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HomeMy WebLinkAbout0306 WILLIMANTIC DRIVE - Health I 66 Willimantic Drive • �Marstons Mills P 103 083002 --- - TOWN OF BARNSTABLE t� LOCATION' �J� �� 11M�n�`L SEWAGE # VI SAGE M- Mgt S ASSESSOR'S MAP & LOT /03— INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) X G ` �� (size) 140.OF BEDROOMS 3 rc: B".k'II,DER OR OWNER TQ tJAV►l MALGQ^A -PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility))-r Feet Furnished by �r1S'AGw+ (r0� A B gk { O O a a° 34 3 y 50 LO SATION � SEWAGE PERMIT NO. VILLAGE 0�3 A= f()-73t II A LLEIt's NAME i ADDRESS BlUILDER OR OWNER S8N2A)KOR 450NE DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 7,�-- � . � . ` �---• JVO r 7 C ,� tin �a ,�'` . �. �-ous � TOWN OF BARNSTABLE LOCATION,/''///��k6 W, 11,ma.n1te Onye SEWAGE# `0'�0/`7�— 4/5-0 VILLAGE Gi�eS ns /✓'t I�S ASSESSOR'S MAP&PARCEL I03 �(ock 83 MOL INSTALLER'S NAME&PHON/E NO. Q.-Ima.lm"I 564�-776- 211 SEPTIC TANK CAPACITY /j/0�06 T LEACHING FACILITY:(type) e, S 4i e- (size) NO.OF BEDROOMS OWNER L/n PERMIT DATE: f 2-/g_/q COMPLIANCE DATE: le? -!f -/P] Separation Distance-Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 1 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /�t Feet FURNISHED BY \dl S' On S-� r ► Noose peCh 177 't7 Slit 'D-4, 2 `� Fee /00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Misposal 6pstem Construction permit Application for a Permit to Construct Repair( ) Up ade( ) bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. wner's Name Address,and Tel.No. ✓®6 ad/l��, WAr7ZG AQ/vim ,v.Yop P'C_T7,F .w4AN Assessor's Map/Parcel rye_ g3 �0 00 Z .?D/o cIJrLLirvJ i¢M1C !7 - /j 40nuS tw' Installer's Name,Address Tel.No G, esig�er's Name,Address,and Tel.No. �® M 135 VA40AW111 ,0. M.47S .:r9 IAWivST a[T �2 Type of Building: d$2-Yvy) Dwelling No.of Bedrooms Lot Size l999g sq.ft. Garbage Grinder(Al) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required .3 3® gpd Design flow provided 49W 4-31-33 -- Plan Date /2 / 'p/ Number of sheets Revision D Title Size of Septic Tank M510�9-4 . Type of S.A.S. //A16-/9A4:21 �574-/VE Z_A��rxtF Description of Soil��/ CZ �✓' �E� Nature of Repairs or Alterations(Answer when applicable) A,;C54 C/ ��A��1 �'j£Cd rQ/l7 D_JF&W 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 alt gned Date Application Approved by Date jah Application Disapproved by Date for the following reasons Permit No. /.®/ ' Date Issued hell K I Fee s THE`COMMONWEALTH OF MASSACHUSETTS Entered in computer: L✓ PUBLIC HEALTH DIVISION - TOWN.OF BARNSTABLE, MASSACHUSETTS Yes application for Misposal �6pstrm (Construction joermit Application for a Permit to Construct Repair( ) Upgrade( ) ¢Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. IV1' + Owner's Name,Address,and Tel.No. ,,,0,6 fiP1/,eX IWW,VT/C I� %l� :�. .. 411mp,�9 Pe 1'T I_M4AA1 Assessor's Map/Parcel ryj_ g3 �o p _iW& tUiui �¢e+rr� , �. p�Q57 rx.15 �!/CLy Ingtaller s Name,Address, an Tel.No.W n 6�y , Designers Name,Address,and Tel.No. ,+pv oX 2.35 "_.WWr// 114. 0267!57 1P.:rf IAWIAI t ± u,4T 40 Type of Building: ',3,5 7- Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(A/) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' _ Design Flow(min.required) 55 0 gpd Design flow provided 3..33�gp- Plan Date 12/181201�` Number of sheets Revision D e Title _ �*_/,7 irk'.' t / Size of Septic Tank- -_ 1�faVfjf/4 Type of S.A.S. Description of Soil e'/- � Nature of Repairs or Alterations(Answer when applicable) 4AJ D-^BOX Date last inspected: Agreement: •:F 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 I Rrealt Sign'd.� Date Application Approved by ��, '��._ Date /-s Application Disapproved by Date for the following reasons Permit No. f ? 0 4 5C Date Issued /p r.r. � - - - - - - - - - , ---_ - - - _ - - - - - - -- - - _ . . -a 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 at L.L l�� � �yQ/U� has been constructed in accordance with the prow"1� s�of ytrlePS an&etfoi i)ifpbgal6�y�s�t1"'(?o struction Permit No --q5O dated /� � '�, Installers . /'/ � ' • Designer Z,'P CIV ,:�A #bed roo ., Approved design flow d gpd The issuance of this permit shall not be construed as a guarantee that the system will/frin`ction as designed. Date I% .2.d J J Inspector No. ,/ t �') Fee / O C) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal *pstem Const rtion permit Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at 4C/1 Z61 W,,4Arr'14C and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be/complete �within pthree years of the date of this permit. j - ---- Date % /�1 � O Approved by j i S TRA-NS. NO.: CITY/TOWN: APPLICANT: G ar-� ADDRESS: : 30e t/; t"JLAP- DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OIL NO -�sP1;3Jsaa�?