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Home My WebLink About0120 TUPELO ROAD - Health 120 TUPELO ROAD, MARSTONS MILLS A= 057103 r r TOWN OF BARNSTABLE LOCATION. (d 12 SEWAGE# J 6) VILLAGE, o Al S ASSESSOR'S MAP&PARCEL J0 5 7- /0,3' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Th V 0 LEACHING FACILITY:(type) '3 _5100 6LChamhey,5-(size) NO.OF BEDROOMS OWNER DO M A (W Ul SCK- PERMIT DATE: /0 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 1 � I J � i -0 Z^ rr. ___0br No. / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliCation for Disposal *pstem Construrtion permit Application for a Permit to Construct(,�.K Repair(4<Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./ -ruPe 4 0 1"10ma Owner's Name,Add ess,,and Tel.No. M, ,-f1-0HS 01/11,f Pool13/gacvsfcl Assessor's Map/Parcelo_57/0 511wwl I taller's�1ame,Address,and Tel.No.sog-y2 0_g 93 Designer's Nayne,Address,and Tel.Notf'D&S(v0-.3311 X s min h !J-&43AP_`p.5* 1WA2_.Y15/^,4 Sao,9.Z'NG Type of Building: Dwelling No.of Bedrooms y Lot Size ( ± sq.ft. Garbage Grinder(QED Other Type of Building i No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) I gpd Design flow provided L' f gpd Plan Date 0 1�J Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 3 ij f?� c✓t��(n� Description of Soil Nature of Repairs or Alterations(Answer when applicable) rW T /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. i ed c 4 . Date Application Approved by p Date Application Disapproved Date for the following reasons Permit No. �" Date Issued 0, Lr) _n No. / i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Misposal 6pstem Construction Permit Application for a Permit to Construct(G,K Repair(l,)-lipgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./ .' T-,Jfje z U Owner's Name,Address,and Tel.No. `�•��i��5 GYI�f/s Ua�r��2vu1�k� Assessor's Map/Parcelo-7-/6)3 In taller's Name,Address,and Tel.No.S`OG`Y2 U-q 13 Designer's Name,Address,and Tel.No.SUS'3(vU X/ 6�d,6"vti-e/7` 12el h(/I �(e5 Ta r9 5 Type of Building: Dwelling No.of Bedrooms `T ! Lot Size c' . ( . sq.ft. Garbage Grinder(vU D Other Type of Building 5`�T�- -�,„ ,�1., No.ofPersons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) t ! (/ gpd Design flow provided L� ( gpd Plan Date 10' b 1�j Number of sheets Z Revision Date Title Size of Septic Tank Type of S.A.S. 3 - 5 o c,4( `(/M Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: �. The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed �� > Qc Date Application Approved by Date Application Disapproved Date for the following reasons J" i Permit No. Date Issued n _ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired O Upgraded Abandoned( )by \as fZ11 /�� dx -;/S at / /iaU li L 1/) d i29r,TUB?.S /�y,A has been con Vein accor ewith the provissio'nofTitle5 and the for Disposal System Construction Permit N . ated I• ast ller /(�.5�t�l� Ur �af'/�(JS DesignerScis? i�'G- r . #bedrooms Approved design flow gpd The issuance of his ermit shall not be construed as a guarantee that the system will nctio as�dg�signe AZ>Date Inspector �d J Q \Ij ------'-------------------------------------------------------------------------------------------------------------------------------- No. s Fee h�l f THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS NspoBal 6pstrm Construction 3permit Permission is hereby,granted to Construct( ) Repair(G-) Upgrade( L)- Abandon System located at is(— uy/=L(J fuarli/ 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:Construc/,ion m t be ompleted within three years of the date of this permit. Date / Approved by Town of Barnstable tSt-HE T Regulatory Services yP �n Richard V. Scali, Interim Director * BARNsrAE;LE. 9 MASS. .a Public Health Division i639• �0 Thomas McKean, Director 200 Main Street, Hyannis, vIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form i Date: 2 � �(0 Sewage Permit# )��) Assessor's Map\Parcel Designer: Installer: ` as Address: PO Address: cl-7-m dyl sxe-,0_5 Alt On DO5� �l )00o-Swas issued a permit to install a (date) '(installer) septic system at !,h —ru r p 84-D �fj , M , I''l� i based on a design drawn by I^/� (address) dated (designer) A A I certify that the septic system reerenced 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 constructe v , r e with the terms of the IAA approval letters (if applicable) DAR �I SREN (I staller's Signature) (Designer's Signature) (Affix Designers amp Her64 PLEASE RETURN TO BAI STABLE 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.doc TO OF BARNSTABLE LOCATION� , !G� o- � � / SEWAGE # j ' II.LAGE � l � ASSESSOR'S MAP & LOT �} p INSTALLER'S NAME&PHONE NO. ';7 SEPTIC TANK CAPACITY _ ,r LEACHING FACILITY: (type) ' 4`�`S (size) NO.OF BEDROOMS !