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HomeMy WebLinkAbout0038 WINDING COVE ROAD - Health 1_38 Winding'Cove"Road : Mantons Mills I h 14 i i i� DSO-0(�f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �N 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 r required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When Inspector Information A. Insp ,1 filling out forms5 f # 1 7 a on the computer, Daniel Hawkins use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return key. Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code txty (508)477-0653 S114324 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address lis ted above;the Information reported below Is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑■ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Dan Hawkins ;Digilally signed by Dan Hawkins .Date:2021.05.2412:43:18.04'00' 5-20-21 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 L c Commonwealth of Massachusetts wn= - Title 5 Official Inspection Form — la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) , System Passes: FE1 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: The system was in working order at the time of inspection. 2) 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): t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I Commonwealth of Massachusetts an - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts �.. . Title 5 Official Inspection Form � M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fain 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts 4 --; Title 5 Official Inspection Form + - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every St page. City/Town ate Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ El 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. ❑ El Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ED 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.] ❑ El The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ n 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts = -� Title 5 Official Inspection Form j" to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f 38 Winding Cove Road yl Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ 0 Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? El ❑ Has the system received normal flows in the previous two week period? ❑ a Have large volumes of water been introduced to the system recently or as part of this inspection? O ❑ 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? 0 ❑ Was the site inspected for signs of break out? E] ❑ Were all system components, excluding the SAS, located on site? E ❑ 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? ❑ a 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: El ❑ Existing information. For example, a plan at the Board of Health. ❑ 0 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.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 x Commonwealth of Massa chusetts Title 5 Official Inspection Form :� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t / 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is required for every Marstons Mills Ma 02648 5-20-21 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 4 4 Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 457/GPD Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes [E No Does residence have a water treatment unit? ❑ Yes No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ® Yes No information in this report.) Laundry system inspected? ❑ Yes F!] No Seasonaluse? ❑ Yes [E No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: 2020- 1 -53,000gallons 2019 150,000gallons Sump pump? ❑ Yes ❑■ No Last date of occupancy: currentDate t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 1e t Commonwealth of Massachusetts -� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lj 38 Winding Cove Road Property Address Lisa Farley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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 Water treatment unit'present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: Owner- date of last pump is unknown Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 f Commonwealth of Massachusetts Title 5 Official. Inspection Form i;t p Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is required for every Marstons Mills Ma 02648 5-20-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El 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: New SAS added to existing tank in 2008 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑cast iron ■❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town waterfeet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts w� ^ � Title 5 Official Inspection Form -: Rio Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: 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 1 Dimensions: 500gallons 211 Sludge depth: 3411 Distance from top of sludge to bottom of outlet tee or baffle 311 Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 1411 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. Tank has a zable filter than needs regular maintenance. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 r Commonwealth of Massachusetts d = - Title 5 Official Inspection Form - w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t - � % 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: NAfeet 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.