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0106 WATERSHED WAY - Health
106 WATERSHED WAY.; A = 059 009.006 t TOWN OF BARNSTABLE LO WAY SEWAGE# D®) 7 VII/LAGE/VpyZs is a.5 �t ASSESSOR'S MAP&PARCEL 0,0—0v —(Ja6 Ii4; TALLERS NAME&PHONE NO.f a--,4 7 SO.-7 �Jr SEPTIC TANK CAPACITY 47x f`s i e O v Z LEACHING FACILITY:(type)(�k)A/2e SD (size)la NO.OF BEDROOMS ' OWNER l' U1 r-h t O.0e D PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ° (� 3 G 3:: /D-`3 COP: > 1 4 _ y No. "� i'r — / Fee (/ THE COMIb1,ONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF,BARNSTABLE, MASSACHUSETTS es pplication for Mi.5pont *p.5tem (tOn0truction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No Owner's N me,Add ess,and Tel.No. lad G�/A� �s!@dOG>U�y / , P � , dry a e~~,q u Assessor's Map/Parcel O Installer's Name,Address,and Tel.No. �� d tD �l�S— Designer's Name,Address an Tel.No. �.�i9 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ) v gpd Design flow provided gpd Plan Date l 5 C7 Number of sheets Revision Date Title Size of Septic Tank % a d Type of S.A. 3) .3 af Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. � Signe Date �-a�•. � Application Approved by Date d Application Disapproved by:0Date for the following reasons r Permit No. p / • ate Issued ,� U�• . THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) v PX� C DATA Fee / 0 � ✓ e THE COMMONWEALTH OF MASSACHUSETTS - Entered in computer: PUBLIC'HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zfpplicatiou for Migoar *pgtem Con.5truction Permit Application for a Permit to Construct( ) Repair(i)'�Upgrade( ;) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No.j y/ y Owner's Name,Address,and Tel.No. 11%7 d ✓U fI C GI_ 4 r.�/ ~ ✓-/i A /'jJ�� �'r 1 r� rJ "ram C,� s Assessor's Map/Parcel Installer's Name,Address,and Tel.No. �} tii- 13 6 )Al Designer's Name,Address and_Tell.No.�_ Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) - -! gpd Design flow provided i fir' 2 gpd' 4 Plan Date 1 ,�� ; '��.r Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S.! ) 1� c'�,, ' i s' /�? �'�-4 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Awl' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date / `7 Application Approved by r, r y�,r.r< .. Date �� ! Application Disapproved by: r- Date for the following reasons Permit No. (/f! `� -7 Date Issued 1 r b 710 ei -- —————— -- �.__ —————————————————— F 1VI �s�.►�a�.s. a �a.- E�i% �.: :� �nLs �acr?�saraasz �3.THE COMMONWEALTH OASS., BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (,1 ) Upgraded ( ) Abandoned( )by r' at f o s 6"y" T c r 2 <; has been constructed in accordance f with the provisions of Title 5 and the for Disposal System Construction Permit No. -) t.�tio?-. 01� 7 dated V/;>_7/v �. Installer Designer #bedrooms 7 Approved design flow 7 gpd The issuance of this per shall not be construed as a guarantee that the system will function as designed. ? Date 0 ''?. Inspector f/; ———————.— ———`--——————————— W rt_o—+t, �.c.:�..�• r•s��i�� �.r sr >:' z �r:s��g +s++:_ s WWz±aa:i-7,�ea�-'-� -s.z.=r_ar_ats s No. fa r Feer`a r THE COMMONWEALTH OF MASSACHUSETTS " ,v PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS �Mponl *p5tem Cou5trurtion Vermtt Permission is hereby granted to Construct ( ) Repair O Upgrade ( ) Abandon ( ) System located at 4.. i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with,Title 5 and the following local provisions or special conditions. Provided: Constructionmust be,completed within three years of the date of this permit. Date L I f -) ?/ j "y/ Approved by �i 6L ze i i 4 ae TRANS. NO.: l D CITY/TOWN: 6�a�1e APPLICANT: -PCIO\ ADDRESS: `o(p (_zqkcS�o� W" a M e Mo\1s DESIGN FLOW: 3,30 gpd REVIEWED BY: DATE: 41 o 0 N/A OK NO Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 / CMR 15.220(4)(u)] V Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for / upgrades]- if not, a variance is required [310 CMR 15.412(4)] v Location of impervious surfaces (driveways, parking areas etc.) / [310 CMR 15.220(4)(d)] V Location all buildings existing and.proposed 310 CMR / 15.220(4)(c)] V Location and dimensions of system components and reserve areas. ✓ [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity(required and provided) soil absorption system (required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on / each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper V/ elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 1 5.220(4)(n)] u Address i QU OC'i�ef S N ,1,5 Sheet 1 of 7 i i N/A OK NO Location of every water supply, public and private, [310 CMR 15.223(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] j Stamp of designer [3 10 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required if construction ✓� activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to:demonstrate four feet of.suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] V Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specificaticns noted? [various sections of 310 CMR 15.000] System components not> 36" deep (unless Local Upgrade Approval or LUA rec_uested) [310 CMR 15.405(1(b)] I I i i I i I i i t � Address C)(-gL- Sheet 2 of 7 i I N/A OK NO Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR ✓ 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems >1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR A 1� 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] VrA H-20 Where appropriate? [310 CMR 15.226(3)] VA Setbacks from resources [310 CMR 15.211] Multi Com artment=Tanks S � _ W Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] �A First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and(3)] ��►'� "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] ��R