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HomeMy WebLinkAbout0186 THISTLE DRIVE - Health 1 '6 Thistle Drive Marstons Mills A= 149 - 13:0 018 i' i .I TOWN OF BARNSTABLE OCATION (���C,�,���� �`�ca �� SEWAGE# �� . VILLAGE(**-N-rs Co--,S M,\\!�ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Q5c)Q kS LEACHING FACILITY:(type) 4,.s/ size Ya K k a NO.OF BEDROOMS �( OWNER `' U P�� S Ccj`^ti r�•3.3�� �+'U` ghG t PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility). Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY L' 4. � y \a3 No.� Jl Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for ]Bisp08ar 6pstrin Construction permit Application for a Permit to Construct( ) Repair(6,)"-Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. �� "1 ���� �S� Owner's Name,Address,and Tel.Noscmli?' � 3 Assessor's Map/Parcel O ` �� �.c,�sy'r✓r Installer's Name,Address,and Tel.No. .j ,� �GQ T D igner's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �Zt f& , No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �{�® gpd Design flow provided gpd Plan Date ( � Number of sheets Revision Date Title Size of Septic Tank sc> Ck� pe of S.A.S. Cq✓�.G���i". Cyr.A�v.��s�S �T��.P�. Description of Soil _S�,tz—;, , 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 Health. gned Date g Application Approved by Date Application Disapproved by---*" i Date for the following reasons Permit No. X19 m � 5 Date Issued 6A(M8 - ~ .. + No. F Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9pplication for �M1sp08aY*p8tem CoTCBtCUctIDTC 3permit , `:- Application for Permit to Construct Repair U ade Abandon PP ( ) p (1a'� pgr ( ) ( ) ❑Complete System N�,Individual Components `} - r . Location Address or Lot No. ` '� '� �5��'_. Owner's Name,Address,and Tel. �a > . Assessor's Map/Parcel Installer's Name,Address,and Tel.No. jc�i, ,w Designer's Name Address,and Tel.No. S 5-` -�'`► d Type_of Building: Dwelling No.of Bedrooms Lot Size ,?_-2, —sq.ft. Garbage Grinder( ) Other Type of Building �{'C , No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) L( CD gpd Design flow provided gpd ,F Plan Date C ' Number of sheets Revision Date Title t Size of Septic Tank of S.A.S. G4�O Description of Soil ��` e Nature of Repairs or Alterations(Answer when applicable) p Cyr r i C" 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., / € i geed Date tom. /7/ Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 2pl9 Date Issued A(7Z0/$ --------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compfiance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( by at Fyn e V� ; `��. y _ has been constructed in accordance , 4 with the provisions of Title 5 and the for Disposal System Construction Permit No.jaft dated i N 2d,I? f Installer�`�.beci "C�-}" �,�4u' Designer ( A o L #bedrooms .. Approved design flow It Y D `���� gpd The issuance of this pe its shall I e construed as a guarantee that the system will tib as�sied. Date /1 V Inspector 71 y o -- ----- ------------------ - -- No. (moo I's 7 Feetp THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS mispoBal 6pstem Construction Permit Permission.is hereby granted to Construct( ) Repair(✓) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constrqctiola must be completed within three years of the date of this permit. Date 6 h9 117 J Approved by - m, Town of Barnstable Regulatory Services Richard V. Scali,Interim Director • ■nxtvsrnaM • ig Public Health Division 1639' Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit# �95 Assessor's Map\Parcel 30 �. Designer: CSN Installer: Address: ,I-01 Address: g -i &-ewS+1t,C, AAA 02-6-S I On was issued a permit to install a (date) '(installer) J � septic system at 11�1(0 i4M based on a design drawn by (address) 0-5 N Frtc)me e_rt n!) dated (o (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed 141 joUlptice with the terms of the IAA approval letters (if applicable) H oFMq 00 C�N�A✓. �� R (InstallersSig-nature) Fib o c Nc 1 i STEREO �Q (Design 's Signature) (Affix De ere) 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:\Septic\Designer Certification Form Rev 8-14-13.doe - _ 4 Town of Barnstable P# Departitnent of Regulatory Services 4.0,. Public Health Division Date 200 Main Street,Hyannis MA 02601 h ,: Wh Date Scheduled I a I( �2�(�)1 ( 0'ZI Time.1.�,��1.. Fee Pd. �a�. X iul�9 Soil Suitability Assessment for Sewage ,disposal �A Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address Owner's Name Address S7, l-.ik SF. i�.av-mot-sac �tA Assessor's Map/Parcel: 1 lke 14i PC Q-ed 13� t>t Sr Engineer's Name b a l, -� �-�IV EV1�ii1L�7� n� NEW CONSTRUCTION REPAIR t// Telephone# Land Use f�l Slopes(96) 0"`� Surface Stones _ Distances from: Open Water Body ft Possible Wet Area NO- ft Drinking Water Well ft Drainage Way i- ft Property Line 1 V ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands{n proximity to holes) -VP 2 Parent material(geologic) C A C0 1 i l Depth to Bedrock —00' Depth to Groundwater. Standing Water in Hole: N Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: In. Depth to weeping from side of obs.hole: In, Groundwater Adjustment E. Index Well# Rcading Date: Index Well level :_ Adj.&ctor— Adj.Groundwater Level PERCOLATION TEST butt: N da U.,, 1 oe Observation —����� Hole# -L `— Time at 4" c► Depth of Pere b Time at 6" Start Pre-soak Time @ 0 lima(9"-6") End Pre-soak `2- ih.r �lnz� Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back--------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICPERCFORM.DOC DEEROBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,,Boulders. Congistency.'