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HomeMy WebLinkAbout0040 JOHN MAKI ROAD - Health (2) 40 John Maki Road West Barnstable A = 217 025 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owners Name information is required for every West Barnstable MA 02668 2-20-15 page. City/Town State Zip Code Date of Inspection Inspection re suits 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 on the computer, Inspector: D ` �;��H..F......V use only the tab 1. Ins `� � •`q° I •.ti S. key to move your =��:' JA M E S '•�' cursor-do not James D. Sears =g: : _ use the return Name of Inspector = cH K :I= key. CapewideEnterprises,LLG o Company Name '��! >?T1F.�'\%i reS P Y F S I N SPtiG`O`�� 153 Commercial Street Company Address Mashpee MA 02649 City/rown / State Zip.Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on.site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15:340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 2-21-15 spectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. r 15ins•3/13 Title 5 ONidal Inspection Fort:Subsurface Sewage Disposal System•Page 1 of 17 r r Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owner's Name information is required for every West Barnstable MA 02668 2-20-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 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: The system is a 1500 Gal.Tank D Box and field. 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 exfrltration or tank failure is imminent..System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3/13 Title 5 offidaf Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 1 - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owner's Name ` information is required for every West Barnstable MA 02668 2-20-15 page. cityrrown State Zip code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipes)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation Is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety,and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Offidal Inspection Form:Subsurfsoe Sewage Disposal System•Page 3 of 17 T \ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 40 John Maki Drive Property Address Mark Scavetta Owner Owner's Name information is required for every West Barnstable MA 02668 2-20-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, If any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑.The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank.and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private.water supply well**. Method used to determine distance: **This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. t 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 savaW is less than 6"below invert or available volume is less than day flow .4&4el,li v6' t5ins•3/13 Title 5 Of6del Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 L_ f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owner's Name information is required for every West Barnstable MA 02668 2-20-15 page. Cityrrown 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 wilt 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 It 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 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments vy. 40 John Maki Drive Property Address Mark Scavetta Owner Owner's Name require information is West Barnstable MA 02668 2-20-15 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of 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 Mina•3/13 Title 5 Official inspection Forth:subsurface Sewage Disposal system•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Fo rm orm Subsurface Sewage Disposal System.Form Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owners Name information is required for every West Barnstable MA 02668 2-20-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal.Tank D Box and field. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 204-71, 00 Ga s g ( y g (gp ))' 2014-71,000 Ga4's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Oftldal Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 II Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owner's Name information is required for every West Barnstable MA 02668 2-20-15 page. Cityrrown State Zip Code Date of Ins &lion 9 Pe D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 2011 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•3113 Title 5 Oftldal Inspecdon Form:Subsurface Sewage Disposed System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owner's Name information Is required for every West Barnstable MA 02668 2-20-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 2001 Permit # 2001 - 264. Were sewage odors detected when arriving at the site? " ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 21 feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. i 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 Dimensions: 1500 Gal.Precast H-10 Sludge depth: 2" t5ins•3113 Title 5 tJ(Bdat Inspectlon Form:Subsurface Sewage Disposal System•Page 9 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owner's Name information is required for every West Barnstable MA 02668 2-20-15 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-TapeSludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank at working level.Tank at V below grade,in and outlet tee's. No sign of leakage or over loading. 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•3113 Title 5 oifidal Inspection Form Subsurface Sewage Disposed System•Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not.for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owners Name reg fired f n is every West Barnstable required for eve MA 02668 2-20-15 page. City/Town State Zip Code Date of Inspection. .D. System Information (cunt.) 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•3/13 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 11 of 17 f Commonwealth of Massachusetts gym Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owner's Name Information is required for every West Barnstable MA 02668 2-20-15 page. Cityl-rown 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 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): D box is 10"below grade. Box is clean and solid w/ 10 lines out. No sign of over loading or solid carry over. 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.): *If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5lns•3/13 Title 5 otfidel Inspecdon Form:Subsur(aoe Sewage Disposal System•Page 12 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Ownefs Name information is required for every West Barnstable MA 02668 2-20-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number,dimensions: 20'x30'x6" ❑ overflow cesspool number: ❑ innovative/altemative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): Leaching is a 30'Long-20'Wide 6"Deep Field. Field and D Boox show no sign of over loading or solid cant'over. No sign in field of holding water. 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•3/13 Title 5 otfidal I nspecdon Fain:SubsuAace Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form-Not for Voluntary Assessments 40 John Maki Drve Property Address Mark Scavetta Owner Owners Name information is West Barnstable MA 02668 2-20-15 required for every page. Cityrrown state Zip Code Date of inspection D. System Information (cunt.) 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•3/13 Title 5 Of6dal Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owners Name information is west Barnstable required for every MA 02668 2-20-15 page. Cityrrown State Zip Code Date of Insp ection D. System Information (cunt.) 