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ElYes ElNo 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 9. Distribution Box(if present must be opened) (locate on site plan): orr Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts n - Title 5 Official Inspection Form rJ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t k/ 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): NA If pumps or alarms are not in working order, system.is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: (3)500 gallon chambers El leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road L Property Address Lisa Farley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Leaching chambers were 1/4 full when viewed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is required for every Marstons Mills Ma 02648 5-20-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts �^ Title 5 Official Inspection Form _ — Ii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address Lisa Farley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection Da System Information (cont.) 14. 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 SWl111G TIES. t?ESCRIPT ION HC 1 HC 2 SEPTIC COVER 1N(1) 22,2'2 14Z SEPTIC COVER.OUT(2.) I&T 17.6' DISTRIBUTION BOX(3) 48.0' 555.2 LEACHING CC3VER(4) 52.8" 59.4' EXIST NCa 9.500 GAL:' LEACHING COVER(5) 54.7' S5.8' SEPTIC TANK t7GK ()ISTf21t3tJTI0N DECK: BOX #3$ H(.2 EXISTING 4-E3EDftQG?IW3=500 GALt:ON DWELLING ,_ HC T ' LEACHING {2) CFiAMi3EFt5 n• a 4) o *f, 0.1 NG i Sti, �i t5insp.doc-rev.7I260018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form - ,� Subsurface Sewage Disposal System Form Not for Voluntary Assessments � % 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope Surface water 0 Check cellar Shallow wells Estimated depth to high ground water: No GW @ 138" feet Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record If checked, date of design plan reviewed: 7-16-2008Date ❑ 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: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address Lisa Ferley&Shana Townsend Owner Owner's Name information is Marstons Mills Ma 02648 5-20-21 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑■ A. Inspector Information: Complete all fields in this section. ❑■ B. Certification: Signed &Dated and 1, 2, 3, or 4 checked ❑■ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ❑■ D. System Information: For 8: Ti ht/Holdin Tank—Pumping contract attached 9 9 P 9 . For 14: Sketch of Sewage Disposal System drawn on . 16 or attached 9 p Y P9 For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 f. Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 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 A. General Information filling out forms �1 on the computer, -V'{OF use only the tab 1. Inspector: rc key to move your p JOHN L, v cursor-do not 0 CH %%a ILL John L. Churchill Jr. P.E., P.L.S. Jf?_ use the return Name of Inspector i'��if. key. P�, 41,107 JC Engineering Inc. i0 „� Company Name ° 2854 Cranberry Highway Company Address emm East Wareham MA 02538 City/Town State Zip Code (508)273-0377 PE#41807 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 urther valuat' a al Approving Authority March 9, 2011 Insp is Signature Date '9 system inspector sh II ubmit a copy of this inspection report to the Approving Authority(Board ealth or DEP)within 0 days of completing this inspection. If the system is a shared system or fas 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 k 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. II t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal yslem•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 page. City/Town State Zip Code Date of Inspection B. Certification (coat.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System. Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y i❑ N ❑ ND (Explain below): 151ns•09/08 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 GSM 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of W r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9 2011 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 f Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9 2011 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of 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): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins-09/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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 ears usage d 389 gpd (2010) 9 ( Y 9 (gpd)): 260 gpd (2009) Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No. Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 page. CitylTown 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: Tank pumped approximately August 2010 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 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 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Rona ne Owner Owners Name information is required for every Marstons Mills MA 02648 March 9, 2011 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: Tank installed prior to 2008; d-box and sas installed July 2008 per recent as-built card on file with the local board of health. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 foot feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1.5 feet to top of tank 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: Approximately 5.8'W x 10.51 (i.e. 1,500 gallons) Sludge depth: 1 inch t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments %M 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" 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 18" How were dimensions determined? Field 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.): Recommend pumping once a year. Liquid level up to invert out pipe. No evidence of leakage. Zabel filter installed on outlet tee (not clogged). Plastic riser over outlet cover in good shape. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 page. City/Town State Zip Code. Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 inches 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 appeared level. However, it appears that both pipes out of the d-box are not carrying equal flow to the leaching system. Recommend both outlet pipes'flow equalizers be adjusted to equal elevations in order to provide uniform distribution of flow to the leaching system. Top of d-box to existing grade = 50 inches. Top of d-box plastic circular riser to existing grade = 22 inches. Recommend additional riser over d-box to bring to within 6 inches of existing grade. Pump Chamber(locate on site plan): Pumps in working order: Yes No P 9 ❑ ❑ 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: SAS is shown on page 14 of 15. t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Two (2)500 gal. ❑ 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.): No evidence of failure present at time of inspection. 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•09/08 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 4.1 38 Winding Cove Road Property Address John J. Ronayne Jr.., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form I, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address John J. Ronayne Jr_, and Nancy B. Ronayne Owner Owner's Name information is Marstons Mills MA 02648 March 9, 2011 required for every — — - -- - - page. City/Town 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 SWING TIES DESCRIPTION HC 1 HC 2 SEPTIC COVER IN(1) 22.2' 14.3' SEPTIC COVER OUT(2) 16.3' 17.6' DISTRIBUTION 3OX(3) 48.0' 55.2' LEACHING COVER(4) 52.8' 59.0' EXISTING 1,500 GAL. LEACHING COVER(5) 54.7' 65.8' SEPTIC TANK DECK DISTRIBUTION DECK BOX #38 HC 2 EXISTING 4-BEDROOM ° 1) 3-500 GALLON DWELLING HC 1 LEACHING 2) CHAMBERS (3 4) � o - 5) k 3 w% 1 DIN o CO R0 roUrJgD 15ins•091013 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Winding Cove Road Property Address John J. Ronayne Jr., and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 page. Cityrrown 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: > 11.5 feet b.g.s. 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: July 14, 2008 (rev. 7-16-08) 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: Obtained from observation hole/perc test conducted on the property on July 7, 2008 as shown on the approved Proposed Site Plan plan dated July 14, 2008 (rev. 7-16-08). Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 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 38 Winding Cove Road Property Address John J. Ronayne Jr.,.and Nancy B. Ronayne Owner Owner's Name information is required for every Marstons Mills MA 02648 March 9, 2011 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 cC�� ff '' TOWN OFBARNSTABLE LOCATION D w Ili I CO v e— �. SEWAGE# a0y 9?' VIij�LAGE Mq,,S4v,qS A I S ASSESSOR'S MAP&PARCEL 14 INSTALLERS NAME&PHONE NO. 9 i SEPTIC TANK CAPACITY J 5®6 GC,l(0r,5 LEACHING FACILITY:(type) �j Gl-f1�cT/( �,$ (size) q NO.OF BEDROOMS L4 OWNER - a R rL ✓1 N'�A YlickV rn e— PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) -- Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet c ng facili Feet FURNISHED �j 2zP P1 1 LO�� Q �. s WA pl. L4 7 Wgl, 571 7 B , 1 No. v `. , Fee CJ® THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH'DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplicatton for Mi opal bpqtem Con.5truction Permit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System ElIndividual Components Location Address or Lot No. 1 1 11.OWLe I CU4E P—D. Owner's Name,Address,and Tel.No. M las $44 INW allo RAmot e t-4A,ENE Assessor'sMap/Parcel _j:j,4S 6%VA-,4ot-t4 C(bVe- MAelift4S Mttk Installer's Name,Address-,�an-d Tel.No. �Fj-1y3"t7�IS�+ Designer's Name,Address and Tel.No.-STYPt6a ID �Z"13-Q3-1'1 Q.0 %bY. ttot gr 640-40 r✓944 2-S91 Cra+nbe - A G. Type of Building: ^^ Dwelling No.of Bedrooms "t Lot Size 2 Jl sC2 sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Z Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) t4LAD gpd Design flow provided gpd Plan Date Nuoe 14, L06 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil o'*%/v tonm' V IirAQ 1 Z""-sI K LowX 9WD 0 <4�—�( It . SgAfo /0YZ 3 z /DYe 4A. Nature of Repairs or Alterations(Answer when applicable) Flew P/'- 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 thiFkBoard of Health. Signe Date Application Approv Date l�j Application Disapproved by: Date for the following reasons Permit No. g' ^ Date Issued � 5 No. �< � ._ T � Fee �Q THE COMMONWEALTH OF MASSACHUSETTS J Entered in computer: PUBLIC HEALTH bIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 3pplication for 3iz ossar ztem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. B �'i N D)nl Cove l2 p. Owner's Name,Address,and Tel:No. t-AAan rot+S.MIIIs 1�•1 AfJ� N►�Nc`C eotilA�(N6 Assessor'sMap/Parcel 20577 # ( �Jg �� �+o A«a Cbver 1`�111QS �1S MilIS sOF,-�y3--bc `ram Z�7' b��� Installer's Name,Address,and Tel.No. ISS Designer's Name,Address and Tel.No. Gk1215-cvw�a O T�rz*aE2 JC rtw(attiAce_%Ocq,l NCc P,OX l lot SA(nw-4oQE(?J 4 Type of.Building:Dwelling No.of Bedrooms Lot Size J,Sq I Z. sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Z_ Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `Iy0 gpd Design flow provided qsi . ' gpd Plan Date_'�VL`( 14, 7WS Number of sheets I Revision Date Title i Size of Septic Tank f'<;r)b (i Type of S.A.S. 'C Ka�4�ie S-TzwF 9wow-1>43 Description of Soil "- /V' -tQOJ}� .Sf9N? l7 -SL/ / bpNl y SWD �U —/? 3�� /� l�. S3Nv Nature of Repairs or Alterations(Answer when applicable) )ZtS�2tkI C6 D A fsPA/aak/ LEtrN f/T 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 b;y1tys Board of Health. Signer ( Date �g Application Approv Date Application Disapproved by: Date for the following reasons T i tw Permit No. Date Issued �� Q THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CER IFY,that the On-,ite ewage Di sal System Constructed ( ) Repaired ( ) Upgraded ) Abandoned( )by ?? �I'`' J _ , s a has been constructed accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer #bedrooms Approved design flow gpd The issuance of this it shharp not be'construed as a guarantee that the systemVw_%�nction as designe ` Date p// Inspector v----------- No. qac ? 