Address Sheet 3 of 7 ' I N/A OK NO Located at least ten feet from any water line? [310 CMR / 15.222(2)] V Disposal piping at least 18" below water line (when water and `/ sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) I A Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 tJ� CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) v Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 j CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(0] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] j Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd tJ1ia [310 CMR 15.232(3)(d)] I Capacity(emergency storage above working=design flow)? [310 CMR 231(2)] (� Proper setbacks [310 CMR 15.211 (same as septic tanks)] tj A Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? j Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and (8)] 1 Stable Compacted Base [310 CMR 15.221(2)] iJ p Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] Address �Qk_q_ GS w it,$ Sheet 4 of 7 N/A OK NO €O I�ABS'®gRPTIO SYSWe We Calculations Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.2411 Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] [GAI.L ]RS,P�IS�� RS 31 QlR �S�2S3� ;_ � �` r ,HE Chambers and Gal. in trench configuration supplied with inlet ~ a. every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must `1\ be to grade) [310 CMR 15.253(2)] C� Aggregate I' minimum- 4' maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 1.5.253(6)] t� I�S�FN�4�� � � � Q� �` �<�� �,� _�"�,`��`.��raa,:.,,3;a��'+�zs�w'�v'y". "�,z.^ Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet - maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] \t'+ Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] 1S\pc minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM RI5.252(2)(d)] �J Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10' minimum. [310 CMR 15.252(2)(0] f Bottom area used in calculations only [310 CMR 15.252(2)(1)] Address Sheet 5 of 7 j I N/A OK NO �.4 h. Pressure Dosed System ? Provided pump and piping R 15.220(4)(r)] A calculations as re uired 310 CMI q [ � Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system - make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year (systems<2000 gpd) or quarterly (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill - Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] 1� Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] e ( f�"- Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] P, j Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] �l At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] � Check DEP Approval letters for credits and design conditions 1� If used with pressure dosing do not allow pressure discharge to scour soil interface �1 Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all I DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits T�\pt Did the applicant submit an operation and maintenance j manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan . [310 CMR 15.220 / 4 y RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed - [Refer to 310 CMR 15.4141 Address Q(Q U)GA asy QA woq "S Sheet 6 of 7 i N/A OK NO air Natr�geriSensrtrvelleas ... n. .> � w: s., Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 3I0 CMR 15.215 and / 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? / [310 CMR 15.214(2)] V Are the nitrogen loads proposed in compliance? [310 CMR nJ) 15.216(1)] `S„icin MlSC�ll�7leQ�uS�;,,z�.�•„Y��.�����er�tsa`� �:a�,.<,F, � �� � ; �`�� ��" ``'�'''�.'�,,,.e=�i 9 $�� ���i�' ,� Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address IOU Wc� U3 Sheet 7 of 7 M MII [s . Town of Barnstable �FIME Tph, Regulatory Services ti Thomas F. Geiler, Director * BAMSTABLE, 9 MASS. g Public Health Division ArED39,�A Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 04/28/09 Designer: Shay Environmental Services, Inc. Installer: ARCH Construction . Address: P.O. Box 627 East Falmouth Address: PO BOX 914 MA 02536 Hyannis, MA � a.3/5 On 0 /27/09 ARCH CONSTRUCTION was issued a permit to install a (date) (installer) septic system at 106 WATERSHED WAY, M. MILLS, MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 04/15/09 (designer) XX 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. GF r�gsS nstaller's Signatu ° CAR�"'`t�� ` SH No.ccehou"' I 1181 r c�GISTFFi (Designer's Signature) (Affix Deli �111ere) 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 v COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A.:Signature Item 4 if Restricted Delivery is desired. ,41 J' ent ■ Print your name and address on the reverse�,, X "'��' AYE L9'Addressee so that we can return the card to you. B Received b ( Name) 4C. Date of Delive ■ Attach this card to the back of the mail leee, or on the front if space permits. p ��'^ O� D. Is delivery address different from Item 1? 0 Yes 1. Article Addressed to If YES,enter delivery address below: O No au I -l�libDd�U i�✓la rs-�n s hn i(I�, ��� 3. ce Type U Certified Mail ❑Express Mail l� (J E3 Registered 0 Return Receipt for Merchandise 13 Insured Mall ❑C.O.D. 4 Restricted Delivery?Pft Fee) 0 Yes 2. Article.Number i _ 7 0 0 6 215 0 � 0 0`0 2 10 4:1 8641 (Transfer fro t m it label) i PS Form.381�J� February.'20W Domestle"Retum Receipt" 1022595-02-M-1549 v UNITED STATES POSTAL SERVICE t 'FiR5"h4eil..Cw"' • :-•T'S't' r'Y i ^1.Sfyir^�°# .,rR91.h�0. CC '. *h� .'