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HomeMy WebLinkAbout0025 WEATHERVANE WAY - Health IF25 eatl er;vane Wad 14'4 39` Marstons Mills a wD- I � o�J tl' � o �- a� Y' No......qL531 Fim"...16 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH l Appliration for Dig .aiial Workii Tomitrnrtinn ramit Application is hereby made for a Permit to Construct X-) or Repair ( ) an Individual Sewage Disposal System at: .4rs2�a:. .s------------- -------------------------•-------•-----------..................-- �!►�e.c►.z��.�....tb.,�. Cn'Is�c�.l�u...l'11a1 -- --=�.--f�----......... Nation-Address or Lot No. �..... brrer J��a. 57 L '1. ..p. � .K/.��r/I.`/.� ............................ Ad Installer Address Q Type of Building Size Lot..A3 .s5'_L1......Sq. feet V Dwelling—No. of Bedrooms.-_.�1 .........................Expansion Attic kj) Garbage Grinder ( i) Other—T e of Building .............. No. of persons___--_______-_--.-_-.__-__-- Showers — Cafeteria Q' Other fixtures -------------------------------- --- W Design Flow..................................f"5----gallons per person per day. Total daily flow....................: _9?...........gallons. WSeptic Tank—Liquid capacity.IL,!—gallons- Lengthlbk!._.... Width'4'-1Q..... Diameter................ Depth_`VI.*.... x Disposal Trench—No..................... Width.................. Total Length.......:...p....... Total leaching area....................sq. ft. Seepage Pit No.___.,rxtc------- Diameter..... Depth below inlet.....'........... Total leaching area...442 ......sq. ft. Z Other Distribution box (j< Dosing tank ( ) Percolation Test Results Performed by---t)_��--- A'I., :l................_...................... Date.4 ..Or.�a�er..I.�Y�_/. 1.4 Test Pit No. I.....2......minutes per inch Depth of Test Pit---/Sf....... Depth to ground wa er .................. 0-4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to grou S.. I.......... a -•-•---------•----------•---•--------•-•-------------•---••••••--•---•----..........•----------•-----•-•--••---•-- . TH�t� t. Description of Soil ©- 3 o o sn,/. '.. abs d......................................................... U ..................................... ._.f .....Z/0, -I;a l.................................. ------i4LLYh..---••-• (il WILSON Vs'-t'1' -----------------•---------•----------•--------- - •--------•-------------•--•-•--•-•------------------------------•------ . '" U Nature of Repairs or Alterations—Answer when applicable..................................................... •------------------•-•------•--•------•-------------•--•--•-------•-------------•-_.. __ Agreement: '. =- i ..y The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia has i sued b the rd of health. Signed . ... -- --- -- ----------- ----- .....---oJ-/�--F-I Dare Application Approved By ---- --- ----- --- - --- - ................. .. ..-G - -------- --- .. .. . ..........' - - ----- ............ ......--------' —-- ------........ Date Application Disapproved for the following reasons- ------- ---- ------------------------------------ .....-----........_------.......-------.....------------------- Date PermitNo. ... ------------ Issued ............................................... .... Date all �� �� Fxs...fl...........� No......q THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............70W1_7..............OF.........61reirA-hk................................................. -Appliration for UWpatial Works Toustrurtion Vrrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .............................................................................. 0 tion-Address or Lot No. 60.np................................ ................................ Owner 7, Address .................................................................................................. . .................................................................................................. Installer Address Type of Building Size Lot_.43..,.5_&J......Sq. feet U Dwelling—No. of Bedrooms...Thrc.. .