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 P L i� t5lns•3113 We 5 official I nspeAfon Fomr.Subsurface Sewage Disposal System•Page 15 of 17 1 r I • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 John Maki Drive Property Address Mark Scavetta Owner Owner's Name information is required for every West Barnstable MA 02668 2-20-15 page. Cityrrawn state Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells /Va 11'+ Estimated depth to high ground water: 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: 2001 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: T.H.on File 2001 No G.W.at 11.+. Field at T below grade. Field at 8'T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 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 40 John Maki Drive Property Address Mark Scavetta Owner Owner's Name information is required for every West Barnstable MA 02668 2-20-15 page. C4rrown 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 Ail Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file �I Wins-3113 Title 5 Of idal Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r TOWN OF BARNSTABLE 1 SEWAGE #0100 LOCATION L10'�ehn -Q213—�$�,(0 ASSESSOR'S MAP & LOT VILLAGE / � INSTALLER'S NAME&PHONE NO. i SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER r19 2 QTra PERMIT DATE: �6 o COMPLIANCE DATE: f Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching hing facility) anY wetlands exist Edge of Wetland and Leaching Facility( wea + Feet within 300 feet of leaching facility) Furnished by I �9 _ 3S V �'P 1 Town of Barnstable • Departntent of Health,Safety,and Environmental Services Public Health Division Date 01576 367 Main Street,llyannis MA 02601 S BAmirrii .B, MAS& 1 Date Scheduled - (O`\Sk 0 Time 00 CA(n _ Fee Pd. ED l+A� n � Soil Suitabilitv A.ssess»zent for S'ewaze Disposal Performed B: Co.nS-,A, Witnessed Dy:,Q 1 Vn LOCATION & GENE ftAL tNFOR Location Address 'Owner's Name Mark Scavetta Le a S6,\A Mc k C` Address a 41 Stonybrook Rod !—Marshfield,-MA 02050 Assessor's Map/Parcel: a\1/�a� �/W�(? y Engineer's Name & 6� NE STRUCTION X REPAIR I�elephone# Land Use ReSQ1f��y1 Slopes(^/^) S Surface Stones S061e dU ro Distances from: Open Water Body —" R Possible We(Area _ R Drinking Wntcr Well R Drainage Way R Property Line R Other — R SKETCH:(Street name,dimensions of lot,exact locations of lest holes&per tests,locate wetlands in proximity to holes) Lo � a o aoa \ So�� MJ04f 9,0 NO V\TE A Parent material(geologic) �'l\ \C 1' Depth to Bedrock n�Y\e Depth to Groundwater: Standing Water in/Ilole: '(\0Y\C ' ` Weeping from Pit Face mY\e Estimated Seasonal High Groundwater (See SO�� Mt, �%Ay 0 n ( hri D `l'EIt11 INA'TION OR SEASONAL,:HHG t 'VVA'TV, TAT3I,_. Method Used Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment R. Index Well#_.__ Rendine Date:---.- Index Well level..__`_ Arli.factor___ Adj.Groundwater Level I'ER C::: L I' ON TEST vine. T*nc� Observation # � 3 Hole# a Time at 9" \1 o \a 35 u Depth of Perc ��'S4�� 3a -SQt 3V-S411 Time at 6" Start Pre-soak Time @ `�107 \V.\0 Q.\5 _ Time(9"-6") S 5 End Pre-soak ( \, Rate Min./Inch \�'S^UcoQ ��o!LA Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(YIN) " DEEP,OBSERVATION HOLE'I LOG . H le#,_:> Depth from Soil Ilorizon Soil Texlurc Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Doulderes. L o avh l0`I a3�a 611 - 30" 30" -q3 ll (. SAr,(\-. L041A D,S 1614 j( ,' Fc�'t k N-kwlte DEEP:OBSERVATION HOLE LOG Hole# a I,cI H frcm Soil itorizor. t Soil'1'cxturc ' Soii Coior Soil . Odu:r ' -, Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel) A_ Lo av-\ � —S— A V, a,S� �4" a.s�R4�y LvpSe- no C!,vt. Ts41 -1,0`b 114 elx A ok (ki q,5'1 -7IS LoosC f'o X\ DEEP OBSER`VATION.HOLE LOG Mole# _ ' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel) Lor, a GO (. M{ �� as � a,sy 1 B0��a5�R��4 LqoSC Poe Ae C,NA � DEEP OBSERVATIONVOLE LOG Hale# Depth from Soil Ilorizon Soil Tcxture Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Boulderes. ° ry Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes X Within 500 year boundary No Yes ` Within 100 year flood boundary No 4 Yes Delnth 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? \1 e5 If not, what is the depth of naturally occurring pervious material?