%'Gravel) (� 4 C. � M -IQ- Ca, LS iID SI (Id DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o sis en %Grave O 4 1 F- MIL j0 0- 3�>, C' (L t.14 Ito -122 CZ CL.S �jt, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsisteneL%G ]DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Flood Insurance Rate Map: / Above 500 year flood boundary No— Yes Within 500 year boundary No V+ Yes Within 100 year flood boundary No.: Yes _ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? ES If not,what is the depth of naturally occurring pervious matarial? Certification I certify that on Mu%l Lao?- oil evaluator examination approved b the (date)I have passed the soil pp y Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trai ing,expertise and experience described in 10 CMR 15.017,. Signature Date Q:\S.EPTIC\PERCPORM.DOC TOWN OF BARNSTABLE OCATION SEWAGE# 00 ILLAGE Miters ! `NO,\kS ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE 6oSS SEPTIC TANK CAPACITY --© � T LEACHING FACILITY:(type) 6 6( (o (size) ( ( . NO.OF BEDROOMS OWNER PERMIT DATE: �T(�d t( COMPLIANCE DATE: Separation'Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �'s� 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 `�'�A�� .3 J a► 33 1 No. 0 tiT____i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in com uteri Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipplitation for ?Mispo8Ar *pstrm Construction pffmit Application for a Permit to Construct( ) Repair( ) Upgrade(l/�Abandon( ) ❑Complete System MIndividual Components Location Address or Lot No. �`a 6 �� � r Owner's Name,Address,and Tel.No. Sec-e-A k+:k1 1, ' g% h1o.p'G V j'd-e -7�3 t� Assessor's Map/Parcel �^�`� ^ p c� e,_YbjrC c_S-�-c r YVIN A a 603 Installer's Name,Address,and Tel.No.c��scA\ R cx���?'i `designer's Name,Address,and Tel.No.C_:vNcSQa 17 I S��-�a%• Ss p Q . G(ek Q 6 3 o -a 1<C ®3�?sa Type of Building: Dwelling No.of Bedrooms C'l Lot Size -J::� , 333 sq.ft. Garbage Grinder( ) Other Type of Building �r©u,p "cD-YM-<_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Lf�(CD gpd Design flow provided �{Lr L( gpd Plan Date 1-a b G, d Number of sheets ' Revision Date Title /� \ Size of Septic Tank = l�K �T Type of S:A.S. ���, ��G`36 (-, Lc�4cV\ C�dvH��rs, Description of Soil Nature of Repairs or Alterations(Answer when applicable) 13 cr�K uh,4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date k Application Approved by ? Date Application Disapproved by Date for the following reasons Permit No. ..° i Date Issued �•N A, No. (� ! _ Fee THE COMMONWEALTH-OF MASSACHUSETTS Entered in computer: 4 14. Yes PUBLIC HEALTH DIVISION - TOWN 'OF4SARNSTABLE, MASSACHUSETTS Zipplication for ]Disposal 6pstem (Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(1/�Abandon( ) El Complete System Pfndividual Components Location Address or Lot No. V�(:� TZ^`SQL' r• Owner's Name,Address,and Tel.No. �A-5 YAo Q-- s,--, - Sow-`�S6 -7413 e� Assessor's Map/Parcel rCc.-c-' r c' YVI\ O 603 Installer's Name,Address,and Tel. 11 V besigner's Name,Address,and Tel:No.(—*.v,c.P� �,4``0 p.b , 3cdc 3-7 -3 a so II S \1v1-A 6aS3G Type of Building: t Dwelling No.of Bedrooms C"� Lot Size , 33_') sq.fl.r Garbage Grinder( ) Typ e e of Building I yp g <;r�c_, \Ao PA<_ No.of Persons Showers( Cafeteria( ) S Other Fixtures Design Flow(min.required) Lf�(C7 gpd Design flow provided I-{�'�L( gpd i Plan Date 1 (� © \ \ Number of sheets 1 Revision Date Title \ e f Size of Septic Tank Type of S.A.S. Lc,AC1n Description of Soil 1 s, i Nature of Repairs or Alterations(Answer when applicable) 1 r(✓� .�,.�w`�y��. - 0 p tc Date last inspected: i 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. Si Date i Application Approved by h,. Date i Application Disapproved by Date t for the following reasons I Permit No. :2 Date Issued J ? v l THE COMMONWEALTH OF MASSACHUSETTS BARN STABLE,MASSACHUSETTS E Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )byat �o \ �'��a �r `M�c S�ov�5 V�•1(5.has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 11 '113I dated ,z 76 /i i Installer7;��.n,S?,q �oo�-cr-r "�/�e , Designer V,Z. G #bedrooms �'� Approved design flow 1_f t'/V gpd The issuance of this permit shall°of be con trued as a guarantee that the system ill furi tton ads desig d. Date r �`t Inspector ----------------------------------------- ----------------------------------------------------------------------------------------------- i No. ZG _ ... Fee /Dv THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(VZ Abandon( ) System located at ( �� \7 i 1-, and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with I ' Title 5 and the following local provisions or special conditions. 4 Provided:Construction must be completed within three years of the date of this permit. 'j Date 2 /r, Approved by Town-of Barnstable Regulatory Services Thomas F. Geiler,Director MMWAB 4 Public Health Division .`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: j,9 a Sewage Permit#J�ptj- �131 Assessor's Map/Parcel 141/13a e�ce Installer&Designer Certification Form Designer: CS N Lro Installer: Address: Address: SPC—S=X 2:2 On V -cam, Q ' � ,a,�P�J�g j,;-t ,,� was issued a permit to install a (dat) installer) septic system at GAv-Ville, based on a design drawn by (address) CSN dated 4-1It. Ill ` (designer) V I certify that the septic system referenced above was installed substantially g accordin to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if require cted and the soils were found satisfactory. �jH of MgSs ti LINDA J. PINTO IL (Installer's Signature) 1 N .4 60 (Designer's ignature) (Affix Desi Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc rIOCAT [ON SEWAGE PERMIT NO. kr1LLAGE I N S T A LLER'S NAME i ADDRESS —Y F M 6 rein.) rp1,) B U I L D E R OR OWN ER I Ua DATE PERM FT ISSUED b DATE COMPLIANCE ISSUED • .. �. f.