�!v'.tl':;�/'� �'s;:"•',s.`.��`��-•-�""�-�` 'r>'t��.3��"u`#s..,`"�,F. �-��rf:i%.'�'is?s�'`���}'��`.���;S..''.:�����:t;w'i(ik �k:F.'t';6'�:,r. _4.::fl Legal boundaries denoted[310 CMR 15.220(4)(a)] Street, Lot,tax parcel number and lot number noted on plan [310 CMR 15.220(4)(11)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown[310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]-if not, a variance is required [310 CMR 15.412(4)] I Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] j System Calculations [310 CMR 15.220(4)(f)] , daily flow j septic tank capacity(required and provided) soil absorption system(required and provided) whether system designed for garbage grinder �f North arrow[310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] aJ Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative[310 CMR \J 15.220(4)(h) and(i)] ' Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.2421 Certification statement by Soil Evaluator[310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given.or indicated) [310 CMR 15.103(3) and 310 CMR 1.5.220(4)(n)]. n i Address Sheet 1 of 7 J � i i N/A, r NO i Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case j within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. lbeyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located[310 CMR 15.220(4)(m)] (if waterline cross see 310 CMR 15.211(1)[11) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(6)] Stamp of designer[310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line)[310 CMR 15.220(3)] I Test Holes adequate(two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as v approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] . -7- i Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] j Test Holes adequate to confirm adequate groundwater separation? jff [310 CMR 15.103(3)] I Benchmark within 50-75` of system[310 CMR 15.220(4)(q)] ' Materials specifications noted? [various sections of 310 CMR V i 15.000] System components not>36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(l(b)] v I I I i I i i i Sheet 2 of 7 Address i a i 1 t i N/A Oki NO � i p Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CUR 15.227(6)] Outlet tee 14" or 14" L 5" per foot for increase ft depth[310 CUR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CUR 15.227(4)] Note regarding installation on stable compacted base[310 CMR 15.228(1)] { Separation between inlet and outlet tees(no less than liquid i depth) [310 CMR 15227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for . J upgrades under LUA[310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers j on all openings and on the d-box) [310 CMR 15.2228(1) and.310 J CMR 15.232(3)(f)] i Three access covers(inlet and outlet must be 20" or greater)- middle access at least 8" (by 7/07) [310 CMR 15.228(2)] i Access to within 6 " of grade -one port for systems<1000gpd, itwo for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers-secured to unauthorized access? [310 CMR 15.228(2)] y > 10 ft from building foundation[310 CUR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] —d H-20 Where.appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] ti $' YI' PyY S' •'{�r. {4J. kL a.,:.i id ry ^§1 wulom_partme_ntfiauXc� _ Required when other than single-family dwelling or flow>1000 ; gpd [310 CMR 15.223(1)(b)] First compartment 200%daily flow; Second compartment 100% daily flow[310 CMR 15.224(2) and(3)] "U"pipe through or over baffle,outlet of each compartment with 1 gas baffle or approved filter[310 CMR 15.224(4)] 1 1 i t i Address Sheet 3 of 7 I • i i N/A OK NO I r�g - .ate: - :.�atits:;..,y-:;r'e. °M.�t[;;,,rs-rrv^ _ri�• °¢7; ,�.:k:�;�'�..-_z:`' : 1 7� � Y�' d�" 1�®dYJLlyi (�,_14,,; r"'.�+;F'''€ =B .Ll�li*.`..r.. Slim d��a�,s{''':.x' ?,.�..,-t-:- .s '�';. r>. z... Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18"below water line(when water and I I sewer cross, see 310 CMR 15.21l(1)[1]) Cleanouts required/provided? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Shope of sewer line not less than 0-01 (1/8"/$) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/(leachfield below pump chamber) l Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller / than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) «,sued ix a h •A� '` 3' ` '? �x �e'§. ; . DFBIITOiBOX � - �t� r Stable compacted base [310 CMR 15.221(2) and 310 CMR t 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] ' Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd);waterproof manhole if>2000gpd � I [310 CMR 15.232(3)(d)] IS Capacity(emergency storage above working=design flow)? [310 I CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at-least 20"MUST BE - - TO GRADE [310 CMR 15.231(5)] Service components accessible(not too deep with piping, j disconnects accessible) Alarm floats- alarm on circuit separate from pumps specified? Exceeds two units insist have two pumps operating in lead-lag � r mode. [310 CMR 15.231(6) and(8)] i Stable Compacted Base [310 CUR 15.221(2)] Buoyancy calculations needed?Provided? [310 CMR 15.221(8)] 1 Sheet 4 of 7 Address I S j • I f i I f N/A OK NO Urt• -'z.. W . rr- fitr-e5 d' rti t-�F. � Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15240(1)] Required separation to groundwater? [310 CMR 15.212)] i Aggregate specif ed as double washed[310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.2411 Inspection ports specified and within 3"final grade? [310 CMR 15240(13)] Breakout requirements met? (No violation of breakout elevation j within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and, i Guidance Document] j ]GES;PTC_ 15: 3"IOFCMR �3Ngi n :.. � .: Chambers and Gal. in trench configuration,supplied with inlet j every20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole(if>2000 gpd must be to grade) [310 CMR 15253(2)] Aggregate 1'minimum-4'maximum. [310 CMR 15.253(1)(b)] 2'sidewall credit maximum[310 CMR 15253(1)(a)] i In�bed configuration,inlet every 40 sq. $: [310 CMR 15.253(6)] l M amp MMIN Width 2'minimum.3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length[310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15251(2)] ' Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] 3'ED §1VIaau i� of,befz 500o g,I f minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 �k CMR 15252(2)(e)] _ Aggregate depth below discharge pipes 6"mun'mum, 12" � maximum:[310 CMR 15252(2)(g)] is Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only[310 CMR 15.252(2)(i)] k I i Address Sheet 5 of 7 f • I f N/A OK NO Pressure Dosed Systein ? Provided pump and piping j calculations as required[310 CMR 15.2ZO(4)(r)3 1 Pressure dosing required on all systems>2000gpd or alternative / systems under remedial approval [310 CMR 15.254(2) and I/A V/ Remedial Use Approvals] i If used in gravelless system-make sure jet is directed as not to i scour soil interface [Guidance Document] j Inspections once per year(systems<2000 gpd) or quarterly (>2000gpd) good to note on plan[310 CMR 15.254(2)(d)] Coj%st,"ucL,io Z in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? hn ervious barrier and/or retaining wall?.,[Guidance Document] i Impervious barrier installation must be supervised by designer[310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer[310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recomm_nded) [310 CMR 15.255 (2)(e)] _ a 4- ' row tee s s �?' ess5�sema° Check DEP Approval letters for credits and design conditions r . If used with pressure dosing do not allow pressure discharge to scour soil interface ,y Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all V DEP Approval Conditions? P> Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits . j _ .. . Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenancek i - fat'a�ace : , Are the variances listed on the plan.? [310 CMR 15.220 r � (4)(q)J RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] ' New construction or increased flow proposed-[Refer to 310 CMR 15,414] f Sheet 6 of 7 Address i [ f N/A. ®K NO ttn:-: �•.� � � ;$� �.:'3` ro �i ar-� xk'�. -. � s r.,.xf��''ti.•.�i'p�k, xix p rr4���fib' I�' .,(. i [ L1Y02lZ S2YlIfL�e 1�7 EClS .ON Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214,,310 CUR 15.215 and / 310 Ma 15.216- also refer to Policy regarding upgrades of such I existing systems] Is the system proposed on the same lot as served by private well ? J [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310-CMR i 15.216(1)] _ I Ramping to septic tank? [310 CNM 15.229] Shared System[310 CMR 15.290] i I I I Address Sheet 7 of 7 , i f Town Of Barnstable THE r, Regulatory Services vices Thomas P. Geiler,Director * BAHPSTABIX MASS. Public Health Division, pin 39. Thomas McKean,Director 200 Main Street,Hyannis,IbIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: ` 2D 1 Sewage Permit# Assessor's Malp\Parce 002 nn A 11 CP KK V 2� ,,,fi►�t, Designer: OVJf4 (?APE a(AJ�yU=W, Installer: N � R� C.va►Mc. Address: q Jl/ lk(W Address: O S-6 LLt- L fa""&'p : R_om ` -IT On was issued a permit to install a (date) (installer) septic system at -30(o WU-L MAtJTIC 1>94 M,/{- #M 4 rA.IU,.S based on a design drawn by (address) DPr Ia A-03ALA, F L. , dated 4-4— 2017 / (designer) y I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified i as-b ilt by designer to follow. i��f��/c%r.