/ Certification I certify that on AgC%, 4 I A(A (date)I have passed the soil evaluator examination approved by the b 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 4V�n Date f0 6 ` No. � 1/" THE COMMONWEALTH OF MASSACHUSETTS, FEE A top BOARD OF HEALTH Cc VV O yJ A OF J APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (x) Repair ( ) Upgrade ( ) Abandon ( ) - [-]Complete System ❑Individual Components A .M V% t;yct� ex- (�(}l�(y y�/�, pg K C app 9''/gion if . rl\ 90N\bQ90� O�WS-eO'lIA4'a\�l� AA AMap/P I #J©�C ` Address 0` 4 `yam^ /mot L `GOLI] J—X 0 phoV�� 1 a er's Nam �tW�D�es' er's a e u n►� N�� oa �l Address Address `Telephone# i` Telephone# Type of Building: �i lQ ��A 0Vj k% Lot Size S Glq t Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(mi .re uired) gpd Calculated design flow �L gpd Design flow provided 4y`f gpd Plan: Date at@ Number of sheets Revision Date Title C � ��__ rl Description of Soil(s) � 1t1VV\ Soil Evaluator Form No. "VOW n Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with th TITLE S and further agrees not to niece the system i operation until a Certificate of Compliance has been issued by the Of s Signed Date �O(/- -Q �� CHARD 9cyn m ins .ur '�c5� foff Y Nc). 38072 FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 � , � ems,- -^-''-� .-,w...•,f. -.,�,- .-•..'�..v.-�..c.e:, -. ':._•,.'" ., :'•+•-v���..;,,.�.... .i.., ri � ,. 4�:�-.-...,.r .:,H,..r, �ay+w-'-- s..,..,.r+v ..., .— 1 0. ,;s � THE COMMONWEALTH OF MASSACHUSETTSr ;M FEE _ ,i BOARD O F, H E�A LT HOF - �"' ✓� 4PPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct (Y,) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑,Individual Components o LA (� L ion O er's Na e �y Lo Map/Parcel# Address 1 L t# < �.-` ( t Telepho e# w to RE I 6a esNa Des er's ame 4JIA,1; - m n�a C1�, ( b �q \ U►cw�Ociu u � M� oazG44 Address j `\ .^ Address t v � `Telephone# r 1 Telephone# Type of Building: SSA le �m+ kl owQ,``1Y% Lot Size S� �9�_I �-Sq.feet Dwelling—No.of Bedrooms t f Garbage Grinder ( ) O Other—Type of Building I f / �` No.of persons Showers ( ), Cafeteria ( ) f Other fixtures I U,1 ~ � `y d Design flow provided Design Flow(imp.re uired) � gpd Calculated design flow gpd g p �y`f gpd Plan: Date � ai\t�n Number ot sheets Revision Date ` Title cp - e. iS C�Sq] %£ Description of Soil(s) -: (o I- 4 1t 2e�tuw� Soil Evaluator Form No. _ CUW Y1 Name of Soil Evaluator Je� �4\ -6iNki Date of Evaluation 3 Q DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees:to install the above described Individual Sewage Disposarsyste h,in accordance with the p v's'o of TITLE 5 and further agrees'not to place the system i. operation until a Certificate of Compliance has been issued by the B �,SH OF�S Sig 1G ned Z'G- _ Date A v• "G/ s90 sg ��` RICI BARD Incti�ns 7` _ s7 �G7,� �' - m v G!+ADY r`o. 38072 FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 'Ctl C No. THE THE COMMONWEALTH OF M•ASSACHUSETTS FEE su BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual,Component(s) `Complete System ; The undersigned hereby certify that the Sewag.(Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) r` f by: --40,gt Jr771 has been installed,.in accordance-with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as built plans relating to application No.Z,!Z& y 7 �l'afed _ham^ * I. Approved Design Flow �/ (gpd) Installer A (� )iM— Designer: Inspector 1 r` Date � d The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 91�THE-COMMONWIEALTH OFFMMASSACHUSETTS FEE ��0 A R"D OF `H E A LT H DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( Repair ( ) Upgrade�(� ) Abrandon (. ) an individual sewage disposal system at /.6 ).1 13Ls , ; a i �%r� s^7/� �h/i' �°f as described , in the application for Disposal System Construction Permit No. Gi �d!F-+ .