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HomeMy WebLinkAbout0345 WHISTLEBERRY DRIVE - Health 345 Whistleberry Drive Marstons Mills \ A= 062-020 - - , / i TOWN OF BARN$TABLE `ZkLOCATION 3K SEWAGE# 2001 - 6 2f(o -=VILLAGE f n , VIA t S AS ESSOR',S MAP&PARCEL 020 INSTALLER'S NAME&PHONE NO. �� fn a ale ? Pf 27 — 1 M; SEPTIC TANK CAPACITY '.,N'QQ p lV to I! LEACHING FACILITY.(type)' u Afe 3(o I(g (size) / ,S n 2 NO.OF BEDROOMS OWNER �N 01�e.1�- �„ C!2 Is- PERMIT DATE:��- 2 - (( COMPLIANCE DATE: 3 ` 3 /( Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility No fl 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 exis4 INSPECTiI, 300 feet of leaching facility) ' ��" `� )(Feet �k FURNISHED BY s`bd 1. J t f � Ai 3 yjq y 9�.� ss � Town of Barnstable P# �0(6 � Department of Regulatory Services ja_�— Public Health Division2 1) '� 9. Date A�� 200 Main Street,Hyannis MA 02601 Date Scheduled_ .3 I /(� _ ' Time / f2"M Fc epd � . Foil Suitability Assessment for Sewn Performed By: ' �2 gePiSpo��al � � Q Witnessed By:_Location Address f vr� LOCATION& GENERAL FORMATION U I-S f L(l)vi,j ry Owner's Name DQ54✓4151 Q6'1 7 AA. /\,\ [ 1,� I Address I I,, _ "del Assessor's Map/Parcel; /e� l�� Engineer's Name C W C& ` � e NEW CONSTRUCTION REPAIR Telephone#. 52—C, —7 �e.s , Jq / 3 2— `Z(Z ' Land Use � � ,-� Slopes(% —-�� Surface Stones Distances from: Open Water Body 1.3� ft possible Wet Area Gr �� ft Drinking Water Well �Y—`Jft Drainage Way. �/I — ft property Line sue / ---ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn Proximity to holes) USA r / Parent material(geologic) 6Cf_ Depth to Bedrock Depth to Groundwater. Standing Water in Hole: : � --f Weeping from Pit Face- 4 1 Estimated Seasonal High Groundwater > f 1 L-i Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: in, Depth to soil mottles: Depth to weeping from side of obs.hole:Index Well# in, Groundwater Adjustment ft. Reading Date: Index Well levelp Ad,t'aCtor, ,�4 Adj.Groundwater level,,e PERCOLATION TEST Date Tune, FHole# n Time at 9" Depth of Pero Time at 6" -_ Start Pre-soak Time @ Time(9"-6") End Pre-soak Cw- 4- ref r Rate MinJlnch Site Suitability Assessment: Site Passed L✓ Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIWERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones;Boulders&11en _Zy 5 tc �Y1 z 1 0 f2 2—/Z6 . Depth from DEEP OBSERVATION HOLE LOG Hole#=v`� Soil Horizon Soil Texture Soil Color Surface(ia.) (USDA) Soil Other (Munsell) Mottling (Structure,Stones,Boulders. o si % rave y 1 �- Ci �- Z S L z-r&7 ,ems DEEP OBSERVATION HOLE LOG Hole# FSZrface(in.) Sail Horizon Soil Texture Soil Color Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. 1 to 0 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No .61,11, Yes, Within 100 year flood boundary No •\ Yes � Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �S If not,what is the depth of naturally occurring pe ous material? Cei ti— fication �s�- I certify that on, �( IQ QJ (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trai ' expertise and experience described in 310 CMR 15.017. Signature Date QNSEPTICIPERCFORM.DOC Town of Barnstable Regulatory Services 51, Thomas F. Geiler,Director Public Health Division 39. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: Sewage Permit# Assessor's Map/Parcel ®6 Z_ 6 7 0' Installer&Designer Certification Form Designer: y?n e e��^c� W a rl l S kl-Q Installer• Address: P� i s e� ss g�� IZ14 Address: KG yes �-4c, LQ i On �4_W c� �" �' was issued a permit to install a (date) (installer) A septic system at 3`2 S W k`S+U 6&(-\rJ V, I"I based on a design drawn by (address) dated l 1 (designer) 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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) acted and the soils were found satisfactory. �I"OF 4f,,q�. PETER T. o McENTEE Her's ature) " CIVIL C 9 ,a F,9 N0.35109 G o��sS /STD V-%G\�`�.,� (Designer's Signature) (Affix Desi ere) 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:\office forms\designercertification fonn.doc No. D Fee V V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Migpogal 6pacm Congtruction 3pPr 't Application for a Permit to Construct( ) Repair t� Upgrade( ) Abandon( ) El Complete System Individual Components Location Address or Lot No. is S�� r'y ��""t Owner's Name Address,and Tel.No. Assessor's Map/Parcel fc 2 — v 2- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. y 7 7-731 3 �p,�/� tN10% �A/?,n u� �YlSttnQ.t.L�y 't,1to`f(CS Type of Building: Dwelling No.of Bedrooms Lot Size 4J; 7a sq. ft. Garbage Grinder ( ) Other Type of Building /Z F No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) S 3 O gpd Design flow provided 3SS, 2 gpd Plan Date J -/ - // Number of sheets Revision Date Title Size of Septic Tank /400 1410 ?Y 3Y,L..r Type of S.A.S. ay Afe 34,/6 //?u S�­e 4e SS Description of Soil �� lk ed z/2 Sew pL�n 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 ealth. Signed Date Application Approved by A Date ! r.2.