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0372 WILLIMANTIC DRIVE - Health
372 Willimantic Drive Marstons Mills A= 103-087 i I I i I i I I �il�.■�C�CC���■CNp����0 �p.e Y C'....a�■��1�.... ��C..� ACC. .C..� I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is 4 Betty Ave E.Sandwich MA 01/15/15 required for every y 11 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:When filling out forms A. General Information on the computer, � �( use only the tab 1. Inspector: r/ key to move your cursor-do not Brian Reyener use the return Name of Inspector key. , Ranger Construction Company Name 46 Crowell Rd. Company Address East Falmouth MA 02536 City/Town State Zip Code 508-274-9753 SI 13242 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority i1A k 01/15/15 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. t5ins•11/10 Title 5 Official Ins 'on rm:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 Betty Ave E.Sandwich MA 01/15/15 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: System is in good working condition 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 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is �required for every 4 Be Ave E.Sandwich MA 01/15/15 page. Cityrrown 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 pipe(s)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 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11110 Tltie 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is �required for every 4 Be Ave E.Sandwich MA 01/15/15 page. Cityrrown 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: No active wells within 150'+ D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 BettyAve E.Sandwich MA 01/15/15 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. ❑ ® 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 Betty Ave E.Sandwich MA 01/15/15 page. CityTrown ' State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 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 o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 5 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 Betty Ave E.Sandwich MA 01/15/15 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1000 gallon Septic Tank with 2-3'x 30'trenches Number of current residents: 0 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 Water meter readings, if available(last 2 years usage(gpd)): Detail: ZOI4 Z3;0wo &,I/61Vs 20 13 216 1 0 0 0 Gil 10-43 Sump pump? ❑ Yes ® No Last date of occupancy: current 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 11 L Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 Betty Ave E.Sandwich MA 01/15/15 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: None available Was system pumped as part of the inspection? ® Yes ❑ No If yes,volume pumped: gallons i 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is 4 Betty Ave E.Sandwich MA 01/15/15 required for every Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Septic tank installed in 1970's Leaching installed 2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: NA feet Comments (on condition of joints, venting, evidence of leakage, etc.): PVC in good condition Septic Tank(locate on site plan): Depth below grade: 2'0' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 0" t5ins.11/10 Title 5 Official Inspection Forth: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 M 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 Betty Ave E.Sandwich MA 01/15/15 page. Cityrrown 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 45"+/ Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? measured ' Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic Tank is in good condition with sanitary T's intact , risers installed Pumping recommended every 2 years Grease Trap (locate on site plan): Depth below grade: feet 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: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 Betty Ave E.Sandwich MA 01/15/15 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: ❑ Yes ❑ No Date of!last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 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 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 Betty Ave E.Sandwich MA 01/15/15 page. Cityrrown 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 0" (at time of inspection) 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.): Good Condition-liquid level at correct height, Riser installed at time of inspection 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 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 Betty Ave E.Sandwich MA 01/15/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2-3'x30' ❑ 