliratiou for DhiVosal Work.5 Tow5trurtiott Urrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
------------------------------•--------•---•'•-•...---•--------•----------------------------•....' .................................................... -•'••----------•••--•--•-••--••--•--•••---
Location-Address or Lot No.
W Owner Address
Installer Address
UType of Building Size Lot--_---•-------------------Sq. feet
«� Dwelling—No. of Bedrooms----------------_--____-__-_---------------Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building -------------------_-_--- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
p' Other fixtures
W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter_-.--_-------_ Depth---------.......
xDisposal Trench—No- -------------------- Width.................... Total Length-------------------. Total leaching area--------------------sq. ft.
Seepage Pit No------------------ Diameter-------------------- Depth below inlet----------_--------- Total leaching area------------------sq. it.
Z Other Distribution box ( ) Dosing tank ( )
W
Percolation Test Results Performed by----------................................................................ Date----------------------------------------
Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...--.--.-----.---.-.---
G1. Test Pit No. 2________________minutes per inch Depth of Test Pit.-__-_-__-----____ Depth to ground water------------------------
P4 -------------------------------------------•• -•------------•-•--•---------•---------•-•---------------•---------------------------•------------------------
O Description of Soil------------ -----------------------•----------------•----•-----------------••----------------------- ----------- ----------------•--------------------------- ........
x
U --------------••-•---------------------------------•-------•-------------•--------•-----••-----•------••-•----------------------------------••-•--------------------------.-----------------------.----
W
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 Article XI 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.
Signed...................................................................................... ................................
Date
ApplicationApproved By-------------------...............................................................................
Date
Application Disapproved for the following reasons:--•----------------------------------------------------•-------------•----------.--•---------------------------
-•••••-•-•------------------•---•--••- ------•------------------------.-------------•---•---------------•-----•--•---------.-•--------------------•-----------.---------------------------•-------.-•---
Date
PermitNo......................................... --------- Issued........................................................
Date
....�» •...-.-r..-.................................... ........._......
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Trrtifirate of Toutpliattrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by..............••••••-•-••-••-•••----•••-•-•---------•-•-•-•-••--•--••---•-•-•••......•--•---- -- ---•--------------•-•-•---••-•••-•••-•------=-•---•--•••-------------••-•-•......--•••-•--•••---
Installer
at----•-------•--------------•----••------------.-----•-------------•--•------------------------------------------------------------------------•-----------
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No----------------------------------------- dated.....
...----------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL PLOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector....................................................................................
......................................................................... ..................... ...............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
A'
..........................................OF...........................---------...............................................
No......................... FEE........................
Di_nVoiittl Norkii ClIvnfitrurtion prrvtit
Permissionis hereby granted................................................................................ .............................................................
to Construct (, ) or Repair ( ) an Individual Sewage Disposal System
atNo.••-•••..................................................................................................
Street
as shown on the application for Disposal Works Construction Permit No_____________________ Dated----__-..-.--.-._-..------___--.-•-__.---
••------•----•-•••---•-•..............••--------------•------...-•---- ................................
Board of Health
DATE................................................................................
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
� - t
(617)325-4634
CWCamnneti Village
at MARSTrONS MILLS • • •
6 Chisholm Terrace Roslindale, Massachusetts 02131
--� -Nj
8 w��
4.
Y
„t .;. _ stable Fafi7Uuth Rtl_,
LEGEND
il Rr
-
I -�.
' PROPOSED CONTOUR ' �
( r
_ s — 98 PROPOSED SPOT GRADE
—— EXISTING CONTOUR
+ 96.52 EXISTING SPOT GRADE
BENCH MARK W— EXISTING WATER SERVICE ti,' i 5 l” j '
i I �� TEST PIT L_,
44.1 74%' I TOP OF FOUNDATION
ELEVATIONBARNS = 77. 56
1: t� 1'
TABLE CIS DATUM
Q ij I 00 r l
LOT 62
LOCUS MAP N.T.S.
AREA = 20000 sf +— GENERAL NOTES:
/ o l
_ �75
i6� _ 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
,�'� BOARD OF HEALTH AND THE DESIGN ENGINEER.
2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
74. LOCAL RULES AND REGULATIONS.
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
/ N r �- TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
Exist g Leochpits // DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
ee Note O� / �I�/ FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
O2 // � / ,2 ENGINEER BEFORE CONSTRUCTION CONTINUES.
c0 / TH-2 co0 / 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
® / 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
/ ! 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
�O / TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
P I 76 1 % THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION.
10. EXISTING LEACH PITS TO BE PUMPED, CRUSHED. AND FILLED PER TITLE V.
11. 48 HOUR NOTICE.FOR ENGINEER CERTIFICATION
/20 ,t 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
_Z_ 1\ / I / % 13. NO ADDITIONAL PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING
14. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPECIFIED OTHERWISE)
TH-1 !/ 15, THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
\ / l N j FOR THE USE OF A GARBAGE GRINDER
16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING
\ CABLE TV--OF
OF
�IEYER 8
rt� " NO. 1140 �S
t p pp �. %•
slE�
/ PROPOSED SEPTIC SYSTEM UPGRADE PLAN
X4NI TAR0'�
12- L-t[L9 i
86 STARLIGHT DRIVE, MARSTONS MILLS, MA
Prepared for: Mike Dedecko
SURVEY REFERENCE: / MAR 100 Engineering by: Surveying by: SCALE DRAWN JOB. NO.