1-5 Fee ZQ Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS m vs�-/P Digool 6petem Couttruction Permit ,�I Permission is hereby granted to Construct ( ) Repair ( ) Upgrade Abandon ( ) �)cinS 8,9 Cc System located at -38 k1 fi1J Pi 1112 Cn,1P_ �A. / pfLS?b� 14t 11C. and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction mpst be completed within three years of the date pe it. Date ��( � Appro d by Town of Barnstable Z -Z9S �pf 1HE . o Regulatory Services BARNSTABLE, Thomas F.Geiler, Director MASS. 07.9. ��� 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: '7 j �� Designer: , [A)(- Installer: Address: Z�S y N�E%vty 1&`,4,Y Address: On is � -) was issued a permit to install a (da e) (installer) septic system at �jg CA)7 '00i1-o6 Qve JF_.-hY.,D based on a design drawn by (address) T C. ���1iw t2�r�G, /�C dated 5�1 Ve U i Tv�Y I ej �e y 1 Zay g / (designer) V/ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by-designer to follow,- - v OF MA� 2 'SG F° JOHN L 0 CyURCHILL (In gn staller's Siature) ARIL. N 41807 (Designer's Signatur (Affi esigner' tamp Here) LEASE RETURN O BARNSTABLE PUBLIC H TH ]DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 1 Town of Barnstable P# Department of Regulatory Services W,,,s,ARM . Public Health Division Date MASS, lb3q �a� 200 Main Street,Hyannis MA 02601 lfp � Date Scheduled 7., Time Fee Pd. So 0 Suitability Assessment for Sewage Disposal o ",D)NA cs Performed By: . ( a Witnessed By: A) 1 LOCATION& GENERAL INFO.RWTION Location AddresS 2 cok Owner's Name l6�„ Gnj 14QnLy 1�Uv1Gyn� MhV( / 1 7 iUg Address A Wl Assessor's Map/Parcel: M G p 5'7 V O r j 1 y Engineer's Name\ /� CCi,Y&4 M►6 NEW CONSTRUCTION REPAIR _ Telephone# Land Use 4 Slopes(%) 0—3 V6 Surface Stones A k k/F Distances from: Open Water Body ? lot ft Possible Wet Area�_ft Drinking Water Well 60 ft Drainage Way, l VO ft Property Line /� � 2 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) • ME �>. s c. N m _ DECK DECK W EXISTING dAEDR00M DWEL 9JG 0 TOF=100.T TP 1 99.3 STONE ,.„ DRNEWAY J \ - GRASSED O AREA TP 2 99x2 CBD MULCHE V x L'SB.00. Y7 AREA R�340 .....;;:/ OF CBD 3013, I.56 ``D-,,,. Parent material(geologic) � ��2� t Depth to Bedrock �J Depth to Groundwater: Standing Water in Hole: /3 6$ Weeping from Pit Face Estimated Seasonal High Groundwater " 6•� DETERMINATION FOR SEASONAYJ YIO WAEI .TM Method Used: II Depth Observed standing in obs.hole: _ in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level _ Adj.factor Adj.Groundwater Level PERC( I.A'I" ON EST exit® . ' e Observation Hole# Time at 9" rq- Depth of Pere 1i 72 'f Time at 6" . Start Pre-soak Time @ pI 1' a/� Time(9"-6') q a End Pre-soak /�" �b Rate Min./Inch 42 Y,l III In Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Y Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEP'TIC\PERCFORM.DOC i DEEP OBSERVATION HOLE LOG We# d ' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons istency,%Gravel c MS ;7,rV6 j DEEP'OBSERVATION HOLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel U—1 a A 3/-L 11-55 5 Lj DEEP OBSERVATION HOL LOG We Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel I DEEP"O$SERVATION HOLE LOG ITole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, o Gravel) 0 Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes m s Within 100 year flood boundary No—Y-,— 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? —YES— If not,what is the depth of naturally occurring pervious material? Certification I certify that on 7 a 4 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise�nd experience described in 310 CMR 15.017. Signature I/. Date Q:\SEPTIC\PERCFORM.DOC i I t i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION. �M- She TITLE 5 OFFICIAL INSPECTION:FORM-NOT FOR VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ARSMIVED PART A CERTIFICATION MAY 142002 a Property Address:. �� (�(J � TOWN OF BARNSTABLE HEALTH DEPT. Owner's Name: Owner's Address: Date of Inspection: /} Name of Inspect,r: please print). PC Q �- Company Name: Q/� EL Mailing Address: ,O Ar- LOT Telephone Number:150E= -7-7 ° CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information,reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal'systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(MO CMR 15.000). The system: Ypasses Conditionally Passes eeds.Further Evaluation by the.Local Approving Authority. ails Inspector's Signature: / Date: lC - 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. 4 Notes and Comments � f�GLe. ****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 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICATION (continued) Property Address. 2vzze, 6,2�69W . Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section 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: $. System Conditio.nally:Passes: ...Qn>9r more systeiftomponents 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.H.ealth. *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. 'Nt)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 wiI]: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 t ; Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.,INSPECTION FORM PART A / CERTIFICATION(continued). Property Address: �2Owner. V. Date of Inspection: p� _, (�CI�_. 