�L l BUILDER OR OWNER A z�r r PERMTTDATE: <,— 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 Wedand and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by �r ; ry � �,� ._ i y[� i f '�t C� � -v. �- y � _� � `4 � 1��f � Jam`.ti"A e� t�1 �� — ��,� _� �� is i � p i r Fee $50 .00 No^ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprtcation for 0i5po5al *p5tem Construction Permit Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. 12 0 T u p e 1 o Rd Owner's Name,Address and Tel.No. 4 2 8_6 2 6 4 Marstons Mills MA Fred Cahill Assessor's Map/Parcel Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Spet Sry PO Box 1089 Centerville ,MA Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ng) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching consisting of 4 hd stonepacked infiltrators . 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 Certifi- cate of Compliance has been issued by this ar4k Health. Sign Date Application Approved by m Date Application Disapproved for the following reaso Permit No. Date Issued _ TOWN OF BA//R;;N ,TABLE r ✓C r Ci 9< SEWAGE # LOCATION .. ASSESSOR'S MAP LOT INSTALLER'S NAME&PHONE NO. +� 16 SEPTIC TANK CAPACTI'Y 3 '� a (size) LEACHING FACILITY (type) NO.OF BEDROOMS / % f BUILDER OR OWNER — �' COMPLIANCE DATE: PERMIT DATE. Feet Separation Distance Between the: Facilityng mum Adjusted Groundwater Table and Bottom of I-eWells exist eet Mau . If any F ' 't aciL Lea ching c tun g Facility Private;Water Supply Well and facility) on�site or within 200 feet of leaching If.an etlands exist Feet Edge of Wettand and Leaching.Facility Within 300 feet of leaching facility) Furnished by } 37 Fee$50.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes y� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zipprication for Migpooar *p!5tem.Cou!5tructiou Vertnii° Application for a Permit to`Construct( )Repair'(X)Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. 12 0 Tupe 1 o :Rd Owner's Name,Address and Tel.No. 4 2 8-6 2 6 4 Marstons Mills MA Fred Cahill Assessor's Map/NiZel Installer's Name;Address,and Tel.No. 7 7 5"8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Spet Sry PO Box 1089 Centerville ,MA Type of Building: Dwelling No.of Bedrooms 4 Lot Size sq. ft. Garbage Grinder( ng Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan`"Date Number of sheets 4 Revision Date e. Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching consisting of 4 hd stonepacked ifif ilkrators. I r, 1 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 Certifi- cate of Compliance has been issue by this ar of Health. [� �` i Sign d Date J ~`� 7 Application Approved by a u Date Application Disapproved for the following reaso Permit No. Date Issued =——————— —— ——— ——————— —————————— THE COMMONWEALTH OF MASSACHUSETTS JJI BARNSTABLE, MASSACHUSETTS Cahill Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( X)Upgraded( ) Abandoned( )by at 120 Tupelo Rd.' , MArstons Mills h s n constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Wm E Robinson Sr Sept Sry Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date - '7 9`2 Inspector � —----------------------------- No. J / 4 Fee$5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Cahilll j Migpogar *Pgtem Cou!5tructiou j3ermit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 120 Tupelo Rd. Marstons Milks Installer Wm E RobinsonsSr Sept Sry and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constructirlux�q completed within three years of the date oft ' e •.it"' ` ` o Date: %.7 Approved by f Y i 1 NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CER I IR ATION Or SKETCII AND APPLICATION FORA DISPOSAL NVORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLAN hereby certify that the application