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HomeMy WebLinkAbout0064 TIMBER LANE - Health 64 Timber Lane Marstons Mills A=149-057 II i Town of Barnstable OHE Tp� f P ti Regulatory Services 3AS2NSTABLE. = Thomas F. Geiler, Director MASS. A 9$ATFo39- Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 7, 2007 Mr Robert Wadleigh 64 Timber Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system owned by you located at 64 Timber Lane, Marstons Mills, MA was last inspected January 181h, 2007 by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of your septic system after further evaluation"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Distribution box is decayed and leaking. Tank has liquid only, outlet baffle is cracked and needs to be replaced when new leaching pit is installed. You have 60 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health TOWN OF BARNSTABLE LOCATION G 5' 71,wher G I W e_ SEWAGE # 7007—yo3 VILLAGE /'11mr2rd-nS l�9i/ls ASSESSOR'S MAP & LOT 0L 2p- 7 8— arm 1 � rra INSTALLER'S NAME&PHONE NO. S 5' � � � p (/ �� 5 SEPTIC TANK CAPACITY ldeW LEACHING FACILITY: (type) .l' -50� �Is�N,dF/S (size) NO.OF BEDROOMS BUILDER OR OWNER 49W161 4Uy,J/G 1g4 PERMITDATE: 9- //-07 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 leachi g facilityl Feet Furnished by a�Srb Lit. 44. �hSPEcnon Parr ?No. � � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: y Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 3pplicattou for �Dtgpogal 6p5tem Congtructton Permit Application for a Permit to Construct('Repair( pgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. !,Z/ /«her 414,*11' Owner's Na e,Addres ,and Tel.No. �ilr�r�ro�s �,lls d� Assessor's Map/Parcel /Y _ Installer's Name,Address, d Tel.No. . 2�� ��� g S-08-4f7�"S�13 ,,q�nn O� Desi ner' Name,Address and Tel.No. Jos��ti d /1�srro 1-44110"413i�rihy u/ar/<f Type 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) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) -j D4 4 l 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. Sig Date Application Approved by ned Date 9�� 0 7— Application Disapproved by: Date for the following reasons ' T Date Issued CIL1116 7- -----------------.--------4..J. on No. aLW"T T(/ :E—k!'010MIMORNWEALTH , Fee OF MASSACHUSETTS Entered in computer: y PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for �Dioogal *pgtem Con0tructton Permit !' Application for a Permit to Construct Re air rade Abandon pp (� p (� ( ) ( ) ❑.Complete System ❑Individual Components Location Address or Lot No. G� /'�l/�r L�pNN Owner's Na e,Addres ;and Tel.No. Na. � P 1 Assessor'sMap/Parcel v9_ ^ p 2CO-��S`L So8-4���-S3✓3 1 Installer's Name,Address,,And Tel.No. S08 Designer's,Name,Address and Tel.No. J0.5eP4 !fie �/ G ` Type of Building: Dwelling No.of Bedrooms .3 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) I � Other Fixtures i Design Flow(min.required) gpd Design.flow provided gpd Plan Date Number of sheets Revision Date Title + Size of Septic Tank Type of S.A.S. Description of Soil J Nature of Repairs or Alterations(Answer when a)plicable) Q -j'DD 6 l Zz _ # w4l/ Date last inspected: Agreement: ' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in & I, accordance with the provisions of Title 5 of the Environmental Code and not to place the syst�m in operation until a Certificate of ' Compliance has been issued by this Board of Health. �•,, '' ,, Signed Date Application Approved by ( Date i 9 // U� " I , KM Application Disapproved by: Date for the following reasons Permit NO. "�6 Date Issued // 6 ' —————=—————————————————————————————————————- , THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Dispos//al System Constructed (� Repaired ( g�Upgraded� Abandoned( )by = - '` """" l/OSz!f��i !/� &6- at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2n D- -yU:5 dated (Installer o5G/01 [�&f?✓'D�S Designer 6 Cl/N.GGi"y�l�i�,C, S r 1 #bedrooms Approved design flow ! ' gpd The issuance of this ermit shall of b co rued as a guarantee that the system wi un tion as designed. // C Dat----e----- ------------Inspector �' Jam------------' /-- /(/ I f ---- No. (�200_-;� /v3 Fee /W THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwigpogar *pgtem Corrgtruction Permit Permission is hereby granted to Construct (G-) Repair Upgrade ( ) Abandon ( ) System located at /y �� -/^ G,c�s�✓. 