` �f �� �o ��� ' TOWN OF BARNSTABLE .. t6CA.TION ��G �k,St�e Df, ✓e SEWAGE # SS-737 -YG.;GAGE M R'R.STMeJ5 M US ASSESSOR'S MAP & LOT 14q' 136)"1� INFJALLER'S NAME&PHONE NO. P M�RI N SEPTIC TANK CAPACITY LZ-S LEACHING FACIL11Y: (type) P is (size) 'NO. OF BEDROOMS Q' BUILDEROROWNER IZuSS��C $ �E1�NIFEIz PET�IZSDU PER MITDATE: I5I COMPLIANCE DATE: AgP65 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 I oo + on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist 001 0t within 300 feet of leaching facility) Feet Furnished by GCO-T e'C H E1,)y1M1,)MDaTkL C NSPteT►o� --- LOCATIONS = A 6 1 27 FF 34 Ft 2 16 FE 46 FE t 3 25 Ft 60 Ft 4 31 Ft 44 Ft EXISTING DWELLING P # 166 i LEACH B r PIT O ❑z F D-BOX SEPTIC i TANK I w 1 ` LEACH i O PIT ; • O 1 NOT TO SCALE THISTLE DRIVE M iG +Z No� �...�TT� 4 THE COMMONWEALTH F TS BOARD, OF HEALTH fi -r-- v 3a / g 1.dW ... ......--.OF...... ............................. Application for 11ispnsal Works Cnnnitrurtw'n Vantit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: LE -.I..f+......��.._........... ........ ............... ....... . . ............ -T-....... -----------.............................................. - ..-- ---Location_ dress ! . t Nq� . ................ ......nAY .............................. --- Owner -•----•.--•___•-•-•-•---_.---. •Address Installer Address Type of Building Size Lot2?1 33______Sq. feet U Dwelling—No. of Bedrooms.••-• ------•••----•--- __ ___-_Expansion Attic Garbage Grinder Other—T e of Building No. of persons____________________________ Showers — Cafeteria dOther fi ures -----------------------••------._...------------...----•-•••-------------••••-•---•-•---••-•••-•--•••--•---•--•••---._._.....-•-•••---...........--•- W Design Flow.........57 ...........................gallons per person per d�T. Total daily flow_..____ � .....................gallons. WSeptic Tank—Liquid capacity_I___.aallons Length_K?'____._._ Width... Diameter................ Depth... Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No._.___ .__,,___``_.. Diameter__.___-___ Depth below inlet___6............ Total leaching area__�5�.0.__sq. ft. Z Other Distribution box (� j Dosi ank (� � 1 '-' ot Percolation Test Results11` Performed by ,4�4 __1 ___________. Date._i...... .......... a ` � Test Pit No. 1___Z,.Z-___minutes per inch Depth of Test Pit----J�-._._..___ Depth to ground water_f4JQ cote LX, Test Pit No. 2................minutes per inch Depth of Test Pit__.................. Depth to ground water........................ a --- ____ ............. O Description of Soil- ....L--Q/± ------------------------ ------•--- ...... :b3 l 1".4_ 1� U W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ----•-•-•--•---•----••-•----••-•.....__...--•-•--••-•----•-•--_._...•••••••---••-•-•-----•---_--••-••----•-....•••--•--•-•-•-•--•-•--------••••--••--•--•-•--•-•-•-•••-•---•-•-•-•-•---•.....-•------••• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee s ed by the bo rd of health. PI 'f VJr — Signed , -----ate __--____ D Appli tion Approved BY -•--------- •- -- =--- '-�---=-- '--.-.-•-•---------- -----------•-----•-- !5--- A--ate Application Disapproved for the following reasons-------------•-----------------------•--------------••---..•---•-----------------•---------------.......--------- ....-•.............................•-•-•......---...•••--•-•--.....-•••••-•-•-----•------•---•-••--•-•--•-•--•••-•-••-•--•-••••-----•-•---•-----•--•---••------••------•-•---•------•••------•-•--••.... Date Permit No......................................................... 1 Issued---------------------------- i Date --——� No................_..... FBB........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliraa#ion for Dispuiiaai Marks Tonstrurtinn ramit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal ":SLstem at: _........... - 07 _....------•-•.................•-- --••-......... . -••-----•------- ......................................................... -• .... Location-Address or Lot No. ......................—........................O r....--.._._.............._................ ..........--........•-•-----•---------••----..L- res.s .......................................... Owner Address W Installer Address Type of Building + Size Lot_��)_-3 3------Sq. feet Dwelling—No. of Bedrooms___....................................Expansion Attic (tyj Garbage Grinder (rL j� a`4 Other—Type of Building No. of persons............................ Showers YP g ---------------•------------ P ( ) — Cafeteria ( ) P4Other-fixtures ..---------•--•--•------------------------------------.....-------------•-••-----•------ ------------------ W Design Flow............................................gallons per person ppr dqy. Total daily 4ow........ IAQ__________.__________gallons. WSeptic Tank—Liquid capacity__ allons Length.1�12... Width...5s..!�?.. Diameter................ Depth...S�"... x Disposal Trench—No..................... Width_................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........Zr....I--- Diameter.._..._�-�_.......... Depth below inlet....G........... Total leaching area...AQ.0_._sq. ft. Z Other Distribution box (�t� Dosi nk (K�)G o q Percolation Test Results Performed by_______..! ?� ... `1_��_....__ ____________ Date.................._.__�•� - p p P ground P!':5-t" Coca(taZxgV TM Test Pit No. 1...�_..____.minutes per inch Depth of Test Pit.____I.�____.._.._ Depth to ound water__ _________ _____ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ra _ ------------------------------------------------�J. - ��� -�?'e_ x UA.......................................................................................................................................... 