_""'Rs«... �+:a • Sender: Please print your name, address, and ZI in this box• '' 41e0 l-f-h [71 V, ki . � S4rej W1A y . _ Town of Barnstable Barnstable Regulatory Services Department M*nWCaCftV Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70062150000210418641 4/14/2009 Paul Thibodeau 106 Watershed Way Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 106 Watershed Way Marstons Mills, MA was last inspected on February 11, 2009,by Patrick O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Town of Barnstable P# Department of Regulatory Services Public Health Division Date �,�IV12q_ 200 Main Streef,Hyannis MA 02601 �FGMh�A ,4 Date Scheduled IOTime Fee Pd. C� Soil Suitability Assessment for Sewage Dis osal D Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address Owner's Name 11 co ). ..Address cl Assessor's Map/Parcel: O�S ci d 1 —OC)`N Engineer's Name GA NEW CONSTRUCTION 11R.-EPAIR Telephone# Land Use :Rgsi `f l�Fic,.� Slopes(%) (52 Surface Stones Distances from: Open Water Body. ft Possible Wet Area n1 ft Drinking Water Wellft Drainage Way ft Property Line _115 ft Other /0 f ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands 3n proximity to holes) -: J' Parent material(geologic) W C122I.`cam Depth to Bedrock l�JE) ' Depth to Groundwater. Standing Water in Hole: fV OV'4L OD V Weeping from Pit Face J )CC�& 2 'Estimated Seasonal High Groundwater L`,a �,�j�0 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method.Used: Depth Observed standing in obs.hole: ___ __in, Depth to soli mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: index Well level— Adj,factor a— Adj,Groundwater Level PERCOLATION TEST Date 31213 Thne.l C ;6 Observation Hole# Time at 4" 4� Depth of Perc AB Time at 6" I sUL° � Start Pre-soak Time @ ( 1 5 _ Time(9"-6") End Pre-soak o Rate Min./Inch �1 Site Suitability Assessment: Site Passed_ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the., Barnstable Conselrvation Division at least one(1)week prior to beginning. Q:\SEPTICWERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# i Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.% ravel f�?� 5� f�le� �3 /►� 'lc�� Co \P a.,s Coo -Ls , DEEP OBSERVATION HOLE LOG Hole# a Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% j S LQ 3 r+ 1e �? ? LjL t S 1 - S Fern t r, p1a, -I Mel SC- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture- Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ons' to c 0 el DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell)- Mottling (Structure,Stones,Boulders. o si en Flood Insurance Rate Ma Above 500 year flood boundary No_ Yes . _ Within 500 year boundary No Yes Within 1o0 year flood boundary.No Yes Depth of Naturally occurring—Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? _. If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro mental P P and that the above analysis was performed by me consistent with . the required train i ,e s nd xp ience described in 310 CMR 1.5.017. Signature Date 1 QAS.EP110PERCFORM.DOC ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is required for Marstons Mills MA 02648 February 11, 2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms the I �� computer, r,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address Marstons Mills MA 02648 Rrt'" City/Town State Zip Code 508-428-1779 SI 12855 Telephone Number License Number B. Certification 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 16.000). The system.- El Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority (7 "a k. �2�({v� February 11, 2009 In ector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at`the time of inspection and under the conditions of use at that time. This inspection;does not address how the system will perform in the future under the same or different conditions of use. 09-17 Thibodeau.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 UY 3/01 i A ' r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name inormation is Marstons Mills requiredfor MA 02648 February 11, 2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist..Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level_in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 09-17 Thibodeau.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 1, Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is required for Marstons Mills MA 02648 February 11, 2009 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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. 09-17 Thibodeau.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is Marstons Mills required for MA 02648 February 11, 2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or "No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 09-17 Thibodeau.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is Marstons Mills required for MA 02648 February 11, 2009 every page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes . No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 09-17 Thibodeau.doc-08106 Title 5 Official Inspection form Subsurface Sewage Disposal System•Page 5 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 106 Watershed Way Property A rty p ddress Paul Thibodeau Owner Owner's Name information is required for Marstons Mills MA 02648 February 11, 2009 every page. Cltyrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)) 09-17 Thibodeau.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,. 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is required for Marstons Mills MA 02648 February 11, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 09-17 Thibodeau.doc 08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is required for Marstons Mills MA 02648 February 11, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Compliance date: 8/27/93 Were sewage odors detected when arriving at the site? ❑ Yes ® No 09-17 Thibodeau.doc•08106 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is required for Marstons Mills MA 02648 February 11, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer (locate on site plan): Depth below grade: 1' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ----------------------------------------------------------------------------------------------------------------------- Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3° 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 8 How were dimensions determined? Measured 09.17 Thibodeau.