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.): System in good working condition 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 Betty Ave E.Sandwich MA 01/15/15 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 Commonwealth of Massachusetts Title 5 -Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owners Name information is �required for every 4 Be Ave E.Sandwich MA 01/15/15 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 Ar3 70 � -71 9 i ^ ! i =Ira x 2 O � t5ins•11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 15 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 Betty Ave E.Sandwich MA 01/15/15 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: 10' +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: 2011 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Design plans on file show no GW at 10'+ below grade 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 5 372 Willimantic Dr. Marstons Mills Property Address Frank Saluti Owner Owner's Name information is required for every 4 Betty Ave E.Sandwich MA 01/15/15 page. Cityrrown 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 Forth:Subsurface Sewage Disposal System•Page 17 of 17 TOWN,( OF BARNSj�TABLE LOCATION �7J l�2 � �"'V`I I1 A0 M k 1 &SEWAGE# 2011 —00 5 VILLAGE /bi I ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. (� tin �P�/ N �f(L S �'^ 2 74'q7 S3 SEPTIC TANK CAPACITY E)6 ST, /00 0 LEACHING FACILITY.(type) ;0 ' f{/C- (size) t 0 _ NO.OF BEDROOMS . OWNER 1 A owl'CD, PERMIT DATE: 114/2©// COMPLIANCE DATE: -7 ( Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 119 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) 1V/A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ✓! IL. a � xoq _ yya� No.20 1� — (DO Fee I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y__ es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(pplication for Disposal *pstem Construction permit Application for a Permit to Construct( ) Repair KI Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Ad s or Lot N . �e� w j((jMAA+YC- Owner's Name,Address,and Tel.No. Assessor's Ma � Installers Name,Address,and Tel.No. .46 C 4W i1 (z Designer's Name,Address,and Tel.No. (Jr;Un 1� fV1 t ` _1Mop OZ53y Type of Building: Dwelling No.of Bedrooms Lot Size 201 00 sq.ft. Garbage Grinder(/VY) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3o gpd Design flow provided 36p4. S gpd Plan Date l b 5 I Number of sheets 2 Revision Date Title ! Size of Septic Tank 6- -t. /000 Type of S.A.S. (IT gl o Description of Soil 1-12 rye c. Nature of Repairs or Alterations(Answer when applicable) k ce €x�S r+h� �, � Q�� Li i �vt w �A S Car. ;r, ► o), 10 7 a O; �,s Alf v✓ `� $a Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date i 6 J Application Disapproved b Date for the following reasons Permit No.Zo 00 5 Date Issued ——------—— u——--- — —— - — -------------------- ----------------------------------------------------- No.2 0 I Fee Y I ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes e PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS i 210plication for ]Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Ad' d Ces-'o'r Lot G( Wj(jjM,,n+1C W. Owner's Name,Address,and Tel.No. Assessor's M - 68 . Mt I f own-r,t 0� 9(.fG c Installer'ss Name,Address'" and Tel.No. qG C 4,W(0 R Designer's Name,Address,and Tel.No. 1✓ ,Un 1� Q✓1 1 (: i ''�v�"' /0A 01537 �, Type of Building: ` Dwelling No.of Bedrooms Lot Size Z,0100 sq.ft. Garbage Grinder(/ Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided �� 4� S gpd as rl 2 Plan Date �� Number of sheets Revision Date i r Title Size of Septic Tank L Xi Sf. /000 Type of S.A.S. C 1 y> ��0 �' F ✓}� S Description of Soil ZM,n P,2 j y.t k II Nature of Repairs or Alterations(Answer when applicable) 'n Li MVJ S/AS �6r, ,n�N� jp 6ia 7jJ4U)tes NQ � `b $a X V Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system'in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. 1 Si ed Date t/ Application Approved by Date I 6 Application Disapproved by Date for the following reasons Permit No.Zo 11 ' 00 5 Date Issued ---------------------------------------------------------------------------------------------------------------------------------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS ti Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed-( ) Repaired( Upgraded( ) Abandoned( )by (:` ft,yr l at312 A401 3C6 W I ILn c i A 01 A n i C 8M NS At-,s"f as been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No.Z011-04 dated 6 20 Installer TWOAP TEyCNC-flL Designer *DA(L(LftJ I&Y69- #bedrooms 3 Approved design flow gpd The issuance rf thi permit shall not be construed as a guarantee that the system will funct 4 1 n as desi d. Date 7 Inspector ------------------- 00 No. 2 Oil - ao t Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstrm Construction Verm[t Permission is hereby granted to Construct( ) RepairkkX Upgrade( ) n Abandon( ) System located at 'j12 A" 366 WiLLiAM/ANT1C A � �lNC ,1't+4R5i.,15 MILLI. 