-_--_-----------------Expansion Attic kL Garbage Grinder 114 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 Other fixtures ...........................................................................- yflo...... ................................................................. Design Flow..................................-5'5...gallons per per3on per day. Totalw.....................3.3.9?............gallons. 9 Septic Tank—Liquid capacity-ILY-40.gallons Length.94I..... WidthA'-I.0..... Diameter.............. Depth5.!�40'.­ Disposal Trench—No_____________________ Width___............... Total Length.................... Total leaching area............ q. ft. area___......._.__------ s Seepage Pit No.....k-W....... Diameter.....1.3.......... Depth below inlet......4........... Total leaching area....ZiA......sq. ft. Z Other Distribution box ()( ) Dosing tank ( ) Percolation Test Results Performed by__.:5.4.r.-SA---%.k) 5.1...................................... Date..15.. Test Pit No. I.....Z_....minutesperinch Depth of Test Pit---/4FG.//... Depth to ground water________________________ (s, Test Pit No. 2................minutes per inch Depth of Test Pit................._.. Depth to ground water. ......... .............................................................................................................. .... ........ 0 -A 0 If...... il .1. -50b so f/ Description of Soil.......jP... ..... Z819A!�!............................................................................... :..... .. .............. ................ ...... ......................................... txj -----------------------*-- ----- I...-----------.................................................................................................................................................. -----4mtslm........ U Nature of Repairs or Alterations—Answer when applicable........:............................. ........... J 02-1& ................................................................................................................................................ Agreement: UAL The undersigned agrees to install the aforedescribed Individual Sewage Disposal Syste in ac I I the provisions of TITLE 5 of the State Environmental Code—The unde signed further agrees not to place the system in operation until a Certificate of Com lance a ssu by board of health. Signe ....... ................. -- ------------- ... DaW ApplicationApproved By --- ------------ -- - - -- - ................. ---------- .. .. ... .. .... . ... ........... ................Date................... Application Disapproved for the following reasons: -----------------------------------.................................................................................................. ---------------------------------------- ----------------........................................................... ........................................ Date PermitNo. ..... --- Issued .................................................................... Dam THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH ----fo- ----- OF --- - ---- - Oer#ifirtt#P of (11'antyliance THIS IS NC Y, a,Th I ti .1 e,�vftge Disposal System constructed or Repaired ... ....... ................................................ at ........k ......... ..... ................ ---- )y --------------------- �............... .... ---- ------------ en e n e provisions ofTITLE :f he nvironmental Code as described in has be'' installed/in accordance wit the the application for Disposal Works Construction Permit No. ...... ... ..... . ...... dated -------------.................................. I OS THE ISSUANC OF THIS CERTIFICATE SHALL NOT B 6NISTR AS ,.ARANTEE THAT THE SYSTEM WILL,FUN TION SATISFACTORY. ................................................................ Inspector DATE----------. .. ......... r ...... ........................................... ----------- THE COMMONWEALTH OF MASSACHUSETTS OARD F HEALTH OF...... No ..�CFEE I ingPntt ;AT- Permission is)`ereby granted...... Fu'ai �ped ........... ... ...................................... Xe D s Z at No ... .. 4 .. [ ------ ... i,It! ....... to Constr ct or air ivi.. lag s osal S s KC&I ... Street as shown on the application for Disposal Works Construction Permit N .. ..... Da ed...1.1.... .. ... .... .................. ........................................................ Board of Health DATE................... �/-------------------------------- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS TOWN OF BARNSTABLE LOCATION /o �3a7S WCc �rr�aac gay SEWAGE # 1' / VILLAGE c;rs to-1S ��s ASSESSOR'S MAP & LOT/y-7`6 37 I INSTALLER'S NAME & PHONE NO. e C�oNsT�z�e>sQ,;1 y, �mSDS� CZ)SEPTIC TANK CAPACITY 1066 Ga//Dp— -- L.EACHING, FACILITY:(type) (size) MOO NO. OF BEDROOMS PRIVATE WELL O UBLIC WATE BUILDER OR OWNER G2C-�.�3�z1E.� -loMEs DATE PERMIT ISSUED: l DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I V (�(-rr�, �zyArvf wn�/ ATTORNEY: JEPSKY & SACK 19400 PLAN BOOK: 411 PAGE:95 LOT(S):12 LENDER: GATEWAY FUNDING PLAN NUMBER: OF OAER:NANCY PECKHAM APPLICANT: HELENA STEJSKAL & CLIFFORD JOHNSTON REGISTERED LAND DATE: 06/30/2004 SCALE: 1"=50' REGISTRATION BOOK: PAGE: CERTIFICATE OF TITLE: FLOOD HAZARD INFORMATION PLAN NUMBER: LOT(S): FLOOD MAP COMMUNITY NO.: 250001 ZONE: C ASSESSORS MAP PANEL: 0015C DATED: 08/19/1985 MAP: 147 BLOCK: PARCEL 39 V N/F PATOKA N/F TRAFTON N/F SMITH N/F WHITELEY CONC BND(fnd) 17.62' 254.78' LOT 13 43,561 S.F.t f sro DEC_ �y DwE`Ci�Y 1 --w4 n+0 N N/F CONNELL o '--,,,LOT 01 rQ J 8 00 chi}; 272.40' Aj WEATHERVANE WAY MORTGAGE LENDER USE ONLY THIS IS THE RESULT OF TAPE MEASUREMENT, NOT THE RESULT DEs LAupj_FR_S .OF.,-AN INSTRUMENT SURVEY AND IS CERTIFIED TO THE TITLEc �i INSURANCE COMPANY AND ABOVE LISTED ATTORNEY AND LENDER. & ASSOCIA LJ, INC. THERE ARE NO DEEDED EASEMENTS IN THE ABOVE REFERENCED 40 KENWOOD CIRCLE, SUITE 8, FRANKLIN, MA 02038TEL.:(800)287-8800 FAX.:(508)528-4011 DEED OR ENCROACHMENTS WITH RESPECT TO BUILDINGS SITUATED ON THIS LOT EXCEPT AS SHOWN. ZH OF A4 THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE. NORM �. p IRVI G LIPSI THE LOCATION OF THE DWELLING AS SHOWN HEREON EITHER NO. 2 WAS IN COMPLIANCE'WITH THE LOCAL ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL �i^��FGfST V ASSESSORS MAP NOI-(� COMMONWEALTH OF MASSACHUSETTS PARCEL NO- EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 1° F W ld30 RLIV314 j tl 318VISNdV3 d0 NM01 Jq �ooz c inr bV0 a3A//��I3338 aT�� vv TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Q Property Address: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Owner's Name: NANCY PECKHAM Owner's Address: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Date of Inspection: 6/21/04 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 COP 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: X Passes _ Conditionall P/�sses _ Needs Furt r valuation by the Local Approving Authority Fails Inspector's Signature: Date: 6/21/04 The system inspector shall submit`a py of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspectio 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 SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****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 Imnertinn Fnrm 6/15/M00 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Owner: NANCY PECKHAM Date of Inspection: 6/21/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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 PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. 