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 functioniDg 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 aseptic 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 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 l l OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM', PART A CERTIFICATION(continued) r Property.Address: -411 Owner:.k Date of Inspection: oZ. D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes N _ Backup ofsewage into.facility or system component due to overlo aded 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 1 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 .J 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 l of a public well. Any portion of a cesspool or privy is within 50.feet of a private water supply well. Any portion of cesspool or.privy is less than 100 feet but greater than.50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen-and nitrate nitrogen.is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The systeni fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 1.5.3.03,therefore the:system fails.The system owner should contact the Board of Health to determine what w.ill be necessary to correct*the failure. E. Large Systems: To be considered a.large�system:the system must serve a facility with a'design flow of 10,000 gpd to:15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no 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 questibn 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 Page 5 of I.I. OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.S.YSTEM INSPECTION*FORM ...PART B CHECKLI.ST Property ddress: 9 a OwneP Date of Inspection: 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 _/I Were.any of the system components pumped out in the previous two weeks? as 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? je!!7_ 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.Far 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)]. 5 Page 6 of 11 OFFICIALINSPI+✓CTION,FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTI.ON:FORM PART C SYSTEM INFORMATION r Property Address: °. Owner:. Date of Inspection: AZ12AJ. `Z , FLOW CONDITIONS RESIDENTIAL V� Number of bedrooms(:design):_ Number of.bedrooms(actual): DESIGN flow based on 3 l0.CMR 15.203(for example: 11:0- d x#of bedrooms):_�3' Number of current residents.✓ Does'residence have.a garbage grinder(yes or no)�i Is laundry on a separate sewage system(yes oriro [if yes separate inspection required] Laundry system inspected(yes or no); Seasonal use:(yes or no): a Water meter readings, if av able(last 2 years usage(gpd)): I—®®D A® Sump pump(yes or nQ140— Last date of occupancy: COMMERCIAL/INDUSTRIA4,41& Type'of establishment: Design flow.(based on 310 CMR.15.203): gpd Basis of design flow(kats✓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 infotmafion:.9 ,S . Was system.p►imped as.Part of the inspection.(yes or no)(/ L.46 -- If yes,volume pumped: gallons--How was quantity pumped determined? Reaso i'for.pumping: . TYPE OF SYSTEM IZ!reptic 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 DER:approval _Other(describe): Aj)proximate age of all corloponents,date installed(i a f infor ation: Were sewage odors'detected when arriving at the site(yes-or no): Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: A Owner: SZ'1UP6j a Date of Inspection: O a BUILDING SEWER(locate on site plan) ✓/w 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: t/ (locate on.;ite plan) Depth below grade: Material of construction:-,Z160ncrete_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:/Q,$?C Sludge depth: Distance from top of sludge to bottom of outlet tee or:baffle: 7,6 Scum.thickness:. Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee 9r ba e: How were dimensions determined: � � Comments(on pumping recomme� tions, i let and outlet tee or baffle condition,structural integrity,liquid levels s related to outlet invert vidence of lea�ge,etc. J i GREASE TRA&&locate on.s.,te 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 i Page 8 of 71 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: a) Owner(' Date of Inspection: . 0 TIGHT or HOLDING TANK tank must be pumped at time of inspection)(loca'te 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 fast pumping.- Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: tf (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:an�qu i�� Comments(note if box is level and distrial, any evidence of solids carryover,any evidence of leakage into or out of box,etc. P e PUMP CHAMB!EIZ`�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 � F Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: g QW. teovo Owner Date of Inspection: Q60SI SOIL ABSORPTION SYSTEM (SAS):.V60cate on site plan,excavation not required) If SAS not located explain why: Ty pe eaching.pits,number: leaching chambers,number: leaching galleries,number: leaching trenches, number, length: leaching fields,number,dimensions: overflow cesspool;number: innovative/altemative system Type/name of technology: Comments(note condition-of soil, signs of hydraulic failure, level of ponding, damp soil;condition of vegetation, CESSPOOL(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 vegEaation,.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.): 9 Page 10 of 1 l OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property.Add ress: Owner."- �e P 1,)rvAj;q, Date of Inspection: `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. �a �� T t i I �o ''IJa 7 10 I' i Page l 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATI/OJN(continued) Property Address: A SG�/[atCGY' Owner Date of Inspection: 03 SITE EXAM. Slope Surface water Check cellar. Shallow wells Estimated depth to ground water it 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: hecked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: � Q 11 i Permit Number: Date: Completed by:. HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 3 /oli it /� �� �®//� �� � /"`. ✓�/��,5 Lot No. 1D.wner:�d/�9��/� ®i Address c, Contractor: /JQt fal'o'j�/ Address: Dlotes:. STEP: 1 . Measure depth to water table l to nearest.1./10ft................. .................... ........................ .Date month/day/year- STEP 2 Using.Water-Level.Range Zone and Index W611:.