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:Constfuction must be completed within three years of the date of this permit. Date ] '6ZO 1 t Approved by I Town of BAi Mstable P# 7 Department of Regulatory Services Public Realih Division Bate -� 3 •s IBTABU. • I •iKA-q& �e 200 Main Street Hyannis MA 02601 3 Fee Pd. (d Time Date Scheduled ' --�- ! I i AWil �` itability �4ssessr�n for Sewage ilsposar Performed By Witnessed By:_o / l > i LOCATION & GENFRAL INFORMATION ' i Owner's Name FEV �!'iT, M6'�, SSr! Location Address :2��1 �! ��� �/2q (,(flipsf�( t p0 Address P l ht • k Assessor's Map/P4rcel: i Engineer's NameP"� Kt e r ®� ( NEW CONSilZUt2ON REPAIR Telephone# 509 1 Land Use �Q�S���� t ! Slopes(�o) Surface Stones ft Possible Wet Area ft Drinking Water Well >- ft Distances from: Open Water Body } 2. Drainage Way ft Proprrty Line ® ft _ Other ft s( M A• j goP(c/BOO 0 SKETCH ( (p'� m O / D sae no�Oh / , I m I I SF I Z 20 ItFn N ./ r° fn ° 11 ° X ; r o f m Vi, o o Z A I Water line 1 Wq N I I Z G, I —' Gq p o ez — I I I (Nit I i DRIVEWAY / t o 26.73 ��I T/y, Pw(9 \\ \------------- cAs — ay gReq<pT 3 ------- --- V V 2OlOQ` 93 t sF t x 9 159.28 ft i 2 Parent material(geologic) ac(.ae.E G U L.J S Depth to Bedrock ry I Depth to Groundwater. Standing Water in Hole: Weeping I P g from Pit Face 1 Estimated SeasonalttHigh Groundwater ! D TE ATION FOR SEASONAL I UGH WATE1 R TADLE Method Used: Depth observe standing in obs.hole: in. Depth to soil Motu"'. in Depth toiweeping from side of obs.hole: ! in. ©roundwater AdJuettnent Index Well#— Reading Date: index.Well level -- _ A ,fnetor. _r� Adj.Crroundwfiter].evel.,,e j PERCOLATION TEST . Date ')7e>sC Observation I I Time fit 91' 4A. Hole# Time at G" Depth of Pere t( Time(9"-6") Start Pre-soak Time.@ End Pre-soak Rate MinJlnch ! Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) ' Original:,Public e':=el lth Division Observation Hole Data To Be Completed on Back— ***If percolaion test is to be conducted within 100' of wetland,you must first notify the Barnstable C41iservation Division at least one (1) wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel 814 911-3711 S !v ( 57 jX11 G 2:5� DEEP OBSERVATION HOLE LOG Hole#3G Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) 0`�$ e11 nl • `'- 'L'' G �� fatit 2` DEEP OBSERVATION HOLE LOG Hole# N Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# N Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten ra I Flood Insurance Rate Map: J Above 500 year flood boundary No_ Yes V Within 500 year boundary No V 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? If not,what is the depth of naturally occurring pervious material? Certification ' �9 I certify that on (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 require wining,expertise and experience described in:U0 CMR 15.017. Signature Date D/ OS 11 Q:ISEPT0PERCFORM.DOC iL APPLICANT: ADDRESS: WILIA MAadfll, YA DESIGN FLOW: gpd REVIEWED BY: DATE: N/A OK NO Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] ' X Locus Provided [310 CMR 15.2204 t k Plan proper scale?(1"=40' for plot plans, 1"=20'or fewer for corn orients) [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 u ades]- i not, a var red [310 CMR 15.412(4)] X Location of impervious surfaces (driveways,parking areas etc.) 1310 CMR I5.220(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)] �( [System Calculations [310 CMR 15.220(4)(0] daily flow septic tank capacity (required andprovided) soil absorption system (required andprovided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)( )] Existing and ro osed contours [310 CMR 15.220(4)( )] X Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] X Names of soil evaluator and B OH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] x 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 x 15.220(4)(n)] Location of every water supply,public and private, [310 CMR- 15.220(4)(k)] x. Address �f'o(� )��/�L �R, Sheet l of 7 a within 400 feet of the proposed system location in the case of surface water supplies and ravel packed public water supply �( within 250 feet of the proposed system location in the-case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and an), catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines-and dtheF=subsurface utilities located [310 CMR 15.220 4 m if water line cross see 310 CMR 15.211 1 1 Profile of system showing invert elevations of all