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 rep%cement 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: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Owner: NANCY PECKHAM Date of Inspection: 6/21/04 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: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Owner: NANCY PECKHAM Date of Inspection: 6/21/04 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 ''/z 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 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [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.] NO (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 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. A Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Owner: NANCY PECKHAM Date of Inspection: 6/21/04 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 J 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: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Owner: NANCY PECKHAM Date of Inspection: 6/21/04 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:2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no):YES [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)):ohr V -IM00 Sump pump(yes or no):NO : vvl Last date of occupancy: n/a U 3 340W 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: 1991 PER OWNER Were sewage odors detected when arriving at the site(yes or no): NO Page 7ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Owner: NANCY PECKHAM Date of Inspection: 6/21/04 BUILDING SEWER(locate on site plan) Depth below grade: 14" 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: 8" 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:3" _ Distance from top of sludge to bottom of outlet tee or baffle:31" 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: 15" 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 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Owner: NANCY PECKHAM Date of Inspection: 6/21/04 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:LEVEL WITH BOTTOM OF PIPE 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 IS STRUCTURALLY SOUND. 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 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Owner: NANCY PECKHAM Date of Inspection: 6/21/04 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 IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.SYSTEM SHOWS NO SIGNS OF FAILURE.STAIN LINES INDICATE PIT HAS NEVER HAD MORE THAN F OF LIQUID IN IT. 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 A Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Owner: NANCY PECKHAM Date of Inspection: 6/21/04 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. W YbAE U r�L � 9 Ub h14 21 A-Y)5-7 (P ,D21LO 10 Page l 1 of 11 OFFICIAL 'INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 25 WEATHERVANE WAY MARSTONS MILLS,MA 02648 Owner: NANCY PECKHAM Date of Inspection: 6/21/04 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 4'-011 21'-0" 1 1 I 1 I I I 1 1 ^ I I { ■ 1 1 � I 1 I I 1 I I 1 I I 1 1 1 1 � I I 1 I 1 1 ----------' S o rn W O O _ CJ rn N = O O I I I 1 1 I I 1 1 I 1 1 I 1 1 1 I I I I 1 I I I I 1 I W 1 1 I I f 1 1 1 I I 1 I I I N W O I 1 1 1 1 I I I I I I 1 I 1 I I I I 1 I I I I 1 t 1 I = 1 I I I I I I I 1 I I I 1 I U) rn m Z m O { m 24'-O" 01 251-0u 1'-O" JOHNSTON RESIDENCE 25 WEATHERVANE WAY EXISTING MILLS, MA. COX CONSTRUCTION COMPANY FLOOR PLAN DRAWN BY: TPC PACE 6 WINNIES WAY EAST SANDWICH, MA 02531 4 OF (6 PHONE:508-888-3838 SCALE: 0.245" = 1' EMAIL:coxcorpgmsn.com DATE:,VDATE 04/16/2010 /L LA �1l1G V 5 ; f 6-------------- � i I i y j'� f f.4hcr 169 ` a IUl 0 ; de1`ecl-,- S 1 i�_ t Ca �y ���tta�1 �;n�S�ed bC0elMeh f a S W P&A-hty-vc f W G i Ma�sitin5 t1�li A N ON PLAN _ 20 MINIMUM OR S INDICATED NOTES: i 0°i MIN. . `. Wea thervane 1. AL WORKMANSHIP AND .MATERIALS SHALL'CONFORM TO 'D.E Q E ,w athe one s TITLE 5 HE O r Pond EXTENSION To 12 RULES AND sElow GRADE 8 cKFlIL WITH y o A W A <OF SEWAGE;TOP OF FOUNDATION B' IN. REGULATIONS FOR THE SUBSURFACE DISPOSAL M 6 0 -c AN AN LE MASONRY EXTENSION TO 12 F Q _ o N F PLAN.io AND THE `REQUIREME REQUIREMENTS 0 THIS , a w - d� o �., BEtO GRADE � LOCus U1 'O N NSHALL; B .. .BROUGHT TO O 2. ALL COVERS TO SANITARY UNITS E R ti _ :WITHIN 12 OF FINISHED ,GRADE. � ,. s r .' P PIPE 0 4 SCH 40 VC E �/ 4 N TO GRADE , 3. ALL MASONRY UNITS USED T 0 BRING COVERS r IN.