✓6 yZH OFAIgss� o O,y DANIELA. o OJALA �+ ( taller's Signature CIVIL ' No.46502 �Q7 9 0/ SNAL (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH IDMSION. CERTIFICATE OF COM PLUNCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc I 4_� Public Reafth-DIAsIon cm 200 Molu.Sircat,'yannls WA,02601 �y Date Scheduled 1 Z 11 t I'zTune � r 0 .1Ei`ee J�sA, 10 IX) Soil Suitability AssesSment for Se a g Disposal PerformedBy: RN Witnessed By. i al w'&-� LOCATION&-GEN I.oeadonAddreSs Address '�(o W 1 La mA ter tC "p tZ, p M.l�t2S�rN��5 M����l��ippl Assessor's 1YIap/i'arvel: {®� /9 3'2. Bngxnocr's Z'Iarnn PDVvN I�PC(G, Iry � ►1.1C, NEW CONSTRUlMON REpAIIt Telephone# — �2" Cl Land Use: Slopes(9b) Surface Stones A Alstanccs from; OPOnWster13odYW,6 4 #t possible Wet-Area -t Drinking Water Weil- dzJ ft Drainage Way l • ft Property I.inaft Other —ft. SIMMCM(Sticet:name,dimensions of lot,exaot locations of test holes&pore tests;locato wotlands•�n pxoxirrk to holds) fi t . ort• �'PAu Parent material(geologic) ' De th tp 13eGirgcl� c P • Depth-to Groundwater: StandingWaterin Hole: 4ftslc. WaepingTrain Pit FA*Qa Estimated seasonal High Groundwater DRTE WA`]lION FOR SEAS ONAL MO•R WATERr�.t�,�L Mothod Used: Depth Observed standing in obs.hole: Depth to vrcepingfmm side of obs.hole: ln, GroundwutarAdjugtmcnk Index Well## Reading Date:_ IndexWolll6val .. ,,,.,,._.,, AdJ,AMil,.,.r..,,-,.r.Adj...prolliltlwatuLeval z ]PERCOLATION TFISIT Observation .f Dole#k r�/' 'IlAnp•at. " _ ., _� _. Depth of ftu. ` Tlzma At G" StartFre-soakTima @ ,t�i� dime 9 G iro.d I'rc-soak ' 4 Date IY.(ln.11nch ���. •.. . SitrSultability,A,sscssraent; SiCo�assecl � >iit�Failed:� AdditionalTesting•Nceded(:�lPf • Original: Public health Dlvisloa Dbhervatioa Hole Data To Be;Completed on Back—------__ ***jf percokado' n test is to be conducted witbint 100' of wetland,you must first xLotify the. Barnstable +Consqvadm DiMsion at least one (l) week prior to beginning. r�:�sa~�z'zc�z�z�cPoitlyl.poc , ao�u�azod��tizd�z�aa��� • ' amant�x A)P-9 ut a �x asa aauat zadxa Pup 7,u�, zxnL a ` 2U1�T0 QTt .P �. � � gJ11A 4ua4stsuoD azu Xq pawxq od sim 9teL,j1eu-e anoq'e oglaql pine uogaa�oza Z>�uautlzo tnug o au�tu e.claQ oq;,�q pa�,D.zddl: UppTi uze��a ao}EnZena dos a passEdane x(e�ep) zxo;uuj pQa x �I.21d91nuT snOIA-Ig • U=1000 XjjOTr4 u;a gjdop aq5 sT 4:21P°qou;l �IIIa)6S8IIOT dZOSCyTIDE Qq4-1q; 7a9odoad,ww q��no>� n�tt�aRan.t��gaG�Iat>;��> UTaGT7G�I���i. �no�ncadfuTunovo41juxn�eup4ea�ano�JsUax4esaocE • �nra��.� sz�ta�t�ag� u�;�ataaa�p- �uaza�n, ��•�,�. a� �Szapun°gpaazua�DpTn6gjIx M pun❑g reor QQ uT sa1L --aI+I fisepunagpS-g.zeaS-QQSanagy ' '• a �,a�.n�,�.auBxa�ta��QoX,� fi L 'snap?nog",&aUo�I;'aan7an.�5) �u??aTpy� C1lasunbn1l C1{QSIa) (•n?)a���zttS xgio IIaS "LOD Has aanlxad,nog v❑xpaH II°S W04 ipdaq ' a p ❑ as I D� tt gag n • '�oFInO�`s?uQla�`axnaan.r}gJ �ulla�°T^I �Ilasnny�?) C1+QSla) �" Ia � S ,aa�0 ??RS •�o1°�IIoS azn7xad,g°g uozpCa�Itag m°z,I.gadar� . 'W aasar�o^y ua srsu❑ ^—' ' � 'Saapin❑�'sau❑ag`a.�ntanAg) �u!A7°�I {�asun7�y) ('dQ51�1 ('nr)aaE,�n� . ❑ nz❑ da ,�aga0 Z?°,� aaI°DTI°S azryxa,Z;IiR,.g • n❑zu❑klll 5 ' /-4 V� fi Z snap?no�{'gauRa� �azn�aruTS) �uI?�7oI (IIasunTPiT' CVQSCl? zay�Q ~I?❑g a0100IIps' aan)xod, DS u❑z?aR I?RS ui❑z�zl�daQ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP - '10' R Dv-, PARCEL • 0�3 OOZ 1 AUG 0 9 2004 LOT 2Q TOWN OF BARNSTABLE TITLE 5 III HEALTH DEPT. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 306 Willimantic Drive Marstons Mills, MA 02648 Owner's Name: David& Maureen MacDonald Owner's Address: Date of Inspection: July 26, 2004 Name of Inspector: (Please Print) James M. Ford �? Company Name: James M. Ford Mailing Address: P.O. Box 49 3 �? Osterville,MA 02655-0049 1 to Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the info ation reported,— below is true,accurate and complete as of the time of the inspection. The inspection was performed ased on�iity training and experience in the proper function and maintenance of on site sewage disposal systems. am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs F her Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: July 28, 2004 The system inspector shall submt copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 306 Willimantic Drive Marston Mills, MA Owner: David&Maureen MacDonald Date of Inspection: July 26, 2004 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. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 - Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 306 Willimantic Drive Marston Mills, MA Owner: David& Maureen MacDonald Date of Inspection: July 26, 2004 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 I 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 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: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 306 Willimantic Drive Marston Mills. MA Owner: David&Maureen MacDonald Date of Inspection: July 26, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for 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 forma 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 System: 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 the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 I Page 5 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 306 Willimantic Drive Marston Mills, MA Owner: David&Maureen MacDonald Date of Inspection: July 26, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)J. I 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 306 Willimantic Drive Marstons Mills, MA Owner: David&Maureen MacDonald Date of Inspection: July 26, 2004 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): n/a [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)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gnd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 16 days ago-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed 9126178-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 306 Willimantic Drive Marstons Mills, MA Owner: David&Maureen MacDonald Date of Inspection: July 26, 2004 BUILDING SEWER locate on site Ian ( plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" 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: 14" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 f Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 306 Willimantic Drive Marstons Mills, MA Owner: David&Maureen MacDonald Date of Inspection: July 26, 2004 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 . Page 9 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 306 Willimantic Drive Marstons Mills, MA Owner: David&Maureen MacDonald Date of Inspection: July 26, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 ag 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.): The pit had 2'of water on the bottom. The scum line was approximately 2.5'up from the bottom. There did not appear to be any signs of failure. The bottom to Qrade was 8'. The cover was 2'below grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 i 1 . Page 10 of 1 1 II OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 306 Willimantic Drive Marstons Mills. MA Owner: David&Maureen MacDonald Date of Inspection: July 26, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 3 a � � Q C a� a C 3a 3 y SO 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 306 Willimantic Drive Marstons Mills, MA Owner: David&Maureen MacDonald Date of Inspection: July 26, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 35 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstabie topographic maps and water contours maps the maps were showing approximately 35'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 Page 10 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 306 Willimantic Drive Marston Mills, MA Owner: David&Maureen MacDonald Date of Inspection: July 26, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 3 a � � Q � as a aO 3a , 3 y SO 10 I Ens...... , .-No........... • _....... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH - .,:.....(OCO ........OF......[�>AAV(;.W. `�.`-A&L�.................... Appliration for lliipnsal Workfi Tomitrurtion Vamit Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal. System at: R J A 25 N 1 L[. �b% ' Z ...�.1__-.(-MA-�!�-�--- L �t Q --------------------------t�........- Loc t'on-Address or Lot Nq� !� ��...... P 1 ........... .f '°..._..._ . ....� ....1�R ....... illf.h!ltt. .s.s Owne AddrSR a a-ARY..W-_�r..R�d ..KR!1 R.(.Uk..&.g3�2.Ai.