—It Application Disapproved by: Date for the following reasons Permit No. 2.01 l (1 L Date lssued ? - / 7 No. b it IY4 Fee V U 7 IT THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes u ZippYication for Dig'ogal &pgtem Congtruction Permit Application for a Permit to Construct( ) Repair(1/ Upgrade( ) Abandon( ) ❑ Complete System V1,dividual Components Location Address or Lot No. 3y5- W"���+r✓.� 71- "t Owner's Name Address,and Tel.No. r Jan.fiTtLvK vin+ �l) Ojos a�,c4.t/'S Assessor's Map/Parcel a(,Z — V 2 v 3 9( W�kJki� 16t Installer's Name,Address,and Tel.No. (12 7" 9,�-7 Designer's Name,Address and Tel.No. t/7 7-57 3/ 3 orla w�c%� �'✓+l-u�rt t�> �hs,�w.0��1/ t,!or�c 5 Type of Building: Dwelling No. of Bedrooms 3 Lot Size 4 j 7)) sq.ft. Garbage Grinder ( ) Other Type of Building ►Z o No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �3 G gpd Design flow provided 3 SS , 2 gpd Plan Date - / - // Number of sheets Revision Date Title Size of Septic Tank I600 14 •o Q r >>,j,a Type of S.A.S. 'u Ale 3(0/! 117c, S 1G;_1 1.S1 Description of Soil 1)4-0 /� c/Z SQc i 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 Y sewage disposal system in P i 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 ealth. Signed Date Application Approved by ry 4j Date ? -I Application Disapproved by: Date for the following reasons i Permit No. 1:2 01 L Date Issued ` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (�) Upgraded ( ) Abandoned( )by �T Pw to-If S� 5 at 3q S 1.d, 4-t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2�j "U , dated f--�`/ Installer < 161J. L.a-11-41A4 V I Designer Cn p,..a-" 1,V& C 5 #bedrooms 3 Approved design flow 3S f 2 gpd The issuance of t %is permit shall not be construed as a guarantee that the system wiK function as designed. Date Z dal �� Inspector l No. rl ! ll Fee f Ou THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS xigpogal *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon ( ) System located at 3 y 5- 111 rAZ and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construc ion must be completed within three years of the date of th' erm}� Date f a Approved by !/ / v • � Ll'lLi�l.lJ�1 • 9 F ru Postage $ �6 nj Certified Fee 0 Return Receipt Fee Here O (Endorsement Required) O Restricted Delivery Fee E:3 (Endorsement Required) USP S m $ S�r ti Total Postage&Fees m nt o Street,CO Apt.No.; •,`� N or PO Box No.3.� ---------/ City,State , IP+4 Certified Mail Provides: o Amailing receipt e A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the. fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mallpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3600,August 2006(Reverse)PSN 7530-02-000-9047 I SENDER: DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign Item 4 If Restricted Delivery Is desired. �' ❑Agent ■ Print your name and address on the reverse X ✓ ❑Addressee so that we can return the card to you. B.'Received by(Printed ame) C. Date of Delivery ■ Attach this cans to the back of the mailpiece, z-S or on the front if space permits. ✓ D. Is delivery address d' erent from Item 1? ❑Yes 1. Article Addressed to: d If YES,enter delivdress below: ❑No 1 Mr.�&,Mrs.,Robert E Desautels 345 V�"fistlelierry Drive I'' MarstSns Msl:+1`s, MA 02648 3. Service Type k , „ ❑Certified Mail Express Mail :•* $` ❑Registered ❑Return Receipt for Merchandise - ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑ 2. Article Number 1 r� (fransfer"service label) 0 U oZ.,7 O o o❑a PS Form 3811,February 2004 Domestic Return Receipt' t t; I I ; UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • PUBLIC HEALTH DEPARTMENT L N OF BARNSTABLE AIN STREETNIS, MA 02601 ltltlilt-111 Ill II fit li)il'1i111l aIIll,54.1shl]]I1$118811isIII IKE Town of Barnstable Barnstable P� O Regulatory Services Department 1 e"a j 9� 63 Public Health Division m ATE°M4A�ra 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO r CERTIFIED MAIL# 7008 3230 0002 5178 2466 February 23, 2011 Mr. &Mrs. Robert E Desautels 345 Whistleberry Drive Marstons Mills,MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located 345 Whistleberry.Drive,Marstons Mills, MA was last inspected on 2/08/2011, by Robert Paolini, 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: • Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow 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 BO RD OF HEALTH ean, S.., Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\1-I SAMPLE 60 Day Deadline.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for.Voluntary Assessments °M ,.•'w 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name . information is required for Marstons Mills Ma. 02648 2/8/2011 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. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer, use . 1. Inspector: only the tab key v iii to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name tab P.O.Box 763 Company Address Centerville Ma. 02632 rennn City/Town State Zip Code (508)477-8877 . S14454 Telephone Number License Number _ . Tr ' 1 . B. Certification I certify that l 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::j340 i Title 5 (310 CMR 15.000).The system: t =— ❑ Passes ❑ Conditionally Passes ® Fa li s ❑ Needs Further Evaluation by the Local Approving Authority 2/08/2011 ., Inspect is 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 101000 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. V v V t5ins,11110 Title 5 Official Inspection Form:Subsurface Sewage Di oral System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 345 Whistleberry Dr. Property Address Meg Van.Bael Owner Owner's Name information is Marstons Mills Ma. 02648 . 2/8/2011 required for 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: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of.the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) 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. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 02648 2/8/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 pipes)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑.N . ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 b0 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts v Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 02648 2/8/2011 every page. City/Town State Zip Code Date of Inspection B..Certification (cont.) 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: **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 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 El ® 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 t5ins•11110 Title'5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments oM 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 02648 2/8/2011 every page. City/Town State. Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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.El . ® Any portion of 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 1 of a public well. ❑ ® Any portion of.a cesspool or privy is within 50 feet of a private water supply well. El ® 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.) 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 El ❑ the system is within 200 feet of a tributary to a surface drinking water supply E] 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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 02648 2/8/2011 every page. City/Town 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 breakout? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ElWas 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. El ® 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)] 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 02648 2/8/2011 every page. City/Town State Zip Code , Date of Inspection D. System Information Description: 0 Number of current residents: 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 Seasonaluse? ❑ Yes ® No ,000 :77 09 Water meter readings, if available (last 2 years usage (gpd)): 2020 9:77,000 Detail: Sump pump? ❑ .Yes ® No Last date of occupancy: NA Date 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: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 02648 2/8/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 02648 2/8/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)sand source of information: Were sewage odors detected,when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 104 feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 1, Depth below grade: feet Material of construction: ® concrete ❑ metal El-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: 1500 gallon . 5" Sludge depth: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System:Page 9 of 17 Commonwealth of Massachusetts Title 5 Official -Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills- Ma. 02648 2/8/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 1 7" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 1311 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.): Pump tank every two years.lnlet and outlet tees are in place.No evidence of leakage.Tank appears structurally sound. Grease.Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete El metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle .Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 V Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is Marstons Mills Ma. 02648 2/8/2011 required for every page. City/Town 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.): 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): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: El Yes El No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): M Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No' t5ins•11/10: Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma: 02648 2/8/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes_ ❑, No Alarms in working order: ❑ Yes ❑ No 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: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 - M Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .H 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 02648 2/8/2011 � every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding,.damp soil, condition of vegetation, etc.): Sandy soil.System shows signs of hydraulic failure.Leaching pit was dry at time of inspection but stain line observed up to inlet. 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 1 o , Commonwealth of Massachusetts - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 345 Whistleberry Dr. Property Address _Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 02648 2/8/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface.Sewage Disposal System•Page 14 of 17 J Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C M 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 02648 2/8/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately Ib 3S t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 02648 2/8/2011 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 high ground water: Bottom of LP 35' 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: As-Built ❑ Checked with local excavators, installers (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of . groundwater elevations. 4 E Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 1 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments 345 Whistleberry Dr. Property Address Meg Van Bael Owner Owner's Name information is required for Marstons Mills Ma. 0264.8 2/8/2011 every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B,C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems)completed E System Information— Estimated depth to high groundwater . E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate.file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 LOCATION SEWAGE PERMIT NO. VI Ll AGE i INSTAI. LER'S NAME i ADDRESS Josea Da.�/,;n BUILDER OR OWNER DATE PERMIT ISSUED � .� 4171, 93 DATE COMPLIANCE ISSUED �, � - m°�'' S Z96Gy te, � ,. � _ !. �� � tl t7a i `No....... / Fps.....:: THE COMMONWEALTH OF MASSACHuSETTS BOARD OF H A TH ..�7. .1/\...........OF....... ..... ...P.h ....... �_..... Appliration for Dhipoii al Works Tnnitrnrtiun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at I Lpcat, n-A ress ...��. I ... Z 33...0.141. �...� Q 1 Owner -•-Address .............. .[A-1,..... ....•-----------------•---------------.--... - ------.----•-•-------------.._.__...--.- -•--------•-•-•-------------•-------- Installer Address d Zype of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms _____._ ._............................Expansion Attic ( ) Garbage Grinder (�) '4 tc_. ...... No. of persons............................ Showers — Cafeteria pa, Other—Type of Building _ p ( ( ) Q' Other tures -----•--•------------ . W Design Flow...... .......................... allons per person ay. Totalidail�� flow...... _.._._..__ ._.._...... lon0. WSeptic Tank—Liquid capacity. allons Length.__ __ ._. 4Vidth__1 _...... Diameter................ Depth_. e._.. x Disposal Trench—No. ................ --- Width.................... Total Length.......... j___-_- Total leaching area___..�.�__ sq. ft. Seepage Pit No..................... Diameter......b......... Depth below inlet._._.___.____..- Total leaching area-.!=42d.-....sq. ft. Z Other Distribution box ( ) Dosing to ( 9 , aPercolation Test Results Performed by.__. 1 '. ti..... ram-_4.��2�''k��s...... Date._ . __._. ......... Test Pit No. 1.__4_0 minutes per inch Depth of Test Pit.......}�-•-•••• Depth to ground water. ....... �1� 44 Test P:t No. 2___.��'__minutes per inch Depth of Test Pit..._ /!(-•-. Depth to ground water................ -- --•-- ................................................... i 00 ti(....................... ............................................ ._� O Description of Soil....... 7; 15fl1 r( -. lti � UNature of Repairs or Alterations—Answer when applicable............................................................................................... ..•-•--•-•--•--••--•--•----••---•••-••--•-•-•••-••-------•-•---•-------•-----•--•-------•-•---•--•-••••••-•-••••---•----•-••----•-••••••--•-•••••--••--•-----•.