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Home My WebLink About0010 WATERS EDGE - Health 10,Waters Edge . .. .. -- - Marstons Mills \ A=062-036-Lot 037 f 9 ,s sve orjqzr d 'A paring iu ry a I Fmd MapP ra cel`:, 062036 F� c�Owner Parc dAV 062036 DEI D V Account�Na 000351 parent 0000000 i� // � v � � a'' Neighi�orh©od 15AB DevelLot F LOT 37 Lot Size 1.04 /C�urr "D RYAN WENDY M State C lass 101 ug y 00001438 „ U � a 10 WATERS EDGE YearAdded 00 ` MARSTONS MILLS MA 02648Y. . K sewer acct / eDate 062283 ° �� Reference 13534 029I / o W,GondoCompz Building lJnit3 W,PA3. �i � � t In January 1st RYAN WENDY M / / ee,_ MINYY 0683 Did ntlRef 3777/276 � Buildm st 000139100 Extra Fe y �� uafues and 000080800 � '�' � � � g�tut / 9 aturesa 0000000000 y, Location 10 WATERS EDGE rx Road°Index 1879 Frntg 0164 ` Fire Dist CO r ,� r WHISTLEBERRY DRIVE Sec Index 1885 g 016 Frnt 5 a / SU . h 9 � iv p C. off S )o bS 3 VUe J bQ J i Q 0 O MFURRAY RESIDENCE 10 WATERS EDGE MARSTONS MILLS, MA. 02648 EXISTING BASEMENT FLOOR PLAN FAf LED INSPECTION COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Z DEPARTMENT OF ENVIRONMENTAL PROTECTION l�, F + d RECEIVED (COP? W �e ib^M SV 0� APR 2 8 2004 T01kn&5,5v +AbLE OFFICIAL INSPECTION FO — T NTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 i��\- -\ Owner's Name: KEARNEY Owner's Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 OL Date of Inspection: 4/2/04 'vIAP "'"" 2v PARCEL Name of Inspector: (please print) JOHN GRACI,INC. LOT Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _ Passes _ Conditionall asses _ Needs Furt Evaluation by the Local Approving Authority X Fails Inspector's Signature: Date: 4/2/04 The system inspector shall submit a opy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti . If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner sha I 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 SYSTEM FAILED TITLE V INSPECTION. PIT WAS FULL AT TIME OF INSPECTION AND HAS NO EFFECTIVE LEACHING LEFT IN IT.D-BOX APPEARS TO BE STRUCTURALLY UNSOUND.RECOMMEND REPLACING D-BOX. ****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. Title 5 TncnPrtinn Fnnn h/1 v,)n n 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 Owner: KEARNEY Date of Inspection: 4/2/04 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: SYSTEM FAILED TITLE V INSPECTION.PIT WAS FULL AT TIME OF INSPECTION AND HAS NO EFFECTIVE LEACHING LEFT IN IT.D-BOX APPEARS TO BE STRUCTURALLY UNSOUND.RECOMMEND REPLACING D-BOX. 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. n/a 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: n/a n/a 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: n/a n!a 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: n/a Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 Owner: KEARNEY Date of Inspection: 4/2/04 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ 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 n/a "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: n/a Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 Owner: KEARNEY Date of Inspection: 4/2/04 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 nLa. 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 I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] YES (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 _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 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 3I0 CMR 15.304. The system owner should contact the appropriate regional office of the Department. d Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 Owner: KEARNEY Date of Inspection: 4/2/04 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)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 Owner: KEARNEY Date of Inspection: 4/2/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 4 Does residence have a garbage grinder(yes 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): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _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): n/a Approximate age of all components,date installed(if known)and source of information: APPROX. 1985 PER OWNER Were sewage odors detected when arriving at the site(yes or no): NO h r Page 7.of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 Owner: KEARNEY Date of Inspection: 4/2/04 BUILDING SEWER(locate on site plan) Depth below grade: 12" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 6" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 10"" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a 7 Page k of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 Owner: KEARNEY Date of Inspection: 4/2/04 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-BOX WAS VIDEO INSPECTED AND APPEARS TO BE STRUCTURALLY UNSOUND.D-BOX NEEDS TO BE REPLACED. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R f Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 Owner: KEARNEY Date of Inspection: 4/2/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6'X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): LEACH PIT WAS FULL AT TIME OF INSPECTION. PIT HAS NO EFFECTIVE LEACHING LEFT IN IT AND NEEDS TO BE REPLACED. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 Owner: KEARNEY Date of Inspection: 4/2/04 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. 3 b � 1A 10edc A C AAS I �3 BC I� in Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 WATERS EDGE ROAD MARSTONS MILLS,MA 02648 Owner: KEARNEY Date of Inspection: 4/2/04 SITE EXAM _Slope _Surface water _Check cellar _Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. 11 i i TOWN OF ARNSTABLE pp/r I LOCATION ./�ZQ SEWAGE # b ASSESSOR'S MAP & LOT C) INSTALLER'S NAME&PHONE NO."JDe SEPTIC TANK.CAPACITY Ac2m ' LEACHING FACII.ITY: (,type) .��. i 'G'YLS (size) NO..OF BEDROOMS BUILDER OR 0 R "ir.J PERMITDATE: Iq. b C MPLIANCE DATE: IS Separation Distance Between the: Maximum Adjusted Groundwater le 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 t ` �L pv3T60VI Town of Barnstable OF SFIE Tp� o Regulatory Services Thomas F. Geiler, Director BARNSTABLE, M�; � Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: rJ Designer: c.i, �Y- Installer: Address: ,�j( Ga Address: On _ ages was issued a permit to install a (ate) (installer) septic system at lb \� F , R �R\\f, based on a design drawn by (address) dated designer) /V\ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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. ��H OF AggSS� CARMEN (Installer's Signature) E• SNAPCUM No. 1181 \a (Designer's Signature) (Affix Desi Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE :ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form C_ S^N - 20-01 13 . 52 BARNSTABLE HEALTH DEPT 5087906304 SRS%Oi NOTICE: This Form Is To Be Used For dae Repair Of Failed Septic Systems Only, PERCOLATION TEST At\(D SOIL EVALUATION EXEMPTION FORM QMt►.1 �_ , hereby certify that the engineered plan signed by me JcteC • concerning the property located at meets all of the iollowing cntena This failed system-is connected to a residential dwelling only. "There are no :or merzia! or business uses associated with the dwelling, TT•.e soil is ciass: ed as CLASS l and the percolation rave is less than or equal to -n:nutes pef Inch. The applicant may use histo•neal data to conclude this f3c, ur may :onduct Pre:trni:•,ary tests at the site without a health agent present • There :s no increase to now and/or change in use proposed • i here are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen l,) f.e; aoove the maximum adjusted groundwater table elevation. (Adjust the ounc:wwcr table using the Fnmptor method when apphcablej Please complete the following; TOp DI Ground Surface Elevation (using GIS inform. auon) g; \X Elevacor, _ ,d;us(men( For high G.W. .--.. = 4P :)'FTT:RFN(--F BETWEEN and B 12 • o S.G'►1E D --- — D ATE; a NOTICE 33sec Jr()n L"e above ir.formaclon, a repair pem.-uk will be issued for '7zdroorns Ta,.,r•u r: `:^ ;dd u:nal bedrooms ale authorized to th Future without en,tneerec :ept,c syste-n plans. _— — a, lrcun!r,:act pcicc.tmp Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: w ecS r i Lot No, - Owner: Address: Contractor: Address: p 1MOJ'° Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. ............................... ........................................... .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... OWater level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... (�'� 40t /year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water level zone (STEP 2B) determine water-level adjustment L�•8 .................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water L'C� level at site (STEP 1) .................................. . -T `•`� Figure 13,--Reproducible computation form. 15 No. t4 7 FEE Board of Health, NM. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) RepaxUpgrade( ) Abandon( ) - ❑Complete Systenll>�*dividual Components Location IkA `11g Owner's Name Map/Parcel# © (Q Z 3 Address �M Lot# #J' Telephone# Installer's Name Designer's Name vk- i Address Address D r Telephone# a,, Telephone# ^a Type of Building �j� C?y2,(Z C� Lot Size '451 3a(p sq.ft. Dwelling-No.of Bedrooms i 2� ,"J� Garbage grinder 4/ Other-Type of Building w E No.of persons+Showers (VrCafeteria(uj Other Fixtures L-f�nl R'Tb�� jGt�'(`'�¢��`, ��k, ��t)tJpe•`1 Design Flow (min.re uired) � gpd Calculated design flow L,3Q Design flow provided 3 gpd Plan: Date Number of sheets Revision Date Title �l !;am Skwaonp tm /t Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluators Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS �< C fPA f l The rsigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further ees to of to place em in ration until a Certificate Co p'ance has been issued by the Board of Health. Signed n Date oq P Ins ections / �".. .r^-•./b--. t, .r.r.ry,.ry.,, .-r"�Yv-..-y�+rr�'!`.-1 ._ �_..� r..�-s.r..i.'O+..f✓1�"1� y�'� --""5r�./�..r^.y.n"�+'+rl�t1`�".`r•"`.-Y-"/t.C1"Yy^ts..-•'`�•r^r�'^",•- « � , J 1 - s. S 1 l i No. '- .-,; .-;.v�y t b`� � FEE C PRONWLALT14 ®F MASSACU �S Board of Health,-.41 f 4... APPLICATION FOP, DISP SYSTEM CONSTRUCTION PERMIT E Application for a Permit to Construct( Repai j �Upgrade( Abandon( - ❑Complete System,1Xndividual Components ; f f Location �`t11s Owner's Name "� �� Map/Parcel# (t; �� Address �AM p Lot# :tl-, Telephone# , , Installer's Name Designer's Name �^ r. Address' , Address O _► Telephone# 6%-\e� � p Telephone# Type of Building Lot Size '4-5 1 c (a sq.ft. Dwelling-No.of Bedrooms K\��? �J� Garbage grinder (t�iA Other-Type of Building E�e:)I'l E7 L No.of persons+Showers (Io�/Cafeteria (L�/ Other Fixtures'+ � P. j F,,-mz_� i rtc , LAyo by-Y 2 Design Flow (min.required) � gpd Calculated design flow 0 Design flow provided J�� gpd Plan: Date *'I!-'�1c�.�Q�- v Number of sheets Revision Date Title t� 7R Q Sj�3 S CCZR SQ_11�(111C'19 70�IsootrA '� n Description of Soil(s) Ch'l �* Soil Evaluator Form No. �- Name of Soil Evaluator OM CrQr*) Date of Evaluation t 04 _ y DESCRIPTION OF REPAIRS OR ALTERATIONS "7N G,f')' The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furtherkagrees to not`to-place a sy wtem,in o eradon until a Certificate Com dance has been issued by the Board of Health. Signed A. 1 Date k ! / lns P ectio s / No. 7 COMMONWEALTH]LTH OF MASSACHUSETTS FEE �?� j Board of Health, 61M• /_, , MA. CERTIFICATE OF COMPLIANCE Description of Work: `Individual Component(s) ❑Complete System The undersigned here y certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: 1C ' �,� be, , at has been installed in accordance with the provisions of 310 MR 15.00 (Title 5) and the approved design plans/as-built plans relating to applicatio�No. VV�r 4/ dated /Vt Approved Desi Flow (gpd) Installer Designer: t,Inspector: Date: 1 S ( / The issuance of this permit shall not be construed as a guarantee that the system will f nction as designed. No. C} q FEE C/ COMMON IT14 Of MASSAC14USETTS Board of Health, MA. 0 DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair 1) Upgrade , ) Abandon( ) an individual sewage disposal system at rr� l� 7` lt�� r� S _ as described in the application for y.d .,,Disposal System Construction Permit No t (,.7 ,dated 11 N �� . Provided: Construction shall be completed within three years of the date of this per ,it. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date q1'I/VV Board of Health YC.� 1 E v r. COMMONWEALTH OF MASSACHUSETTS �`� 17 EXECUTIVE.OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF,ENVIRONMENTAL PROTECT ION MA OAF Y • . . S TIT5.LE .. LOT 3� OFFICIAL INSPECTION FORM NOT.FOR,VOLUNTARY:ASSESSMENTS: SUBSURFACE SEWAGE`DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:. LLC Owner's Name: Ow.ner's.Addres.s: Ma C6111A Date of Inspection: IiIAR 2 0 20U2 Name of Inspect r: lease print Company Name p y . T0vv1,.Jr BARNSTABLE Mailing Address: oG HEALTH DEPT. Telephone.Number: O `7 q CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information stported below is.true, accurate and complete as,of the time of the,inspection. The inspection was performed based.onmy training and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP approved:system inspector pursuant to Section 15.340 of Title.5(310 CMR 15.000) The system:` Passes . Conditionally Passes Ne ds.Further Evaluation by the Local.Approving,Authority... F s Inspector's Signature. _ Date:. The system inspector shall submit a copy of this inspection report.to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report-to the appropriate regional office of the DEP.The original should"be sent to the system owner and copies sent to the buyer, if applicable,and the approving. authority. Notes and Comments 1 ****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. Title 5 Inspection Form 6/15/2000 page 1 Pane 2 of 11 OFFICIALlNSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ✓� ;_ r Owner . Date of Inspection-' Inspection Summary: Check A,B;C,D or E I ALWAYS complete all of Section D A. `System Passes: 0� :I have not found any information which indicates:that any of the failure criteria described in 310 CMR 15.3:03 or.,in310.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 o.f-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 tarik is metal and over 20 years older 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:complyind septic tank as approved by the"Board of Health. *A metal will septic tank p ill pass inspection.if it is structurally sound,not,leaking and if Certificate of Compliance . indicating that the tank is less than 20 years-old is available. ND.explain: Observation ofsewage backup or break out or high static water level in the distribution'box duelo broken or obstructed pipe(s)or due to:a'broken;settied`or uneven distribution box. System will:pass inspection`if(with approval of Board of Health): broken pipe(s)are replaced obstruction"is removed distributionbox is leveled or:replaced I� ND explain: The.system required pumping miore 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: 2 Page 3 of l'l OFFICIAL,_INSPECTION FORM.-NOT FOR YO.LUNTARY-ASSESSMENTS SUBSURFACE SEWAGE 1)ISPOSAL SYSTEM-INSPECTION FORM PART.A CERTIFICATION(continued) Property Address: i�-fe+I Owner: Date of Inspection.: Gb= 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 d,etermines.in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in.a manner which wiP proms ct public:health,'safety and the environrent: _ Cesspool or.privy is within 50 feet of a surface-water . _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2. System will fail.unless the Board of Health (and Public Water Supplier,if any)determines that the. system is functioning in a.manner that protects the public health;safety and environment: _ The system has aseptic tank,and.soil absorption system(SAS)and the SAS is within 1.00 feet ofa surface water:.supply or tributary.to a surface water.supply. The system has aseptic tank and SAS and the SAS is within a Zone.l of a public�water.supply. _ The system has aseptic 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 l 00.feet but 50 feet or more from a private water supplywell"...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. faaure criteria are triggered.A,copy of the analysis.must be attached to this form.. 3. Other..: 3 Page 4 of l l OFFICIAL:INSPECTION FORM=NOT FOR VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL°°'SYSTEM INSPECTION FORM PART.A CERTIFhCATION(continued) Property Address: ' p Owner: Date of Inspection: . aOG�3 D. System Failure Criteria applicable to all systems: You must:indicate"Yes,,or"n "t ` ` o 0 to:each of the foll w o m for all inspections: Yes �ol. 1/ Backup:of sewage into.facilrty or systeni`component'due to overloaded or'clogged SAS'or.cesspool. Discharge or ponding ofeffluent to the.surface of the ground or surface waters due to an overloaded or Iclogged SAS or cesspool t�. 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 ''h day flow . _ Required pumping more than 4 times in.the last year NOT due to clogged or obstructed pipe(s).Number of times pumped An ortion of SAS cesspool n ound.water elevation. Y P or p privy is below high gr Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply: _ n' yportion of a cesspool or privy is within a Zone 1'of a public well. . _ Any portion of a cesspool or privy;is within 501eet of a private water.supply well. Any portion ofa cesspool or.privy is less than 1.00 feet but:greater than 50 feet from a private water supply well-with no acceptable water quality analysis.,[Th.is.