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwea lth of Massachusetts W Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is Marstons Mills required for MA 02648 February 11, 2009 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found 1" above outlet invert with solids on top of outlet baffle indicating surcharge from leaching pit. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 09-17 Thibodeau.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 10 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is Marstons Mills required for MA 02648 February 11, 2009 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan).- Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 09-17 Thibodeau.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Com monwealth of Massachusetts w Title 5 Official Inspection Form Subsurface a ace Sewage Disposal System Form Not for Voluntary Assessments 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is required for Marstons Mills MA 02648 February 11, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil.Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: One 6x6 pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: I Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Liquid level in leaching pit was found over top of structure with heavy staining in risers. Pit is in hydraulic failure. 09-17 Thibodeau.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is required for Marstons Mills MA 02648 February 11, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)-. 09-17 Thibodeau.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,r 106 Watershed Way Property Address Paul Thibodeau Owner --- — —...-----—--- ------ -......----- - ------ Owner's Name information is required for Marstons Mills _—_ — — — _ ___ _MA 026_48 February 11, 2009 every page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 12 32 29 48 Water Service anr. Watershed Drive • Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM ,. 106 Watershed Way Property Address Paul Thibodeau Owner Owner's Name information is required for Marstons Mills MA 02648 February 11, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: N/A feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: 09.17 Thibodeau.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 RECav zo Commonwealth of Massachusetts J U N Executive Office of Environmental Affairs - 4 1997 HEALTF!D�PT. Department of �WNOFBARNSTAE3LE Environmental Protection Witham F.Weld Trudy Coxe t3t�rrgr � Arpoo Piul Celluccl Dwld B.Struha It fiorsrnot, Conertlealo of O s�q O g- 0 D/ SUBSURFACE SEWAGE DISPOSAL SYSTEM[INSPECTION FORM b PART A CERTIFICATION PropertyAddrsss: 106 Watershed Way, Marstons MillsAddreaaofOwner. Robin Thibodeau Data of Inspection: G —;L a —1-7 (If different) Name of Inspector. W.E. Robinson SR Company Name,Address and Telephone Number. ( 5 0 8) 7 7 5-8 7 7 6 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT �. I ctutify 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: _liFasses _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails � / n Inspector's Signature: °' Date: le —;-d The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A,B, C,or D: A] f3YSTEM ASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. Tied CONDITIONALLY PASSES: or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,parses ection. o,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, cracked,structurally unsound,shown 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, 03/95) 1 One Winter Street a Boston,Massachusetts 02106 a FAX(617)556-1049 a Teephone(617)292.SM Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddresm 106 Watershed Way, Marstons Mills Owner. Robin Thibodeau Date of Inspeetion: (..j a / D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E]LARGE YSTEM FAILS: following criteria apply to large systems in addition to the criteria above: system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public ealth 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 for of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements o 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information., (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 106 Watershed Way, Marstons Mills Owner. Robin Thibodeau Date of Inspection: B)SYSTEM CONDITIONALLY PASSES(continued) 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): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) THER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) OTHER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddeess: 106 Watershed Way, Marstons Mills Owner. Robin Thibodeau Date of Inspeotion: G -?