----••••--••-•••••-•-••••-------------•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sanitary ode— The undersi ned rees not to place the system in operation unr_il a Certificate of Compliance has bee U th a d o lth. ? Signed----- -•• . •••. ----•-•-•----• ---•-•-• �} ate Application :Approved By----y�=/'� (/ Date Application Disapproved for the following reasons:.............................................................................................................._ --•---•-------••-----•-----...-•--•-•------------------------------------••------•--------------------------•••••--••••-•-•••••••-•-----•--------•••--•--------•--------•••-------•-•••--••--•--•-•----- Date Permit No... 3.. / Issued Date No...... ..:__.'.': Flea.........:.'.: �••- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...--`--�. OF........L~... !` i..`n.`G .� --.�"'........................... Appliration for Disposal Works Toustrnrtinn Prrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .........-- -- - --- ;,Location-Address lr J or-I'or"I'lo. j ......::.:...?. .:...1...................................--... T .�s _ ....Yy.L�........ C^ l `Owner Address ..... --------•-••----•......................•-----.... --•-•-••----------------------•--•--------------------••-•-----------••-•----•--•--•-- t Installer Address Type of Building Size Lot............................S fe t Dwelling—No. of ..... .............................Expansion Attic ( ) Garbage Grindei�l( ) pal Other—Type of Building _Gn c............. No. of persons............................ Showers (-Z) — Cafeteria ( ) Q' Other fxtures ..-•-•••--------•-------•------- W Design Flow.......S_'.............................. allons per person er day. Total daily flow----.?-�. .........................gallons. WSeptic Tank—Liquid capacity_)_�.__.r. allons Length..__.--0. Width_�O__-___- Diameter_______________• Depth....(.__`-..-_. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area._.._�_�__�__^_..__sq. ft. Seepage Pit No--------------------- Diameter....... Depth below inlet.......6......... Total leaching area...ZZA-2......sq. ft. Z Other Distribution box ( ) Dosing tank ( ,) _ _z Percolation Test Results Performed by__._:�i.%____ __ �=..:.....! �t n�--�!'.s^s:...... Date... ............. ............ f i a Test Pit No. 1...L.:U minutes per inch Depth of Test Pit......._ -__.__.__ D pth to ground water..... 5 GL, Test Pit No. 2.....4-minutes per inch Depth of Test Pit.... _----•- Depth to ground water.._. _.....___. ..............................................`........•.......................................................................................................... Description of Soil ( ..;'--•• `�s �� r \ i�S";' �. S = �) (�✓1 (/' ...........................................�__._.._._ _..._____._.___. '"�yt`"/J�— _. UNature of Repairs or Alterations—Answer when applicable................................................................................................ -•-------------------------------------------------------------------------------------•----------•---•----•-•-----------------...------------•----•-----------------••---•-..................--•-•-... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT11 5 of the State Sanitary qode—The undersi ned agrees not-to place the system in operation until a Certificate of Compliance has_ bee i'sue th a d lth Signed -- -- ------ _.--•-• -------------•- Application ...._ ApprovedBy----•----•--••--•------------•------------•---•---•-•-••--••••-•....-••---------------------•--_.. .-••---•---•-•------•----.............. Date Application Disapproved for the following reasons:-------•--------------------•-------•------------------------------------------•-------------•-•-------------- ..............•-•--••----------.....-••---••--•----•-••--•-•...........--•....--------...--•-•--•--•-•---•••••••--•--•---•----------------------------•--------------------•--•----------••-------•---- Date PermitNo.__ .3.:--..P..................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trdif iratr of f omplianrr THfS IS TO CE TI Y, That the Individual Sewage Disposal System constructed (X) or Repaired ( ) by......-?...� -t.-,4 w ...................................................................................................................................................... t f nstaller /� � ' at.... �....__....---•---`-•-_ � s. 5'd! 4__x 4�er. e________________ _ _j. =_..... .......... has been installed in accordance with the provisions of TI T IZ 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__..T......_.._!s..:............... dated___.._y - `--3 --------------------------------- THE ISSUANC CO' THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WVI (F TION SATISFACTORY. a DATE......_y3... ................................................. Inspector.......... ------=-------------------------•----------------------............