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 j� are triggered.A copy of the analysis must be attached to his.for.m:] P" (Yes/No)The system fails.I have-determined that one or more of the above failure criteria exist as described in310 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 System; To be considered aaarge.'sysiecn'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 ofa surface drinking water supply .the systerri 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 ublic water supply well P 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. ,4 Page 5 of 1.1 . OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ..: CHECKLIST:. Property Address: v Owner: Date of Inspection: U - Check if the following have been.done.You must.indicate."yes"qr"no"as to each of the following: Yes No _ zlPumpinz inform ati on.was.provided by the owner,occupant,.or Board of Health , 'Were.any of the system components pumped out in the previous two weeks? 1C_ Has the system received normal flows in the previous two week period'? _ZHave large.volumes of water been.introduced to the system recently.or-as part of this inspection? Were as built plans of the system obtained and examined?.(If.they were not available note as N/A) 1 Was the facility or dwelling inspected for.signs of sewage back up° �= . Was the site.inspected for signs of breakout? _ Were all system components, excluding the SAS, located on site Were the septic tank manholes uncovered,.opened, and the interior of the tank inspected for the condition . . of the baffles or.tees,material.of construction, dimensions,depth of liquid,.depth.of sludge and depth of scum? Was.the facility owner(and occupants if different from ow ne:r,)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 basedon: Y.ev no Existing information.For'example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C.is at issue approximation.of distance. is unacceptable) [3.10 CMR 15.302(3)(b)]. 5 Page.6 of 11 OFFICIAL INSPECTION FORM-- NOT FOR VOLUNTARY,°ASSESSMENTS -PART SUBSURFACE'SEWAGE DISPOSAL SYS CTEM INSPECTION.FORM SYSTEM INFORMATION Property Address: /0 !/d Owner•. 041 Date of Inspection: FLOW CONDITIONS RESIDENTIAL...✓ Number of bedrooms(design) Number of bedrooms(actual) G, DESIGN flow based on 310`.0 R 15.203(for example. 11.0 gpd x#of bedrooms): ( �Nninber of current residents: Does residence have:a garbage grin der.(yes or no):. �s Is laundry on a separate sewage.system (yes or no) �[if yes separate inspection required] Laundry system inspected,(yes or no) Seasonal use: (yes or no) - .. Water meter readings, if available(last 2,years usage(gpd)): Sump pump(yes or,no Last date of occupancy: 'A . G CO,MMERCIALANDUSTRIALL// . Type of establishment. Design f]ow.(based on 310 CMR.15.203).- gpd Basis of design flow('seats/persons/sgft,etc.). . Grease trap present(yes.of no):_ Industrial.waste.holdingtatik present(yes or no): Non-san.itary-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 Source of information . Was system pumped as:part.ofthe inspection.(yes'orno) If yes,:volume.pumped: gallons--How was..quantity pumped determined'? Reason for.pumping: TYP,kOF SYSTEM Septic tank,distribution box,soil ab"sorption 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'(describ'e): proximate agel of all c mpon nts, dat installed(if known)and source of information: I Were sewage odors-detected when arriving at the site(yes.-or no � ..6 Page 7 of l l OFFICIAL INSPECTION FORM-NOT,FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.;SYSTEM.INSPECTION'FORM PART,C SYSTEM INFORMATION(continued) Property Address: OwnerW,� Date of lnspectio oL7 BUILDING SEWER(locate on site plan) d'� Depth below grade: Materials of.construction:_cast iron._40 PVC other(explain): -Distance.from private water supply well or suction liner Comments(on condition of joints.`venting,evidence of leakage;etc.): .SEPTIC TANK: ✓(locate on site plan) Depth below,grade: Material of construction: 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: :S` Sludge depth: 1�ph Distance from top of.sludge to bottom of outlet:tee or baffle: a Scum thickness:' /1 Distance from.top of scum to top of outlet tee or baffle: Distance.,from bottom of scum to bottom of outlet tee or baffler How.were dimensions determined: 10-4i QZAW:i� Comments(on pumping recommen atio t and outlet tee or baffle condition,structural integrity,liquid.levels as related to outlet invert,evidence of leakage,etc.): P ii i GREASE.TRA`P-,&-(4 ate 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.): 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY-ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM :SYSTEM INFORMATION(continued) Property Address: /D Owner:. Date of Inspection 0'0 TIGHT or HOLDING TANKZ."ank must be punped at time of inspection)(locate on site plan) Depth below grade: Material of construction: :concrete:. metal fiberglass..._polyethylene other(ezplain): Dimensions; Capacity gallons Desian Flow: Qallons/da .. Y ,Alarmpresent(yes or no): Alarm level: Alarm in working order(yes or no). ` Date of:lasrpumping: Comments(condition of alarm and float.switches, etc.): DISTRIBUTION BOX.V (if present must be opened)(locate.on.site:plan) Depth of liquid level above outlet invert:l >� �� Comments(note if box is,level_and distribution to outlets equal, any evidence of solids carryover,any evidence of eakage`into or out of box, etc.): L PUMP CHAMBER' (locate on.site<P lan) 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.).- 8 _ - Page 9 of 11 OFFICIAL INSPECTION,FORM-.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE�DISPOSA,L SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION;. (continued) Property Address: Q Owner:(mot/ Date of Inspection. � �A,d� �'S yy .900o2 SOIL ABSORPTION SYSTEM (SAS):.__(.,4ocate'on site plan,excavation not required)' If SAS not located explain why:. . - Type leaching.pits,number: leachincr chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Ty'e/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of pondino,' damp.soil,condition of vegetation, etc.): F. /� CESSPOO.L (cesspool must be pumped as part of inspection)(locate on site plan). Number and configuration; Depth.—top of liquid to inlet invert: . Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of.groundwater inflow(yes or no): Comments(note condition of soil,.signs of hydraulic failure,level of ponding, condition of vegetation,etc,): PRIVIIscate 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.): i 9 Page 10 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM FART C SYSTEM INFORMATION(continued) Property Address: Z Owner• /III Date of Inspection: ;aDOa 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. 1 o . 10 Page 11 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION(continued) Property.Address: Q J-1JIVA R Owner: Date of Inspection. 00- SITE EXAM. Slope Surface water Check cellar. Shallow wells.. Estimated depth to sound water feet 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) Fd Accessed USGS database=explain: You must describe how you established the high.,ground.water elevation:." 0 . I 1.1 Permit Number: n Date: Completed by: ✓��i HIGH GROUND-WATER LEVEL COMPUTATION Site Location: , @ ram. . zIll Lot No. Owner: Address: CD Alalop_S Contractor: G'�� _Address: Gl lGl. s ✓`�1�� Notes STEP 1 Measure depth to.water table tonearest.1/10 ft. ........................................ :....................:............ .Date month/day/Year STEP 2 Using Water-Level.Range Zone and Index Well Map locate site and determine: OAppropriate index well............................ CWater-level range zone ........... STEP-3 Using monthly report.''Current Water Resources Conditions" determine currentde.pth:to O��® �� , water level for indexwell ............................ month/year STEP. 4 Using.Table.of Water=level.Adjustments for index well (STEP 2A),.current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) , determine water-level adjustment ...................... 715` STEP. 5 Estimate depth to.hic}h water by subtracting the water:. level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ......:....._................. J`. ' Figure 13.