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 TITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation unti a Certificate of Compliance has been issued by the board of health. M i ned...................... --•----------- -------- ----------------------------------- -------------------------------- '" 'r' ?` .. ......... Date Appli tion Approved BY == ..................... -• . --------•-•- �T�ate - Applieation Disapproved for the following reasons-------------------------------•---------•---•---------------------------------•-----------------------•-•--•--- ---------•------••---•--------•••----••-----•---.....----•-•----•----•----•---•----....--•-•-•-•-._..........._......•-•--•-------------•-----••-......•-•--•---•----••----------•---------------.....--- S ' Y7 Date PermitNo......................................................... Issued....................................................... Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........:..............................OF..................................................................................... CUrrtifiraatr of Toutpliaanr THIS I TO E VFY, That the Individual Sewage Disposal System constructed (, 'f or Repaired ( ) � z.� --........--•...... • by.... ....r�'+: Installer t has been installed in accordance with the provisions of TITIEo„f Thee State Sanitary Cod scribed in the application for Disposal Works Construction Permit No................... dated.......... � �*_..___. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. E DAT ._.. ?=� ��- - Inspector' --•------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.... . ..........................................OF.........................................................._..,....................... bJ ............ FEE........................ Rquisaal arks Tnn#rnr�ion amit Permission is hereby granted--�:--- .......im.cr."-' ----------------------------------------•-----------•-•-----......---............---._.... to Construct ( ) or Repair ( ) an Individual Sewage Dispo al Syt at No.. t StreetNti y as shown on the application for Disposal Works Construction Permit No..... ...../. ........ 9LI -----•--- ....... a M,,...,........................................_ (j Health -DATE -------------------•------...-------�.....}---�../. .......... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS S►�Y.L� �a�nu..�! - � Fs>E.veoo�. ILL 121�,PCPSAL PIT Uls lDaD roAL., ��W111L AM A► z 2-,cc S•F'. SF ,c 2.S • 75® Q.P.D. BaT-TL AA AZ EA• !ov ST:, t Tc(rAL "VE6I6W a gcfpl�.RL�. 'i'bTa� va►��( Fc.ou.� * c,[c,/p 6�F�D. �C�- c._� C=��. , � I Z . tk OF v►.1 O&TE : CiQ 2htt►J*olz l>tiS. .OF id s 4 PETER SULUVAN wit t lhM C. No. 29733 N Y € CA 'p✓ cr�. �� v ";o. 19334 a D Sub. EMCN Fz -L u I-k su I Tyr' Z/S5 . 5�70 Q°�ob T�57 IW GAL. a / '8oK •J 1►1� / �®AlOC Luca PIT WITw %VAUAILD STOWE— SO,O C-S TIr-IE® PLOT PL- A y-j PQ.O'P-I LE: LOLIATIO W I a c yr i l+%� T g A T T 14r= r /�17i��S I.tOrc1 u at.A R is L_z E WZ.%ZMDt.1 6C.V`VL'-eS W t'rk TNT -jEOIc LI4-1ir L..--,--- i. AWE �CYI�AGK,,jGQUICEAAE-.WTS OF. TlAe OWW . O;7 ,0%)!�,L A w1:> tS l lG f L a G AY ELT> W 1 T-"I W T E FLoot7 PL .� RcGtS tC.RI�.D t-•.�I•dltiJ �U�.v�-`(�c 'r"IS PL4" IS WOT BA5et> oW AW IW5 ME,-tT OSTszv%L.Lc-- o I�if•LS`�• St�`LvBY �i TtAts oFFSETS 11ADOLD UOT $1= Se'D 'To IVV It 11 2 - I h W � Lc- OF rs , btl 1� .� i Commonwealth of Massachusetts ✓ Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification `3 7 Important: When filling ou. 1. Property Information: forms on the computer, use 186 Thistle Drive -Marstons Mills, MA only the tab key Property Address to move your Russell and Jennifer Peterson cursor-do not use the return Owner's Name key. 186 Thistle Drive Owner's Address !� Marstons Mills MA 02632 City/Town State Zip Code Date of Inspection: May 11, 2006Date 2. Inspector. David D. Coughanowr, R.S. Name of Inspector Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364 0894 Telephone Number Certification Statement: I certify that I have personally inspected the sewage disposal system at this address and that,the information reported below is true, accurate and complete as of the time of the inspection. -a e inspection was performed based on my training and experience in the proper function and rriai'ntenancer'of on-'site sewage disposal systems. I am a DEP approved system inspector pursuant to=Section�tS.340-of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails w" ❑ Needs Further E�al�uation by the/Local Approving Authority t- �44 %, C�► V May 11, 2006 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. t5-2245.doc• '11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments -1 U9. Subsurface Sewage Disposal System Form A. Certification (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection 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: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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 kank 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: t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 2of16 I Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: 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 t5-2245.