--- 6 THE COMMONWEALTH OF MASSACHUSETTS _ r•. BOARD OF HEALTH ..... .:�..`^.'........ ..OF....�! C/'� (\.I.)1..:f:.....R............................... No......................... FEE....:................... Dish aut Morks %Tnn.10 lurtwit Vamit Permission is hereby granted aJ- 1._ ...... -- -------------------------•------------------..........-•----•--•-..........----.-•-•- to Construct ()(,) or Repair (, ) an Indivydual Sewage Disposal System at No.. .l�._. h_�S �.t;,+: i' t ' !Cr.J..:.!✓..-... f`Y ......................................................... Street as shown on the application for Disposal Works Construction Permit . ................. Dated........................................... ............... ...•-••----•-----------------•--•-...-----•--...----......_.. ......•. :....•-••••... ---•----•------------------------•-•-------- / Board of Health DATE---�---��---- --� G FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS /VO 'F 2O FT M//V. `1 n=EAGJ//w5 P/T ARE MORE T,44,1.v /Z " BE[ Ow /Q 'Orr. /y/N 1.RAOE, 4 24 "O/AM ETE�• COiYC-.PETS COYEQ ( .�XALL BE BROUGHT TO G,QAOE. `-� •� cr;?.a 4 PYC 0/PL CO/VCRCTEM/N. P/TCN 1 %`OEAV y CA S T /•?O/Y C YEr? L - T ' ` )=t:=f 14 :o COYER� - /B'PER.F"T/ 1 /•_/N OR/VElt/A y i IN M01. P/TcX Svcs ;3 ' G.4L plST. o.• t • • • • • o �4' irASh"FD 57-- 'E j Rem rr, SEPTiC TANK a a x • t • « • , , , • e r e e O�PTH • e t ' • "Pool, ;+.45h+ED STO:YE 188.5 x 2.5 4-1 I G 1 D 00 a t • • • � • � r p v FREC 45 T SEfpAG E /NYe�' &LEVAT/ONS ?8 •5 x F. o _ �18 bl D � � a • EL _ .�B.S YER7' AT B!J/LD/NCs IOfc.o FT. PiT c �C�7`( : 54�i Cam/(� 6 Fr D/.4M. INLET SEPT/C TANK 1a .5 FT TaaUL.aTION� OUTLET.SEPT/C Ti4/VK 105.E FT, bt—P I So°76 %NLET D/STR/8L/T/ON BOXY 4 FT SECT/O/V OF GROuNo yvATER TitOLE OUTLETD/STR/B/lT/ON BOX 105.2 FT. _ . /NLrT LEACHING Fj/T. 104.5 FT .SE1�V�IGE O/S/�O�S'AL SYSTEM LEACH//VG .a/T 7"AdULAa'/ON DES/GN .CR/TEf�/A sCALE %s" _ / - o' OIME/KS/oN A DIAfENS/ON $ FT• ,V U.MBER Of 9EDROOMS 3 D/HENS/ON C_ F T--.(M I W) e,•ReA�Ewisaos•+t vw/r Yes SOIL LOG TOTAL "EST/MAr--D FLOW B3(0 0.41..IPA Y SOIL TEST Af•/ SO/4 7,EST 2 SD/L TEST /1lUMBER OF 44-4CHhvG PITS_ I fFG�Y. 114.2 �^-ELF✓. 103.0 PATE OF SO/L. TEST al 83 S/OE LGAGH/NG PER 0/T ��S<J PT. Lot � Lc7AAA RESULTS -iOTTOM LE�ICN/N�s PER P/T -18 Sq. Fr o-1a" � ,� e' la &,aPsc�L PCRC04AT/O/v � A7--se t -T07,44 LEACH//vG AREA' .9E.tCOLi4T'/ON RATE 12 A� M1N./'INCH .-gESERVE4EACNlN6AREA 2�0� SQ. FT. II,,TTj��� /� Z• o • . NleD e �t _ - • corr-esc. �E Q ; Ste,L ST 6`2 P- 159 8 tZH OF Ie. POSH 9F�f , 18�- 1O Shti� (S -t0 SA-N� ,tn I xE D m�XE-D. [�T �4 VJ f t?STL E( '�? oy' y_, 1 t 111 W IT)-4 loll�1 ES-rz�r� S tA I L:r_ •/' IP \ Ca2hllE( H o WEI.N6 j� ; o (SLAVEL No. 366 EL QREDGE ENGI N,EERING CO,J/1/G. EL= ia4 2. EL= 94). 0 712 MAIN ST. , HYAwwiS. itrtAss. SURD" 0 NO G RO C/No yYA.T�R .ENCO LINTER Eo CL/ENT: r`�-�ct�,L DATE 01 •2.'1 P�3 `.� GRO'UNO 1niAZ`Ei? AT ELEf/ J .JOB NQ' 83oco4 $HEET�OF 'L rs OR BEL.OI-V /O.mr. /fIAI. 24 e0/AM ETER C'O�yC,P�=T COVER t— ALL BE BA?OUGHT TO 47.QA ,0E CONCRCTE . i 4�PYC 0/PL h+E 4 vy CA S T /,1-a/V C 0 YE COVERS M{N. P/TC�'+l =j,v OR/1/EK/-4Y- ►4:o �" :e �E.Q f=T/ r � f LQC//O L E:iEL 4'CAS - MJN. PlTG1Il G.4L _ � I • • • • a r � � e �4'Pe►�e/�T SEPT/C' :. 7A.,V K �7q D J ST. o D I • v • • • s • • • e �� i r';-i Sh"FD ST=.�E • • r • • DlaPTH • • f 0 W45hYEJ STJXE 1SS•5 x,'C,5 4-1 I Cn/ • Oe • 1 • �• • • • • • • p �•v ??�G45T SEEPAGE. IAIVZTT ECFi/AT/aNs ?8 ,5 x i, o -78 61 Q ° • •� r ► • • • • • e • ' sd_o �/7 OR E4U/V. FE L /,1/1/ERT AT BUILD/NG 10G-o FT. P i-F CAR C.-r--f . 549 !NL'E .SEPT/G' TANK io5.8 ::,49 = 3�Co G/D F, 10 '!CT. v/A W. TRB �. G(SFE UL 4T/O/V> LISP .� . OCJTLET SEPTJC7 INK l05.Co FT. 1 50'70 �. BOX ios 4 FT. SECT/,ON OF GROUND WIA7,ER TABLE Ot/azro STR/B[!T/ON BOX 105.2 FT /NCrT LgACN/A/G P -r 104.5 FT. SEh/.4GE ©/SP�SA L SYSTEM LEACHING •a/T TAdULAT/ON DESGGN ['RITER/A -SCALLE : %s" _ /,- a- o/ME/Vs/O/V A 8 F'T. D/ f.ENS/ON S Ft. NC/4N9ER OF BEDROOMS 3 O/MENS/ON C_4 FT.CM I W)'. G,AReAGED/SPOSAI- UN/r 1'�S SOIL. -0& TOTAL EJTIMATEG FLOW 330 GAL./DAY SOIL TEST, 01 SO/L 7EST02 SD/L TEST .tilCJMBE.P aF 4E4CN1WG o/7.S_ 1 EGEY. I-�2 ELFy 103.0 f' — �` DATE OF SOIL TEST a1 . 20• 83 S/DE LGACH/NG PER P/T SQ. /:T. Lam LOAM REsuj-rs h//TNESSED Bf' J /JR P- 30rrom LIC74CH/NG PER P/T 18 54. F7- o-rs" �7ap o,� o'- �a.' atRCOLATioti eATE ,t I La-5 7/0 7,4 L L EACH//YG AREA SQ. FT. F -1eC0 L,4 7-10" RA.7-,=A 2 -r7- AJJ gRSERV46ZE4CNINGAREA 2�Co So. FT IAIED care c c sC �- -�- -.��L �-ST. aS- P- IS9 8 ZN OF i �PISIA OF�QS o 18�-10 SANG i8 -io SAND . LOT -54 V.i t-t�STLE�.P / �q. s9n xit��cE-p Or N IP \hllllt WLT}1 /VIt\�.���(.��J J� 1 �. L UE: h o W/E N� GL��M/ C, r o. 366 �8f4� � N � i EL OREDG,E ENG/NEEfT/NG Co /NC. TER � EL to4./L: EL= 9,5• o 7/2 MAIN ST. , Al ti1ASs. 