-- eproducible computation form: 1 C,l��::`jLf1E'l�l'�J 4 Rr NO, 41999 BOR'fOLOTTI CONSTRUCTION, IN 45 INDUSTRY ROAD, MARSTONS MILLS, MA 8L t t-9� 508471-9399 508-428-8926 FAX: 508-428-9399 SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 0. aldaz ` Date Of Inspection 111119 7--Inspear's Name: Owner's Name and Address: T CERTIFICATION STATEMENT: I Certify that I have personally Inspected the Sewage Disposal System at this address and that the informa- tion reported below is true,accurate and complete as of the time of Inspection. The Inspectioin was perform- ed based on my Training and Experience in the Proper Function and Maintenance of On-Site Sewage Dis- posal Sys(ems.7TIsystem: A Passes Conditional) asses Needs F i E I n By the Local Approving Authority Failu Inspector's Signature Date: TheSystem Inspector shall submit a copy of this Inspection Report to the Approving Authority with 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 Offie 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: A) SYSTE PASSES: I have not found any Information which i udicates that the System violates any of the fail- ure criteria as derined in 310 CMR 15.303. Any Failure Criteria not evaluated are indi- cated 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,nor,or not determined(Y,N,OR ND). Describe bases of determination in all instances. If"not determined",explain why not. The Septic'Tank is Metal,Cracked,Structurally Unsound,shows Substantial Infiltration or exftl- tration,or Tank Failure is iimminent. The System will Pass Inspection ifYxisting Septic Tank is Replaced with a conforming Septic Tank as Approved by the Board Of Health. Sewage Backup or Breakout or High Static Water Level observed in the Distribution Box 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): - 1 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)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)FURTHER EVALUATION 1S 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: Cesspoolor 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,FUNCTION- ING 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 with 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 less than 100 Feet but 50 ~, Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than S ppm. D)SYSTEM FAILS: I have t de ermined t the the e ternviolates s s one or more of the following failure criteria as defined Yg in 310 C1VIR 15.303. The bests for this determination is identified below. The Board of Health -y should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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_outletinverl.,rfue. to;an overloaded or clog- ged SAS or cesspool.. ,.. . Liquid depth in cesspool is less than G"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 -2- SUBSURFACE SEWAGE DISPOSAI,SYSTEM INSPECTION FORM PART A CE11TIFICATION (conlinued) 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,anunonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: _y Pumping information was requested of the owner,occupant,and Board of Health. _.'-None of the system components have been pumped for atleast 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. The facility or dwelling was inspected for signs of sewage back-up. ` r;GThe'system does not receive non-sanitary or industrial waste flow. -The site was inspected for signs of breakout. -All system components,'excluding"the Soil Absorption'Systen►,'liave been located on site. _ The septic tank manholes were uncovered,opened,and the'interio'r of the septic tank was in- spected for condition of baffles or'tees,material of construction,dimensions,depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART II CIIECKLIST(conlinuc(l) ✓The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RIKSMIrNTIAI i" Design Flow• allons Number of Bedrooms:, Number of Current Residents: Garbage Grinder: Laundry Connected To System:. Seasonal Use:420 Water Meter Readi ,if available: � I Last Date of Occupancy: - F,.7ZAdVA- ry C0 MII;R AIJIND ITT IAI.� Type of Establishment: Design Flow: aallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: c) System Pumped as part of inspection:a(D If yes;volume pumped: gallons Reason for pumping: TYPE,OF SYSTEM: _�/Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any)" Other(explain): APP"OX13UTE AGE of all components,date installed(if known)and source of,information: Sew odors detected when arriving at the site: -4- SUBSURFACE S11,WAGE I)ISI'OSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: / ' Material of Construction: ✓11 concrete metal FRP Other (explain) ` Dimisions:j0.5',y& ,X_S' Sludge Depth: _ Scum Thickness: Distance from top of sludge to bottom of outlet (cc or batTle: Distance from bottom of scum to bottom of outlet [cc or ballle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth.of liquid level in relation outlet invert,structural integrity,evidence of leakage,etc.)"o � _ GREASE TRAP:_A9 C) Depth Below Grade: Malcrial of Conslniction: concrete metal FRP Other (explain) — — — — Dimensions: _ Scum Thickness: Distance from top of scum to top of outlet lee or baffle:` Comments: (recommendation for pumping,condition of inlet and oulleu tees or baffles,depth of liquid, level in relation to outlet invert, structural integrity,evidence of leakage, etc.) TIGHT OR HOLDING TANK:_.,A)O Depth Below Grade: Material ofConstruction:_—_concrete_ntetal—FRP—Other(explain) Dimensions: Capacitv:_ i _gallons Design Floc: gallons/day Alarm Level: Comments: (condition of inlet (ec.. conditionu of alann and float switches, etc.) DISTRIBUTION BOX: Depth of liquid level above outlet invert: Comments: (note if eland dislribulion is e(p t1,evi ce of solids carryover,evidenc of I age intoo or out of box,etc.) PUMP CHAMBER./U_0. Pump is in working order: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) SUBS URFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): (Locate on site plan,if possible;excavation not required, but may 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: Co ts: (note condition of soil,signs of hydraulic failure level f poWhig, ondition of vegetation, /i CESSPOOLS: v f , Number and configuration: De th-o f liquid p t p o quid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments:(note condition of soilk, signs of hydraulic failure, level of ponding,condition.of.vegetation, etc.) PRIVY:�� Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) t -6- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. r l(0 DEPTH TO GROUNDWATER: Depth to groundwater. / Feet Method of terminadpn or A pro ' nation: /f leliol, G, -7- e �-` S E P 1 6 � commonwealth of Massachusetts ice{ Euecutive of Environmental Affairs DERP, � fn6C�&�5 rern�s t of t epa nEvironmental Protection SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: q00 Address of Owner: (if different) Date of Inspection: Name of Inspector: Michael D eD ecko Company Name, Address and Telephone number: Atlantic Environmental P.o Box 2384 - M ashpee Ma 02649. Tel : (508) 4771420 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection . The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. The system A Passes ---- Conditionally Passes ---- Needs further evaluation by the local Approving Authority ---- Fails Inspector ' s Signature. � CDate: 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 or the Department of Environmental Protection. The original should be sent to the system'owner and copy sent to the buyer, if applicable and the approving authority. f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: y Uo 0 wners : �_svv,Cq cow Date of Inspection : INSPECTION SUMMARY: Check A, B, C, or D A)SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 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 determinate (Y,N, or ND). Describe basis of determination in all instances. If "not determinated", explain why not. ---- The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. ---- Sewage backup or breakout or high static water level observed in the distribution box 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 H ealth). ..... 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 Y Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address : 'tOo Owner : A gacx,�c_ Date of Inspection: C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ---- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health, safety and the environ- ment. 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 of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING 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 less than 100 feet but 50 feet or more from a private water supply well,unless a well water analy- sis 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 notrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: •- I have determined that the system violates one or more of the following failure criteria as defined in 310 CM 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. --- Backup of sewage into facility or system component due to an overloaded or or clogged SAS or cesspool. 3 � t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: NOS Owner: !z: Date of Inspection : S 130`c� D)SYS T E M FAI LS (continued) -- 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 over- loaded 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 cesspool or privy is within 100 feet of a surface water supply ortributary 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 ana- lysis. 