for disposal works construction permit signed by me dated �--� � ✓ , concerning the property located at TV meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • "There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in Flow and/or change in use proposed • There are no variances requested or needed. SIGNED i ✓ DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. j:ccrt Y 1 J1 �t 1/b'�V � �o al y t Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection William F.Weld Trudy Coxe Governor S-11111.y Argso Paul Celluccl David 8.Struhs U.Gm rnor C unwalwty 019 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 8 PART A - CERTIFICATION 49 property Address: 120 Tupelo Rd, Marstons Mills MA Address of fa Fr C�a.hill Date of Inspection: (If different) CE�VE� O Name of Inspector. W.E. Robinson SR y Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 A Y 8 19 g 7 � Will P.C. Boxx1nson 1089 Septic CentervilleService MA TOWHE°FgAr, ,T if CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the informat n below' to and complete as of the time of inspection. The inspection was performed based on my training and experien r and maintenance of on-site sewage disposal systems. The system: L/PLs Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: ` ��v 3 7 17 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: A] tI PASSES: ve not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, cracked,structurally unsound, shows substantial infiltration or exfltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 0 FAX(617)556-1049 a Telephone(617)292-5500 1•Aj Panted on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 120 Tupelo Rd, Marstons Mills Owner. Fred Cahill Date of Inspection: s- 7-.q Bl SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution boa is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) THER 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is lase than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) O ER (revised 11/03/95) 2 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) propertyAddress; 120 Tupelo Rd, Marstons Mills Owner. Fred Cahill Date of Inspection: D- 7 Q .1 D] 8 STEM FAILS: have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. The basis for determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the Backup of sewage into facility or system component due to an 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E)LAR SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddre" 120 Tupelo Rd, Marstons Mills Owner. Fred Cahill Date of Inspection: C.. C� r] Check if the following have been done: ✓lumping information was requested of the owner,occupant,and Board of Health. one of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. t/The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. ZA11 system components, excluding the Soil Absorption System, have been located on the site. ✓The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of battles or tees,material of construction,dimensions, depth of liquid,depth of sludge,depth of scum. 1 he size and location of the Soil Absorption System on the site has been determined based on existing information or Japproximated by non-intrusive methods. L/The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 120 Tupelo Rd, Marstons Mills Owner. Fred Cahill Date of Inspection: s—7— FLOW CONDITIONS RESMMMAU Design flow :er ons Number of bedrooms: Number of current residents: y Garbage grinder(yes or no):•�O _ Laundry connected to system(yes or no�> Seasonal use(yes or no):_ Water meter readings,if available: 1 9 9 6 — 97 , 000 gals 1995 - 92 , 000 gals Last date of occupancy: 5—7— 7 COMMERCIALANDUSTRIAL: Type of establishment: Design flow:_gallons/day 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: Lest date of occupancy: OTHER(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: s G�,& 0 r-� 5 -•L- 4 q IR,d w o r ►� System pumped as part of inspection: (yes or no)A,0 If yea,volume pumped: gallons Reason for pumping: l?t m a o/L TYPE O 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) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: /6 Sewage odors detected when arriving at the site: (yes or no) k_ (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 