4 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. } Provided: Construction must be completed within three years of the date of this permit. Date 111U7 Approved by f 12/07/2007 02:50 5084775313 ENGINEERING WORKS PAGE 01 Town of Bu=Wle Rqubtwy Services } Thomas F.Ceder,Dirsotor Thomas McXtan,Dlreotor zo6 Maid Street,$Y�lo,MA UZ6O1 . Fox; SA8-790-6$04 Sewage Per"M od - i0" Assessor's MapTnr 41 's +7 rl S Imager: -Joe, t ss 9 '�^c (� i4el t: Address; T? 02, 07. ma's Se (instal ex) "." was issued a perrgit to iastati a C . ►;fit .6 q 77m&o- lang based on a doecigp dtaa by (addtese) !"ek- 7: j�e 007 dad `� o 000 " ,zhat the septic systam referenced above was riled submtautisuy accw Oft m s , which may include uukor appmved changes such as lateral re ocat o of the u trox and/or septic tank., dw the septicuatw*l 1,0 sysmm re ced above was inw aialed with l O' lateral relocation the SAS or any vertical reioc, !Mof xaali y t s )but in ce with state&Lacs1 as1b desigaer to follow, PETER . l aF PETER r. MCEN7EE CIVIL H 9 No,38109 ¢ ark,�018T C NAL.- "s igaiatur e) (,A.ft DeSig-er sLU= Dom TM EM An S AM r Q'H"*J&P*A)wiVw Owlifiadon Pam 3.26-04.de0 I I 1 1 1t ' 1 . - - I I 1 I { f I I t I, , IX I 21 IV Town•of Barnstable P# ,>/:g $ Department of Regulatory Services s > Public Health Division Date , 1:7 1639. �� 200 Main Street,Hyannis MA 02601 EOfA►Y� f� l�l Date Scheduled 1. Time--41-() Fee Pd.,�!00�0 e) Soil Suitability Assessment for Sewage Disposal Performed By: e `� ( r / "�'� �✓1 Witnessed By: LOCATION& GENERAL INFORMATION Location Address u / v' n y . 1 1 cn1 h Owner's Name (� r,(/ ,I/ '��l s Address Assessor's Map/Parcel: /,�4CI /0,5- 7 Engineer's Namep,_f..e, M C ,t NEW CONSTRUCTION REPAIR _ Telephone# (s-a0 77 3 3 Land Use i l /� � Slopes(30) 1 Surface Stones Al Distances from: Open Water Body _ft Possible Wet Area: ft Drinking Water Well Drainage Way. 1,%a I_ft Property Line 2 ft Other__ < SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetian4?n proximity,to holes) 64 C,J t-- r�qq V Z -- ►tM (3 CA-VV(5 r Parentmaterial(geologic) �1�,'�utc Depth to Bedrock f if Depth to Groundwater. Standing Water in Hole: 4 Weeping from Pit Face f IJ AL Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE 11 1' 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 ft. Index Well# Reading Date: Index Well level,�, AdJ,factor- Adj.Groundwater Level a Q;. PERCOLATION TEST Me� Thne.._�___ Observation 2� Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"•6') End Pre-soak -1 b�Cjt �A y: f a J � C . RateMinJinch `^ � O�lrZt'�� �``A { 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:ISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole.# Soil Other Depth from Soil Horizon Soil Texture Soil Color Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones;Boulders. o i to vel _ L d CACILO lU2 c 2 S eel S6 Z,5 7 DEEP OBSERVATION HOLE LOG Hole#_ 7 Depth from Soil Horizon Soil Texture Soil Color Soil Other Mottlin (Structure,Stones,Boulders. Surface(in.) (USDA) (Mansell) g s' a 4fo a CZ r G VIC& 5ctiu1 Z5 DEEP OBSERVATION HOLE LOG Hole# Soil Other Depth from Soil Horizon Soil Texture Soil Color mottling (Structure,Stones,Boulders. Surface(in.) (USDA) (Muosell) g C i to e DEEP OBSERVATION HOLE LOG. `Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Mottlin Structure,Stones',Boulders. � Surface(in.) (USDA) (Mansell) S n r 4y U L Jk : Flood Insurance Rate Man: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No—/,— Yes , Depth of Naturally Occurring 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? \e-s If not,what is the depth of naturally occurring pervious material? Certification 11�FACLA�5I certify that on (date)I have passed the soil evaluator exatrformed byyme consistent with Depa rtment of Environmental Protection and that the above analysis wasp Y the required training,expertise and experience described in 310 CMR 15.017. �. Date Sig nature nature Q;\.SEpTIC%PERCFORM.DOC • I March 19, 2007 64 Timber Lane Marstons Mills, MA. 02648 Thomas A. McKean Director Public Health Division Town of Barnstable 200 Main St. Hyannis,MA. 02661 • Dear Thomas McKean: As we agreed on the phone today,we will have our failed septic system brought into compliance by December 2007. Thank you. Sincerely, Rob Wadleigh Marcia F. Woods r'a � 4. A ruEr p'• : ru rl p Postage $ . y9 C3 `/ p Certified Fee p r > / p Return Receipt Fee S! (Endorsement Required) •(�0 U Here cfl p Restricted Delivery Fee (Endorsement Required) rq Total Postage&Fees $ fs SIN . Ln p S nt To Q / tti r 0 e n t.------ -- e tre t Apt.No.; .�. or PO Box No. ��'/�m�Pr cm,sreie;zia+a h/Ars�ns �'l t�•1-5 OaG rl Certified Mail Provides: n A mailing receipt (6—ea)zooz ounrooee wood Sd a A unique identifier for your mailpiece r n A record of delivery kept by the Postal Service for two year Important Reminders. o Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. o Certified Mail Is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not.available on mail addressed to APOs and FPOs. COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign�tLre i! item 4 if Restricted Delivery is desired. �" Y(/? ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B,. "eceived by(Printed Name) C. Date of elivery ■ Attach this card to the back of the mailpiece, /' or on the front if space permits. O�c° r"' e 1. Article Addressed to: D. Is delivery address different;A Rem 1? 0 Yes If YES,enter delivery address below: ❑No (,Ja��e�$� /*QrT tV/ S �'1•�� SAl� 3. Service Type ❑Certified Mail ❑ Express Mail ❑ Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 1 7-51 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) �' [10 0 0 0191 2 8 9 2' orm 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATEk?,1RgtL�E M, �:i;�;,-,v. 1 CR'l:l..P ...v aMlt. a� • Sender: Please print your name, address, and ZIP+4 in this box• PUBLIC HEALTH DEPARTMENT ,.i TOWN OF BARNATABLE 200 MAIN STREET HYANNIS,MA 02601 I t��lFtll�Ji1111itI!'tt?ttl��itii�'lttlllll117?f�-f�?lil�ii!!�?IJI Town of Barnstable yP ti Regulatory Services snivsrns Thomas F. Geiler, Director MASS. ••� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 16, 2007 Mr. Robert Wadleigh 64 Timber Lane Marston Mills,MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system owned by you located at 64 Timber Lane,Marstons Mills,MA was last inspected January 181h,2007 by Patrick M O'Connell, a certified septic inspector . for the State of Massachusetts. The inspection of your septic system after further evaluation"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Distribution box is decayed and leaking. Tank has liquid only,outlet baffle is cracked and needs'to be replaced when new leaching pit is installed. You have 60 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. STABLE HEALT DEPARTMENT Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION M 0W I y 1 5�0 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 64 Timber Lane Marstons Mills MA 02648 Owner's Name: Rob Wadleigh Owner's Address: Same i73 Date of Inspection: January 18,2007 Job#07-09 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 ' CERTIFICATION STATEMENT ` I certify that I have personally inspected the sewage disposal system at this address and that the informatio reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ���`''� ,0 Passes Conditionally Passes =;, F' .r,I ' �• Needs Further Evaluation by the LojAppving Authority • r Inspector's Signature: Date: 1/18/07 V". The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Liquid level in leaching pit is currently 4" below inlet pipe high stain lines indicate pit has been full to top. Distribution box is decayed and leaking.Outlet baffle in septic tank needs to be replaced. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 64 Timber Lane, Marstons Mills Owner: Rob Wadleigh Date of Inspection: January 18,2007 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 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: f Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:64 Timber Lane, Marstons Mills Owner: Rob Wadleigh Date of Inspection: January 18,2007 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 priory is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ 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 I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 64 Timber Lane, Marstons Mills Owner: Rob Wadleigh Date of Inspection: January 18,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ _ Backup of sewage into facility or system component due to 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_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 _X Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of 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 1 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. I.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 forma _Yes_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 64 Timber Lane, Marstons Mills Owner: Rob Wadleigh Date of Inspection: January 19,2007 Check if the following have been done. You must indicate"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_ Were any of the system components pumped out in the previous two weeks '? _X_ _ Has the system received normal flows in the previous two week period ? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ Was the facility or dwelling inspected for signs of sewage back up'? _X_ _ Was the site inspected for signs of break out'? _X_ _ Were all system components,excluding the SAS, located on site _X _ 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 _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems`? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. X _ 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)] Page 6 of 1 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 64 Timber Lane, Marstons Mills Owner: Rob Wadleigh Date of Inspection: January 18,2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x #of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): N/A Well Water Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system (yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped every three years. Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_gallons.-- How was quantity pumped determined? Reason for pumping: 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) _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: 1981 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Timber Lane, Marstons Mills Owner: Rob Wadleigh Date of Inspection: January 18,2007 BUILDING SEWER: XX (locate on site plan) Depth.below grade: 2' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition ofjoints, venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 1' Material of construction:_X_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Dimensions:8.5'long x 5.2'wide— 1000 gal. Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: STICK WITH HINGE FLAP. 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 has liquid only,outlet baffle is cracked and needs to be replaced when new leachine system is installed. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass`polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee,or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM .INFORMATION(continued) f Property Address: 64 Timber Lane, Marstons Mills Owner: Rob Wadleigh Date of Inspection: January 18,2007 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): . DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Box is decayed and leaking. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): I Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 Timber Lane, Marstons Mills Owner: Rob Wadleigh Date of Inspection: January 18,2007 SOIL ABSORPTION SYSTEM (SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type —X_leaching pits,number: One 6x6 pit. _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.): Hieh stain lines indicate liquid level has been above effective leaching capacity. CESSPOOLS: No (cesspool must be pumped as part of inspection) locate on site Ian Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY: No (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.): Page 10 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 64 Timber Lane, Marstons Mills Owner: Rob Wadleigh Date of Inspection: January 18,2007 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. Timber Lane Well ............ ... .. 21 29 19 � 28 35 20 Page I I of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 64 Timber Lane, Marstons Mills Owner: Rob Wadleigh Date of Inspection: January 18,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water Please indicate(check)all methods used to determine the high ground water elevation: _Obtained from system design plans on record - If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: _Checked with local excavators, installers-(attach documentation) _Accessed USGS database-explain: You must describe how you established the high ground water elevation: A perc test will be performed prior to repair to determine groundwater elevation. Massachusetts Department of Environmental Management 104220 Office of Water Resources TYPE OR PRINT ONLY Well Completion Report "fib WELL LOCATION GPS�OPTIONAQ LATITUDE LONGITUDE - Address at Well Location: G �/ T,�,ti1r Property Owner:. o�' 620 It! ` Subdivision Name: Mailing Address: City/Town: e"�,'s e�s .., ti,� (So.�STo�O(- cu,��r City/Town:�''� St. i A.. /1s H c, Assessors Map 1 Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if nostreet°address available Board of Health permit obtained: Yes 2' Not Required ❑ Permit Number Dafejss ed' 2.WORK PERFORMED 3. PROPOSED USE 4. DRILLING'METHO[} ❑ New Well ❑ Abandon C7"Domestic ❑ Irrigation ❑ Cable Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal ❑ Air Hammer °N❑ Direct Push C2"Re lace ❑ Other ❑ Industrial ❑ Other ❑ Mud.Rota ❑ Other 5 WELL LOG Ir Unconsolidated Consolidated 6.'SITE SKETCH:( i anent landmarks with distances) . HPermeabil'dy T Y v a �n Q — .a -o w co From (ft) To (ft) High Low c� �, m Other Rock Type ti t w T.WELL CONSTRUCTION 8.CASING � Total Depth Drilled SJ From (ft) To (ft) Casing Type acid Material Size O.D. (in) Well Seal Type Date Drilling Complete d `/ q 'nt.P�G y `r 9. SCREEN From (ft) To (ft) Slot Size Screen,Type and Material Screen Diameter y 9 Sa IS sS v ' f 10. FILTER PACK/GROUT/ABANdONMENT MATERIAL 11. ADDITIONAL WELL INFORMATION ` Developed? ❑ Yes ❑ No 'From.,(ft) To (ft) Material Description Purpose Fracture i.. Enhancement? ❑ Yes ❑ No Method Disinfected? ❑ Yes ❑ No i2.WELL TEST DATA(PRODUCTION WELLS) 13.STATIC WATER LEVEL(ALL WELLS) Yields: Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM) _:(firs &min) .(Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT) e 14. PERMANENT PUMP(IF AVAiLABtE) - 15.NAME/QRRi SS°QF PI1Mp INSTALLATION"COMPANY; ,. Pump Description /a�Ss�S Horsepower Pump Intake Depth "(ft) Nominal Pump Capacity (gpm) 16. COMMENTS ' `" 17. WELL DRILLER'S STATEMENT This well was drilled and/or abandoned under my supervision, according,to applicable rules { 1 and regulations, and this report/is omplete and correct to the best of my knowledge. Driller: `'� �' Supervising Driller Signature: Registration #:1 1 o mac. � r r :S � Firm: �/� ., ��H� � f� -Date. ��� Rig Permit#. � � � � � � NOTE. Well Completion.Reports must be filed by the registered well driller within 30 days of well completion. B :D OF HEALTH COPY I, LO CA T 4 I S E W AG E PERMIT NO. t VILLAGE r INSTA LLER'S A i A DRESS BUILDER OR OWN R DATE PERMIT ISSUED _��__ - DATE COMPLIANCE ISSUED r �fa ' / 'r �C� �� i �� q �G r :z. r ., { ti No......y..[.. ..... y - FE.B ................. THE COWFMONWEALTH OF MASSACHUSETTS BOARD �HE H �.' ApplirFatiou for Dh4p ii al ilirkti Tomitruni at Vamit e Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: - �► . 2...... T®•ter: /Z�ts - - - ALocation-Address or Lot No. • -:Address �0�PI�a ✓T ......- a -----------•- -----•---•--------- W Installer Address Type of Building Size Lot. ��._d�-----Sq. fe t Dwelling—No. of Bedrooms........3..............................Expansion Attic ( ) Garbage Grinder ( ). `4 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures ------------------•-•-•---------- \ dI� - ----•------------------------- ---------•--•----•------------....._......_....::... W Design Flow....../Z®..........................gallons per-peps®n per day. Total daily flow................ : .........galosns. WSeptic Tank—Liquid capacityeO�-`Q..gallons Length._......_. Width--__-....._ Diameter................ Depth.y__........ x Disposal Trench—No.................... Width.................... Total Length----_............... Total leaching area...... .___....._...sq. ft. Seepage Pit No------/........_. Diameter.. Vic_ .__. Depth below inlet-_ .._ __.... Total leaching area.. .sq. ft. Other Distribution box (�� Dosing tank ( ) ����i''�"� `" Percolation Test Results Performed b ' . /®� Date---7wate�t.. _P -_. _.._._.._.:. Y Y 1_4y a Test Pit No. 1�7z _minutes per inch Depth of Test Pit/.z ..._ Depth to groun - G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_................. a ------••--•---•-•----------------------•••••----------------------------------......-••••••••.•••---........................................................ Description of Soil. -'_ -y 4'__ �y __ ! _ Z K" Y � WO_ .v_~_. id!__-/___Z__./�_�!�� __.._fa-� :M_____ v'____ ...!!� l G ......-v- _ 1...._..... U Nature of Repairs or Alterations.—..A �A s r when applicable.__-___•------------ ------------------------------ ---------------------------------------------- / ----- -- Agreement: /t. �2 l dz %�" )- The undersigned agrees to install the aforedescribed Individuals Disposal System in accordance with the provisions of -T ?EE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig . ----------------------•--.................................... .....Date--•`--......._. Application Approved By...... jl- - ------- -=---- -- =-----G'yi�Y <......�--------- -� --�' } ` . Dati Application Disapproved for the following reasons----- ---------------------• -----------••-•--••-------------------------- -------•-------••-••----- .......-•--------------------------------..................................................... - ti ` ........ D _ --------------------.............. ate PermitNo...••••••................................................ (/ ss ........... ' Date *41W No.............?� Fimic...... ............ TW„ COMMONWEALTH OF MASSACHUSETTS - BOARD 0, HEAtj L: '0........... ......... OF ....... ......................... Appliratiou for Uhipaiial Workii Tomitrurtion PrMfit Application is hereby mad for a Permit to Construct ((,,T16r Repair an individual sewage Disposal System at: /14 ..........4. �................................................. Location-Address' or Lot No. .4 ''L I, . r ,. .........Jjr.Z.......e22&!. Y.,vuo.erW.......................... Own Address i ............. . . ...... ........................ ...................... ......................................... Installer Address ...... Type of Building Size Lot...--.I-D --el—,t;?.Sq. feet Dwelling T No.,o'f Bedrooms.__......31-�.............................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............ .......... No. of persons.............._...__.__._... Showers Cafeteria ( ) P4Other fixtures ...................................................................................................................................................... Design Flow......._//­.�.........................gallons per person-per �y_ Total daily flow----........... .......gallons. 1:4 Septic Tank—Liquid L capacity.X-2��.i:igallons Length... Width......!-Z..... Diameter................ Depth...Y........ p 11 , Disposal Trench—No. .................... Width.....__..._...._.... Total Length.._...__..........._ Total leaching area....... .....sq..ft. Seepage Pit No-------- ----------- Diameter-___ Depth below inlet--- Total leaching area. ft. Other Distribution box Dosing tank 101j: — Percolation Test Results Performed by....z�? ........�/ .................................. Date.... 1.4 ground Test Pit No. l..e:5:;—_'_7?�_rninutes per inch Depth of Test Pit../.:�-:_ Depth to d water.. e%e..477 Test Pit No. 2................minutes per inch Depth of Test Pit................_... Depth to ground water........_............__. ............................................................................................................................................................ .............. ........................ ... 7 Vo 0 Description of ..... ......V........... > ............. .................... ..... U ........... .................. ............ ....................... _r.............. = -----------------7--- 3_z:a -4 U Nature of Repairs or Alterations—A s r when applica ------------------------*---------------------------------------------------------------------- 2.............................................................. ----------------------- `7 Agree%ent: ' The undersigned agrees to install 'the aforedescribed Individual Sewa Disposal System in accordance with the provisio14 of LE, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. it 'Si d ... .. ................................................................. ------------ ate Application Approved By..... .. •. . ....... ...... ... .......U44A.,41 ....... Application Disapproved for the following reasons:.........................../------------I.................................................................. ............................... ................................................ ................................................................................................................ Date PermitNo........................................................j Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH 0"t oe .....y... .....44..%...........OF........ . ....4!.ti.".L....!" ................................ (9rdifiratr of Toutpliattre T To at the I64iOdual Sewage stem constructed (je) or Repaired byi0. ... ......... . ...... ......I... .............. ................ ...............................�--A.......... ta r ........... ......... ......... .................... .......... at. ........... has been installed in accordant with the provisions of 5 of The State Sanitary Code,as.describ d in' the ----- --- - application for Disposal Works Construction Permit N .. ........74.................. dated--- --- --- ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED,.AS.A GUARANTEE THAT THE SYSTE14'WILL FUNCTION SATISFACTORY. DATE..... Inspector................ p ................................................................... .THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEAL27H UAt X 4.............................. . ..... .......... ..........OF......... No...... ........... ....... FE . ................. ---------- ------ --- ..........wt -Z---------------------------------- Permissioq4ig-n—ereby granted..' ...... . ...... .. ...................................... ..... . ...... . ..... ... ...................... I nn � -------- ..... tor pair#A( n Sewage sal low c ....... ... . ... .... CoC; .... . ............... a t N .ej'0Z.. . r✓ mot' as shown on the application for Disposal Works Construction P it N ...... .... .... Dated.2......2 a ......• ....... ................ and 0 Healt DADATE.......... ........................