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. k• r p SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: lioc) u-., Owner: ft'200\(- Date of Inspection : E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above : The design flow of system is 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 foNowing 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 I I of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compli- ance with the groundwater treatment program requirements of 314 CM 5.00 and 6.00. Please, consult the local regional office of the Department for further information. ' Z SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 'too uJA, 0 wner: (2sT�ecoo t_ Date of Inspection: Check if the following have been done : -x Pumping information was requested of the owner , occupant and Board of Health. --x None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. --x As built plans have been obtained and examined. Note if they are not available with NIA. --x The facility or dwelling was inspected for signs of sewage back-up. --x The system does not receive non-sanitary or industrial waste flow. --x The site was inspected for signs of breakout. --x All system components,excluding the Soil Absorption System, have been located on the site. ---x The septic tank manholes were uncovered, opened and the interior of the sep- tic tank was inspected for conditions of baffles or tees,material of construc- tion, dimensions,depth of liquid, depth of sludge, depth of scum. ---x The size and location of the Soil Absorption System on the site has been deter- mined based on existing information or approximated by non-intrusive methods ---x The facility owners and occupants if different from owner were provided with information on the proper maintenance of Subsurface Disposal System. I t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: `{OU Owner: r cv-& , Date of Inspection: RESIDENTIAL: Design flow: 33o gallons Number of bedrooms : 3 Number of current residents: 1) Garbage grinder(yes or no) : tic) Laundry connected to system (yes or no): "S Seasonal use (yes or no) : N o Water meter readings, if available: tj Last date of occupancy : 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 : Last date of occupancy : Other: (Describe) ............................................................................................................ Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of infognation: ,s •.�,� ...! ,...�!1......:... System pumped as part of inspection (yes or no) :....Uv� ........ if yes, volume pomped : .................... gallons Reasonfor pumping :............................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 4100 Owner: �,�g,L�� Date of inspection: TYPE OF SYSTEM K 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) --- 0 ther (explain)........................................................................................... R OXI MAT E AG E of all components, date installed (if known) and source of information P�.�x.... .. ..... ................................................................................................................. ............................... Sewage odors detected when arriving at the site : (yes or no).... ?Q.. SEPTIC TANK : (locate on site plan Depth below grade: .Al... Material of construction: .... concrete .....:... metal ........ FRP ........ other (explain) ................................................................................................................................................ Sludge depth • Distance from top of sludge to bottom of outlet tee or baffle:...... .................. Scum thickness �i Distance from top of scum to top of outlet tee or baffle: .........16........................... Distance from bottom of scum to bottom of outlet tee or baffle :.....).6... Comments : (recommendation for pumping , condition of inlet and outlet tees or baffles, depth of liquid level in relationR to outlet invert,structural integrity, evidence of leakage,etc.) CC;y�r4�a Asr�: ;c..er3......�.... SAX?.^f.��...�'�.P�... :�.��,�? '�., U.a O �.Srro -cl...... ...tiC.1&6C.................................................................................. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: '-I(x) . Owner: Ssi R F3C2c �_. Date of inspection: e5 c� GREASE TRAP : .......KM... (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FRP........other(explain).... ............................................................................................................................. Dimensions:............................... Scum thickness:........................ Distance from top of scum to top of outlet tee or baffle:....................................... . Distance from bottom scum to bottom of outlet tee or baffle:............................... Comments: (Recommendation for pumping condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.)........................ ................................................................................................................................................ ................................................................................................................................................ TIGHT OR HOLDING TANKS:....fAQ.. (locate on site plan) Depth below grade:............... Material of construction:........concrete........metal.........FRP..........other (explain).......... ................................................................................................................................................. Dimensions:............................. Capacity:....................gallons Design flow:...............gallons/day Alarm level:............................. Comments: (condition of inlet tee, condition of alarm and float switches, etc.) ................................................................................................................................... ................................................................................................................................................ I� R SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: W 00 �ti sTL¢ Owner: �S►,�&Goo Date,of inspection: DISTRIBUTION BOX:...(�5 (locate on site plan) Depth of liquid level above outlet invert:....��va�,..c>J� Comment: (note if level and distribution equal vide ce of solidZ carryover, evidence of leakag into or out of box, etc.). ................................................................................................................................................. PUMP CHAMBER:...NQ... (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.).................... ................................................................................................................................................ ................................................................................................................................................ S 0 1 L ABS0RPT1ON SYSTEM ........ (locate on site plan, if possible; excavati n not required, but may be approximated by non- intrusive methods) I not determined to be present, explain: . ................................................................................................................................................ .....................:............................................. ........................................................................... Type: leaching pits, number: ..(. ..� G. leaching chambers, number:........ leaching galleries, number:........... leaching trenches,number , length:..................... leaching fields, number,dimensions:................... overflow cesspool,number:.......... Comments: (note ond�it�ii n�of soil , signs of hydraulic failure, level of pondin condition of egetation, rind R................. 1 ..!.............!Ja ..c*�. c ..... � .�o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property address: uoo w ti, Owner: Ww Date of inspection: CESSPOOLS:.... .a.. (locate on site plan) N umber and configuration: ........ Depth-top of liquid to inlet invert: ........................... Depth of solids layer: ............................................... Depth of scum layer: ............................................... Dimensions of cesspool: ...................... Materials of construction: ..................... Indicator of ground water: .................... inflow (cesspool must be pumped as part of inspection) ................................................................................................. ................................................................................................. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ............................................................................................................................................... ................................................................................................................................................ PR IVY: .....V�p.. (locate on the site) Material of construction: ................................... Dimensions: ...................... Depth of solids: ................ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.). ................................................................................................................................................ ................................................................................................................................................ a a . � 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address : Owner: LS i ccn v Date of inspection:e12 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100' DEPTH TO GROUNDWATER: Depth to groundwater: �-..9,0..feet Method of determination oar-aapproximative: ..9 V................................................................................................. ................................................................................................................................................ TOWN OF ARNSTABLE gL 1� LOCATION � SEWAGE # b C G VILLAGE 1 N as`�`� 1 A yam, S ASSE R'S MAP & LOT -Q INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY `C ZM LEACHING FACILITY: (type) 1i-A��"I�C��'T�S (size) '00( NO. OF BEDROOMS BUILDER OR O RJ PERMIT ATE �� COMPLIANCE DATE: IS 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 t � � i 1 � i �� o3TI> Town of Barnstable Building Department ComplainVInquiry Report Date: -` Rec'd by: Assessor's No.: Complaint Name: lif a4d LocationG O Address: . Originator Name: Street: Village: State: Zip: Telephone:D/E Complaint Description -L/2 Inquiry Description For Office Use Only Inspector's Action/Comments Date: Inspector. D. r Te Follow-up �'� I _d-t G `s (owe e.tw9� Q(L �` Action �V it-. 'i J 1 c)Cc d- c:^ 6-f Z a-i t vt. G✓G- U O 6 v CW� i.Pcf 4, - C fd.Gtc yo. u*A"6(2 cwutd tw 4-- 4-R a(671W4d /vow Additional Info.Attached Copy Distribution: White-Depamnent File Yellow-Inspector Pink-Inspector(Return to Olrce 3fanager) qoo 1-7 ; LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS R U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED L �A ay,. u 1-61 1 Fit 35 i 11121 Stone 1500 Ca`� �Ilive' =267 S.F. I TV/ _tur. .3 wAT off+ 3o Proposed q 3 zy 57 W W o J 10 , 00 Iz W i J•Z Q i •1 j ,Lot,, area Lot 37 Lot 36 45026 Q.F . O r LAM 9CAL`�.: 1"-40' I i8.9 ZOO 1 DATE 2/14/15 0 { A�4 15. - srw ^JH L13.�;UHY 1)YS � a IST � 1 q 501-wide 1 All We .:nnineerin? � � - 49 H arbor Road 1+.4 1Hypnnis, ] n . 02601 1500 IG. _, . `l'. i PROFILE VOICALi,: ! SIfir:TGH QAN OF LAND IN 1�1AI�:��TO $ WILLS , 1 fox Steve Wilcox 1 Being lot Was shown on a Olan of :'�histleberry, 1 and recorded in plan book 34 .—age 57 Barnstable ! Registry of De_eds .' � . Z tlevations shown are above water in bog north of locus. ------------------ ----- ---------------------------- !, Date: . Agent : Barnstable Aunrd of Health i T '.T FIT F 986 ode 1/1�` 85 it , Jim Conlon u o rr��te r encountered 1 erh rate 2 mi.n:per 1t1 ; 14.Z To • lol I 15.3 12.2 i curse cours FF hr s P Loney honey - p? WILLIAM H. 1 v FARDIE cn ...... p No. 89915 Ago i .; FFSSION�1:�a6 i S.3 z.z T.P, I T.P. Z Ji , { THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•............._.............._.........OF....................................... .Z ppliration for Disposal Works Toustrurtion Prrmit Application is hereby ade for a Permit to Construct p or Repair ( ) an Individual Sewage Disposal System at: el .... .... n.......................... •-•-•--------•---------•......-•••------------••-•••......................••............-•-•••-- • el� Nor Lotation _ O,tivner Address .......................................... -----...........-•-••-----•---....••-•---•••--.........-••-•----•............--••-........------.. Installer Address - Type of Building Size Lot..V- feet Dwelling—No. of Bedrooms.............3.........................Expansion Attic ( ) Garbage Grinder (`/�► per, Other—Type of Building ............................ No. of persons............................ Showers (,Z) — Cafeteria ( ) at Other fi tures ..--•-•-••--••......--•-•••••--- W Design Flow.........._ ...........�..........gallons per person per day. Total daily flow...........:3,1?_ ....................gallons. WSeptic Tank—Liquid capacity jtJLP..gallons Length................ Width................Diameter................ Depth................ x Disposal Trench—No. ...........&..... Width........(e......... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (i-1 Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ i rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water...................... .. P4 .---•-•....•------------•.......................••-••----•-•-•-•••-•-••-••-•........--•.......-•---•..................................... ............... O Description of Soil L �W:S�..:t_•�J.�tyl.f/ -•--------------------------------------------- I V ---------------- .................................................. ........................................................... ............................................ -----••----- W x •-------------...--•---•-•-----•••-------••-•----•------------------------••--•-......•--_......---•-•••-•-.._.....•--•----------.......•---_....••----..............•-•-----........._._............ V Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. ••-------------------••-•-•-••-----......••--•----------•--•---•••••-•----•---•---•...-••••--••-•-----•---•••-•-----------..._.....---------••-..._._.........._..----------------.........._.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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. , Appli tion Approved Y - ...... .................................................� /Z e�E3 { G ate Application Disapproved for the following reasons:.........................................................................................-----D .-.............. I -•-----•••-•-••-•----•••••-•--•-•--•-•-•--•-••--•••••------•••-•-----•-•-•--••---••••---....-••-----••••.-----•----•••••-•----•-----------••-----••--------- ........................................... Date Permit No...........Z�S. ! �c ........� ... Z--•---..... Issued_.------••------ .--� -9 ............ i Date 1 i I THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH ..........................................O F..................................................................................... Trrtif tratr of Tout rliatme THIS IS TO CERTIFY, That t e Individual Sewage Disposal System constructed ('") or Repaired ( ) by Installer (n! has been installed in accordance vvilh the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..............................................( "`', r' "dated-......_... / �_:......---•---•••-•• THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. ....... �...�e9S......................... Inspector....._.,.rSETTS THE COMMONWEALTH OF MASSA H BOARD OF HEALTH NO......................... FEE.. ................... Disposal Works Cons rnr#inn "pumit Permission is hereby granted........... .......kA. —z,.....----••----••••--•----••----......•-••--•--........•-•..................... to:Construct ( � ) or�Repaiy ( I ) an Individual Sewage Disposal System at No...............z...... .................._..•--�-••-• .............----•------- ----------------..........-•-• ................................_......... .__ . . Street .. as shown on the application for Disposal Works Construction Permit No.4...........:..... Dated........... ...'._........................... .� -•..... •• ••................. Board of Health DATE ... ............................................................... FORM 1255 A. M. SULKIN, INC., BOSTON } C. No, .��....��`� Fps.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ----------------- ----------------OF........----..........................------------........------...................-----• Applirattiun for 11iipusal Works Tumitrnrtion amit Application is hereby rpade for a Permit jo Const uct ( ) or Repair ( ) an Individual Sewage Disposal System at: 10 .._ 1 r .................. ................•------.............----••. ---------..._........ --........... • ation- es or Lot N O,Qvner Address w � -•---- .1.4. .......................................... Installer Address Pq U Type of Building Size Lot../su� &-----Sq. feet Dwelling—No. of Bedrooms.............. . .....Expansion Attic ( ) Garbage Grinder (.407)7 Other—T e of Building No. of persons............................ Showers /Z — Cafeteria Other fixtures .................................... W Design Flow........... gallons per person per day. Total daily flow............ ....................gallons. W Septic Tank—Liquid capacity.. .00..gallons Length................ Width................ Diameter________-__.._-- Depth................ Disposal Trench—No................... Width....... ......... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------_-------_--- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (L-0) Dosing tank ( ) 1.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ------------------------------•-----------------------.._........----...............---..._.._....--......................................................... 0 Description of Soil....... .....f.hpj?_. ....................•--••-•-------•-•-------------------------------•--------------------------------------------------• V ......----•------•-----••-••-•--.....-•--------------------------------------•---.......-----._._.......-------•-•--.........-----------------•---•-................................................... VNature of Repairs or Alterations—Answer when applicable........................................................................................... ----•---•--•---------------------------------------------------•---------------------•-••----•--------------•-••------------------------------------------------------------------------...--•-•.....--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. G` Z (�F3 Appli tion APProved Y---•------------------- �--•----...--------------._.._..-•--•---•---......-•--------•--------- 5---- _.._.__...--•-- ---Date----•- Applieation Disapproved for the following reasons:................................................................................. ................................•-•------.........-•-------------...........------....-----•---........----..................--•--------------------------------------------------------------•-------- Date Permit No.............. ............. Z .. -��-----•--•------. Issued----- ------------------•--•--.................... Date No.�f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................................6F.......................................................... ................. AvOration for Disposal Murks Toustrurtion rrrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Dis posal System at: ........................... .................................................................................................. ration- r%.y . # , . F -1 -Y, 7'?/D ;... ........................--------------------- Address ........... ........ ............................................. .................................................................................................. Installer Address Type of Building Size Lot......7...................Sq. feet Dwelling—No. of Bedrooms............ ..........................Expansion Attic Garbage Grinder (4Q PLI Other—Type of Building ............................ No. of persons............................ Showers 4;2,-) — Cafeteria P4Other fixt1ires ..........................f.............................................................................. C11 37.0................................. Design Flow.........-" gallons per person per day. Total daily flow............................................gallons. 6 Septic Tank-7-- Liquid'capacity "gallons Length................ Width................ Diameter................ Depth.............._. Disposal Trench—No............h------ Width.......(0......... Total Length..................... Total leaching area....................sq. ft. Seepage-Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Z Other-D iffribution box (b-j Dosing tank ( ) Percolafidh-Test Results Performed by.......................................................................... Date........................................ Test Pit No. I...........:....minutes per inch Depth of Test Pit.................... Depth to ground water.....................__. Test Pit-No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----------**...........&................................................................................................................................... 0 Description of Soil.. C6"Se + 0nV .............................. W /...............................*--------------------*---------------------- .............................. ------------------------*-------- ------ --- ------------------------------- -------------------------------*-------------"...**--------------------------*------------------"-------------------- ..............................................................................7......................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be W issued by the board of health. A i--siCried... -1/710 — - --------*---- ............ �t Approved off....... U aty'p— ......................................................................... ........................................ Date Application Disapproved for the following reasons:................................................................................................................ ..........................................................................................................................................................................*------------**---------- Date .................7 Permit No......... .. s ................... Issued_............................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (9rdifiratr of Tomplitturr THIS IS TO CERTIFY, That t ,le Iqdividual Sewage Disposal System constructed 01:1') or Repaired by............................ ............1.5.. ..................................................................................................................... Installer at.........Z..?..... .......................................................................................................................................... has been installed in accorace W—Rh the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....................................... dated___.... .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. ....... _?-.5......................... Inspector....... . ................DN__ • ----------- ------------- SETTS THE COMMONWEALTH OF MASSA Hr BOARD OF HEALTH Ff . . . ...........................................OF..................................................................................... .... f4o......... ........ .... FEE........................ Disposal Works TVnstr=tw' n "prrmit Permission is hereby granted....------. ....... . .............................................................................. to Construct or\Re , ( i ) an Individual Sewage Disposal System atNo............. ..............jo...................... .............................................................................................................................0...... Street as shown on the application for Disposal Works Construction Permit No..t......... Dated.......................................... lo� ............................. ... ....................................................................... '2:q Board of Health DATE..'.............................................................................. FORM 1255 A. M. SULKIN, INC., BOSTON Ic.B: r v LOT 38 zss,si u 35' t . T far/?t Stone 1500 qSI' �rive� 'OQ -2 67 3-7549 i i J F r v/ - 1� 1 1C)0; c�xj ,r"�1 Tyr;. �a F'roFosed 1 i Zy q 3 rwG3� 0+ 1s5t V 10 , --:` - I ,how area Lot. 37 A . , ; Lot 3 . 451326 S: -P, DFiTE ' �l1 �.i ZZ 5 0 T; yrK q 4.HI T L�E3t R-HY DKVR , ci t - - _ -•-----....�_ - i En-i ;leerin? 4c lr -rbor '.l.o ad I¢,4 ^ - ".'annis , Fn 02601 SUU Cr. T. : 1-6,xb1 P I I' Lro'/2:'stone ;�.'�� PROFILE a��? �j S.IC;TO I'LA-N 4F LAND....hN PIhR:Z?O I - 1=SILLS , f: . for _ Steve Iilcox Being lot 37 as 'shown on a plarr-of :v"histleberry, and recorded ill n pL n book 349 ;page 57 I3-arristab.le _ RP a :str'; of D.eed.s..' levatians- shown are above wat-er in bog north of locus: Date:------- --- s - -ent t barn able _�� rc, of Health 7:; =T r TT F-3o81 ; `it . Jir Conlon o wr,)ter enco, tAer(,d erc. r=;te - miry. >:er 1" 173 l4,Z To;' TOE i 153 Ours course, _ a _ .. •-- _�N OF MqS ?coney boney d o? wILuAM yam; H a - v._.._._ FARDIE n o Q No. 8995 _ Fc r S-T �FFSSlONA1-�a�\ T.Pa I T.P, Z _...-_-_._ ..... ........ ... ....-... ,• .. ... -. ♦.n—..,ram+:::.w6.e_...iV..4,.