% u L0T.-048 DARRENM.MEYER,R.S. Eco-Tech Ravironmentel 1"=20' DMM
PLAN OF LAND BY DAVID H. GREENE, PLS LCPA'186167 PO BOX981 508) 364-0894
DATED: OCTOBER 1961 �/ EAST SANDWICH,M402537 DATE: CHECKED SHEET NO.
i�1 508-362-2922 02/24/09 DMM 1 of 2-.
L NOTE:' TO PREVENT BREAKOUT, THE PROPOSED DESIGN CRITERIA "
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:71.14
FOR A DISTANCE OF 15' AROUND THE NUMBER OF BEDROOMS: EXISTING 3 BR
PERIMETER OF THE S.A.S. SOIL TEXTURAL CLASS: CLASS I
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. DESIGN PERCOLATION RATE: <2 MIN/IN
T.O.F. EL.=77.56 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER.
" DAILY FLOW: 330 G.P.D.
OUTLET AND SET TO 6 OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIl�.) AND SET TO 3" OF F.G. DESIGN FLOW: 330 G.P.D.
' F.G. EL.=74.7t F.G. EL.=74.5t F.G. EL: 74.0t F.G. EL: 74.0(MAX.) GARBAGE GRINDER: NO
PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY
LEACHING AREA REQUIRED: (330) = 445.94 S.F.
L = 10'"t L 40' L = 5'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) 74
0 S=1% (MIN.) 0 S=1% (MIN.) ® S=1% (MIN.) } DISTRIBUTION BOX: 3 OUTLETS (MINIMUM)
4"SCH40 PVC 4'SCH40 PVC 4"SCH40 PVC PRIMARY S.A.S.
f, 10" f 8 11.3" TO USE 2 TRENCHES (10 TOTAL UNITS) OF 16" ADS BIODIFFUSER H-20 UNITS—NO STON14' E
INV.=72.79 48'LIQUID INVERT
INV.=72.54 - BOTTOM & SIDE AREA
LEVEL PROPOSED 1 (BIODIFFUSERS): 10 UNITS xN 6.225 LF x APPROVAL/LF R 7.493F 5L S OF BIODUFFUSER)
GAS BAFFLE INV.=71.80 2—TRENCHES (5 UNITS) AT 6.25'/UNIT= 31.25'
D—BQX a DESIGN FLOW PROVIDED: 0.74(493.75 GPD/SF) = 365.38 GPD > 330 GPD req'd
De-3 SOIL ABSORPTION SYSTEM (PROFILE)
INV.=72.0 INV.=70.7
EXISTING 1.000 GALLON SEPTIC TANK
RESTORE VEGETATIVE COVER
EXISTING SEWER OUTLET
75"NOTES:
1) SEPTIC TANK AND D-BOX SHALL BE SET LEVEL
AND TRUE TO GRADE ON A MECHANICALLY COMPACTED t
SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN BREAKOUT=TOP E V.= 71. 5 _ I EXISTING SUITABLE
310 CMR 15.221(2). INV. ELEV.= 70.75 MATERIAL
2) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM ELEV.= 69.81
3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 2.83'
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. 5' MIN. ABOVE BOTTOM OF `„� 76" _
T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH
4) REPLACE EXISTING 1,000 GALLON SEPTIC TANK WITH (8.31' PROVIDED) 2—TRENCHES (5 UNITS EACH (10 TOTAL)) PROFILE
1500 GALLON SEPTIC TANK IF FAILED, DAMAGED, OR UNDERSIZED. BOTTOM OF TESTHOLE EL.=62.0 — 06.25' PER UNIT= 31.25'
SEPTIC SYSTEM PROFILE TYPICAL TRENCH SECTION
KT.S 16"
N.T.S. 11.2"
DATE: FEBRUARY 23, 2009 SOIL LOGS t +
SOIL EVALUATOR: DARREN MEYER, R.S., CSE I 34" �
WITNESS: DONNA MIORANDI, BARNS. BOH P#: 12480 SECTION END CAP
F
Elev. TH- 1 Depth Elegy. TH-2 Depth HIGH CAPACITY (H-20)BIODIFFUSER UNIT
,
74.0 A LOAMY SAND 0" 74.50 A LOAMY SAND 0" MODEL 16" HICAP
10YR 3/2 10YR 3/2 LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
73.33 8" 73.33 8" EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
B B DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
LOAMY SAND LOAMY SAND k SIDE WALL HEIGHT 11.2"
10YR 5/8 10YR 5/8 4
70.84 38" 70.75 39"
OVERALL HEIGHT 16"OVERALL WIDTH 34" 4640 TRUEMAN BLVD
C1 C1 ��+ OF ,k9ss� Ems13.E CF HILLIARD, OHIO 43026
MEDIUM MEDIUM I E R CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC.
C
SAND PERC ®69.25 SAND "2.5 Y 7/4 2.5 Y 7/4 No. 1140 N PROPOSED SEPTIC SYSTEM/SITE PLAN
•
c/st- 86 STARLIGHT DRIVE, MARSTONS MILLS, MA
QNITAR0p111 Prepared for: Mike Dedecco
IEngineering by: Surveying by: SCALE DRAWN JOB. NO.
62.0 144" 63.5 126" 0 b a DARRENM.MEYER,R.S. Eco—Tech Environmental NT_S P.T.M.
PERC RATE <5 MIN/IN. ("Cl" HORIZON) PO BOX 981 (508) 364-0894
EASTSA/vDw/CH,MA02537 DATE CHECKED SHEET N0,
NO GROUNDWATER OBSERVED 5a6-3622922 02�24�09