120 Tupelo Rd, Marstons Mills Owner. Fred Cahill Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: ✓concrete_metal_FRP_other(explain) L It Dimensions• Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffler 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: 1 �l Comments: (recommendation for pumping,condition of inlet outlet tees or baffles depth of liqui level ' relation to tlet invert,structural integrity, evidence of leakage,etc.) m — l G E TRAP:_ (locate on site plan) Depth low grade: Mate ' of construction:_concrete_metal_FRP_other(esplain) Dime ions: Scum ess: D' from top of scum to top of outlet tee or baffle: D' from bottom of scum to bottom of outlet tee or baffle: Comm ts: (repo endation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evide ce of leakage,etc.) (revised 11/03/95) 6 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 120 Tupelo Rd, Marstons Mills Owner. Fred Cahill Date of Inspection: TI TOR HOLDING TANK_ ( oa sits plan) Depth low grade: Ma of construction:_concrete_metal_FRP—other(explain) Dime 'ono: Capaci gallons Design flow: gallons/day Alarm evel: Cc nts: (co on of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP HAMBER: ( on site plan) Pumps ' working order:(yes or no) Comme (note co 'tion of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddres, 120 Tupelo Rd, Marstons MIlls Owner. Fred Cahill Date of Inspection: 5--9-9 7 SOIL ABSORPTION SYSTEM (SAS):_z (locate on site plan,if possible;excavation not required,but may PP be approximated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits, number: leaching chambers,number:. leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Comments: (note condition of soil,signs of hydraulic failure, level o f_ponding,co f ve e do�tc.) D O� A_ r$ �/�3 /Y o� A 1 C OLS: (locate on site plan) Number d configuration: Depth-to of liquid to inlet invert: th of lids layer- ;Depth of layer: ensio of cesspool: e ' of constriction: n of groundwater: inflow(cesspool must be pumped as part of inspection) Commen :(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate om site plan) Mate ' of construction: Dimensions: Depth of solids Commas :(note condition of soil,signs of hydraulic imbue, level of ponding,condition of vegetation,etc.) jt .= (revised 11/03/95) 8 y L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddrese: 120 Tupelo Rd, Marstons Mills Owner. Fred Cahill Date of Inspeotion:S'-9-7 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' \ lr) J ) n DEPTH TO GROUNDWATER Depth to Voundwater: feet � method of determination or approximation: 57 �f/a L5 (revised 11/03/95) 9 . ZC) TOWN OF B.ARNSTABLE I:OCA'IION Ld,7� 7y pe /C�ZQSEWAGE VILLAGE i p 1 4 L5ASSESSOR'S MAP & LOT NSTALLER'S NAME PHONE NO. Me 4 — �ti,T�: SEPTIC TANK CAPACITY 6 C) O BEACHING FACILITY:(type) (size)-4Q C) O NO. OF BEDROOMS 2 PRIVATE WELL OR PUBLIC WATER� (l BUILDER OR OWNER 17/71 sl �� a✓ ` DATE PERMIT ISSUED: /y 1 DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �# `' �� r �`+ p I � e ..�� f �� 1 No................_....... Fss............._............... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH , .......d .......►•................oF. . AP s ........Kk.4.5------- ApplirFation for Disposal Works Tonotrurtinn Vamit Application is hereby made for a Permit to Construct (V-15%or Repair ).,an, Individual Sewage Disposal System at: v ........ ? .P:L0.. .. :...................................... ......................1-'o-T...._. 3. ..... ...._........ a ion_-Address • Owner Address ------------------ ... Installer Address U Type of Building Size Lot..43_r5l,_A...Sq. feet Dwelling—No. of Bedroom`s---3............. . ..__......Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building W0� o. of persons Showers 0.� YP g -------------------- - � P ------------------ ( ) — Cafeteria ( ) t14Other fixtures -----------------------------------------------------------------------------------------------------••---------------------------•---............---• d W Design Flow..... .. ..........................gallons per person per days. Total daily flow.....�.�__C.�......................g ollons. WSeptic Tank—Liquid capacityl O!gallons Length.l��`4;_._ Width.±^A.4� Diameter................ Depth.4.'.0.. x Disposal Trench—No..................... Width_i .`....._...._...... Total Length.................... Total leaching area....................sq. ft. 7 � Seepage Pit No.....9............... Diameter.......11...�.0°. Depth below Inlet...1..�...... Total leaching area4.83:1t<a Z Other Distribution box Dosin tank ( ) _i} '"' rs Percolation Test Results Performed by...._. _. _ ..._ �Z,..z-'_. �'2d0 o Date Test Pit No. 1.... .........mmutes per inch Depth of Test Pit.....1.16�_.. Depth to ground water....... ®a-+.�.=�-__. (s, Test Pit No. 2...`2..-------minutes per inch Depth of Test Pit.... Depth to ground water.n1).4. ___ Ox ------. Alki ® - Description of Soil - 4T..�! ----••:.......•-•---..... __.`--3 . M� Q 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 TITL 12 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. Signed .. .... -- - -- f 6 / Dto/ Application Approved By--- -a .. -----=------------------•--•-•---•-•------- --------------- Date Application Disapproved for the following reasons:.............................................................................................................. ....................••-------•---•-•--•---.................--•-------------------.....---•----------•-•------------------------------------------------------.._....---------•--------------------....... Date PermitNo.......— ------- - --I------------------ Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH Appliratiun for Uiupuutal Workii Tunitrurtiun Prrutit Application is hereby made for a Permit to Construct ( le�or Repair ( ) an Individual Sewage Disposal System at: .. e..= = :............................•-•--_... ..._...-------------- -............---•- ..... -- ----------------.... ---- on- ddress or t No J .�►......................... ..4g__ ca:5g U . Q. .N Nl tFkwD ......................r ._.. _. -- - Owner Address , Installer Address Type of Building Size. Lot... .t_S.O:I.Sq. feet U Dwelling—No. of Bedrooms.....�1...................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building R p� yp g ___. __. o: of persons._.___ ________________ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------- ----------•--•----------------------------•-----------------------•------•--......---• Design.-Flow....... ...................._____ allons er erson per day. Total daily flow...._._ W- gg P P P4 ,Y e Y 9 ga�lons.I P4 Septic Tank--Liquid capacity.1$�0gallons Length._i.'-_lP._ Width.A!n O biameter________________ Depth____'_4f. Disposal Trench—.No_____________________ Width__9................. Total Length._____.___.-_ i_- Total leaching area....................sq. ft. Seepage Pit No.................... Diameter.__.. "._�?��. Depth below inlet-- I-_.V_.____ Total leaching areaAW:1910r.4 P.D. Z Other Distribution box (s Dosin tank '—' Percolation Test Results Performed by---%A: ®: &- ........ ..............................� Date____. �� l�r a2 63v�j Test Pit No. I...._........minutes per inch Depth of Test Pit_______t_' _- Depth to ground water____ _ !6m Test Pit No. 2.:__�......minutes per inch Depth of Test, Pit,.... Depth to ground water. ............................................... D Description of Soil " tea T e `' `4 ..�6� .,��o� �O� �, . �+a_�-�4�4_�'--------------•- U ,.._, _. .. � � `.-----�1Zt�X.5a........... �s��.....�..a_2! � �- ��'�!'�,� ............................................ W -----------------•-----------...----•----------•----------------------------------------..---------•----------------------------------------------------------------------------------------•-----•----- UNature of Repairs or Alterations—Answer when applicable................................................................................................. -•-------------------------------------------------•----------•--•-••-..._-•••---•..-...----- _ Agreement: d : L �' r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with F � the provisions of TIT1Z- 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. Signed .... ....... .....? Application Approved BY--•-------- ` Date Application Disapproved for the following reasons:............................................................................................................... _ .....................