(1lla.p:locate site and determine: S�f �S O Appro.priate.index well................... :- O Water-level range z.one::........... .............................. C STEP.::3:. Using month ly.repo.r-t,"Current Water Resources Conditions" determine current depth to J Water level for index well ......................... month/year STEP. 4. Using..Table.o.f•Water,ley Adjustments for index well (STEP 2A),.current depth to water-level for.index well (STEP 3), and water-level zone (STEP26) determine water-level adjustment ................................,.............. STEP : 5 Estimate depth to high water by subtracting the water level adjustment..(STEP 4) from measu.red.depth to water level at site (STEP 1) ............................................:....................... . /I Figure 1.1--�19eproducible computation form. .. � � r I e/j/� r C'��1 . .`v t./. � �J�t�A�'w� R r �®�ry �1 � -Y-e-� / + r , D A-f ION SEW A G E PERMIT N0. a!sR Core -1, —� '`VILLAGE ' a INSTA LLER'S NAME i ADDRESS R U I L D E R OR OWNER DATE PERMIT ISSUED 'i � DATE COMPLIANCE ISSUED -7) 95 I ,r' No.......... ..-? Fins ........ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1.®. Sl44...............OF F ..1�p�...._..E.--------•---.........-•------ Appliratinn for Uh4puiial Workii Totwtrurtion Urrutit Application is hereby made for a Permit to Construct (N or Repair ( ) an Individual Sewage Disposal System t .......�i: .......... .............: t...----•---`......--..... .- Location-Address or Lot No. [. � . : ............................................... -••----•----------...--- •--•-•------•-•-•-----•-----•----••••......-----•..... caner Addres �1�r�1.._.. ..........................................••-•-- ----•_. � -����1c- //- t _-............ Installer ddress Type of Building Size Lot._4a.5,) .......Sq. feet U Dwelling—No. of Bedrooms....._5.................................Expansion Attic 06 Garbage Grinder 00 Other—T e of Building No. of persons............................ Showers — Cafeteria Q° Other fixtures -----•-••----------------------- . W Design Flow.._.._-ti5__5............................gallons per person`per day. Total daily flow.._..-�3.V.........................ga4lons. WSeptic Tank—Liquid capacity_i�OS?..gallons LengthS..-_42____. Wldth_`�__,_1Q_.. Diameter_-_s-........ Depth.S_�.... x Disposal Trench—No......... ..... Width................... Total Length.............. Total leaching area....................sq. ft. 3 Seepage Pit No.___i ............ Diameter-----5----------- Depth below inlet.._............. Total leaching area. .....sq. ft. Z Other Distribution box (✓) Dosing tank ( ) 11 '-' Percolation Test Results Performed by._ ------------ Date... ------------ a � Test Pit No. 1... Z._minutes per inch Depth of Test Pit__!Z�........... Depth to ground water.. o?-..�. . -_-.-. Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ - - jr-------o--------------------------------------- ----------- ------------ - O Description of oil---- "..��5_... `-���!+!L �. 1e---------.\! - ..----e - - - - - D................ W ---••----•----- --------------------•----------------------------------------------------------------------------------------------------------------------------------------------------------------••. 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 ii`:LE 5 of the State Sanitary Code— The undersigned further agrees not to place the ystem in operation until a Certificate of Compliance has bee is "M by the ea t �a �5 !( p --- Igne ._. _.. ... -- ----- .---••---•----- --•-/ --- -a..........------ /1' � j2 J ate ApplicationApproved By..-- --•- •--•-= ----........--------------------------------------------------•---•--• •---.--- ! Date Application Disapproved for the following reasons:------....-•---•-•---------------••------•----------•-•...--•......-------•-------•-------•----------------•-. ----------------•-----•---...-••••-•--•-----•-•-----•-------•---••--•-•---------•----------------•-•--•----------•-----•-------•-----•-------•-•--•---•----•---••----••-------...--------•........... Date PermitNo.......................... ..y, b , ----------- Issued_....................................................... Date No ........... y Fps.:= -•--•--• THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C !. - :atL.. ..........OF......t .tr��.................................... ApplirFatinn for Uhipos ai Works Tunstrnrtinn Vrruat Application is hereby made for a Permit to Construct (;' or, Repair ( ) an Individual Sewage Disposal System t: 41, .. . ...... .......... ...................................... .... ................................................... t »• Location.-Address or Lot No. caner � Address a �f{e� ---•------••--•-•- �Gf�/L-!� o�1/IS�• . ....... -- � Installer Address �.� Type of Building Size Lot_�1 ._u...`=�..._...Sq. feet U lq Dwelling—No. of Bedrooms.......: .................................Expansion Attic ( Garbage Grinder ( Other—Type of Building No. of persons............................ Showers — Cafeteria Otherfixtures ------------------------------------------------------ ------------------------------- ----------------------.-------------------------- W Design Flow...... : ..............................gallons per person per day. Total daily flow...... . ?.��-..........._............gallons. i Septic Tank—Liquid-capacity.0" .gallons Length&... �-... Width A-.N.0•- l.-_ Diameter-_ --_----- Depth.f..... Disposal Trench—No. ................... Width...___......__._.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..... .-_----_-_-- Diameter--_-_ ---------- Depth below inlet---12............. Total leaching area....' 04.....sq. ft.. Z Other Distribution box ( Dosing tank ( ) 1 '-' Percolation Test Results Performed by.....` *L� � °! _..... _.._.....__. Date.. "Z . '.. ..`. aTest Pit No. 1..._:;,. ..minutes per inch Depth of Test Pit__� _'.._........ Depth to ground water_- k`?r'�.IF,_.__. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................•.. Depth to ground water........................ .............................................................. .• ......................................................... D Description of Soil ,* .. ...SJ................��:!:�:'.::F"$:� .. �.�r-� _._„-_'.'9'� .-•..._. e?..s _ad_ -\Tv++_?�.w._.."'�65..�.° rP".?t_51 �-+�a:t ._ ...............•..••.. ..............................................................................................................................................................•.................._._....._.............. 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 iILTI L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue the bo�� . 5 , . ated ApplicationApproved By..............' ....-......................................................................... ... Date Application Disapproved for the following reasons:------•---------•----------------•----------------------------...------------------............•-••--•-----•--- -----------------------•-.......=..-------------------•----.....---------------............-------•----------•-•------•-------••----------•......--------------------- ............................... Date `Permit No......................................................... Issued.--------•---•••.----•-------------•--- Date .......---.................. THE COMMONWEALTH OF MASSACHUSETTS b. BOARD OF HEALTH .........................................�� .OF......4Y /�� ................................. Tntifiratr of Tome aurr THI IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by•-••••--: ....................................................................................................................................................................... r Installer. y has been insta ed in accordance wrt�..h-• --•_����.......... ,_~`�•-•-��j ------- _ -- _ tl1 rovisions of ' J, 5 of The State Sanitary Code a described in the application for Disposal Works Construction Permit No.___.. 5��'a_:_ -�?.�....... dated_ .-'E`� 5........_............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FJJNCTJON SATISFACTORY. " DATE............... _ ey,a ----.._... Inspector....-- I -I.... -- __&A------------------_- )M ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.�y ..'....... I'EE.... , tn ��ano#rtuan rrnttt r" Permission is hereby:granted---------�t:l:r _ - ............---••-•-......---'-•-•-•-----•-•...............•--•------• ................................... to Construct or Repair ( ) an Indi*idtiial Sewage Disposal System at No..-•----L a- 5-a t f '- ._.�l�='�`'' C-. ��')` ......1 tY'� --=5- , n -- ....... as shown on the application for Disposal Works Construction Permtt Na; _.: _ Dated--------1 ? ................. c€ ............ Lam' `r ._ _ C Board of health DATE-------- V-•--•---- ----------------•- N FORM 1255 HoeBS:4i'4WARREN, INC.. PUBLISHERS i w 6$ V RIG HARDBAXTER N 9 Flo. 28133 --. vNo.240480. fg- 0evKW> 9L, i se tG ' 1--o�-A`t�o►-1 `--'6 T ©T 8� <_ 3s� � NA I s 6A M 2dP►� •—�_- - _ .� ► - mot r `,1'` O ATA S I{E l'T �`�. ,511 6LE- FAMILY �5 6E0200M bN%t s(: Ft_ow z IIa X. .� SEPTIG TA*QK = 330x15c>% =-49%6.P �L ?�� a U5r-- 1000 GAL. 0t5PO-4AL Pt'r v5E 1000 GAL. j g0?TO/K AREA- • 5 0 5,F• 5o S.F x 1- 0 5+o G.P p... . 'IOTA 1- !. ' 'Tc>TAt_ 330 G ED F'E2GOLl�TIOu RATE k 1''IN 2MIN o�Ltr55 OF ryjgti PETER SULLIV-A,N . �r RI CHARD _.. ..: 2973 No. 3 tt A +� BAXTER N.24C48 SS�O,VA ��6 ��Is R� �.i2�27•S�{� TE��T�"3512 _ �C- •.`Ip TOP FWD- ,,-TS 1. ,7 y r:• i ,,,., i oK I 97-7 MomlL ass INS. eaaL. i ('Od0 50Y 5EPTiG INY• 9"t� -rAwld 51,7 L`• , �4/�1U ; R1T... - INY INY • . . WAS>AQD ,. , Td .... � - _ 6.._...Nt7 t 1 CER.TIt=IGD P1-o-T P1.:AtJ 1.o G A'T►o N _ . ems ►�. i2 fit.ECs 7 WO �5 CA.L r-- y `. Iti1, L� 5CALMAA l pAT� u1 ..85� co � ;GER'j'tF�( THAT TH6 `�•'041ti1fl+4r�0�5uo4YN PLAN REF•E2eNGE- NEREOt�I GOMC�I.YS YJITN-tH>r. S�1 o�t_IN� At.iD SET>�4GK-26Qvtu.>rM�I�-r� t=-C1l -'Boor. 315' _ !'To W N O F :$"04 A AND. 15, t.OGp.TED WIT N TNT G oD l.Atl�1 ! - i DAT e -8'� XT C. , 6A EtZ tit E INC. ... REG 1 S'T 1c.SZi�V't-AN o 5 u -Y r- oZS ! LTtA15 PL&KI 1�5-1 NOT t3nSr_n oa AN C53TEt2.VLLLE • h%p6e I .�CN:STRQMENT -SUtzvt Y..4-TNE--vt-;: 1,s r5..5uout,'1� . .- ••r� -- -- 1,1o't CONTRACTOR SHALL VERIFY SIZE AND FINISH GRADE OVER D-BOX= 99.3' FINISH GRADE OVER CHAMBERS= 99.2' - 99.4' VENT WITH CHARCOAL FILTER GENERAL NOTES CONDITION OF EXISTING SEPTIC TANK REMOVABLE CONCRETE COVER o SLOPE @ 2/o MIN. OVER SYSTEM TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2m DOUBLE WASHED STONE TO CROWN OF PIPE 1• UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION METHODS FINISH GRADE @ FND. EL.= VARIES 99.2' SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL CODE AND ANY FINISH GRADE OVER TANK EL.= 5"DIA. OUTLET(S) ACCESS BOX WITH COVER TO GRADE 2"OF 1/8"TO 1/2" DOUBLE WASHED STONE APPLICABLE LOCAL RULES. 20"MIN.ACCESS COVER PLACE RISERS ON ALL 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND (TYPICAL FOR 3) TOP OF SAS= 95.7' CHAMBERS WITH INLET THE DESIGN ENGINEER. 11 - - �- - 36"MAX. 94.7' 36"MIAX. BREAKOUT EL = 95.2'N. PIPES TO 6"OF FINISHEDGRADE 3• 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEE NOTE#19 SYSTEM UNLESS OTHERWISE NOTED. _ C 2"DROP MIN. " " 4"SCH.40 PVC PROVIDE WATERTIGHT _ - -- 3 DROP MAX. 4. TO PREVENT BREAKOUT,THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN --_ ---_ 3 9 s -- --- = JOINTS (TYP.) oo ELEVATION =95.2' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 14" = ' 4"PVC IN FROM 4"PVC OUT TO 0 o 0 0 C� O 0 C� 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF _ SEPTIC TANK o b THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. " LEACHING FACILITY oo o oo 0 0 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 48" CONTRACTOR SHALL OUTLET TEE 95.17 MIN 95,0� 2' ED Q o o o0 6• THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. EXISTING TEES VERIFY ION OF " 6"CRUSHED STONE o C� 0 0 0 o 0 00 0 6 0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 22 ZABEL FILTER OVER MECHANICALLY - FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION.SYSTEM IS AND REPLACE AS ?