__1t A E:_....A( �/F, Installer Address Type of Building Size Lot_ C?,_ Q.....Sq. feet Dwelling—No. of Bedrooms.............. ..................... Attic (><) Garbage Grinder ( ) '4 Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Other fixtures ----------------•----•---_---_. _ . W Design Flow.........................:..................gallons per person per day. Total daily flow___°-__3C)..........................gallons. WSeptic Tank—Liquid capacity,_IOallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No- -------------------- Width-.r..._.._._....... Total Length....... ...._...... Total leaching area....................sq. ft. Seepage Pit No---------a.......... Diameter...1_ _'_C) Depth below inlet_&.....0..... Total leaching area.2!4-.�..sq. ft. Z Other Distribution box ) Dosin tank ( ) aPercolation Test Results Performed by__ r - .---- - �4 ............ Date.._. __-_Z3................ ,_l Test Pit No. 1.......7,__.minutes per inch Depth of Test Pit_-1 1__'_°_.. Depth to ground water.... 10 (i, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....._.................. C.�... = --------�=L��t ! ....................................................................... 0 Description of Soil............ __---- 1..A2 ._? N® C.GLF7l------•----------•---------•-•------------•-••------------ -------------------------------------------� _ .---_. ri. ►.� •---•---•--•-•----•--------------•---••---...•-•---...---------...............-=------------ W v 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 TL ME 5 of the State Sanitary Code-- The undersigned further agrees not to place the system in operation until a Certificate of Compliance has*beeiby board 1 ealth./� ateApplication Approved By----•------,4P. G �` - Date Application Disapproved for the following reasons:................................................................................................................ _.....____•---------•--•------------------------•-••-----•--....----------•-------------------------•-------------------•-----------------------•-----------------------------------------------•---•--- Date PermitNo.................................................... -' Issued---•== =•-- �r-- ------............-- ------------ Date 1 No. ..........._....... Fss..... — THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .O"G:. ... ----....OF...... ! ...\.. ...................... App irafion for DhipmFal Works Tonitrnrtion ramit Application is hereby made for a Permit to Construct X or Repair ( ) an Individual Sewage Disposal System at: n A L A QS l C.�I ; t �!. -..1.��.�.__............... .. t..--.-.-.---.---... -••-... �v ...z. :...---......... ......-.. ._. •.... Location-Address or Lot N t:5t ........_. ... �• l Owne Addr � � � �� _ W 1 /�l� I e ) 1 Installer/ Address U Type of Building Size Lot.���Jf. 1L'2.....Sq. feet .......................Ex Expansion Attic Garbage Grinder �., Dwelling—No. of Bedrooms...................-�_ p ( ) g ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Pa Other fixtures ---------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow---3.30.........................gallons. WSeptic Tank—Liquid capacitAC allons- Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No--------------------- Width ....... Total Length................... Total leaching area....................sq. ft. Seepage Pit No---------t.......... Diameter...). ..'..U... Depth below inlet.&......L..... Total leaching area. 61(,.__1..sq. ft. Z Other Distribution box (X) Dosin�tank ( ) '"' Percolation Test Results Performed ........ Date...__5.. ...; 3................ a� Test Pit No. 1------Z....minutes per inch Depth of Test Pit...1.7--k......O_. Depth to ground water..__N.Q (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ i ..........................•----•-------••--•----•---•--•---...----------- Description of Soil---------.. .=...��-o= ........ ,,......S1a!�•R �, (:Zr.i_,Ay........................................................... W x ------------------------------------------ �� `C� ��,L>>.t _: ...� �t.1_R.-----------------------------------------------•-•----------------...-- U Nature of Repairs or Alterations—Answer when applicable.-.............................................................................................. -•---------------------------------•-----------------------•----------------------------•----•---------------------------------------------------------------------------------•-----................._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL:p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee i ued by t board o health. Signed-- -••-------•--•--- ---- /� � ate _ Application Approved By..