'yo o IV CrOC/N0 kVA7ZT .E/VC0UIV7 REO DATE � at Z1 • �3 su ` cuE�►r: �rc�.,L *`;. G.40UN0 Lv/aTER AT JOB NO,• SMEE OF 2 N4i 0R1 ERE TL , 99- E ms° o = _�F - �e3_pp ���T_ = SOY WIDE .} ILA q Et-,oc.o D 07J cf3faD Telepko-e S►o _ r�. f Jr U OD OD.. 1 1`r � �.SET STK SL`-T ` 4 hh //�� ElecEnu.�noa 4 �.I` 10 0-0 6 6 ' P _ _ 3_ ,� 4,. aa , kjF y.: 1 o O ° 3: Ul [\ �. for 35 , rs7 UL 04 x� 1 . G in 10 Llb - o Altr`J v 5 ZONtD. R.F, ,pQ Lo r 47 ?? N 10s 4150' FRONTAc�E 4 F RUNT S. J. i _ n x 0 ti1oT� F 'r �E=oui2Elv► �'r wA ucu PE: RQ T SP�e al �LY=-ur1AL100 s_ G ¢yOF o ��,� , PEA -,Aoi,yq, No. .,,. o ;t0iitl J, no F� 412 5URV� . l or,'::4E3 LEGEND ` CERTIFIED PLOT PLAN �' i c EXISTING SPOT ELEVATION 0x0 EXISTING CONTOUR 0 , / FINISHED SPOT ELEVATION LOT 311 lNHISTLEBEARY DR.°Nq&jr 1 FINISHED CONTOUR: .A t n IN APPROVED , BOARD OF HEALTHSA k .31 T AGENT r .` t : 'its , x + SCALES 1 ° = 40' DATE lJAN 19` ` 83 DATE ; 1' CERTIFY THAT THE PROPOSED EGISTERED REGISTERED ` •- -r-- — . JOB cac7kg BUILDING SHOWN ON THIS' PLAN x; CIVIL L.ANQ w `CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR 433.4. r @ARN S.TA E eti�+ 'r.^ k_ T fl 2 M A 1 5 S7,77 T * A•M..f .P,.t..,.. f i w < ,.. -.._ w raven' , S LE_ PA1��LtY._ _:50, `YVIJjE ;' r q � qC fi FuDT. M Ip 3 i 3 O,oO.��•_ .�� 13D aT� cRFl.+D 1 1 x t Xp° t sar .Ta4.2 (r"; a r� I }� - FI �* • p b .R . 10 ' `` • r to "Al 0 a 3. d 4ON l♦ ' �i w' Lor 3- cq _t. ut i o a Q ` M /p �; �♦ `�x ;f n �r ♦No =, 0. S 1f _ 2 of ♦ yy �� Ir p ZnONED R. ipo •LOT 47 !7 RE ARIQC o• too 3 O' F avNT 5 g 1 - 1 K ^0 \A�,• ,f�OTE : FY - "AC= �Cl+�uNT r `J wAl�ED P��' AST =a, Snob .l iJ sP^-E at5- - f-rAt_ OF �F\ O O El 9I �y1" �t r � \ : a` • h o N i • �.f�\� t,• f i Q�t� Q no • �� � - < =' •<;; � SURD :;l -40 �f Sri 1 ' LEGEND CERTIFIED PLOT PLAN :EXISTING SPOT ELEVATION 0x0 : EXISTING CONTOUR ---.� 0 _ Z11 §dw 11Kt..YJ r FINISHED SPOT ELEVATIONI r' " $ �;�W _„ 8 % *,T �., �r LOT 34 1 HISTLEBERRY Da MRasraNSly� ! CIF !SHI»IJ CONTOUR r F v� t gv k h} ` j x r tk 5x a IN 4 APPROVED t 80ARD ` OF HfAITI� , r w t � :rt: DATE AGENT . , . SCALE = 40 GATE AN' 9 83 J , tV L DI?£OGE' E/IIGJ � G:C `/N N; � x �"` � ` � �_ �. ,, � , , • � .t `' I'=;CEA.TIFY.. THAT THE PROPOSED 4� `` ; BUILDING SHQWN ON THIS 3 P.�,qN 4 EQISTERiD fi�01STERD > Oar CIVIL M . L• J0� -CONFORMS -TO THE YQNINQ °l'AW$. a� d °a4° A' � S: ' `� �yka a• t K -tir3 �4,H„ 1 ii` t 4 ! r ifi 1 -� �` :. SURVEYOR � f BY,;� �` xa �, �, t' OF IARNSTA E Al OX ENGINEER , , 41 �" • x aas o- r, . q�R�� • }fi , Lf•FTM;+ c c i e.' ,'L j-:.g� eery .. �- 1: 71:2 .MA i N _3'TRE_ETr .----- e� N o r ti 'ri oti m 3 I u I t\o Grp 3 �� 0A u a eberty �ry / e / m i ° a BE_RR_ Y DRI +60.35 WHISTLE 60.99 _ VE 60.33 - s9.s7 EDGE OF60.04 PA CEMENT 60.40 LOCUS 6129 ".65 60.68 Wvt � -6fl ers ------- Ed e 7Q.Q ' •6 0-.3-4--- -----s ------ 62 . CB CB SEAL LOCUS MAP =a 6 6 48' x 61.32 , 100.00' NOT TO SCALE �. 62.35:G ---- ------- 6� -- 98 -- EXISTING CONTOUR G x 100.98 EXISTING SPOT GRADE 102 PROPOSED CONTOUR \� 63.07 -W EXISTING WATER SERVICE - -G ---- o, EXISTING GAS SERVICE - '-6�":. - X U UNDERGROUND WIRES TEST PIT BENCHMARK - _ r,►: : 6 69''- -- -----66- - -�-- 71.06 LEGEND o 1!Al x 70.23 68.85 '' W Cp x 70.98 �.;... ;;,:70.93 x �k93•' _ C ^� �; �- (LOT 34) Z v y-; P APN 062-020 71.13; :_; 45,727 S.F.t cN , of ` i : txs 74.5 N� 1 I O �� , , I ; 71,76 ,. I , + 2.50 CO ' Vk .».. . Y .. ------- ' l 2.48 EXISTING LEACH PIT I , T•: (RECORD AS-BOIL T) c¢e� �� �`�\x 70.28 TO BE PUMPED, FILLED W/ +•�7.�5, \ 3.58 SAND AND A87 NDONED ' ; ; ` c� ' I I ��`, 70.�6 X` EXIS77NG HOUSE(#345) max 66.06`, T.O.F.=74.56t x 72.s3 Cellar FL.=67.0t _ j +.65.51It '-_- 1 66.72 x��s.7o cif 4 I I � J 6.45 `�TQ 65. �� qr 0 66.70x DECK `���� .14 0 ' f { g& 68 TP-2 6 . '-�, 64.59 �D ;' •`• _ 633.99 �%'�% `;' x -- -.___ _ BENCHMARK SET bl/ ,�62.21 _ •e• TOP OF CONCRETE SON077JBE EL.=66.86 (ASSUMED DATUM) joo.g.♦ 2y vE-NT/ ` +6 a �:' -- EXISTING SEP77C TANK -_------ ----5.8__ `.� . �•' ?• 6p •, F, TOP OF TANK, EL.=65.34 +57.20 ----___ ♦• �• o� INV.(OUT)=64.00E 6-26---- -----_ _ �:'� '� (FIELD VERIFY) . / �\ yam, R6; \` --- ------------5 ---+s3.s51 1 . ---56 �.'� OF 44ss9 A 5�------ o PETER T. J McENTEE CIVIL - +a9-i � ',--52 35109 :`•`• � 6� .Q0` N , A R£C/ E� OWNER OF RECORD .• �• 03 �� - �,�0 F DESAUTELS, ROBERT & DOROTHY V •.•• +43.38 `�\ 00., 4',85 � ; C/0 MARGARET VAN BAEL •••�OFO♦F l f �' 8 345 WHISTLEBERRY DRIVE .• F ♦ ( I ( MARSTONS MILLS, MA 02648 F�cF•°?cy♦. 44. j �6 PROPOSED SEPTIC SYSTEM UPGRADE PLAN `• 345 WHISTLEBERRY DRIVE, MARSTONS MILLS, MA +44•• � .14 ••• •� Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632 Engineering by: SCALE DRAWN JOB. NO. Engineering Works, Inc. 1'.=20' P.T.M. 119-11 12 West Crossfield Road,.Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 3/1/11 P.T.M. 1 Of 2 a jr r �.. NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.61.3 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT INSTALL INSPECTION PORT OVER END UNIT T.O.F. OUTLET AND SET TO 6' OF FINISH GRADE COVER SET TO 6" OF GRADE EXISTING F.G. 64.0-66.3(MAX.) CHARCOAL F.G. EL.=66.1 t � F.G. EL: 66.0t VENT MAINTAIN 2% GRADE (MIN.) OVER S.A.S. _ INSPECTION ® SL 1% (MIN.) p S=1$((MIN.) PORT 4"SCH40 PVC 4"SCH40 PVC (1 MINIMUM) 6" io'I e 14" 0. 5" TO EXISTING 48" LIQUID INVERT LEVEL ADD GAS BAFFLE INV.=63.72 PROPOSED INV.=63.55 5 ROWS OF 4 UNITS AT 5.0'/UNIT = 20.0' INV.=64.00t D-BOX INV.=60.9 EXISTING SOIL ABSORPTION SYSTEM (PROFlL� EXISTING SEPTIC TANK ESTABLISH VEGETATIVE COVER BACKFILL WITH CLEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS NOTES: BREAKOUT=TOP TOP ELEV.=61.33 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INV. ELEV.=60.90 INVERTS, PRIOR TO INSTALLATION. 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.=60.00-' GRADE ON A MECHANICALLY COMPACTED SIX 2.83' INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 AMR 15.221(2). 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH=14.2' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. EXISTING SUITABLE 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE NO G.W., EL=53.5 MATERIAL AS (MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. USE 5 ROWS OF 4-ADS Arc 36HC UNITS WITH NO SEPARATION BETWEEN EACH ROW & NO STONE SEPTIC SYSTEM PROFILE UNITS MUST BE STAMPED H-20 TYPICAL SECTION N.T.S. SOIL LOG DATE: MARCH 1, 2011 (REF# P-13,206) SOIL EVALUATOR: PETER McENTEE (SE#1542) GENERAL NOTES: WITNESS: DAVID STANTON-HEALTH AGENT 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL Elev. TP- 1 Depth Elev. TP-2 Depth BOARD OF HEALTH AND THE DESIGN ENGINEER. -� 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 64.0 0" 64.6 0" OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 62 5 FILL 18„ 63.6 FILL 12" -..-- LOCAL RULES AND REGULATIONS EXCEPT.AS REQUESTED_ BELOW: _ A __ _A -310 CMR 15.405(1)(b): SANDY LOAM SANDY LOAM 1) A 3' variance to the 3' maximum cover requirement, for 6' of 10YR 4/2 1 OYR 4/2 max. cover. S.A.S. shall be H-20 and vented. 62.0 24" 63.1 18" 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR B BSANDY LOAM SANDY LOAM TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 60.5 10YR LOAM 10YR 58 42" 61.1 / 42" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING C C FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN PERC ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF MED. SAND MED. SAND HEALTH FOR FROPER INSPECTIONS DURING CONSTRUCTION. 2.5Y 6/4 2.5Y 6/4 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 53.5 126" 54.1 126" DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY PERC RATE <2 MIN/IN. - IN SAND ("C" HORIZON) RECORD THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING NO GROUNDWATER OBSERVED CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 63.25" IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE ts" INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 34.5" IS NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. DESIGN CRITERIA TOP VIEW 60" END CAP END CAP NUMBER OF BEDROOMS: 3 BEDROOMS FRONT VIEW SIDE VIEW SOIL TEXTURAL CsLASS: CLASS I END CAP DESIGN PERCOLATION RATE: <2 MIN/IN REAR/TOP VIEW : UNITTY DAILY FLOW: 330 G.P.D. To CHANGE WITH UTRATION NOTICE. PRODUCTANDABILI DETALSMAYECT SIDE VIEW DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. DESIGN FLOW: 330 G.P.D. 4640 TRUEMAN BLVD GARBAGE GRINDER: NO HILLIARD, OHIO 43026 Arc 36HC DETAIL LEACHING AREA REQUIRED: (330) = 445.9 S.F. ADVANCED DTtAINAGE SYSTEMS,INC.Ins, UNITS MUST BE STAMPED H-20 ak 74 PROPOSED SEPTIC SYSTEM UPGRADE PLAN EXISTING SEPTIC TANK: 1000 GALLON CAPAC TY PROPOSED D-BOX:: 1 INL OUTLET IM M) 345 WHISTLEBERRY DRIVE, MARSTONS MILLS, MA USE 5 ROWS OF 4-ADS Arc NITS WITH NO Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632 SEPARATION BETWEEN EACH ROW & NO STONE Engineering by: SCALE DRAWN JOB. NO. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) Engineering Works, Inc. 1"=20' P.T.M. 119-11 (Arc36HC Units) 20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. DESIGN FLOW PROVIDED: 0.74(480.0 S.F.) = 355.2 G.P.D. (508) 477-5313 3/1/11 P.T.M. 2 Of 2 ` r , Robillard Residence 345 Whistleberry Drive TradeMark Professionals Marstons Mills Michael baker 4 Moon Compass Lane Sandwich, MA 02563 Waste Pipe-to Septic 508-717-2982 204ODH 2O4ODH 5068 204ODH 2O4ODH co CE WH N BATH 10'-51' x 7f-1lit FAMILY N i — — B483 — — 22'-4" x 12'-9" 2668 35'-6 1/4 N 2668 5068 STORAGE N 13'-811 x 22'-9" CE Chimney 3'-5 3/4" 2668 OFFICE CE 12'-7" x 11 '-9" UP 22'-6" 2x4 wall system w/ PT plates R-21 fiberglass wall insulation w/ vapor barri, 1/2" drywall on walls & ceiling