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 3of16 I Commonwealth of Massachusetts Title 5 Official Inspection Form 18 Not for Voluntary Assessments M Subsurface Sewage Disposal System Form A. Certification (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cont.): 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: ❑ 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❑ y p a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *" This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: M t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ®l 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes No ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 5 of 16 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection 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. t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection 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 N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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 CMR 15.302(3)(b)] t5-2245.doc•11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd Number of current residents: Does residence have a garbage grinder? Removal of grinder is recommended ® 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 ears usage d 186 gpd g ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: current 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): t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 8of16 I Commonwealth of Massachusetts �W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Age: 20 years. Certificate of Compliance issued 11119185 (Board of Health permit#85-737) Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 9of16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form GSM C. System Information (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: Not determined feet Material of construction: ❑ cast iron ❑ 40 PVC other(explain): Not determined —slab foundation ® Distance from private water supply well or suction line: 20+feet Comments (on condition of joints, venting, evidence of leakage, etc.): No evidence of backup or leakage into dwelling was observed. Septic Tank (locate on site plan): Depth below grade: 1feet 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 ❑ Yes ❑ No certificate) Dimensions: 10 ft x 5 ft x 5 ft(1250 gallon) Sludge depth: 4 inches Distance from top of sludge to bottom of outlet tee or baffle 30 inches Scum thickness 1 inch Distance from fop of scum to top of outlet tee or baffle 9 inches Distance from bottom of scum to bottom of outlet tee or baffle 14 inches How were dimensions determined? Design Plan t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM C. System Information (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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): t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM C. System Information (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection 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.): Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At outlet inverts 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 appears structurally sound with no evidence of leakage in or out. Some solids in sump. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 12 of 16 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ;M Subsurface Sewage Disposal System Form C. System Information (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection 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.): Soils above leaching pits appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into the distribution box and was observed to pass through in a rapid and unobstructed manner, and could be heard splashing down loudly into the leach pits t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection 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.): t5-2245.doc• '.1/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments iG M Subsurface Sewage Disposal System Form C. System Information (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. LOC/�TIONS A B 1 2F FL 34 FL 2 16 FL 46 FE 3 25 FE 60 FL 4 31 FE 44 FE EXISTING DWELLING # IB6 A LEACH a O PIT 2 3 �� D-BOX w SEPTIC TANK w LEACH O PIT 3I 4 THISTLE DRIVE NOT TO SCALE t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form o Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 186 Thistle Drive Property Address Marstons Mills MA 02632 City/Town State Zip Code Russell and Jennifer Peterson May 11, 2006 Owner's(Jame Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 35 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: 8/15/85 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: Barnstable GIS Department records You must describe how you established the high ground water elevation: t Approved design plan on file with the Board of Health shows bottom of system to be 4 feet above the bottom of a witnessed test pit in which no water was encountered. Town of Barnstable GIS Department records indicate that the property is over 35 feet above groundwater table. t5-2245.doc• 11/2004 Title 5 Official Inspection Form: Subsurface Sewage Disposal System Page 16 of 16 i 42' TOP OF FOUNDATION 24'dameter concrete covers ENTE RV I LLB, EL=49.8 rarsed to within Cof hni.5h grade MA I 8.5' 8.5' 8.5' 8.5' 4'� MA (or as noted) Old Sta e Rd I . Assessors Ma 149 Parcel 130/018 9 oa rx-eting EL=50.0i± EL=49.7t EL=45.5_ � Z >cj o v 2,) Deed Book 2 071 Pa e 134 � `� D - � � 3') Book Plan 32G Page 29 Lot 4 'cs ,. •. -.;:-- =- k,= , ro � 4.) This property Is in a Zone II of a Public v �, N Water Supply O m 3 5.) Flood Zone: C Panel #25000 100 1 5C v� 49.a+ o o� LacUS ,� L 472E GEOTIXTILE FABR/C m Cxrst�ng 47.8+ (1N PLACE OF//4'-//2'PEASTOMF) �Q �p�j w Eristrn 47.5E 4G 6© N 46.63 46 40 N N 3/4"- /-//2 STONF D-Box C� mp `✓ - Existing PLAN VIEW � z r v Zabel Filter Oee Note#23) 44.40 SCALE: 1" = 1 0' Th'Stie �` Ex/is2tin Longest Rn 63' 2/ FOUL(4)5H0REYPRECA5T 500 D51-6 O Dn GALLON LEACH CHAMBERS W1TH 4' EY15RNG /250 GALLON (H-20 Rated) OF STONE pALLL AROUND EL=39.4 Bottom of Test Hole ` GD 9� 5fPT/C TANK D-BOX LEACH C1-1AML9fR5 �59�0 33 SITE Locus NOT TO SCALE FLOW FROFI LE CONSTRUCTION NOTES NOT TO SCALE KEY MAP n0_0 333 1.) ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5 (3 10 CMR 1 5.000): N STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE, AND EXPANSION OF ON-SITE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE TRANSPORT AND DISPOSAL s�. Q- SCALE: I = !00 /r`oo OF SEPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. < N �3 SAS b Rip 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE IS POTENTIAL FOR VEHICLES OR HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO WITHSTAND AN H-20 LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE ATMOSPHERE. ��_ per, p \ 30G3 s 3.)TO MINIMIZE UNEVEN SETTLING, ALL SYSTEM COMPONENTS SHALL BE INSTALLED ON A STABLE Sun Ed9 of(�wnO�`� �Oo i 09�9 MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. Room Q' .: �� Existing5epticcomponents to V u�o -, Loving be z be Abandoned(5ee Note#2/) �g fx• i �p p `G� � � 4.) COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION BOX,AND THE Bdrm Bdrm 6 S G, O tx #3 i � '�O� � 2�•3� SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. LEACHING FIELDS #2, f' x L R= 2 43.207.50, = a TRENCHES, AND OTHER SOIL ABSORPTION SYST)a MS WITHOUT ACCESS MANHOLES SHALL HAVE A7 2 , 1P-7 z � � LEAST ONE(1) INSPECTION PORT CONSISTING OF PERFORATED 4"PVC PIPE PLACED VERTICALLY TO THE Bth DB ��' ��' G8.95' R= 120,00' BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP,TIED WITH MAGNETIC MARKING TAPE, Btn �� N 86°43'59"E L= 1 2.85' Kitchen BENCH MARK ACCESSIBLE TO WITHIN 3"OF FINAL GRADE. Bth Bdrm Dining TP-2 �� J Top Corner Concrete 5 #I Bdrm �^� x� / EL=50.00(Assumed Datum) 5.) PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A #4 �' Fo-4d /�oh MINIMUM CONTINUOUS GRADE OF NOT LESS THAN 2% FROM THE BUILDING TO THE SEPTIC TANK,AND Office �' ° O LOT 4 NOT LESS THAN I%OTHERWISE, 5ittinq Area=29,333 S.F.± G.) DISTRIBUTION LINES FOR THE 501L ABSORPTION SYSTEM SHALL BE 4"DIAMETER SCHEDULE 40 PVC (OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE CAPPED AT END OR AS NOTED. 1�j F LOOK LAB I / 7.) LINES FROM THE DISTRIBUTION BOX TO BE LEVEL FOR THE FIRST TWO(2)FEET BEFORE PITCHING TO NOT TO SCALE THE 501L ABSORPTION SYSTEM. DISTRIBUTION BOX SHALL BE WATER TESTED TO ASSURE EVEN DISTRIBUTION. 4Patio-. LEGEND 8.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE 5TRUCTURE5 IN CC�� (� / ii� : ORDER TO PROVIDE A WATERTIGHT SEAL TEST HOLE LE LOGS /f j // ^ .:.= aISTING SPOT GRADE 24x5 PROPOSED SPOT GRADE 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE // / LOT �1 DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. /j/ Existing 4 Bedroom Dwelling // ---24--__ EXISTING CONTOUR Test Hole#i (EL=49.G±) �\ J f/// / !j/ Top of Slab Foundation {i/ Area=29,333 S.F.± 24-- PROPOSED CONTOUR 10.) IN ACCORDANCE WITH 3 10 CMR 15,22 1,-ALL SYSTEM COMPONENTS SHALL BE MARKED WITH l // / /! EL=49,8± 4W WATER SERVICE LINE MAGNETIC MARKING TAPE. Depth Layer Soil Class Sod Color Comments �, �x\ ST\xx /�i / O OVERHEAD UTILITY LINES 1 1,)THERE ARE NO KNOWN WELLS WITHIN I00'OF THE PROPOSED SOIL ABSORPTION SYSTEM. 0"-4- A Fine-Medium Sandy Loam I OYR 3/2 4, / / G GAS SERVICE LINE 4"-1 O" B Fine Sandy Loam I OYR 4/G ��O // / TIP FENCE 12.) FROM THE DATE OF THE INSTALLATION OF THE SOIL ABSORPTION SYSTEM UNTIL RECEIPT OF THE 10"-1 19" C 1 Mecum-Coarse Loamy Sand I OYR G14 20%Gravel 6, a. j / f� TEST HOLE LOCATION CERTIFICATE OF COMPLIANCE,THE PERIMETER SHALL BE STAKED AND FLAGGED TO PREVENT USE OF 1 19"-122" C2 Coarse Loamy Sand I OYR C/G Perc @50" �• Qd. SEPTIC TANK ST THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. ° 4 . .°.: a. o f/� `� 4 f DB DISTRIBUTION BOX 1 3.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS CONSTRUCTED ° j�/ /f �O� SAS 501L ABSORPTION SYSTEM AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE DESIGNER. Test Hole#2 (EL=49.G±) Errstrng5eptic d i r� Gj Tank to be Utilized a- 4 . j/0 �o 14.)THE BOARD Of HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF THE Depth Layer Sod Class Soil Color Comments (5eeN°te BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT THE SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE 0"-5" A Fine-Medium Sandy Loam I OYR 3/2 APPROVED PLANS. 48 HOURS ADVANCE NOTICE IS REQUESTED. 5"-181. B Fme-Sandy Loam I OYR 4/G 4 ° 18"-1 20" C 1 Medium-Coarse Loamy Sand I OYR G/4 20%Gravel 15.) LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR 1 20"-1 22" C2 Coarse Loamy Sand 1 OYR GIG 4° DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO . ° ° a Survey Work h COMMENCEMENT OF ANY WORK, THIS INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO DIGSAFE,ANY a ". p Y y PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. SITE PLAN DATE OF TESTING: 1 2/1 5/1 1 P#13495 ° SOIL EVALUATOR: LINDA J. CRONIN, P.E., C5N ENGINEERING �,4 ..4°' A & M Land Services I G.)CONTRACTOR SHALL VERIFY THAT ALL WA5TELINE5 ARE CONNECTED BY WATER TESTING WITHIN BOARD OF HEALTH AGENT: DON DEMARAIS, HEALTH DEPARTMENT ��� 618 Route ,28, Suite 3 THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. e Qa SCALE: I" = 20' PERCOLATION RATE: LESS THAN 2 MIN/INCH IN "G 1"LAYER _ �o, �,� West Yarmouth, MA 02673 17.) CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY SEPTIC a < Pb- (508) 737-1777 Email.- anmland®comeast.net SYSTEM COMPONENTS. NO GROUNDWATER ENCOUNTERED , . a 18.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. 51TE PLAN SHALL NOT BE USED FOR STAKING, OR ANY OTHER PURPOSES. SYSTEM DESIGN CALCULATIONS �.?