system X components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2)] X Stamp of Registered Land Surveyor(required if construction k activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as X approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? x 310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? x [310 CMR 15.103(3)1 Benchmark within 50-75'of system [310 CMR 15.220(4)( )] x Materials specifications noted? [various sections of 310 CMR 15.000] X System components not>36" deep(unless Local Upgrade Approval or LUA requested){310 CMR 15.405(l(b) f Address j � �l(�(�� 2, _ Sheet 2 of 7 Size OK? -[310 CMR 15.223(1)] Inlet tee located ten inches below flow line 310 CMR 15.227(6)] Outlet tee 14" or 14"+ 5"per foot for increase ft depth [310 CMR 15.227(6)] x Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] �( Separation between inlet and outlet tees (no less than liquid depth) 310 CMR 15.227(2)] - x Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for X upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(0] x Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (b 7/07) [310 CMR 15.228(2)] Access to within 6 "of grade - one port for systems<l 000gpd, two fors stems>1000 gpd 310 CMR 15.228(2) All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] X > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done 310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] X Setbacks from resources 310 CMR 15.211 t Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1)(b)] X First compartment 200°o 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 as baffle or approved filter[310 CMR 15.224(4)] Address 3r W l�(.l ,� �� , Sheet 3 of 7 i Located atleasi ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18"below water line (when water and sewer cross, see 310 CMR 15.211(1)[1]) X Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/811/ft) 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) 310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/ leachfield below pump chamber) Endca s or vent manifoldspecified? 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) ON Stable compacted base [310 CMR 15.22](2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 X CMR 15.323.(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] X Minimum sum 6" [310 CMR15.232(3)(e)] X Watertight cover if<2000gpd);waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity aci (emergency. =storage above flow)? wor p tY( g y g kmg design flow). [310 CMR 231(2)] k 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, disconnects accessible) Alarm floats -alarm on circuit separate from purn s specified? Exceeds two units must have two pumps operating in lead-lag mode. [31:0,CMR 15.231(6)and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] Address 6 wl C,l,� l�71 ��� Sheet 4 of 7 Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation togroundwater? 310 CMR 15.212).] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241], X Inspection ports specified and within Yfnal grade? [310 CMR 15.240(13)] . Breakout requirements met?(No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and �( Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be tograde) 310 CMR 15.253(2)] �C Aggregate I'minimum-4'maximum. [310 CMR 15.253(1)(b)] x 2' sidewall credit maximum [310 CMR 15.253(1)(a)] X In bed configuration, inlet every 40 s .ft. [310 CMR 15.253(6)] X Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] X 100 feet-maximum length [310 CMR 15.251 1) a Minimum separation 2x effective depth or width whichever eater 3k if reserve between trenches 310 CMR 251(1)(d)] Situated along contours [31 U CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] 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 CMR 15.252(2)(e) Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)( )] Separation between beds 10' minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only 310 CMR 15.252(2)(i)] Address_ W tLL1 AAk?JT-1Q i �, Sheet 5 of 7 . , I Pressure Dosed System ? Provided pump and piping calculations as re uired„ 310 CMR 15:220(4 (r)] x Pressure dosing required on all systems>2000gpd or alternative systems undelnedial approval [310 CMR 15.254(2) and I%A Remedial Use Approvals] x If used in gravel less system -make sure jet is directed as not to scour soil interface Guidance Document X Inspections once per year(systems<2000 gpd)or quarterly . (>2000 d goodtonote on plan [310 CMR 15.254(2)(d)] K Construction in fill -Did the plan specify that the fill shall meet the s ecification of 310 CMR 15.255(3)? X Im ervious barrier and/or retaining wall ? Guidance Document] X Impervious barrier installation must be supervised by desi ner [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional X En gin [310 CMR 15.255(2)(a)] Side Slone not exceed 3:1 ? 