-0 (4 Check if the following have been done: Pumping information was requested of the owner,occupant,and Board of Health. _None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period.. Large volumes of water have not been introduced into the system recently or as part of this inspection. built plans have been obtained and examined. Note if they are not available with N/A. facility or dwelling was inspected for signs of sewage back-up. -:6 u`system does not receive non-sanitary or industrial waste flow V e site was inspected for signs of breakout. —1 1 system components,excluding the Soil Absorption System, have been located on the site. _L,A�e septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions, depth of liquid, depth of sludge,depth of scum. �size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. _4,4�he facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 106 Watershed Way, Marstons Mills Owner. Robin Thibodeau Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:�gkllons Number of bedrooms: ` Number of current residents: Garbage grinder(,yes or no): Laundry connected to system(yes or no):.1 Seasonal use(yes or no): A- Water meter readings,if available: 1 A q ci — 1 A F,, ()0() gal a 1996 - 134'000 Sals . Last date of occupancy: COMMERCIAL/INDUSTRIAI. 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 information: i System Aped as part of inspection: (yes or no).,&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(yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: : Sewage odors detected when arriving at the site: (yes or no) 4-0 (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddresw 106 Watershed Way, Marstons Mills Owner. Robin Thibodeau Date of Inspection: 9r 7 SEPTIC TANK:_ (locate on site plan) � c Depth below grade: Material of construction:IeIncrete metal_FRP_other(explain) ` Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thickness: 3°' b► Distance from top of scum to top of outlet tee or baffle: 3—_ e , Distance from bottom of scum to bottom of outlet tee or baffle:-% Q__ Comments: (recommendation for pumping,condition of inlet and outlet tees baffles,depth of limed level in relation to outlet invert,structural integrity, evidence of leakage,etc.) v o O C/cd c %2 A- c e e�. !4F SE TRAP:_ (loca on site plan) Depth low grade: Mate ' of construction:_concrete_metal_FRP_other(ezplain) Dime ions: thickness: from top of scum to top of outlet tee or battle: from bottom of scum to bottom of outlet tee or baffle: Comme to: (recomm ndation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence f leakage,etc.) (revised 11/03/95) 6 L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 106 Watershed Way, Marstons Mills Owner. Robin Thibodeau Date of Inspection: G �p.d. q TIG OR HOLDING TANK:_ G _ site plan) Depth grade: Material construction:_concrete_metal_FRP_other(explain) Dime 'ons: Ca ty: gallons I ¢allons/day Alarm evel: Comme ta: (condi on of inlet tee,condition of alarm and'float switches,etc.) DISTRIBUTION BOX:_V (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP BER:_ (locate o site plan) Pumps' working order:(yes or no) Cc nts: (note edition of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOAM PART C SYSTEM INFORMATION(continued) PropertyAddrees: 106 Watershed Way, Marstons Mills Owner. Robin Thibodeau Date of Inspeotion: G 'a.® -.Q '7 SOIL ABSORPTION SYSTEM (SAS):, (locate on site plan,if posarble;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: Comments: (note oo tion of soil,signs of h ulic failure, level of po nding,ding,condition of vegetation etc.) vC IZ is ,a h C OLS:_ (locate II site plan) Number d configuration: Depth-to of liquid to inlet invert: Depth of lids layer: Depth of layer: Dimensio of cesspool: Materials f construction: Indicatie of groundwater: inflow(cesspool must be pumped as part of inspection) Comments:), omments: condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY:_ (locate on si plan) Materials of oonstruction: Dimensions: Depth of Comments: (n condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 106 Watershed Way, Marstons Millis Owner. Robin Thibodeau Date of Inspection: (, b 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' DEPTH TO GROUNDWATER Depth to groundwater: )L-� feet method of determination or approximation: 13 6 1-1 (revised 11/03/95) 9 TOWN OF BARNSTABLE LOCATION td_o W&r-e`Z+J (il?a/ SEWAGE#-1 15P (F,4) Va,LAGEt ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. (T7y SEPTIC TANK CAPACITY (000 LEACHING FACILITY:(type) (size) ( UOC) �J NO.OF BEDROOMS j .OWNER. t ht o JZCd PERMIT DATE: C DATE::r7o I Gc� 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 A A A A A A • A 4 A A 4 A k \ \ A A \ 4 A A � '� r try 12 32 f ° x 29 .48 � � .� �. Water u °� :Service fn r� . . y ; ,� ft tershed Drive` � nTIOWN OF BARNSTABLE LOCATION % fnJ (L�N L�L4� SEWAGE # VILLAGE (VlQ4Yt4 ASSESSOR'S MAP & LOT 66-'�--409 40 INSTALLER'S NAME & PHONE NO 90r-40104t 0010% SEPTIC TANK CAPACITY 1, 000 s3q�s LEACHING FACILITY:(type) P". C/) (size) J(J NO. OF BEDROOMS PRIVATE WELL OR BLIC WATE BUILDER O OWNER dQ-l(?I) 4 o" DATE PERMIT ISSUED: iR IQ-7 /c7,9 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No r, �- ;,, y�g` - �', ,� \� THE COMMONWEALTH OF MASSACHUSETTS JV�C' BOAR® OF HEALTH � y �2cw4................OF.........3ccrem--&AX6 ---....--....................................... ApplirFation for DispasFai Workii Tomitrn.rtinn Frrutit `O Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: .............................. ................... t?x ,?a. .......................................................... .. -Address or Lot No. _ -- —�,_..... 1��........... � � -t.... --------------------- Owner � ��// // •- Address _ .......... v _ ..--• r = ........ .-Cl1.c"/s........................................ Installer Address Type of Building Size Lot-----1 .�_�'F`/1.....Sq. feet U Dwelling—No. of Bedrooms....__ �` ____________________Expansion Attic (/ x) Garbage Grinder (/1►�s) Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixtures ------------•-----------•---------------•-.................---------------------------- •-•--•---•---•--------------------••--•--•------------------. W Design Flow............................. Y�5 7__gallons per person $er day. Total daily flow................................. WSeptic Tank—Liquid capacity.10�.Wgallons Length.1-n4a"__. Width.W.10". Diameter_.:_...