-- h?! !1._._� ��'�'............... `_ .... ---- / Date Application Disapproved for the following reasons------------------------------------------------------------ ------------------------------------------------- ' Date PermitNo......................................................... Issued-..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........�..�,?:i.€..�. .........OF............. :. P,_i.Z....... ............. %rrtifiratr of TontpliFanrr THIS IS TO CERTIFY, That the Ind,' idual Sewage Disposal System constructed ] or Repaired ( ) by........ r..A_ ' .....�2 -.Rl.a_r- .�_ 1 __ 'i .t _�c. t Ern. x . � --�....L! U.1 1�, ._. �.. I taller v1 �, A �..................•-----•-•----....._ at....... n.T-------Z-yl----- .1_!-.1.1.r?:1.A,0'e_`i--' =3= r' - 5 1 =`�?c Z �s-----•-- ................... has been installed in accordance with the provisions of T 'r j of The State Sanitary Code as described in the ___ -__-application for Disposal Works-.Construction Permit No ....._ -_!'........... dated-.... __._G_._ s '__.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL UNCTION SA 1SFACTORY. DATE ...............•-•---.....--•------- ................................... Inspector------------- -! ,�— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1-y►cj' .. .c . ..�..........OF...... -+.f ��.. � T - ........-_.. No......................... FEE............------------ io oo d Works Tontrnrtion Wrufit Permission is hereby granted.... f?. /exn to Construct .OQ or epair ( ) an Individual Sewage Disposal Sy j� at No. - j� C,?. 11J...l.b? n� !G._.__. '..:_.:..._. r'—. s�1�1 ► .l. -: ........................... Street as shown on the application for Disposal Works Construction Permi ._.._..__ .. ____ ed...... .................................. 7( Ioard of Health DATE------ -----A9-v--..................................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS I l i to ~• • I • i 4. X1Z r S39 °42- 30 °le�_ "Jrr s U \ rJ 5EP7 TANK •V � �E-- 3 8�.---�I ,� `�.v,l3 o x. � �, ,O" ,, y ,,,� a �.7 4 I Q 00 CvAL { .. Y'^^ /0 v%v vJ ✓ r + i 7 541 pq I L•-.O T . :Lo f r - �x f E �� a t� ROB J ®UNIKI ; c..) Na 22162 13, y 1 1 at AL6 t. i L,E G E N D d� EXISTING SPOT"ELEVAT10N OxQ CERTIFIED.. BLOT PLAN" ` � . EXISTING - p — _ FINISHED SPOT ELEVATION 10.0� l! o r Z"7. 6✓/�� cmAwTiC DR/✓E �r 1 'FINISHED- CONTOUR --_ p ---- M4 R S7 0/✓5 IN APPROVED : BOARD'`, OF HEALTH' aFs. DATE - AGENT. SCALE / �— 4�D DATE,, 9—// I€LDREDGE ENGINEERING CO. ING�i GUc2ivc- CLIENT I CERTIFY THAT:.T,HE PROPOSED-: EGISTE RE� ["REGISTERED1 JOB N0. ?�"1 F-Z BUILDING SHOWN ON THIS PLAN CIVIL I LAND CONFORMS TO THE ZONING : LAWS . ENG,IAlEERS,� hSURVEYORS DR. BY /1 OF BARNST BLE , MASS. a — — .i33 NO, MAIN ST. 712 MAIN ST. CH. BY : �_�'.,. /3___ SO YARMOUTH, MASS. HYANNIS., MAST. SHEETL_ OF Z_.__ DATE REG. LAND SURIEYOR /:- NOTE :- /F. /TN2'R THE S PT/C 7Alov OR 20 FT. M//V. A �EAc%/ �rG P/T'ARE MOR&k 7-NAN /G P7 /rf/N.` „• 5RAVE,,f1 24'0/AM ETER CONC'A-.7-W _C'Gi�ER SWALL 49E SAP0 4SR7 :EX7 ;. CONCRCTE 4~PI�C PIPE h�EA.Y,y 'CA ST /RO/Y C0V4--A' ,TAIAI-LL !3E USED �L; / U � COVERS M/N. P/TGN /F/N'L7/P/VE'WA y , 2•Jr, MIAll. CONCRZ-TE A AOE CC) N N ✓ER ' _ CZ EA .SAG A. Llgi//D LEVEL - a+L'AYER 4" CAST v v o o 0 o OF /�a -J18" IRON P/PE /"D O y GAL. o ;8 M/N. IP/TGN o' a I • • • • • • �„ WA5HF0 sm/vE V4'Rem >:T. 5 IC TANK B X p c ►• 0 o A or,p d� -- s v vD � 1 I •EFFECT/VE I • • e d 3�4 W- / �2 =°, e OEPTN • • I ' • o WASHED STONE`. 0: . 'tic'.• - ,,: :•:: •c-, I 7 I 'I • • s a • •.I 1 � � o 0 a I • • • • • • • , e PREC45 T SEEPAG E Q v:o • • • • • • • • • ' oe o P/T OR ZVu/V ° /A/liL'A-r ELEVATIONS e INVERT AT BUILDING 96.0 FT• 6� Dli4M. INLET SEPT/G' TANK Fr _ �Q_ FT. C SEE T.�iBULAT70/V� OUTLET SEPTIC TANK S 3 FT. _ INLET D/57R-1BUT/ON BOX 9 S•0 A7 SECTION O F GROUND WA7-.-R TABLE OUTLETD/STiQ/B!!T/UN BOX 9 2,9 FT !i1/LET.LEACN//MGr._/?/-T 21.s FT SEIoIIAGE O/SPOSA L SYSTEM 'T�B41L�1TlON LEACHI/VG P/T DES/GN CRITERIA , sr.aLE. : %a = � - 0,. D/MANS/ N $�-FT. NUMBER OF BEDROOMS �D/HENS/ON C- FT. M ��✓ c GAReAGEO/SPOSAL UNIT_ SO/L. LOG E.3T//�lArED FLO H/ 3 3 O SOIL TEST TOTAL , _GAL./DAY SO/L TEST #/ . SOIL TES,Ty0t2 NUMBER OF 404CHiNa P/T5L �L�IE-V 7 D �ELEY ,DATE OF SOIL TE. r �/Z� /7 S/OE,�E:4C'/-1/NG PER P/T _I �SQ, FT. T� • �. 8u�✓//�iS O - RESULTS 6V/7NESSED BY BOTTOM LEr9CN/NG PER P/T so. A7 ",t—1 `/ Pt/rCOLAT/ON RATE A'/ M//V3//NCH Sv/3so��- ' TOTAL LEACH//YC. AREA Zb b SO, FT. _ 3 AERCOL�4Tio/V RATE fk2 — M//v.1/NcH RESERVELEACNI/VG AREA -2 b 519. FT. AN o /V E R- ' } C(H OF M,jsn'14 aRA ✓EL- 407- Z.7 GV/e.4.1MA oV7-1 C Pk r LIE =O ROBER�P. �G i;y r z;�:/'(/4/�c5 TD/✓S ^'l L.