310 CMR 15.255(2)] X Breakout requirements met? [310 CMR 15.252(2)and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] k P _ �� � s Check DEP A roval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface X 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 DEP A roval Conditions? Is there a note on the plan regarding the requirement for e etual maintenance a eement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Are thevariances listed on the plan ? [310 CMR 15.220 (4)( )] 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] Address_ 3W, VJ, A, Sheet 6 of I t , Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR-15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] X Are the nitrogen loads proposed in compliance? [310 CMR 15.216(l)] Pumping to septic tank? [ 310 CMR 15.229 Shared System [310 CMR 15.290 211 1 Address Sheet 7 of 7 l Town of Barnstable '"E'�'�.� Regulatory Services Thomas F. Geiler,Director (� snaxsrnsi.a. 9�pT. � � Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 1 7 r11 Sewage Permit# Assessor's Map\Parcel DLI �G�J�Caps Designer: DAMWI � Installer: (i Mtn R ell► -42 Address: ��/ T Address: G C eo w, 1 �t On b1l, (�� �� dl {/(-- was i 37 ssued a permit to install a (d te) (insta ler) septic system at -312 A VA 366 W 1.1[1 MA#164_ Pit on a design drawn by (address) V e l'ss�dated 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. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or amr 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. OF ° DA N M. G' EYER (Installer's ign re) " No. 1140 i STEM 4' SANITh?, OIId� esigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORNI AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-4doc -7_o�i Commonwealth of Massachusetts Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM j7 m ant c Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 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. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number rkn B. Certification Ea;int7enan I certify that I have personally inspected the sewage disposal system at this ad AECO information reported below is true, accurate and complete as of the time of the The ins�ctionwas performed based on my training and experience in the proper function and n site sewage disposal systems. 1 am a DEP approved system inspector pursuan #0 Title 5 (310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails Xee h r Ev ation by the Local Approving Authority 9-21-10 re Date The system inspector shall submit a copy of this inspection report to-the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the . report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 CornmonWealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 366 Willimantic Dr (AKA 372 Willimantic Dr);:O aitn Mid T15:Tti A)""- Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ' ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or,not determined (Y, N, ND) in the ❑ for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old,is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health) ❑ broken pipe(s) are replaced ❑ obstruction is removed t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form _ of Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °�M y 366 Willimantic Dr (AKA 372 Willimantic Dr) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass.unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or.privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a'manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 366 Willimantic Dr (AKA 372 Willimantic Dr)' Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/ day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 i Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 366 Willimantic Dr (AKA 372 Willimantic Dr) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): f Yes No" ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either`yes"or"no"to each of the following, in addition to the questions in'Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to.a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Q,M 366 Willimantic Dr AKA 372 Willimantic Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 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 NIA) ® ❑ 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 maintenance of subsurface sewage disposal systems? proper 9 p Y The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 366 Willimantic Dr (AKA 372 Willimantic Dr) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? . ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 8-2010 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: Last date of occupancy/use: Date Other(describe): t5insp official document•OW08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 366 Willimantic Dr (AKA 372 Willimantic Dr) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: " Source of information: N/A 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): Approximate age of all components, date installed (if known) and source of information: 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp official document-03/08 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Vol untary•Assessments 366 Willimantic Dr (AKA 372 Willimantic Dr) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 42' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 36" feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle. 26" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape t5insp official document•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 366 Willimantic Dr (AKA 372 Willimantic Dr) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 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.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 366 Willimantic Dr (AKA 372 Willimantic Dr) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day i Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box not in good condition and overgrown with tree roots. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp official document-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 366 Willimantic Dr (AKA 372 Willimantic Dr) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type. ® leaching pits number: 1-1000 gal ❑ 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.): Leach was empty at inspection with stain line at inlet invert. t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 366 Willimantic Dr (AKA 372 Willimantic Dr) Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 366 Willimantic Dr (AKA 372 Willimantic Dr) �^M Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. G i C 00 i - - Q�'n'' i �. t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 366 Willimantic Dr (AKA 372 Willimantic Dr) Property Address Bank Owned (Contact David Holt @ Today Real Estate 17800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 9-20-10 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: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database - explain: You must describe how you established the high ground water elevation: USGS maps show groundwater at greater than 20'. t5insp official document•03/08 Title 5 official Inspection Farm:Subsurface Sewage Disposal System•Page 15 of 15 i I 372 Willimantic Drive Marstons Mills A= 103-087 ■■ ■■■■■■■■■■■■■■■■■■■■■■■■■MEMO■ ■MOO■■■■■■■■■■■■■MOO■■■O■e■■■■EEO■■■■E■■■■■e ■■■O■■■■■EOM■■■■■■■■O■■■■■■■■■■■■■■■■E■■■■■O■ ■■■■Mee■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■EMO■■■O■ ■■■■■■■■■■■■■■■■■■MOO■■■O■EEE■■■MMMEM■MMM■■■■ ■■■■■■■■■■E■O■■■■■■OEM■■■■■■EEO■■O■E■E■■■■■■■ MENEM OEM MENEM ME mom MMMMEMMMMMNMMMM ■■■■■■■■■■■■■■■■■■■E■MOO■■E■■e■■EEO■■e■O■■■■■ ■■■■■■■■■■■■E■■■■■■■■O■■O■■■MOO■E■■E■■■E■■■■■ ■■■■■■■■■■■■■■■■■■■M■■■■■O■■MOO■■■OE■■■■■■■■■ � ■■■■■■E■■OEM■■MOM■ � �1 ' -�I . x °s�■■MMMEMM■■EE■M■■■M ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■E■E■■EEE■■ ■eM■■■■■■■■■■■■■ , � ■■■ t f, 1 ;•, LEGEND BENCH MARK �o L� ���_ PROPOSED CONTOUR RgCE GN CORNER OF �� / 9® PROPOSED SPOT GRADE CONCRETE PATIO / rn ELEVATION = 93.64 94 h 0, C -- 98 -- EXISTING CONTOUR BARNSTABLE GIS DATUM !94 \� + 96.52 EXISTING SPOT GRADE j 93 1 �I �`� / W— EXISTING WATER' SERVICE 0 I �Z� TEST PIT MgNric D 15g•'� I I I 92 LOCUS MAP N.T.S. 91 \ exist. 1 000 I I \ \\ sep tic tank I II WATER GATE / GENERAL NOTES: \ \ (n p d\er'/ \\ 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL \ \ I E< < -o lJl� �j ' I BOARD OF HEALTH AND THE DESIGN ENGINEER. \ \ 11 2C \\ 0,� �� � �' � O 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS \\ \\ existingleach it 2 OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE (see note 10) I � r II LOCAL RULES AND REGULATIONS. \ \\ I OZ ����P� 3 KFILLED PRIOR TOE SEWAGE DISPOSAL I SPECTION AND APPROVAL BY THE BOARD OFCHEEALTH AND THE \ \ l I R / DESIGN ENGINEER. *1 \ �� / 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING \ \ I �� L� FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN = \ \ ENGINEER BEFORE CONSTRUCTION CONTINUES. \ \ i 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. \ \ \ S 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. \ \ \ 1 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. \ \ 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. \ 10. EXISTING PITS TO BE PUMPED, CRUSHED, AND FILLED. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION nsp ports \\ __, // 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY _ AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING 14. ALL PIPE TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPEC. OTHERWISE) II b TH-1 LOT 32 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW I \ S ► FOR THE USE OF A GARBAGE GRINDER AREA = 20100 sf +— 16. ,NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING \ d W } 91 \\ 15g 2a I D A��R \ \ - , a. 1140 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 92ciSE ° 372 aka 366 Willimantic Drive, M. Mills, MA • � S4NITAR\ � Prepared for: Ranger Construction Engineering by: Surveying by: SCALE DRAWN e j DARRENM.MEYER,R.S. hco-Tech h'nvhvjimen&d 1"=20' DMM MAP: 103 PO BOX 981 EASTSANDWICH,MA 02537 (508) 364-0894 DATE: CHECKED SHEET N0. LOT. 087 50e-362-2922 01/05/11 DMM 1 of 2. r 3 S NOTE: TO PREVENT BREAKOUT, THE PROPOSED f NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:89.39 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. ��� OF Mq s T.O.F. EL.=95.04 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.)'AND SET TO 3" OF F.G. DAR M. d • F.G. EL.=93.6f F.G. EL.=93.4f F.G. EL: 92.0f F.G. EL: 92.0(MAX.) M _-ER No. 1140 9" MIN COVER/ '�EGIE L = 10't 36" MAX COVER L = 30' L 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) 0 S=1X (MIN.) EL. m 91.8 0 S=IX (MIN.) 0 S=1X (MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC LLj10- u" 6 11.2" TO INV.=90.89 48"LIQUID INVERT LEVEL INV.= 90.64 PROPOSED INV.=90.00 GAS BAFFLE D-BOX 2 TRENCHES OF 5 UNITS AT 6.25'/UNIT = 31.25'/ROW - INV.=90.18 DR-5 INV.= 89.00 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1,000 GALLON SEPTIC TANK RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET /�7 BACKFILL WITH CLEAN PERC SAND TO TOP OF CHAMBERS 75" NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING , PIPE INVERTS PRIOR TO CONSTRUCTION EXISTING SUITABLE 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=89.39 MATERIAL GRADE ON A MECHANICALL COMPACTED SIX INV. ELEV.= 89.00 INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.= 88.06 310 CMR 15.221(2) 6.00' 2.83' 2.83' 3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF TANK WITH 1500 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. r� 76 IF FAILED, DAMAGED, OR UNDERSIZED. (7.51 PROVIDED) USE 2 ROWS OF 5 16"-HIGH CAPACITY PROFILE 4) INSTALL INLET & OUTLET TEES W/ ZABEL BOTTOM OF TEST HOLE EL.=80.92-_ ADS BIODIFFUSER UNITS-NO STONE FILTER AND GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE TYPICAL SECTION �- 16" N.T.S. "Ts 11.2' DESIGN CRITERIA SOIL LOG P#: 13167 NUMBER OF BEDROOMS: 3 EXISTING BEDROOM - NO INCREASE IN FLOW PROPOSED DATE: JANUARY 5, 2011 I�34" +� SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE #1614 SECTION END CAP DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DAVID STANTON, BARNSTABLE BOH DAILY FLOW: 330 G.P.D. 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT DESIGN FLOW: 330 G.P.D. Elev. TP-1 Depth Elev. TP-2 Depth 92.25 0" 1 92.05 0" GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) A SANDY LOAM A SANDY LOAM MODEL 16" HICAP tOYR 4/3 1OYR 4/3 PROPOSED SEPTIC TANK: USE,,�EXISTING 1,000 GALLON CAPACITY 91.58 B 8" 91.38 B 8" LENGTH 76' NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT EFFECTIVE LENGTH 75' TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: (330) = 445.95 S.F.'�`': SANDY LOAM SANDY LOAM 10YR 6/6 1DYR s/8 SIDE WALL HEIGHT 11.2" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. '' 74 89.17 C 37" ' 89.05 C 36" OVERALL HEIGHT 16" .DISTRIBUTION BOX: DB-3 (3 OUTLETS (MINIMUM)) OVERALL WIDTH 34" 4640 TRUEMAN BLVD PRIMARY S.A.S. 13.6 CF HILLIARD, OHIO 4JO26 USE 2 TRENCHES 5- 16" ADS BIODIFFUSER H-20 UNITS-NO STONE PERC ® 87.75 MEDIUM SAND MEDIUM SAND CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC. 2.5Y 6/6 2.5Y 6/6 TRENCHES: (GENERAL USE APPROVAL FOR 7.88 SF/LF OF BIODIFFUSERS PROPOSED SEPTIC SYSTEM SITE PLAN (BIODIFFUSERS) 10 UNITS x 6.25 LF x 7.88 SF/LF = 492.5 _SF 136" 8105 132° TOTAL AREA = 492.5 SF 80.92 372 aka 366 Willimantic Drive, M. Mills, MA ' Prepared for: Ranger Construction PERC RATE<2 MIN/IN. (-Cl" HORIZON) DESIGN FLOW PROVIDED: 0.74GPD/SF(492.5SF) = 364.5 GPD > 330 GPD req'd I NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN DARRENM.MEYER,R.S. Eco-Tech Environments/ NTS D.M.M. jr.quiroments Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pOBOX9 EASTSANDVi9CH,MA 0253781 (508) 364-0894 conduct soil evaluations and that the above analysis has been performed by me consistent with the DATE: CHECKED SHEET NO.of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. 508-362 2922 2 D1/05/11 D.M.M. Of 2 g