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS _ > C" . , rzol� No. Fee—------q-' BOARD OF HEALTH ov TOWN OF BARNSTABLE Zipplication-*rVell Con5truct ion Permit Application.is hereby made for a permit to Construct Alter or Repair (--I individual Well at: -, h e,- L" &4r,/cfo".ig AA /(49 r�S I Jb-, Location Address �'s U Assessors Map and Parcel NO b L" Owner Address I, (( D""//_1 — Installer Driller Address Type of Building Dwelling Other - Type of Building - -------- No. of Persons-------______—__--______ Type of Well Capacity-----------__--_--___--_—_ Purpose of Well 00'-S 1"� Agreement: The undersigned agrees to install the aforidescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a C 'fic to of Compliance has been issued by the Board of Health. Signed, date Application Approved By date Application Disapproved for the following reasons: date Permit No. Issued date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate (Of Compliance THIS IS TO CERTIFY, That I Well Constructed Altered or Repaired by--- Installer at— 64'. has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection at In Regulation as described in the application for Well Construction Permit Novl�__ _)___ltXxated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector No.--- C�t - a� Fee------_-�' BOARD OF HEALTH TOWN OF BARNSTABLE Zipp[icat ion ffor no-tructionPermit Application.is hereby made for a permit to Construct YJ), Alter ( ), or Repair ( an individual Well at: — Location — Address Assessors Map and Parcel /IO�7 (.�c �rlv iq I , C { I , -- --- —f=--Owner -_ — — �— _—____----- Address -- ---_--- c r(( 14/,_/1 /'a . /'a,, Y�. --v,!`l- /" ov(. 'i P - l r Installer — Dri Address + Type of Building _ Dwelling --- -- ------ ". Other - Type of B o-of-Persons----------------------- --- Type of Well �� -- —_ Capacit Purpose of Well--Lo A", "T a Agreement: \ '" The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Boardof Health_Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Cer 'ficate .of Compliance has been issued by the Board of Health, Signed /P J---- Application Approved By..- ' \"V L\V. ------ S ( 1z t C-)� date Application Disapproved for-the following easons: --- ---------_ ___-_ -- ___ . £ — ------- ------ date Permit No. W C� �k -- Issued---- - �--I R - -- _------ date ti BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That t e Inj&idual Well Constructed ( ), Altered ( ), or Repaired by--- _ ,�� Installe--- ___--- - —--— -- ----- r y. 7,.0 t p . L VJ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No�' ��(-�Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. d : DATE------ - -- Inspector --- ---- ___--------—-- BOARD OF HEALTH TOWN OF BARNSTABLE Ivell Con5truct ion Permit No. ---- n n Fee- --- Permission is hereby granted - to Construct ( ), Alter ( ), or Repair. ( kT an Individual Well at: !,.C� T., fj P s 41 No. - ----______-- ------ - - - - - street as shown o� the application for a Well Construction Permit / No.- W��,Z� ' D L P Date Board of Health DATE (�� �� 4�` i `�/M���� �N o ROUTE 6 TIMBER LA t NE ............................. _371 T s) TOP 03 N IOPFIELD OR 38*10'00" E 180.00' OLD 150' LOCUS Lot 34 LOCUS MAP N.T.S. 20,0 70± S.F." 0.46± A C. ? Ma LEGEND 149 ,; p Parcel 57 7/1 PROPOSED CONTOUR PROPOSED SPOT GRADE _op EXISTING,: EXISTING CONTOUR HOUSE EXISTING SPOT GRADE cn / !/"; 5- TOF=95.56 LA '(7�_ + - TEST PIT (Assumed) Q) Benchmark Set BENCHMARK rrl Right corner bulkhead C,4 PIT El.=94.81 (Assumed) 4�- --,, \ EXISTING LEACH TO BE PUMPED FILLED WITH SAND EXIST. SEPTIC TANKI TOP EL.=92.21 TP INV,(OUIT)=9 -2 + 6 L:PROP. 23' VENT Fence 9 74.6 105.38' ' Q S J6 15021., W Stockoa -7^ J6*2239 W GENERAL NOTES: _GENERAI G. THE DESIGN ENGINEER 13 NOT RESPONSIBLE FOR THE FAILURE OF f 1 ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF BOARD0 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 4USS BOARD OF HEALTH AND THE DESIGN ENGINEER- yo [� 2.7AL L WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 7. WATER SUPPLY IS PROVIDED BY PRIVATE WELL. OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE B. THERE ARE NO ABUTTING WELLS LOCATED WITHIN 150' OF THE S.A.S. PET T. PROPOSED SEPTIC SYSTEM UPGRADE LOCAL RULES AND REGULATIONS. McE E 1) 310 CMR 15.405(1)(b) CONTENTS OF LOCAL UPGRADE APPROVAL: 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED CIVIL A 1.5' variance to maximum cover requirement :)f 3' for 4.5' TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 64 TIMBER LANE, MARSTONS MILLS, MA maximum cover. S.A.S. shall hove H-20 units and b� vented. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY No. 35109 0r�d f 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING FPrepared for: David Wadleigh, 64 Timber Lane, MArstons Mills, MA 0264831 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE CONSTRUCTION. Engineering by: Surveying by: SCALE DRAWN JOB. NO. DESIGN ENGINEER. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS A ENG� IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. EngineedngWorky Terry A. Warner PLS' 1"=20' P.T.M. 122-07 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). 12 West Crossfield Road 22 Long Road CHECKED ENGINEER BEFORE CONSTRUCTION CONTINUES. 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY Forestdale,'MA. 02644 Harwich, MA 02645 DATE SHEET NO. 5.-ALL ELEVATIONS BASED ON ASSUMED DATUM. AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. (508) 477-5313 (508) 432-8309 4/13/07 P.T.M. 1 of 2 r NOTE: TO PREVENT BREAKOUT, THE PROPOSED ff T.O.F F.G. EL: 93.5t FINISH GRADE SHALL NOT BE < EL:89.0 (EXISTING) i VENT FOR A DISTANCE OF 15' AROUND THE EXISTING F.G. EL: 93.7t(EXISTING) I l- F.G. EL: 93.6t PERIMETER OF THE S.A.S. 1 MAINTAIN 2% MIN SLOPE OVER S.A.S. 4' SCH 40 PVC PERFORATED PIPE WITH INSTALL RISERS OVER INLET & OUTLET INSTALL RISER OVER D-BOX TO SCREW CAP SET TO WITHIN I OF FINISH �_-500�CALLON LEACHING CHAMBERS GRADE TO SERVE AS INSPECTTION PORT. TO WITHIN 6" OF FINISH GRADE WITHIN 6" OF FINISH GRADE IN SERIES WITH STONE ALL SIDES INSTALL RISER OVER CHAMBER rl L =46' L=4, SHOWN ON PLAN AND SET COVER - (MIN.) ®"SSCH�OMPNc ®a®�®�® WITHIN 6" OF FINISH GRADE s° 4' SCH 40 PVC to" ®® a® 2" LAYER OF 1/8" TO 1/2" Q: a" ® S- 1% MIN. 6 (MIN,) aaa aaa DOUBLE WASHED STONE 48" LIQUID INV. 2' EFF. DEPTH aaa�®61® LEVEL INV.=90.00 3/4"-1 1/2" EXISTING ADD GAS BAFFLE D-BOX 4' S.2' 4' DOUBLE WASHED INV.=90.88 EFFECTIVE WIDTH = 13.2' STONE EXISTING 1000 GALLON SEPTIC TANK INV.=88.50 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING TOP OF CHAMBER ELEV.=89.5 PIPE INVERTS PRIOR TO CONSTRUCTION. -BREAKOUT ELEV.=89.0 INV. ELEV.=88.50 a®a®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO ®®®a®®a®®®® GRADE ON A MECHANICALLY COMPACTED SIX as®®®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.=86.50 310 CMR 15.221(2). 3' 2 x 8.5' = 17.0' 3' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' MIN. ABOVE BOTTOM OF EFFECTIVE LENGTH = 23.0' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE. T.P. EXCAVATION OR G.W. 5) STRUCTURAL INTEGRITY OF SEPTIC TANK SHALL NO G.W. ENCOUNTERED LEACHING SYSTEM SECTION BE RE-EVALUATED AT TIME OF INSTALLATION. BOTTOM OF TP EL: 82.0 SEPTIC SYSTEM PROFILE ESTIMATED DEPTH TO G.W.=30't BELOW EXISTING GRADE (BARNSTABLE G.I.S. DATA) N.T.S. (3) 5" DIA.0UTLETS SOIL LOG DESIGN CRITERIA { DATE: APRIL 6, 2007 (REF.#11,683) C SOIL EVALUATOR: PETER T. MCENTEE P.E. NUMBER OF BEDROOMS: 3 BEDROOMS ts.s" 6' 8„ �--" �/ ! ,/ r' WITNESS: DON DESMARAIS SOIL TYPE: CLASS I ` ' r ,r r' / r'``;% -� r �1' (HEALTH AGENT) DESIGN PERCOLATION RATE: 2 MIN./IN. rr H-10 LOADING 2" jEX/STING/ ;{ � � f' DESIGN FOLOW: 330 G.P.D /� / Elev. TP- 1 Depth Elev. TP-2 De D-BOX ,` / HOUSE (#64) r �- -� GARBAGE GRINDER: NO "Ta TOF=95.56' 93.5 A 0„ 93.5 A 0" ) / (Assumed)' SANDY LOAM SANDY LOAM LEACHING AREA REQUIRED: (330 = 445.9 S.F. 10YR 3/3 10YR 3/3 .74 93.2 8 4" 93.2 4" EXISTING SEPTIC TANK: 1000 GALLON CAPACITY (ESTIMATED) rlakN 0 ®®®® B ®®®®®®® 37" I W LOAMY SAND LOAMY SAND W ®®®®®®� -� IOYR 5/6 10YR 5/6 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES ®®®®E3®® i�-� �1= S2 Co- 91.0 30" 91.0 30" it - 1 Cl C1 SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F. 102" 5Y 5/3 SY 5/3 -----' `��, `� SILT LOAM SILT LOAM BOTTOM AREA: 13.2' x 23.0' = 303.6 S.F. 88.8 C2 56" 89 2 C2 52" TOTAL AREA: 448.4 S.F. PERC V " - - _ - 4" KNOCKOUT 1. DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 G.P.D. 20' OIA. COVER T , M-C SAND M-C SAND 64 4' KNOCKOUT O/4" KNOCKOUT 82" CV �60 10YR 5/4 10YR 5/4 PROP. S.A.S. I r+j 1BO BOULDERS ULDERS GRAVEL, 1BOULDERS GRAVEL, PROPOSED SEPTIC SYSTEM UPGRADE a" KNOCKOUT f----23'__� 85.0 C3 102" 85.5 C3 96" 64 TIMBER LANE, MARSTONS MILLS, MA MED. SAND MED. SAND Prepared for: David Wadleigh, 64 Timber Lane, MArstons Mills, MA 02648 2:5Y 7/3 2.5Y 7/3 Engineering by: Surveying by: SCALE DRAWN JOB. NO. 500 GALLON CAPACITY, H-20 LOADING 82.0 138" 82.0 138" EngfneeringWorkv Terry A. Warner PLS NTS P.T.M. 122-07 CHAMBERS /� NO GROUNDWATER OBSERVED 12 West Crossfield Road 22 Long Road - S.A.S. LAYOUT Forestdole, MA 02644 Harwich, MA 02645 DATE CHECKED SHEET NO. "T& PER'.; RATE <2 MIN/IN. ("Cl & C2" HORIZONS) (508) 477-5313 (508) 432-8309 4/13/07 P.T.M. 2 Of 2 7 U 0-�r 0,1 a e - oo O ba�G 74 t /l;70 ,/oTE Ga✓afe a !/ i s er-✓ioU /-z7af'et-i�! 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