•------••---...------•------------=-----...-•---•-------------------.-.-.-•-....-•-------------------------------------------------------------------------------------••------•-_. Date Permit No.--- Issued Z. .... Date, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH (j.... ....................OF.............. ....:...............:5......................._.................. 01rrtifiratr of TuntpliFatta THIS IS TO CERTIFY, That t e Individual Sewage.Disposal System constructed ( ) or Repaired ( ) Y -------...... _ I _------••--- -- -•-- t] -T 4 Installer at.......................................................... 1 has been installed in accordance with the provisions of TI� / of`T)tState Sanitary Cod�a� d e��ri�ed in the application for Disposal Works Construction Permit No......................................... dated...............-..___/_______I_____.._._.___.___. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... ---•---•--•---•-------=-------- Inspector---._ .. .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7_ // -C�_Aj.........OF................... _. ........._....................... . No. ................. FEE------- MsVoiiFal Work.5 Tunutrtt.rtiun rrutit Permission is hereby granted............. j G-i� @� �at --•---------------------------------•--_---•------•---------------•---.-__----------_- to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo.......... _ra :..."��.------...—,•- = / - " -' -----------------------••---•------------------------- -----------.............. J` -t'f�-----��-•�......____ e�-- Street as shown on the application for Disposal Works Construction Permit Dated____Jj_-Z(g_ ----- __________ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS b � ! 33 •�y .E � 34 t3 E 43, Y . �,y.s.t t,+�d�,Twt�¢, .s ,,'t,� ( "'X'..:,•k t q�. t'�,•�r'yd t3� �„'• y d 7�i'"k k.: k.'' ;4- fita f�.✓tb"' ,� .t ,'• t 4, i.r`tild�K + 1T_ x '; as too 3 �► Lw AGE ca . Rtin Lnva v -10 AR � ,a�',� y. 11 y}. - '�`is},x�Js 1 0% AIN 10 jr kL WALTER E. 15�f A'�F( • J 1't .'t C Y � i (U d r y o , V SMITH,8 JR6 u TE FSS70 AL II /OZ 50 •r � �r to 10 C 015T..gCK 14 ao �dUD 9�3� oo CcFr. D1<1M. Gad. C°^c' A o ea Co�.tc•L.::AcN��ty Pir. � SGP�rc- Ton k 4S 4 4a . e AAO , non 4- A4 A� •S: 9 V A A i�° �¢-I �t washed s�o Bor. PrT tey 100.0 �L� G2O�y�1��.• . �-o fb,-,TA D F.-st la,t4 DA-r-A r ; 'CR•Co�,ATI oN RATL: 2 IvIAllo4c" DR o P q�5 3o TEST -PrsLF-ommED c ��S, rr E3P•DROOMS K 110 GPD = 33o GPp LEAc"lueq Iv0 CiARE�AUE DISPO$AI. L� E. .ECt�C��AI:•SEPiItT i CAPAGITy PR,oVIDsD : i \53•g c-, P D SI DE5-T14 V, K 2.5- 329.9CUD Sow�E. Tcsra� CA FA �Zov/Pep 483.8-C PD . C lV oTE— D 15 POSAC- SY DiE IcTN E D 1 N AcGoRDANGE W ) T44 PROVISIONS Oj C-0V&4-M K\BLS LEGEND MARSTON°S -MILLS PROPOSED CONTOUR i R001 28 0 ® PROPOSED SPOT GRADE \ w � —— 98 —— EXISTING CONTOUR \ N + 96.52 EXISTING SPOT GRADE P W— EXISTING WATER SERVICE \ LOCU a TEST PIT EXIST. I 000 GAL QJ� , SEPTIC TANK t \ �pF�o 66 BENCH MARK Rp 2 i ® \ PAINT SPOT ON CONCRETE STEP eo�e 66.63 \ 3 OF USGS DATUM ASSUMED LOCUS MAP ° O�E�R//,G k 65 ° ° LOCUS INFORMATION 0 64 \�. TITLE REF: C144613 2o� \ PARCEL ID: MAP 057 PAR. 103 VI 66 . - �- - o �f L O T 3 00 1 AREA = 43561 sf+— 6 / I i \ I o� � f/� ! TH-7 LAND COUP.T PLAN 39614—B SEPTIC SYSTEM 65 OiN X v 0 67/ \ I ASSR MAP'57 PCL 1 03 REPAIR PLAN \ r TH-2 ; ; LOCATED AT: I 120 TUPELO ROAD MARSTONS MILLS, MA. cl PREPARED FOR DOMBROWSKI ° ' OCTOBER 8, 2015 REV: JANUARY 12, 2016 OF i G R r '. DA E, ,R 5 PLAN i yd (bo SCALE: 1 in = 30 ft 0 30 60NITAR�P l )I r �o 0 10 20 30 60 MEYER & SONS INC. i / ` \ '65 3� P. O. Box 981 O E. SANDWICH , MA 02537 f PH: (508) 360-3311 O ® FAX: (774) 413-9468 meyerandsonstitle5@gmail.com www.meyerandsons.com O 1 SCALE: 1 in = 30 ft SHEET 1 OF 2 J#1747 NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GENERAL NOTES: SEPTIC TANK GRADE SHALL NOT BE < EL:63.25 FOR A DISTANCE INSTALL RISERS & COVERS OVER INLET & 15' AROUND THE PERIMETER OF THE S.A.S. PROPOSED D-BOX 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL T.O.F. EL.=67.54t OUTLET AND SET TO 6" OF FINISH GRADE INSTALL RISER & COVER PROPOSED S.A.S.� BOARD OF HEALTH AND THE DESIGN ENGINEER. SET TO 6" OF GRADE INSTALL A RISER OVER ONE CHAMBER (MIIN) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS • `F.G. EL.