= Depth.47�_ &..1.. x Disposal Trench—No. .................... Width_.Q......._........ Total Length..........f......... Total leaching area....................sq. ft. Seepage Pit No...OAIR-------- Diameter.......F5........... Depth below inlet...a............ Total leaching area.._Z4 ?...sq. ft. Z Other Distribution box V ) Dosing tank ( ) Percolation Test Results Performed by._.JR0;X .C.V.1-..4,11C.---------------4--------------------- Date...3�o1AY7..._____.__--._.. ,aa Test Pit No. 1......4.._...minutes per inch Depth of Test Pit-----1A1........ Depth to ground water-___ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wate P4 --•-------•-••-•------------•••---•-----------------------------------------------------------------............................ - O Description of Soil_.-®--'.. " ._ mQci�. ti�s�c--�_____.__._. _________________________________ STEPHEN V ------- `. �!�}!�" QLum...-C.o ... Kral..f..CQt0AJ.a.............--•------------------ - ALLY _______________________________________________________________________________________•----.........__..........__.__._...__.__..........._.__.__._......_..........._.. .302t6 UNature of Repairs or Alterations—Answer when applicable..__________________________________________________________________ •--------•------------------•---•--•-------••-----•------------------------------------•---•-------------------------......................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewa e Disposal System in c dance with�� MTm the provisions of 1 S of the State Sanitary Code/ h un pr�i es not to place vre, stem in operation until a Certificate of Compliance has been isG��� � r '/ Signed....-- 333///// -----•--••-------••---- Date Application Approved By......... ------••. Date Application Disapproved for the following reasons-----------------•--•------------•...--•--••-•-•-•-•---•-•--•-----------------•-----------•......-•.....--•------ ...............................--•-••-•----...........................- ... .................................................. -•------....Date .........--- � Q` Permit No....... �- ....�.�.------ Issued..... . r No................_. , ' FIZZ .s.. . -„ f THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ................./ .......................0. ........ .crrrr:�6/e Appliration fear llhipaa al 10orkii Towitrnr#inn trnti# Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: •.....................•----..............•........--•---....-•----•--...............•---••--...... ...-----•----•-------•--•-•-------•--.....--------•---------•-------.........-----•......•......-- Location-Address i 1 1 r ' ,'' jv:7 7td s--�'C E4i_44, t t f� .. -�-�L Y'" &)tc. .....................GCiisr3 ------------------------- Instal............... ....._._._... at~.°�a�'�^��'"".' E.,'^Y�r�..a�"' � f` �,.,.�. � �/1/Cs%S�I�S V///f_/.>r•-•----------------------•-•--^------•---- ler Address Q Type of Building Size Lot._ .--...Sq. feet Dwelling—No. of Bedrooms......... Expansion Attic ) Garbage Grinder ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ----------------•--------------------------------------------••-----•-•--•-•----------- ----•--•----------•----------.......--••------------------•-. W Design Flow.................................��_.-��'_gallons per person per day. Total daily flow.............................-: 'a- P..Olons. R: Septic Tank—Liquid capacity ?©gallons Length.- ...... Width'�._�fQ.--- Diameter__.____..—.... Depth._d_�`-. W Disposal Trench—No..................... Width.................... Total Length.........I.......... Total leaching area....................sq. ft. Seepage Pit No---- ----- Diameter...... Depth below inlet..!f ............. Total leaching area.. ....sq. ft. z Other Distribution box ) Dosin tank ( ) I_' Percolation Test Results Performed by...V, x �:_ N� -................................... Date_._ ..../ 7 a - • • Test Pit No. I.... Z.......minutes per inch Depth of Test Pit----14 ,,....... Depth to ground water.. (T Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wat OF a •-••-•--•••---•---------------•-------•-•-•-••--•-•---------••......--------•-----------•---..------.......................... 0 Description of Soil... _d __.(................. 4 ) s -s SVUo_-C._ S___.•__- rC� `-�-.--C-.- - STEPHEN _._.... .. v- n-- � c .... •___£_-..9G........ /---------------------------------- LLP- . qA------.... ... ....W .... ...............----..................................................................................................................................................... :o .A�Na 3Q2J6�@ V Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------- _ 9 _ �g� -•---------------------------------••----------------------•-----------------...---•------------------------...-----------------------------------...----• ---••--•••------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i ccordance with'u/v��" the provisions of TILL LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in1"/__1 operation until a Certificate of Compliance has bee issued by the board of health. G2 Signed..__, : _ .., ��.�o�•�?/ Date Application Approved BY �.�. �..� . ....... if-n---�`� 1- Date Application Disapproved for the following reasons-----------------------••---------------------------------------...-•----------------------.............--•-_.... ..............• -••--••--•---------•••-----•--•---••-----.............r---- ...... }r Date Permit No.------ � . .......................✓ Issued............... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................OF......... �.. .................................................................... %rrtifiratr ,af Tuntplitanrr T14S IS TO CERTIFY That the dividual Sewage Disposal System constructed ( "-) or Repaired ( ) ..... ---.....--•----•-------...�.--------------•---•--•--•-•-----•---...-•-------------..................----••----•---•----------- at..��....-----� .....l�«�7'..�� r rY .'�J 4ti-.9X Inst/v/*ca4,�"4'�i„J'�,' C1'.+4/�•.,S "A^'/.r/ ........................... ---•---- ----------- ------------------- -------- ----•------•-•--•--------•----------------------•---------- has been installed in accordance with the provisions of TITLE 5 of Th State S-n't i•y Code as described in the , application for Disposal Works Construction Permit No.__... `l'�_ '< °• tic_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................•---.............--••--........_--------••••......••----.... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �'/ �� ................... ...................•--.... ....................... No... .d..l!�7.... FEE........................ DiiiVu irk n Uaxt rrntt Permission is e y granted---. ----------------•- --- to Construct (n or Repair ( )/an Individual Sewage Disposal Systemat ,r x z Street as shown on the application for Disposal Works Construction Permit No� .r2-.2___ Dated.....:.................................... ...................-................................................................................... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS , 1 � jj 4 4 I , i G3 �L �a 00 2 1 106 k _ - PO cy- o 9 Y 1 � to _ t ; 51 NCaLs f=AM I L.Y 3 8 M taa t LY FLow I t o x 3 s 330 G per. of -.U.S17= . ICoO (54L• TANK ALLYN WILE N "bISpr� 1T.._-ti.. U:$M , loco /1 ' 57-N 9� 2�s - � � Q 30"�--+-i ) GdcL A9o,�F GISTEQ' S, F ONAL So 5.1✓. x t. 0 = 5 LILY F't.bVCl = I'? Ca. R D 2h4t OFz L�55 • f _._.-_..._.. . ... .... . SLOPE x 150 12 71-1 ( = o F�CHARD [°-7 ToPF�� 1aG y� A. �` B�AXTEp N ; LOAM _ NIo.24448 2 (ova bIST. Ii1�/' ItiJV ` f lam. F',TN GS • SEPT 1G •A G , wry SNAS EL GS 2 �5 4 � •� SToN� _ _ _FAO 1 L�• MAMSTt f 5 MIL.L5 t ' ALE ►� �o _ G�4TE �2S�69 y 1 EL, SS }. No I=5 ALE ....,.:. __.. . _.. p j�. '13tL d2C. TAG• s"7 I G�izTl�-Y TJ-l�sr T�1E ! ►��anoa 5t�owN �.� .NY5,; llZ. P-�ISTL'�U L.A,Nt- 5UR �-)I=��N CvMt�YS kliTl� TI-+E S1D1=1...�1.I� - �Yofc� A�i7:SE 8A IC REgUI P-SQLl .S OF -rHe 0.STCRV/L LE MAC,S -Town! c ��w�51-A�A1Jp I-s t o1' .a#�i�t_IG.a•I.J�' , apt es k. rr -i..0��?.T�t7�1A1t7'I-�t�► TI-1� FLOOD PI..t�i N. . �. 5 � N OUMP N sl-;rovc..b D �� TO I=S�Af5USH LOT LILACS, . i ? 2a 0J f23 �,��/ �o ! RO Qom' Z04 a T1 �tN I 2 9. . j 0 1 f \ i yy 1 1 �y, I � 41 .r . • � T7�'SI4 t�l ?��cT,4 51 NGsL f=AM I L.Y 3, S CAM t t L-Y F-LD V I- 110 x 3 33o G per• w ; 5� IG TAWY,' `�` X .I r /o C L�4[J' C7.Pi Q• STEPPE - • . __U S IGbO Cxl�L• TANK. ALLYN WILSON US1= loco .e 9No.30216� 4y �i�) G.4t.. 9o�.��FSTEP S�bL WAL.L..4 ,. 15c) S, F." F ONAL6NG\ -- 4_ '1��L,4-r t oN r�•c. �" r N 2 M,t N a� L E55 : ; : ; y -ro //rr ST. �J Ct (ate ��S -e' O C =L-7 G, C�� 1✓ U tog _ - Tor FIND 1D a iilC�RD s I CA o � No., i (ovp bIST. �0oC) �IJV 2 - . • ; C-�a.L. •. IN.0 I N V G�,lr. I N v. GG Ae-A GG ¢ ToIYZ ;• GS•z �S A- bVaSHE .• _ _.. . STONl: %y � v. 59 , . . . -PP ZALS }; 11 E�' Sc, '. . PO fo0 r.�XTE 1- ;25 8. -y 9 ,. . �O VE2 i IZw&G '&L d ZzT11~Y -r-1 -'r —ME FvvtJDAnoa 5MOWN 1-l��ZF 1�1 C171pLV 5 WITH 'r4 E- SiP�I t1.�� �FGISTL}�I-) I:-:Nth 5URy�YO��; AIJI7:SI~T C TZ�QUI��.1v1 -S p1= TWt: CLSTEKVII I �- MA s. ' -rOvvN or -aAw4SrA�ANA l-s c or A>PF'L-14d�IT . . _. N 151�L A,N 16 S+A5.1=T� umaj-r --6uiz TI4C 0��51r T 5 Tp A U H oN S 40ULb 54�0T �>✓ USE b LOT t_IKIE , - l SECTION A -A *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C.n. from Sc T PI 40°Le Least loci ode'Ftker PROFILE VIEW OF LEACHING SYSTEM Existing Foundation house,tolseptc tank `. D-BOX cover must be Not to Scale TOP OF FOUNDATION ELEV. 100.00 (Assumed) 20• Mtn Septic tank covers must b. r within 8 In. of finished grad. within 8" of Grad* 3" of 1 8" - 1 2" Washed Peastone y a Grade over Septic Tank- 99.00 3 HOLE H-10 Grade over D-Box - 95.00 de over SAS - 95.00 / / `y 4 DIST. BOX 3/4" to 1 1/2 " DOUBLE Washed Crushed Sto s °'°2 4" PVC (CAPPED) INSPECTION PORT TO BE _" `�, . `• %� 3' Maximum Cover 3 ,o' EXIST. s.o.ot or rap of System- El.v. -90.30 d+t c ^ Greater INSTALLED AND TO BE WITHIN 6" OF GRADE Y j5 EX,ST. P,PE in 1'000 GAL. S. 0.01" ~` n N 73' Per foot _1, FROM EXIST. FDUNDATIDN rn SEPTIC TANK S CONCRETE FULL FOUNDATKI li H-1 O H N /."•'�6^ >y 3 2' EFFECTIVE DEPTH - •e`se� • 8 in 3 4•-1 , 2" -6 11 (>• 8 .G`I E e c tiv a w�*"""�•'°Oe"'^eO - ^,a SYSTEM PROFILE compact.. stone , 4' �� 4' S dezvadl Not to Scale - _ 'a -� GENERAL NOTES NOTE: SEPTIC TANK & D-Box TO BE CONSTRUCTED ON LEVEL COMPACTED BASE S Effeetlly. Wldth u 3 Units @ 7' = 2V c as a 1. Contractor is responsible for Digsafe notification, Verification of Utilities NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 8 in.of 3/4"-1 1/2• W Separation Provided T5 - - 1 and protection of all underground utilities and pipes. compacted stone From Bottom or SAS to 3S 3,5 2. The septic tank once distri ution box shall be set Bottom of Test Hole m Effective Length level on 6 of 3/4 -1 1 2 stone. 3. Backfill should be clean sand or gravel with no -PERCOLATION TEST Bottom of Test Hole 1 Elev.