= MODEL#Al801-4x22 COMPACTED BASE I NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH NECESSARY 4 0 8 5' 4'0 4.0' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 33.5' (NP•) TO BE INSTALLED ON A LEVEL STABLE 87.7� 8. ELEVATIONS BASED ON ASSUMED DATUM OF 100.0' U.S.G.S. OBTAINED FROM A NAIL SET EXISTING 1500 GALLON CONCRETE SEPTIC TANK BASE. FIRST TWO FEET OF OUTLET 92.7' GROUND WATER ELEv.= 12 9' IN TREE AS SHOWN ON PLAN. PIPES TO BE LAID LEVEL. 3 - 500 GAL. CHAMBERS CHAMBER END VIEW 9• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 5'MIN. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT R SECTION VIEW CROSS TYPICAL H r _ _ SEPTIC TANK PROFILE pISTRIBUTION BOX DETAIL C CHAMBER PROFILE CHAMBER DETAILS (H-20) 1-888 DIG SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES NOT TO SCALE NOT TO SCALE TO THE DESIGN ENGINEER. NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE STRUCTURES SHALL BE MADE ,x.'. r -„si. f.-,..fir t ".w,,. •,. WATERTIGHT " _ '.z�. * a si... ,„ ..�.=r. ..,,x-}:: d... t�,. � �:'. ., >s �... TEST P I T'.DATA NOTE: MAGNETIC MARKING TAPE SHALL BE PLACED O 3 s 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING Y' .' � r �� fi � PERC NUMBER: .:... 12287 ALONG THE TOP EDGE OF EACH SYSTEM COMPONENT. Donna Z. Miorandi, R.S. REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM * S •"r= INSPECTOR: APPROPRIATE AUTHORITY. ° 1l' • * SOIL EVALUATOR: Bradley M. Bertolo 2008 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED ` July 7, + � * DATE: y UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND '1 TEST PIT M 1 H-20 LOADING. ELEV TOP= 99.2' S79 3852 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. 00' 4 _ • , '�„ ELEV WATER= <87.7' 13$. DESCRIPTION HC 1 HC 2v4 '• j' �� t 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE PERC RATE_ <2 MIN/IN CORNER STONE(1) 51.3' 65.4' � MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY CORNER STONE(2) 48.4' 51.4' _ sF _ A + * DEPTH OF PERC'= 54"-72" FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). CORNER STONE 3 60.9' 64.2' "'� M ` •" TEXTURAL CLASS: 1 O � &' i ` ' k`` 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN CORNER STONE(4) 63.3' 75.8' /,ytj .. SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. 0" 992 16. PROPOSED PROJECT IS LOCATED WITHIN: SWING TIES . Loamy Sand A 10YR 3/2 ASSESSORS MAP# 57 PARCEL# 14 v .. , r = 12" 98.2' FLOOD ZONE C AS SHOWN ON PANEL#250001 0018 E f Loamy Sand MAP 57 J%`� '"' w ,.N 10YR 5/6 17. OWNER OF RECORD: JOHN AND NANCY RONAYNE y " ADDRESS: 38 WINDING COVE ROAD PARCEL 14 s $ lot �' �: � � + ���.. � �= 94.7 MARSTONS MILLS, MA 43,592 S.F. Perc Al 72" 93.2' 18. PLAN REFERENCF_:, PLAN BOOK 375, PAGE 92 A 4"PE Cq B.M. ° _ • ,r. Fµ; 19. RFORATED SCH.40, PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION,TO A DEPTH OF THE BOTTOM OF.THE-SASAND EXTEND TO WITHIN 3"OF FINISH GRADE. A Nail in Tree �� 'a: k a ` ' Y$ ,£ ! REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. Elev. = 100.00' a>o, moo. EXISTING 15L'J GALLOR' v _ . : C Medium Sand Assumed �L SEPTIC TANK A ,. 2.5Y 6I4 20. IN ACCORDANCE WITH 310 CMR 15.401-15.405,THE FOLLOWING LOCAL UPGRADE APPROVAL IS REQUESTED FROM 31,0 CMR 15.221:. SHED EXISTING DISTRIBDTiOv BOX 1 1 T I FACILITY. 1. A 0.7 VARIANCE 3.7 -3.0 FOR THE DEPTH OF FILL ABOVE HE LEACHING I TO !3E t1LiANC�OI�•lED ANL� BILLEC} r -t __ --99- WITH CLEAN SAND LOCUS PLAN 138 87.7 N 1 EXISTING LEACHINGPIT a N o TO BE PLIMPED AND FILLET:? SCALE: 1"= 1000' o 'A� WITH CLEAN SAND m o F N W DECK �y DESIGN DATA TEST PIT DATA LEGEND _ W rrl DECK DISTRIBUTION IDX PERC NUMBER: 12287 INSPECTOR: - 50 - - - NUMBER OF BEDROOMS 4 Donna Z. Miorandi, R.S. - - EXISTING CONTOURS EXISTING HC 2 VENT WITH, DESIGN FLOW 110 GAUDAY/BEDROOM SOIL EVALUATOR: Bradley M. Bertolo PROPOSED CONTOURS 4-BEDROOM CHARCOALFILTER DATE: July 7, DWELLING TOTAL DESIGN FLOW 440 GAUDAY 2008 O 3-1500 GALU N TEST PIT#: 2 W w EXISTING WATERLINE TOF= 100.3' 0 x 99.38 LEACHING o _ 880 - HC 1 CHAMBERS DESIGN FLOW X 200 /o - GAUDAY ELEV TOP= 99.2'USE EXISTING 1500 GALLON SEPTIC TANK G EXISTING GASLINE (2 TP 1 ELEV WATER= <87.T 99.- 99x2 • PERC RATE= MIN/IN UGC EXISTING UNDERGROUND UTILITIES STONE � 0 DRIVEWAY 6 , 13 (3) ` DEPTH OF PERC= TEST PIT LOCATION 98 JG GRASSED 9 O r AREA TP 2 TEXTURAL CLASS: 1 \ - 99x2 o INSTALL 3- 500 GAL. CHAMBERS (� (� EXISTING 1,500 GALLON SEPTIC TANK r " \ \ \ " 1 SIDEWALL CAPACITY 4 SOLID SCHEDULE 40 PVC PIPE mow.\ CB� �,� (LENGTH + WIDTH) (2 SIDES) (2 HIGH) (.74 GPD/S.F.) - GAUDAY A Loamy Sand \ x 99.5T / 1 1 _ _ 10YR 312 DISTRIBUTION BOX �� � (33.5 + 12.9)(2) (2 ) (.74 GPD/S.F.) 1;37.3 GAL/DAY 0 1p 1 Q 1 x g9 37 O 500 GALLON LEACHING CHAMBER(H-20) / \`\4V, rn BOTTOM CAPACITY g Loamy Sand NSPECTION PORT 4 \. \', ` ry i 0 10YR 5/6 -9�--- \ ( (LENGTH x WIDTH) (.74 GPD/S.F.) = GAUDAY " g4•T 1 _ �-9g- MULCHED x 99.38 / (33.5'x 12.9') (.74 GPD/S.F.) = 319.8 GAUDAY AREA �8 8.0 , / �" ` TOTALS: 1 7/16/08 BMB JLC RESERVE AREA \ R_ 0 REV. BY APP D. DESCRIPTION 3 DATE 4 •0 \ TOTAL NUMBER OF CHAMBERS 3 \9> - TOTAL LEACHING AREA 617.7 SQ.FT. PROPOSED SITE PLAN _ -� / TOTAL LEACHING CAPACITY 457.1 GALJDAY PREPARED FOR: G E OF q AMEN \ ' CBDH . .\ IVg9°y�ry 6, G Medium Sand / 2.5Y6/4 JOHN AND NANCY RONAYNE �Ilvohvl - - LOCATED AT APR/Vq COV \\ _ cBD 87.7, 38 WINDING COVE ROAD 138 o A D - - F MARSTON S MILLS, MA 02648 RESERVED FOR BOARD OF HEALTH USE SCALE: 1 INCH = 20 FT. DATE: JULY 14,2008 0 10 20 40 80 FEET I,I 2� SH Cc M� cH x JOHN I-' b G�� PREPARED BY: cr�uQrjLL JC ENGINEERING, INC. 2854 CRANBERRY HIGHWAY EAST WAREHAM, MA 02538 SITE PLAN 508.273.0377 SCALE: 1"=20' Drawn By: BMB Designed By:BMB Checked By:JLC JOB No.1447 i