` __ Weathervane,M PITCH 1 ..PER FT. eothervan SHALL BE MORTARED N PLACE. w<. E 1 0 _ � 2 LJ►YER of ,, Y 4 W UNE' irn b PER: FL � 1, 8 1 2 S SHALL. E 'CAPABLE _/ I 4. ALL COMPONENTS OF THE SANITARY SYSTEM SH L B i TEE b W O ro0?, ASHED:STONE ' a a R UNDER OR S THEY ARE N ER OF WITHSTANDING H 10 LOADING UNLESS f 7 _ 3 ,. _ IN. < 2 0 G ON : AU. . . 1N K NG ARE S. -H .20 LOADING r .! WfTHIN 1C� `FT. OF 'DR}VES "OR PAR I A r 2 YIN. LEVEL CH LEA _ _ /P 4 0 tT I R a . P OF `D DRIVES O WITHIN R SHALL BE U5ED' UNDER OR _WITHI 1 9G . H s 3 4,_ 1 2 MIN. t q �o Lu mbert : LIQUID WASHED'STONE PA RKING: -: t O ty DISTRIBUTION _ TR ! v Pond . .. LEVEL H TOCOMPLIANCE.....:WIT D ED 5. 0 DETERMlNAT10N HAS 13EEN :MADE AS E .. _ eox N SHALL C 0 OR N REGULATIONS. OWNER/APPLICANTLL RESTRI Tf NS ZONING RE ._ OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY , . CATION ' MAP i oco , LOCATION GALLON P TANK G LL SEPTIC C t LEVY, ELDRE GE _ A CONTROL SEE L D`z ` 6. HORIZONTAL AND VERTIC L , AP _ , ASSESSORSM �Z__ PARCEL .3 ., & WAGNER FIELD NOTEBOOK _._. f L , OF OUTLET OW FLOW LINE UQUID DEPTH IN SEPTIC TANK :`DEPTH TL.Ef TEEBEL ` F , . . BOTTOM 0 .TEST HOLE 4 FEET 14 INCHES I WATER LEVEL . . ., OR'`USGS:PROBABLE HIGH TE FEET 19 INCHES . 6 FEET 24 INCHES INTERPRETATION: -� CURRENT .`ZONING . . DESIGN CALCULATIONS ' DES G DISPOSAL ,.P O Y F SEWAGE DIS SAL S STEM'PRO PROFILE A .2 ,. MIN. FRONT SETBACK FEET NUMBER OF BEDROOMS NOT TO SCALE 4 -83` - LE ' UNIT _ . GARBAGE DISPOSAL MIN. SIDE SETBACK FEET , W 0 ESTIMATED FLOW. TOTAL ES s x- O J MIN. REAR SETBACKGAL/BR./DAY, .a 3 FEETBR. �_ GAL. DAY 98 .:!!C4_ X EPT1C TANK CAPACI TY TY GAL. REQUIRED S 4�5 SIZE OF SEPTIC TANK ;GAL ACTUAL lAOU 5 G e LEACHING AREA REQUIREMENTS'- _ - N 1 T ST _ PERCOLATION SO L E � '� 2 ' W AREA GPD. S.F. BOTTOM AREA GPD S. SIDE ALL A / ,/ Y . 148 8 4 G ;< s DATE OF SOIL. TES QcEc SIDEWALL 2 / 2 4 SF x2 S GPD SF GAL DAY 0 EST BY _��, . z T .� — 1 BOTTOM TT 2 SF x GPD /S GAL DAY ( f ., 4 \ Lo t 1 WITNESSED BY �—.nv�tc. .drnr s�r$t f� j� _ ca PERCOLATION .RATE ` MIN./INCH _ PERC L 1 2 "..: .Y GAL/DAY SF !` 1 Y 9$ r o � : f CALCULATION: BREAKOUT TEST PIT 2 , o o TEST PIT 1 123 1 oc L c� V V ELE r�o! 9 ELE h t 3 _ , 0.00 0 i o a. W o� , _ 101 S bso C t s � O C c� t , ♦ 101 7 LEGEND. i 9 , 00 0 , EXISTING SPOT ELEVATION X 1 3 32 2 _ 00� EXISTING CONTOUR A cJ I _ J \ Gu b : . - FINAL SPOT ELEVATION 00.0 00 - FINAL CONTOUR TP , AT_ T PIT LOCATION EDTTOM OF TEST HOLE .BOTTOM ;OF TEST HOLE. SOIL TES L W i I 8"7;9 R WATER ELEv, TOWN WATER W OR WATER ELEV. 0 t / i Ud NK _ SEPTIC TA r_ v 01 DISTRIBUTION BOX , . p , A� T LEACHINGPI PRIMARYO 101.19 w WATER LEVEL' ADJUSTMENT. _ Y 1 RESERVE LEACHING PIT R 1 _ _ 100 r _ c3` T ST;DATE WATER `LEVEL c .gg INDEXWELL G,- V , ,WATER LEVEL RANGE ZONE 1" /! / 2t INITIAL ISSUE � .... _ .:.r. •.:.:is A K. ... � / :.., ,�� r W' LEVEL FOR INDEX WELL Lot 13 � r DEPTH TO WATER LE L WE N0. DATE'.` DESCRIPTION BY _ (/\\� 43,561 sq. r � FOR MONTH OF: EP TIC DESIGN . , F SITE PLAN AND S _ r WATER LEVEL: ADJUSTMENT' - r P TO HIGHWATER DEPTH LOT 13 WEA THER SANE WA Y 1147-38-7* IN ' .� hr.G y r dTl f r . TS ABLE MASSACHUSET BARNST 101 FOR _ �ST_PH�hI .r N _ ORATIO _ � 1VBRIER CORP ALLY GREE . APPROVED: BOARD OF HEALTH . vttIlso N�a.3021 �i ., 1599 15 99 . , z 1 40 .. CA JOB N0. S LAN DATE AGENT - SITE P d EDGE & WAGNER ASSOCIATES INC. f / LEVY, ELDR ,E I�1tDSC 1)iCAf18GrS PirlVlrl�S 1iXD $��1� _ :, • -. . BAGtN�S APB m s; MIT:.. -PER ,. . . . �, .: ,. STREET 2632 <889 WEST MAIN CENTERVILi,E MA 0 NEW fMGLAND RfPROGR cS 8 8UPPL Y CO. i