�S BUNIKIS y COARSC _Wo.22162 �L - �O S.4 N J� 9 4/l{� w s= � ®RE®GE E/VC�/�/�R/A/G CO,/I�IC. �" L J tL . 8 S/. .° W 7%2 MP9/N ST 33 NO.MAIN ST. L"E ❑ NO GROUND 1N.4TER E/VGpI//VTEh'EO I/yANM/3 MASS SO. YARMOt�T//�MASS• G1 GR0UAO'O ,WATER AT ELE1/ JOB Alv; 7�OffZ SHEe�T ZOF Z ARK S OF SYSTEM PROFILE M OEACHINGRF FIELD W/ NOTES Airport h� 1 (NOT TO SCALE) REBAR SET 4" BELOW INSPECTION PORT (SEE DETAIL) 1. DATUM IS NAVD 88 tie GRADE 2% SLOPE 2. MUNICIPAL WATER IS EXISTING ACCESS COVERS TO WITHIN 6" OF FIN. GRADE �ooP r ' FILTER F \ FOUND. EL. 90.6ABRIC TOP 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. TOP 86 A FINISHED GRADE- 4" LOAM & SEED MINIMUM JJ OF COVER OVER PRECAST 89 0, W 4. DESIGN LOADING FOR ALL PROPOSED PRECAST i' UNITS TO BE AASHO H-10. �r ,:. MIN. 2" WALL THICKNESS CLEAN FILL Locus 4"OSCH40 PVC 5. PIPE JOINTS TO BE MADE wATERTIGHT o� a f• PIPES LEVEL 1ST 2' .• 4" PERFORATED PVC 5' O.C. S=0.005 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE o Pond 10" **EXISTING 14" 3/4"-1-1/2" DOUBLE WASHED O 6"DEPTH MIN WITH +. TEE SEPTIC TANK TEE * 6" MIN. SUMP 8" STONE LEACHING FIELD o $5 540W INV. 310 CMR 15.000 (TITLE 5.) 86.17 f o°°o°o°o°o°0 12" MIN. TNT. DIM. GAS BAFFLE::: °°o°o °os 8)67' LEVEL BOTTOM o 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND P r NOT TO BE USED FOR LOT LINE STAKING OR ANY Shubael 85.91 ' 85.74 / OTHER PURPOSE. �° ca Pond i •..`••• +':+.••' "'' :.••,• ` � 25 0 WATER-TEST D'BOX 8. PIPE FOR SEPTIC SYSTEM TO UCH. 40-4" PVC. \\c FOR LEVELNESS 85.04' 6" CRUSHED STONE OR MECHANICAL _ 9. COMPONENTS NOT TO BE BACKFILLED OR COMPACTION. (15.221 [2]) 6 84' -7 CONCEALED WITHOUT INSPECTION BY BOARD OF � O HEALTH AND PERMISSION OBTAINED FROM BOARD ( 2 % SLOPE) ( 1 % SLOPE) OF HEALTH. 78.2' BOTTOM TH-1 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP LEACHING NO GROUNDWATER FOUND CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION-EXISTING SEPTIC TANK 13' D' BOX 9' FACILITY VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF SCALE 1"=2000'f *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL "INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT WORK. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 103 BLOCK 83 LOT 002 PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK IF NOT SUITABLE. BE REMOVED BENEATH AND 5' AROUND THE LOCUS IS WITHIN FEMA FLOOD ZONE X PROPOSED LEACHING FACILITY. (AREA OF MINIMAL FLOOD HAZARD) AS 12. EXISTING LEACHING FACILITY SHALL BE PUMPED SHOWN ON COMMUNITY PANEL #25001 CO542J AND REMOVED OR PUMPED AND ,FILLED WITH CLEAN DATED 7/16/2014 r--­7 LEGEND SAND. 99- EXISTING CONTOUR X 99.1 EXIST. SPOT ELEV. 5.0 1 .5 �� SYSTEM DESIGN: -do Imp -[991- PROPOSED CONTOUR o \ O \ GARBAGE DISPOSER IS NOT ALLOWED 198.41 PROPOSED SPOT EL. �' TH1 N 'Q �O DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 110 GPD TEST HOLE m / 72 \ IQ� USE A 330 GPD DESIGN FLOW 2% SLOPE OF GROUND 'N �� � O \ SEPTIC TANK: 330 GPD (2) = 660 �Qo UTILITY POLE ' \ RE-USE EXISTING SEPTIC TANK** �--� FIRE HYDRANT � � �� �\ '._ � _ \ LEACHING: NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING /1 8.0' o 89 SIDES 330 GPD (.74) = 446 SF REQUIRED 5 _ SF O �� Q a� 450 SF X .74 = 333GPD OK TEST HOLE LOGS LE-ACHING DETAIL Q, BENCHMARK 1 ' 10' �h o EL. O9.6' USE A 18' X 25' PIPE AND STONE LEACHING FIELD MAP 103 BLOCK ENGINEER: CRAIG J. FERRARI, SE #13871 ; 83 LOT 002 i 19,998t S.F. DON DESMARIAS - ; EXISTING WITNESS: DECK DWELLING TOF=90.6 DATE: 12/1 1/17 PERC. RATE = < 2 MIN/INCH �\j �C) CLASS I SOILS P 15561 Z� \ EXISTING ELEV. ELEV. SEPTIC TANK o„ 4 0„89.2' 89.5' ` ti A A /LU /LS M A 10YR 3 2 10YR 3/2 � 0 APPROVED DATE BOARD OF HEALTH I 10" 12" TITLE 5 SITE PLAN B B TH2 OF �LS /LS TH T �p 24" 10YR 5/6 87.2' 26" 10YR 5/6 87.3' `h 306 WILLIMANTIC DRIVE c1 MARSTONS MILLS, MA /FLU /FLU PREPARED FOR 421) 10YR 7/2 85.7' 45" 10YR 7/2 85,8' a �� '��"'�' / ~ GARY CLIFFORD C2 C2 ,26SQ' J as' HOFMgssgo� 18 2017 A. �o DANIEL DATE: DECEMBER , PERC MS MS OJF�LA DANIEL tiG� �'� DANIELA. 1OYR 7/4 1OYR 7/4 UNSUITA No.40980 LA BLE A. DANIEL off 508-362-4541 q f aP OJALA N �o OJI4I OJA ` fax 508-362-9880 o wo.�t0°80 / CIVIL I downca e.com Fesa�° p ti No.46502 *. P C1 e No.465 �F S/ONTeEPG\ ASS©h T EV�I;,IJ cape engineering, inc. civil engineers 132" 1 78.2' 132" 78.5' \ f w NO GROUNDWATER ENCOUNTERED Scale: 20' �2�1b_t-� -� land surveyors 939 Main Street ( Rte 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 0 10 20 30 ao 50 FEET DCE # > 7-462 ,7-462 CLIFFORD.DWG