}T Yx P - 7 C w �- v ;w rr _ -________- N O 77; 7EXISTIQN=WALK-INWCLOSET EXISTINGREMOVE EXISTING 0 Q WINDOW iW o i N 48" W i O Z > 48 BIFOLD i O O F_ � DOORS CASED OPENING i ( � Q � EXISTING p 2. EXISTING WINDOW Q O • � m O W z OFFICE ----------- OJ U Q N LL_ Z �f EXISTING 0 N N 10'-0"' W O C) > W c .af II I _ EXISTING 00 d ...._ = EXISTING D' T 0- SEE FOUNDATION v PLAN SHEET A5 w w FOR NEW ADDITION -' -J O- Q DIMENSIONS O u m cn i i i i GC TO COORDINATE WITH OWNER AVAILABLE WINDOW BAY SIZES. BAY COULD BE PRE-FAB SINGLE UNIT OR BUILT UNIT WITH INDIVIDUAL WINDOWS. } LOT #36x 2 �N g 100 �102 ,10A 106 �08 11011� 18 / 1A N 89d 46' 50" E FL 216.3 7' LOT #37 126 Square Feet 'w 16' co Cb ON Cb 477 0-1 Failed CE4.CH PIT fAppro LOT #38 I / / EXIST. 1000 gal. \\ 1 1 / / I Septic Tank I \ Q I 1 I 0 \ !. HOUSE #10 \I � • r . • i EXISTING DECK +••' .� / 1 \\ \ \\ \ 3 BEDROOM HOUSE = �• rY /2 i 1 \ \\ \\ \\ II ;A4r• • ; I � 1 \ \ \ TEST LE 1 .ELEV.=HOLE 98.00 �r • tiK j I �\ 1 \ \ 1 0.\ \\ EXISTING GARAGE i 4 PVC VENT PIPE 11 . I C 1 LLJ \ \ I I 1 1 \\ \ \ \ \ O •` Sr 1 ` \ I \ll\` � � I � \ 00,Et9 (90' 0 L I �\ U \ I \ 95 00) I 3 \\ �0 00' I I I. I I GyT OF _ I TYPICAL 1000 GALLON SEPTIC TANK e VENT PIPE O Least 24 Inches toll i NOT TO SCALE NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. (( ) 10' min. from Schedule 40 PVC w/Chorcool Odor Falter SECTION A •-A 2-18' DIAM. ACCESS MANHOLES ¢ house to septic tank PROFILE VIEW OF ADDITION TO LEACHING SYSTEM Existing Foundation Septic tank covers must be 8 tart!"•-"G" n. T.O.F. elev. 100.00 within 8 in. of finished grade A 1 r t e over SAS - 98.00 to OO.00 3• of 1/8" - 1/2 Washed Peastone Grade over Septic Tank - 0&00 Grade over D-Box - 9°.00 .'b• '. r 5 '' •.�. �. '•. •« '�'"'i'�'r:'e � 3/4• to 1 1/2 Washed Crushed Stone A ' �'. L aI.-.�i.` •"�. .: :c�' > z yy f a" PVC(CAPPED)INSPECTION PORT TO BE a,l t.�• � f ,�1a 111MIRNe te�- p"` S 0.02 6 HOLE - INSTALLED AND TO BE WITHIN 8" OF GRADE TopLoad Elev. 98.00 (H-20) DiST. BOX Tap .('SAS - Gov. -95.50 1 r INLET J ;. OUT ET ` 105.0.01 or Greater ,., EXIST. PIPE L' � EXIST. 1,000 GA par foot FROM FOUNDATION w X SEPTIC TANKt5 0" Effacttve Depth •'• Ey w H-lO 20 THE ACCESS COVERS FOR THE SEPTIC TANK, f M4�y II ov esr d N 5 Units 2 6.25' = 30' t: > II ui CONCRETE FULL FOUNDATI y FI7-- [A c0 (o v1 - .--_ -,.,,. t-.r r.- 0.83 (10 inches) � '% DISTRIBUTION BOX AND LEACHING COMPONENT ��, ;, Mt!eris Dr 11 > rn 3 3GRADE SHALL II II n SET DEEPER THAN 8 INCHES TO BELOW 6' OF AO On y a 31,25' 1 FINISHED GRADE. RAISED TO WITHIN 6" OF SYSTEM PROFILE a> a>> > J I STEEL REIN7F'OR/CED PRECAST CONCRETE m2041 ReR�I'.04ify aG.w'r+y m2002 NrvlgeHw+T«>grk*es r1t > -y m u l 37.25 PLAN VIEW INSTALL TUF-TITS GAS BAFFLES OR EQUALS Not to Scale ; ° 4' �� 'J 4' it Effective Length -2•5' I 24• REMOVABLE LAVERS GENERAL NOTES 6 11 3/4•-1 1/2" Effective Width 1. Contractor is responsible for Digsafe notification compacted atone w �' a• and protection of all underground utilities and pipes. u m° INFILTA�RDR HIGH CAPACITY (H-20 LOADING)/ GEGRGE O'BRIEN '' ' - = "'''' '' '' '' g Bottom of Test Hole 1 Elev.-e6.00 - 3 In. cleowance ,3• " ,� T 2. The septic"tank a (l� distribution box shall be set ----- ------------------------ t (OR EQUIVALENT) Nof. to Scale -�-- Obs. Groundwater - Test Hole 1 Elev.- NONE OBSERVED INLET 8" mIn.�_12 min. Inlet to outlet e.m� level on 6 of 3f4 -1 1p2 stone. LIGuldTevd OUTLET 3. Backfili should be clean sand or ravel with no NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" /EFFECTIVE HEIGHT IS 10" to"Imk. ts' e g 5' -7. a J1 .5' -7• stones over 3" in size. �y 4. This system is subject to inspection during installation E ( 4'-0• min. by Carmen E. Shay - Environmental Services, Inc. uwld depth 5. The contractor shall install this NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE system in accordance: I i ' '� ., with Title V of the Massachusetts state code, the approved plan and Local Regulations. j 6••-0• 4' -10• 6. if, during installation the contractor encounters any CROSS SECTION END-SECTION soil conditions or site conditions that are different from those shown on the soil log or in our design installation must halt & immediate notification be made to Carmen E. Shay - Environmental Services, Inc. p 7. No vehicle or heavy machinery shall drive over the PERCOLATION TEST septic system unless noted as H-20 septic components. LOT #36 8. Install Tuf-Tite gas baffles or equals on ail outlet tee ends. 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. Date of lPercolation Test: APRIL 12, 2004 10. All solid piping, tees & fittings shall be 4" diameter $ 0 Test Performed By, CARMEN E. SHAY, R.S., C.S.E. Schedule 40 NSF PVC pipes with water tight joints. 16 $ 00 102 1�� , 106 / 1� �. 11 12 Results VMtnessed By WAIVER per BARNSTABLE BOH ,9 ,92 ,g/g 1 Excavator: Roberts Septic Service 11. Municipal Water is Connected to ALL OF The Residence and Abutting oj� ,92 96 a$ 1 �/ ,�' �'��' �N' ,� ,' ��' '' �.' �/ Percolation Rate: Less Than 2 min./inch ® 24" BELOW GRADE. Properties Within 150 Feet. ' / N 89d 46 50 E NOTE.THE PROPERTY LiNES ARE APPROXIMATE AND 116 Test Hole COMPILED FROM THE SURVEY PLAN GENERATED BY No. 1 EDWARD E. KELLL=Y OF OSTERVILLE, MA, DATED 4/03/85 DEPTH SOILS ELEV„ ENTITLED " CERTIFIED PLOT PLAN OF LOT 37 WATERS EDGE 0 98.00! BARNSTABLE, MA-, AND IS NOT INTENDED TO BE .A SURVEY PLOT PLAN !' // / , / �' /' /' !' : �� Loamy Sand IT SHOULD BE USED FOR NO PURPOSE OTHER THAN // /� �/ i // , 10 YR 3/2 THE SEPTIC SYSTEM INSTALLATION. 0"-s" AP 97.33 Loamy San 10 YR 5/6 it 1 THERE ARE NO WETLANDS LOCATED WITHIN A 200 RADIUS OF THE SAS. / , / /, 8"- 24" Be 96.00 � '� /� 1/ �� Med Sand r �y ,/ / �/ l' /r 2.5 Y 7/4 NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE r / LOT #37 , ! ,' / / / r/ l \ 48"-144" c 86.00 FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED l � �45>826 Square Feet +f- i �' /' 11 �i /� /'� 11 i/1 / 1 \� i OF AS PER BOARD OF HEALTH SPECIFICATIONS. . EXISTING SAS TO BE PUMPED DRY & FILLED IN PLACE OR REMOVED TO FACILITATE INSTALATION OF NEW SAS IF REQUIRED. r `I r / / / I ' C� \ ASSESSORS MA 062 PARCEL 036 / / / I ES / / / / / / / i / 1 r ' / \ ZONING RESIDENTIAL r t ZO G DE P/ arc. r I O / / I // 1 / / r / hl 4 P r 4 Depth to e c 2 to 2 P Cn J 1 r 1 1 , / / P In. n h _.- . ._ . er ate <2 m I c ,- r / 7 . 1 1 x 1 / w r ! , / Groundwater Not"0 e Wed / / / f - t G bs / t � ry / I ' 1 1 M F I 44 BOTTOM 0 TEST HOLE E e v 1 O f t 0 L i OF THE , t i N WITHiN A 200 RADIUS 0 T E SAS." / i I _ -/ THERE ARE 0 WETLANDS LOCATED / / I t \O / , t 1 / 7 / A m r / ADJUSTED H2O Elev. No Adjustment ant Required. ed. / Cb 1 r q I / \ / / r/ r \ t � / t 1 \ / , r / / / / / \ t , \ / \ _ \ t � \ Al.i OUTLET PIPES r 0M THE / \_ _ 1 C / � LEGEND 4- DISTRIBUTION .SHALL BE G / 1 I . I / •� \ t \ �� 1 Y CONCRETE COVER $ , / / \ I � 1 \ \ \ \ •..� �1 SET LEVEL FOR ATT LEAST 2 FT. T1 / / � \ � , e - s` OUTLET „ ".,•rt . •. .,• ;: 8X0 DENOTES PROPOSED OUTLET 12' INLET SPOT GRADE 1 Failed ` \ ` ` . ` \ . � � �. .,�: ;:: °• °' '; � DENOTES EXISTING .,�. CEACH PIT ` \ \`, O �,,,-.„. 2 X 104.46 (APProkJ , \ 1.75• SPOT GRADE PLAN-SECCTION CROSS SECTION PL PROPERTY LINE � 'o� 6 H10LE H-20 DISTRIBUTION BOX PROPOSED CONTOUR NOT TO SCALE LOT 38 _ -. - / , EXIST. 1000 gat. \ , \ # 97 -- 97 EXISTING CONTOUR Septic Tank P \ I J DEEP TEST HOLE & \ 1 I t b,,. . ' Design Calculations I PERCOLATION TEST LOCATION \ t I HOUSE #t>0 1 ,. � ,M. r,!� /f Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gol./Day Min. per Title V) Garbage Grinder: No \ t \ \ t EXISTING i t \ DECK ;. _ Leaching Capacity Proposed: ,330 Gal./Day Minimum (Mina Per Title V) FENCE I 8 BEDROOM Septic Tank - 3 x 330 Gal./Day - 660 USE EXIST. 1,000 GAL Septic Tank. I HOUSE :k a, 12 SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch, � PRIVATE ,DRINKING WATER WELL I \\ \ \ , 1 ;• , / Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. - 273.8 gallons Sidewall Area: 0.74 gad./sq. ft. x 78 sq. ft. = 58 gallons TEST HOLE #1 ,•. r I , i Providing: 331.80 gallons ' REVISIONS ELEV.= 98.00 ,, . r t \ Use: (5) INFILTRATOR HIGH CAPACITY H-10 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, NO. DATE; DEFINITION t \ \ \ \ 1 t \ \ TO BE USED WITH 4.0' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE -0N THE ENDS. NO STONE UNDER. �jlU \ `\ J O � I O. \ `\ �\ \\ \ EXISTING /4" PROJECT BENCH MARKGARAGETOP OF FOUNDATION PVC I ELEV. = 100.00 Assumed \ \ \ \ \ , �v V `v \ vv vvv °y VENT PIPE110 I i : \\ \ \\ , \\ ,\ iI I W \ PROPOSED �v,-_S \ � , \ \ \ I i � 1 O\ PREPARED FOR : $6 s'Q' \\\. SUBSURFACE SEWAGE DISPOSAL SYSTEM O r9 \ \ , 1�,, o °� i o (9o, OF `� I \ --- ��, JEFFREY P. KEARNEY # 10 WATERS EDGE 1 / I 1 I I , BIB r o� MARSTONS MILLS, ' MA ! � 10 WATERS .EDGE I PREPARED 8Y: MARSTONS MILLS , MA 02648•oo , I u �c"0 F F�,,�Ss I CA:RNEY E. OSHA Y ° , g ENVIRONMENTAL SERVICES, INC. y81 , I I N I (SO , I .� o P.O. `BOX 627 oT �o IsTe EAST FALMOUTH, A 02536 rah N TAR i Wq T EL/FAX. . 508 548 0796 SCALE: 1 =20 DRAWN BY: CES DATE: APRIL 13 2004 T - . PROJEC SD 556 FILENAME. SD556PP.DWG SHEET 1 OF 1 _ Res j _ " I y F