= 84.00 B stones over 3" in size. �= - ------ 4. This system is subject to inspection during installation 'Date of Percolation Test: E..II4� a ` 9 Groundwater Observed - NONE OBSERVED SOIL ABSORPTION SYSTEM (SAS) by Carmen E. Shay - Environmental Services, Inc. Test Performed By. CARMEN E. SHAY, RV, C.S.E. 5. The contractor shall install this system in accordance Results Witnessed By. DONNA MIORANDI-BARNSTABLE BOH OUTLET ROM SHALL CULTEC 3050 INFILTRATOR CHAMBER H-20 (OR EQUIVALENT) with Title V of the Massachusetts state code, the approved plan DISTRIBUTION BOX SHALL 2 g12" CONCRETE COVER EXCAVATOR: Shay Env. Svcs, SET LEVEL FOR AT LEAST 2 FT. and Local Regulations. Percolation Rate: 4 MPI 048" -.,,. NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30 /EFFECTIVE HEIGHT IS 24 3-5•q �- 2 6. If„ during installation the contractor encounters any KNOCI(osoil conditions or site conditions that are different Test Hole Test Hole - 5.5' 12• INLET from those shown on the soil log or in our design No. 1 No. 2 £ Local Upgrade Approvals-Counter Approval: installation must halt & immediate notification be DEPTH SOILS ELEV. DEPTH SOILS ELEV. ' 2 made to Carmen E. Shay - Environmental Services, Inc. ~1s5• 0 95.00 0 95.00 4" SC 40 To,/ 1,75• - `/Y machinery 1. Request Local Upgrade Approval of Vent to place SAS-more than 3 Feet Below Grade. 7. No vehicle or heavy machine shall drive over the - H. Loamy Sandy PLAN SECTION CROSS-SECTION 2• Request Local Upgrade Approval of Double Sleeve of Soil pipe 10 feet either side of the water line. septic system unless noted as H-20 septic components. 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. to YR 3/2 to-vet 3/2 NOTE: SAS ELEVATION IS LOWER THAN BASEMENT FLOOR GRADE. 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. 0•-8" Ae 94.50 °•-e" Ae 94,50 3 HOLE H-10 DISTRIBUTION BOX NOTE: PROPERTY IS LOCATED WITHIN A ZONE II 10. All solid piping, tees & fittings shall be 4" diameter Sand Loamy Schedule 40 NSF PVC pipes with water tight joints. Sand 10 TR s/e 10 rR 5/6 11. Municipal Water is Connected to ALL OF The Residence and Abutting 8"- 36" Be 92.00 6•_ M. Bw 92.50 Properties Within 150 Feet. Slit $ TEST HOLE #1 Mod. Sand Loam �' �- 9 ELEV.= 95.00 LOT # 23 Sewer Line to be Double Sleeved THE PROPERTY LINES ARE APPROXIMATE AND 2.5 Y 7/4 15 Y 8/e �� �' ce 10 Feet Each Side of Water Line COMPILED FROM THE SURVEY PLAN BY BAXTER & NYE, ENTITLED 38"- 132 Ct 84.00 30•_ 48• O, 91.00 i PROJECT BENCH MARK �� FOUNDATION CERTIFIED PLOT PLAN OF LOT #106 WATERSHED WAY, M. MILLS, p19 SHED _ --�� With 6 SCH 40 PVC. MA, DATED NOVEMBER 12, 1990 Med. Sand �,r'' - TOP OF FOUNDATION AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 23 Y 7/4 1 �Op,�'" 1 ' �� ELEV. = 100.00 (Assumed) IT SHOULD BE USED FOR NO PURPOSE OTHER THAN �� ( � 48"- 132r C2 84.00 98.'� 6 ,i ��. D-Box S' 6, THE SEPTIC SYSTEM INSTALLATION. 0 3jr• .t � S� 2s, ---_ EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE i 96 �,�Lt. TES(f HO E I %2'' NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE r• 5.00 � /' FO ,' FROM THE LEACH PIT TO BE DISPOSED I Certify That the results of the I ,EMT. AS-NNE �` 1-0 WA Y OF AS PER BOARD OF HEALTH SPECIFICATIONS. Perc #1 Located at TEST HOLE #2 Soil Evaluation and pert test are as VENT I Depth to Perc: 48" to 66" -- i _Su rfaca•EWctriG�T' lei., � , Perc Rate= 4 MIN shown on com ly with Title V -4,,` / THERE ARE NO WETLANDS ARE PRESENT WITHIN 200 OF THE PROPERTY Groundwater Not Observed 94------- No Observed ESHWT-132" Assumed / ,Muflici title � • � ASSESSORS MAP 59, PARCEL 009/006 ADJUSTED H2O Elev. = None - j� Signature of Soil Evaluato 92-- IF '� LEGEND I / EXISTING Failed1 y / Distance Between Inlet & Outlet Tees to be a minimum of the tank depth. \ DECK 3 BEDROOM Leach Pit i' DENOTES PROPOSED HOUSE 0.5 O O I �, r`` I 104X 1 � h� SPOT GRADE 2-,e• DIAM. ACCESS MANHOLES #106 EXIST. ��T"'� DENOTES EXISTING - 1000 gal. ,, I X 104.46 :':L., :�i::•,,.�,.. ,.; Septic Tank,ter' I r; �\ SPOT GRADE PROPERTY LINE PL PROPOSED CONTOUR INLET ou i i PSP�NL`( ;.I v rI THE ACCESS COVERS FOR THE SEPTIC TANK, EXISTING OR`VEWP i � � - - - - - -97 EXISTING CONTOUR �:• DISTRIBUTION Box AND LEACHING COMPONENT I GARAGE +h►�-rt;;+r. •r;^;^_ r ;;hM•' SET DEEPER THAN 8 INCHES BELOW V141SHED `' -''•• GRADE SHALL BE RAISED TO WITHIN 8 OF ® DEEP TEST HOLE & • FINISHED GRADE I % ` ` \� `� PERCOLATION TEST LOCATION STEEL REINFORCED PRECAST CONCRETE �.� INSTALL TUF-TITS GAS BAFFLES OR EQUALS PLAN VIEW - I � \ -- '-------- I 6 FOOT STOCKADE FENCE 3-2e REMOVABLE COVERS I I Cf) 1 LO #22 '` :` a' , {' ° ► / 10,891 care Feet • 3'min. clearance % ,3• INLET 7 ' INLET 8 mhT- 2^ m1n, inlet to outlet e•min. 1 n1o min U�Tivsi ` OUTLET 1 1 ; P LOT PLAN to � I � 5' -7" a , 5' -r 1 { E " 4'-0• min. I b an soft IIIdepth ; Day QPG� OF PROPOSED SEPTIC SYSTEM UPGRADE 1 Q�� 21 LOT PREPARED FOR . :••,'• , '••t••7 •7 s,,, / � O # \ PAUL & ROBIN THIBODEAU CROSS SECTION END-SECTION ' AT # 106 WATERSHED WAY TYPICAL 1000 GALLON SEPTIC TANK - NOT TO SCALE_ MARSTONS MILLS , MA Design Calculations OF Description By Owner PREPARED BY: Number of Bedrooms: 3 Bedroom EXISTING ptl L r RNEW E. ISHA Y v �4 Garbage Grinder: No E - %gv C/' Y. = d Y Leaching Capacity Required: 330 Gal./Day (MIN. PER TITLE V) = Septic Tank Capacity Required - 2 x 330 Gal./Day = 660 USE EXIST. 1,000 GAL. Septic Tank. °o Kitchen o E Bedroom o o m 0 m m ENVIRONMENTAL SERVICES, INC. SOIL ABSORPTION AREA: Using percolation rate of 4 min./inch - LATR = 0.7gal/SF 0 f 0. "-'!' i Bottom Area: 0.70 gal/sq. ft. x 336 sq. ft. = 235.2 gallons Bedroom 185 ASH U M ET ROAD Sidewall Area: 0.70 gal./sq. ft. x 160 sq. ft. = 112.0 gallons G rCIST� d' Providing: = 347.2o gallons Dining �,/ MASHPEE, MA 02649 9 9 Bedroom �.� At�t I H����� EFFECTIVE DEPTH J ` =�. :�• TEL/FAX : 508-539-7966 HAVING A 2 Use: (3) 3050 H-20 INFILTRATOR CHAMBERS, SCALE: 1 "=20' DRAWN BY: CES DATE: APRIL 15, 2009 (4' W x 7' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND 3.5' OF WASHED STONE ON THE ENDS. 1st Floor 2nd Floor ��PROJECT#SD11125 FILENAME: SD1125PP.DWG SHEET 1 OF 1