^4 a °° �'r-P TH Or4f Proposed Sewage DIspoSal 5y5tem 10.)THIS PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH ZONING BYLAWS, SPECIFICALLY, BUT NOT LIMITED TO, SIDELINE SETBACKS AND BUILDING HEIGHT RESTRICTIONS,AS IT 5EWAGEDE5I61VFLOW REQUIRED:4 BEDROOM DWELLING @ //0 GPD/BEDROOM ,�� C/N 90 1 8G Thl5tle Dr., � udle, MA SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR ISSUED THE BUILDING PERMIT. =440 GPD REQUIRED J CPS � �Alul NS ��t.S I CERTIFY THAT I AM CURRENTLY APPROVED BY THE l L m 20.) EXISTING 1 250 GALLON SEPTIC TANK TO BE UTILIZED. PVC TEES TO BE INSTALLED ON INLET AND 5EWA6E0E5/6N FLOWPROV1059, FOUR(4)500 GALLON LEACli CHAMBFRS W17f/ DEPARTMENT OF ENVIRONMENTAL PROTECTION NQ �5 ! .J OUTLET PIPES IF NECESSARY, AND A GAS BAFFLE INSTALLED IN THE OUTLET TEE. 4'OF57'ONEALL AROUND PURSUANT TO 3 10 CMR 1 5.017 TO CONDUCT 501L S'�c EVALUATIONS AND THAT THE ANALYSIS HAS BEEN ��c c�STEREO CSN 2 1.) EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND AND Vt=[(42.0x 12.63) + 2(42.0+ /2.63)x 2Jx.74 PERFORMED BY ME CON51STENT WITH THE �S Prepared for: ABANDONED IN PLACE. AREA TO B 56/. CPO PRO E COMPACTED TO MINIMIZE SETTLING. REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE CAI 04 P.O.Bor201 = / DESCRIBED IN 310 CMR 15.017. 1 FURTHER (� �, Seven Hills Community Brewster,IgA 02631 22.) EXISTING SEPTIC COMPONENTS TO BE REMOVED. ANY CONTAMINATED SOIL SHALL BE REMOVED 561 GPD PR0V0EV>440 GPD REQUIRED CERTIFY THAT THE RESULTS OF MY 501L EVALUATION Services, Inc. FOR A DISTANCE OF FIVE(5) FEET LATERALLY FROM THE SOIL ABSORPTION SYSTEM AND REPLACED AS INDICATED ON THE ATTACHED SOIL EVALUATION 81 Hope St., Worcester, Phone: (508) 896-1783 WITH CLEAN SAND. AREA TO BE COMPACTED TO MINIMIZE SETTLING. 5EPTICTANKCAPACITYRFQUIRED.• 44061D v20046 =6606PDREQUI9ED FORM, ARE ACCURATE AND IN ACCORDANCE WITH MA 01 G03 ' 3 10 C R 1 5.!00 THROUGH 15.107 ENGINEERING 23.)THE ZABEL FILTER IN THE SEPTIC TANK OUTLET TEE SHALL BE INSPECTED AND CLEANED ROUTINELY SEPT/C TANK CAPACI7YPROVIDED. 1250 GALLON PROVIDED(MINIMUM ALLOWED) 0 20 40 �'0 TO PREVENT CLOGGING AND BACKUP OF THE SEPTIC TANK. A GARBAGE D15P05AL 15 NOT PERMITTED WITfI 77-115 DF516N FLOW �` l SCALE !"=20' 24.) INSPECTION NOTE: PRIOR TO FINAL INSPECTION BY THE ENGINEER,SYSTEM NEEDS TO BE DATE: SCALE: DESIGN: CHECK: JOB NO: COMPLETE INCLUDING BUILDUP FOR COVERS. Linda J. Cronin, Certified Soil Evaluator C:\C5N\RR-7hi5tle\RR-Thi5tle-SDS PlanRevG-G-fB.dwg OG/OG/18 AS SHOWN Lip KM CSN0201 I, i TOP OF FOUNDATION 24'diameter concrete covers 25' CENTERVILLE, EL=49.8 rased to Wthm 6"of finish grade 5.0' 5.0' i 5.0' i 5.0' 5.0' MA (or as noted) lnspectron Port and cap with magnetic Old 5ta e Rd marking tape to within 3"ofgrade 7 7 , 1 . Assessor's Map 149 Parcel 130/018 g Oa�� ' r 2.) Deed Book 21071 Page 134 FnstmgLL=So.of EL=49.7f EL=49.749.9(max> A 3.) Plan Book 32G Page 29 Lot 4 N r�<j r�� ��� r���j�� cn 4.) Thls property 15 m a Zone 11 of a Public D-Box ' °N' Water Supply x X - 5.) Flood Zone: C Panel #25000 1 00 1 5C LOCU5 ,� L 49.0* i s y N t 48./_ V Existing 46.9* v 6� a Existm ° 47.8- Q Z 47.5i 46.80 _ 46.63 46.53 1 LAN VIEW Inspection Ports(See Note#4) w Existing _ Existing N u co Gas Baffle 45.6-3 SCALE: 1" = 10, Ti,, Longest Run 7W--N )- VE(25)AD5 ARC361-IC 12'+- }-- 50' /o' (36/6D92)LEACH CHAMBERS 1N BED Exsting D25-6 CONFIGURATION W/TH FIVE(5)ROWS EV15TING 1250 GALLON (1-1-20 Rated) OF FIVE(5)CHAMBERS °0 \� S 1 T E LO C U S of SEPTIC TANK D-SOX LEACH C-�AA 1BER5 1,ff=39.4�±Bottom of Test Hole ��9 33 Dc3 NOT TO SCALE FLOW PROI=1 LE CONSTRUCTION NOTES NOT TO SCALE KEY MAP �90g 33 1.)ALL WORK SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE,TITLE 5 (3 10 CMR S SCALE: I" = 100' g 1 5.000):STANDARD REQUIREMENTS FOR THE SITING, CONSTRUCTION, INSPECTION, UPGRADE, o "U° AND FXPAN51ON OF ON-51TE SEWAGE TREATMENT AND DISPOSAL SYSTEMS AND FOR THE 4 0- g° SAS 6 4 TRANSPORT AND DISPOSAL OF SEPTAGE, AND THE LOCAL BOARD OF HEALTH REGULATIONS. °���'j56 O 6�,6 2.) ANY SEPTIC SYSTEM COMPONENT INSTALLED IN A LOCATION WHERE THERE 15 POTENTIAL �► 2 FOR VEHICLES OR HEAVY EQUIPMENT TO PASS OVER IT SHALL BE DESIGNED TO WITHSTAND AN � H-20 LOADING. IF UNDER AN IMPERVIOUS SURFACE, SYSTEM SHALL BE VENTED TO THE �' Proposed SAS ag a .� ATMOSPHERE. (See Plan View) Ed9�ofla a v? N 3.)TO MINIMIZE UNEVEN SETTLING, ALL SYSTEM COMPONENTS SHALL BE INSTALIJ D ON A �n 49.5go z loj Ik A G ci F STABLE MECHANICALLY-COMPACTED BASE ON SIX INCHES OF CRUSHED STONE. Q 4.)COVERS OVER THE INLET AND OUTLET TEES OF THE SEPTIC TANK,THE DISTRIBUTION BOX, Room O 49.5 27.50' emu? Uving �_� r L= 43.20" AND THE SOIL ABSORPTION SYSTEM SHALL BE RAISED TO WITHIN G"OF FINAL GRADE. G8.95' R= 120.00' LEACHING FIELDS,TRENCHES, AND OTHER 501L ABSORPTION SYSTEMS WITHOUT ACCESS #2 #3 MANHOLES SHALL HAVE AT LEAST ONE(1) INSPECTION PORT CON515TING OF PERFORATED 4° r, N 8G°43'59"E L= 12.85' O ��_ PVC PIPE PLACED VERTICALLY TO THE BOTTOM OF THE SOIL ABSORPTION SYSTEM WITH A CAP, d5th TP-2 h�gx,5tin Leach Pit to beTIED WITH MAGNETIC MARKING TAPE, ACCESSIBLE TO WITHIN 3"OF FINAL GRADE. L::�K DB l OBth Abandoned(see Note#25.)PIPING SHALL CONSIST OF 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL BE LAID ON A Bd m Dining �d LOT 4 MINIMUM CONTINUOUS GRADE OF NOT LE55 THAN 2%FROM THE BUILDING TO THE SEPTIC Bdrn / J Area=29,333 TANK, AND NOT LE55 THAN- %OTHERWISE #4 A Office - 5 BENCHMARK G.) DISTRIBUTION LINES FOR THE SOIL ABSORPTION SYSTEM SHALL BE 4"DIAMETER SCHEDULE Sitting Top Corner Concrete- 40 PVC(OR EQUIVALENT) LAID AT 0.005 FT/FT. UNLESS OTHERWISE NOTED. LINES SHALL BE y \�\ 1=L=50.00(Assumed Datum) f c^ CAPPED AT END OR A5 NOTED. I=LOOP, t LAN / e 7.) LINES X TO BE LEVEL FOR THE FCRST TWO(2)FEET BEFORE RrFT#E-IJSTRIiU / f PITCHING TO THE SOIL AB5ORPTION_SYSTE-M: DISTRIBUTION BOX SHALL BE WATER TESTED TO ia. /// Patio ° LEGEND ASSURE EVEN DISTRIBUTION. NOT TO 5CALE• / 8.)GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE ° 123 EXISTING SPOT GRADE STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL. 24x5 PROPOSED SPOT GRADE � L Existing 4 Bedroom Dwelling ° LOT 4 r, 24- EXISTING CONTOUR 9.) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE SEWAGE' SY✓TEM DESIGN CALCULATIONS ,' / Top of Slab Foundation Area=29,333 5.F.-- 24- PROPOSED CONTOUR DISPOSAL FIELD DURING THE COURSE OF CONSTRUCTION OF THE SYSTEM. O° i - \so.0 / EL=49.8{ 5EWA6EDE5161V FLOWREQUWREDr 4 BEDROOM DWELLING @ Sz - o ` 1 WATER SERVICE LINE 10.) IN ACCORDANCE WITH 3 10 CMR 1 5.221, ALL SYSTEM COMPONENTS SHALL BE MARKED //0 GPD/BEDROOM=440 GPD REQU/RED Op (511 _ 5T `� / O OVERHEAD UTILITY LINES WITH MAGNETIC MARKING TAPE. 11 �J a / G GAS SERVICE LINE / . ,. . ° SEWAC,EDE5I61VFLOW)'ROVIDED. 7'WENTYF1l/E(25)AD5UNIT5INBED F ?Gt ► / i a ° °° 1 FENCE 1 1.)THERE ARE NO KNOWN WELLS WITHIN 100'OF THE PROPOSED SOIL ABSORPTION SYSTEM. CONFIGURATION IN FIVE(5)ROWS OFFWVE(5)UN/T5 EACH. 5Q.0 ° ° q. . TEST HOLE LOCATION 12.) FROM THE DATE OF THE INSTALLATION OF THE 501L ABSORPTION SYSTEM UNTIL RECEIPT Vt=[(440/0.74)/(4.8 FTz/F7)/5.0 LFJ 5T SEPTIC TANK OF THE CERTIFICATE OF COMPLIANCE,THE PERIMETER SHAH BE STAKED AND FLAGGED TO 24.7A05 UN17.5 REQUIRED(25 PROVIDED) Existing Leach Pt to be a d / ` pB DISTRIBUTION BOX Abandoned(see Note#21) a °. PREVENT USE OF THE AREA THAT MAY CAUSE DAMAGE TO THE SYSTEM. ° q 5A5 SOIL ABSORPTION SYSTEM 444 GPD PROVIDED>440 GPD REQUIRED ° 4y•a ° /f Gj• N OF MASS 13.) THE DESIGNER WILL NOT BE RESPONSIBLE FOR THE SYSTEM AS DESIGNED UNLESS Existing Septic Tank to be =P.:a- a o \?'°\� CONSTRUCTED AS SHOWN ON PLAN. ANY CHANGES SHALL BE APPROVED IN WRITING BY THE SEPTIC TANK CAPACITYREQU/RED: 440 O DX 20096 =600 GPD REQUIRED Utilized(See Note 020) ° ° a n (kg �� L1NDA J. �-n DESIGNER. SEPTIC TANK CAPACITYPROVIDED_ f1'/5T/NG 1250 GALLON 5EPTIC TANK °- / p PINTO 14.)THE BOARD OF HEALTH REQUIRES INSPECTION OF ALL CONSTRUCTION BY AN AGENT OF A GARBAGE DOF05AL 15 NOT PERMITTED WITH TH15 DESIGN FLOW THE BOARD OF HEALTH AND THE DESIGNER. THE DESIGNER SHALL CERTIFY IN WRITING THAT 50. THE SEWAGE DISPOSAL SYSTEM WAS INSTALLED IN ACCORDANCE WITH THE TERMS OF THE PERMIT AND THE APPROVED PLANS. 48 HOURS ADVANCE NOTICE 15 REQUESTED. "" C ° ° ° ° a°` ° a ° TFss O/NAL EN�\�� Sarvep Work by. 15.)LOCATION OF UTILITIES IS APPROXIMATE AND CONTRACTOR SHALL BE RESPONSIBLE FOR TES 1 HOLE LE LOG.J p q`, o � ° / A, & M Land SerWceS DETERMINING THE LOCATION OF ALL UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO I TE PLAN `�� ° `�r(l 618 Route 28, Suite 3 COMMENCEMENT OF ANY WORK.TH15 INCLUDES, BUT 15 NOT LIMITED TO, REQUESTS TO Ota -°°` . W6st YQTIIIOLItI2, MA D26T3 Test Hole#I (EL=49.Gi} P#13495 a �A DIGSAFE,ANY PRIVATE UTILITY COMPANIES, AND THE LOCAL WATER DEPARTMENT. ° Pb (508) 737-1777 Email. ann2land®comcastnet Depth Layer Soil Class Soil Color Comments SCALE: 1" = 20' ' I G.)CONTRACTOR SHALL VERIFY THAT ALL WA5TELINE5 ARE CONNECTED BY WATER TESTING a +`� WITHIN THE DWELLING PRIOR TO INSTALLATION OF ANY SEPTIC COMPONENTS. 0"-4" A Fine-Medium Sandy Loam I OYR 3/2 9 ; ° ° �. Prepared for: `I"-I B fine Sandy Loam I OYR 4/G 17.)CONTRACTOR SHALL VERIFY EXISTING INVERT ELEVATIONS PRIOR TO INSTALLATION OF ANY I O" 119" Cl Medium-Coarse Loamy Sand I OYR G/4 20%Gravel d ° Seven Hills Community Services, Inc. SEPTIC SYSTEM COMPONENTS. 1 19"-1 22" C2 Coarse Loamy Sand I OYR GIG Perc @50" 81 hope 5t., Worcester, MA O 1 G03 15.) INSTRUMENT SURVEY CONDUCTED FOR PROPOSED WORK ONLY. SITE PLAN SHALL NOT BE 1. USED FOR STAKING, OR ANY OTHER PURPOSES. ° Test Hale#2 (EL=49.G+) Proposed Sewage Disposal System 19.)TH15 PLAN DOES NOT CERTIFY, GUARANTEE OR WARRANTY COMPLIANCE WITH ZONING 1 8G Thistle Dr., Gam, MA BYLAWS, SPECIFICALLY, BUT NOT LIMITED TO, SIDELINE SETBACKS AND BUILDING HEIGHT Depth Layer Sod Class Sod Color Comments RESTRICTIONS,AS IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR ISSUED THE BUILDING PERMIT. 0"-5" A fine-Medium Sandy Loam I OYR 3/2 1 CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF Prepared by: 5"-18" B fine Sandy Loam I OYR 4/G ENVIRONMENTAL PROTECTION PURSUANT TO 3 10 CMR 15.017 TO 20.) EXISTING 1 250 GALLON SEPTIC TANK TO BE UTILIZED. PVC TEES TO BE INSTALLED ON 18"-120" Cl Medium-Coarse Loamy Sand I OYR.G14 20%Gravel CONDUCT SOIL EVALUATIONS AND THAT THE ANALYSIS HAS BEEN INLET AND OUTLET PIPES IF NECESSARY, AND A GAS BAFFLE INSTALLED IN THE OUTLET TEE. 1 20"-1 22" C2 Coarse Loamy Sand I OYR GIG PERFORMED BY ME CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, CSN AND EXPERIENCE DESCRIBED IN 310 CMR 15.017. 1 FURTHER CERTIFY Awl 2 1.)EXISTING SEPTIC COMPONENTS TO BE LOCATED, PUMPED DRY, FILLED WITH CLEAN SAND THAT THE RESULTS OF MY SOIL EVALUATION AS INDICATED ON THE �r���O • AND ABANDONED IN PLACE. AREA TO BE COMPACTED TO MINIMIZE SETTLING. ATTACHED SOIL EVALUATION FORM, ARE ACCURATE AND IN ACCORDANCE It�,� in eerin DATE OF TESTING: 1 2/1 5/1 1 WITH 3 I CMR 1 5.100 THROUGH 1 5.C 07 22.)THE ZABEL FILTER IN THE SEPTIC TANK OUTLET TEE SHALL BE INSPECTED AND CLEANED SOIL EVALUATOR: LINDA J. PINTO, P.E., C5N ENGINEERING 20 4C? GO ROUTINELY TO PREVENT CLOGGING AND BACKUP OF THE SEPTIC TANK. I BOARD OF HEALTH AGENT: DON DEMARAIS, HEALTH DEPARTMENT ' P.O.Box 2030 Phone:(508)299-3250 PERCOLATION RATE: LE55 THAN 2 MIN/INCH IN"C I"LAYERJby (;�1 I I•I (f 'T'eaticket,MA 02536 Fax:(508)548-5478 23.) INSPECTION NOTE: PRIOR TO FINAL INSPECTION BY THE ENGINEER, SYSTEM NEEDS TO BE SCALE 1"=20' COMPLETE INCLUDING BUILDUP FOR COVERS. NO GROUNDWATER ENCOUNTERED Linda J. Pinto, Certified Soil Evaluator C:\C5MRR-Thi5tle\RR-Thi5tle-5D5 Plan.dwg Date: 1211 G/1 I Scale:As Shown By: LIP Check:MTA I Project No.CSN0201 -- -- - _-