=67.2t AND SET TO 3" OF F.G. OF THE STATE ENVIRONMENTAL CODE. TITLE V. AND ANY APPLICABLE F.G. EL.=67.12t F.G. EL: 66.30t LOCAL RULES AND REGULATIONS. 19 f F.G. EL: 66.25(MAX.) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILL.ED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. sl 9" MIN COVER/ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 36" MAX COVER `' L = 25' L = 10'(MAX) FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ® S=1% (MIN.) EL.=66.12 ® S=1% (MIN.) 0 S=1% (MIN.) ENGINEER BEFORE CONSTRUCTION CONTINUES. 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" STONE OR FILTER FABRIC 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. T 10. DOUBLE WASHED STONE 6 / 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF �• INV.=65.05 14 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF M'LIOUIOHEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. INLEI kNV.=64.80 ®®®®• O ®®®® f PROPOSED ®®®®®®®®®®® 7. DWELLING IS SERVICED BY MUNICIPAL WATER. GAS BAFFLE J E3 EM®E3 E3 EM E3®®E3 E3 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED INV.=63.60 ®®®®®®®®®®® INV.=63.80 DB-5 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE EXISTING 1.000 GALLON SEPTIC TANK H 3.2 ' 3 X 8.5' 3.25' LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. 10. EXISTING LEACH PIT TO BE PUMPED. CRUSHED AND FILLED PER TITLE 5. EXIST. SEWER OUTLET EFFECTIVE LENGTH = 32.0' 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY INV. ELEV.= 62.2E AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY BREAKOUT 13. NO KNOWN PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. ) NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING TOP CONC. ELEV.= 63.25 ELEV.= 63.25 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW PIPE INVERTS PRIOR TO CONSTRUCTION = FOR THE USE OF A GARBAGE GRINDER. 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 62.25 M 63 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING GRADE ON A MECHANICALLY COMPACTED SIX ®0a®®a® INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM EL.= 60.25 ®0®®®11EIIa 310 CMR 15.221(2) 4' 5 FT. 4' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK EFFECTIVE WIDTH = 13' WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPARATION 6.04 FT. DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SOIL ABSORPTION SYSTEM (SECTION) 4) INSTALL INLET & OUTLET TEES W/ SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 54.21 (500 GALLON LEACH CHAMBER) GAS BAFFLE AS REQUIRED N.T.S. DESIGN CRITERIA SOIL LOGS P#:14705 NUMBER OF BEDROOMS: EXISTING 4 BEDROOOM SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) DATE: 1, 201 E DARR SOIL EVALUATOR: DARREN M. MEYER, IRS, CSE DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DAVE STANTON, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D. X 4 BR DESIGN FLOW: 440 G.P.D. Uf MgS�q� GARBAGE GRINDER: NO (not designed for garbage grinder) Elev. TP-1 Depth Elev. TP-2 Depth DARREN M o . s SEPTIC TANK: 440 gpd x 200% = 880 gpd USE EXIST. 1,000G SEPTIC TANK 65.44 A LOAMY SAND 0" 65.21 A LOAMY SAND 0" MY LEACHING AREA REQUIRED: (440)/0.74 = 594.59 S.F. 64.77 1OYR 3/2 8" 64.71 10YR 3/2 6" 14 y LOAMY USE THREE (3) 500 GALLON PRECAST LEACH CHAMBERS s2.3s B YY 6/0 37" B LOAMY SAND �'£cIS1E 1 oYR s/s W/ 3.25' STONE ON ENDS AND 4' ON SIDES: 32' L x 13' W x 2' D C1 s2.2s C1 35" SANITAR�a FINE- FINE- MEDIUM MEDIUM BOTTOM AREA: 32 x 13 = 416 SF SAND SAND SIDE AREA: (32 + 13) X 2 X 2 = 180 SF PERC TEST 2.5Y 6/4 2.5Y 6/4 0 61.02 TOTAL SQUARE FEET PROVIDED = 596 vs. 594.59 REQ'D PROPOSED SEPTIC SYSTEM UPGRADE PLAN DESIGN FLOW PROVIDED: 0.74(596 S.F.) = 441 G.P.D. vs. 440 G.P.D. req'd 54.44 132" 54.21 132" 120 TUPELO ROAD, MARSTONS MILLS, MA PERC RATE <2 MIN/IN. ("Cl" HORIZON) NO GROUNDWATER OBSERVED Prepared for: Dombrowski System Design and Site Plan by: SCALE DRAWN DATE MEYER&SONS,INC. N.T.S. DMM 10/08/15 • 1. Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX 981 to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA01537 REV DATE: CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I hove passed the Soil EvaL Exam in October, 1999. 508-362-2922 01/12/16 DMM 2 Of 2