-grated Provided: Con truction sh.11 be completed within three years of the date of this emit. nditio ust be met. Date / Board of Health !/ FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARREN rM PUBLISHERS- BOSTON g , FP 1 Town of Barnstable PH..` 3 Department of Health,Safety,and Cnvironinental Services oF"V1�,, Public Health Division Date 0156 Sl. 367 Main Street,Hyannis MA 02601 6ARNSTARLK MASS. p tE�µp�Ct��d Date Scheduled (O1 Titne �Q r4(n _ Fee Pd. Soil Suitabilitv Assessment for Sewage Disvosal Performed B C,c�� ���1SJ\��� Witnessed Dy:�C,A 6 ) t7 Location Address Owner's Name Mark Scavetta i , �► a so\,,n 41 Stonybrook Road Address Marshfield,MA 02050'. a Assessor's Map/Parcel: 1/Hai }"01 W 6C) y Engineer's Name C��,�,t (O11SU`t\r1� LLC NE STRUCTION REPAIR W-t- _Telephone 9 \71 S-VS- 0M0 Land Use Res �y� y\ Slopes(^/^) S Surface Stones 1�0 Me Cult* Awool_�Iyist-nccs from: Open Water Body —' 11 Possible Wet Area — (I Drinking Water Well R Drainage Way R Property Line 3 R Other — 11 SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands In proximity to holes) i(S�e e1rn b� ct��y �OnSuI�'i�1�J L 0 A a o M aoa.� S 01}nl M A)4 f 9101 O V\T E G h —a Parent material(geologic) CZ` C 11 Depth to Bedrock tll�he Depth to Groundwater: Standing Water in hole: f\0Y\C 11`` Weeping from Pit Face f\t,he Estimated Seasonal High Groundwater See SQ%\ PAC, Ay 0 n �ric�) ll 'r�It1VYYNAT:ZC�N X+(�Xi'SEA NA�..Y-HG1T�'V�A'Zy 'AT3T�) Method Used: Depth Observed standing!nobs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment R. Index Well N _._.. Reading Dater Index Well level.. Ad.factor Adj.Groundwater Level I'E12C�Y.AT 0 TEST Hate rtrne Observation . � \ # a 3 1 Hole a a 3 Time at 9" w30 Q,-Is n Depth of Perc 3�"54 3�"-SOr 3V S411 Time at 6" Start Pre-soak Time @ \V. 0 Q 1S Time(9"-6") s 5 End Pre-soak \V a� \�.��J 1a'•3(] Rate Min./Inch 6.sS acee�^3oMcn1 ca < a Site Suitability Assessment: Site Passed x Site Failed:�____. Additional Testing Needed(Y/N) ," E Y:IOBSERVATION HOLE LOG : ...oe#;y_..1: ° Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Doulderes. Consistency,%Gravel) p'-Gil L O avv� lDy a3la 61' - 30" Sane\ LOG D` b 30 -13di1 (. �Prc\- Lot A D,51 V(itl� yk)A�e (,Nut\ DEEP>.OBSEItVATIONBOLE LOG 16k, # - Depth from Soil IIo,izor. t Soii'fcrturc Soil Color Soil Other Surfacc(in.) (USDA) (Munscll) Mottling (Structure,Stones,Doulderes. % Lo Go-\ 10yR��a 30` 30°-gy" �, ,,� a s, �13 �v" Q-SAN4 Lcoc e- At!� �t\ V1 -10% C� S L >,,0 etx A Clej lob- 1�dii C Sa �,51 ��3 LWIC A0914�,1 EEP;:OI3SERVATIOrr 1OLE:I;O :.:Hole,:#.....:..�3:: . Depth from Soil Ilorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Doulderes. Consistency. ae — �r,_ Lcc% \A 1 s a ��-GOV (. M{ Sin as IE3,5,M' , wa-i q LCOSC Poe Ae CINA ...DEEP>OBSERVATION HOLE LOG. . Holy# Depth frorn Soil I lorizon Soil'1 cxturc Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Doulderes. % Flood Insurance Rate Man: Above 500 year flood boundary No `'— Yes X Within 500 year boundary No?l Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption systetn7 \1 e5 If not,what is the depth of naturally occurring pervious material?/ Certification I certify that on Aes%\ 4 1t1t1t1 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and(fiat the above analysis was performed by me consistent with the required training,expertise�nd experience described in 310 CMR I5 g 17. Sip-nature �� nat,. 3\IcAm r � 2828 ,o- o 'f�►�p H Sze L`�Ecic - c�.-o• � � Z�Z'8 - 1 i A eu s Z^eUJ - Oo_• H�2T H ' F r r � TF., o � PZ 2' - -------- R• PAY 11 x c-r44 u�w I>T J t":I--au G�fJ�T'f'e Fl�I t_>eN E= h�lb- 4• f i _ � z �A,*FH�T zd _ LAN I.-Ol IN lm�� N Givers= I/�K-"31�o• la?c6�!rZTiy-n� ING EL.67.50 z i a ` fi EL.66.6 1-24"O MANHOLE COVER BROUGHT INSTALL ACCESS COVER WITHIN r 71F ° y . 9 MIN WITHIN 6 OF FINISH GRADE 12" OF FINISH GRADE 36"MAX z +67.0 +68 5 Qj LEVELER CAPS RECOMMENDED r� FINISH GRADE +66.5 y 4 4' 0 PVC SCH 40 " S=.005 4" 0 PVC PERF 3" PEASTONE END CAP w O ` 0 PVC SCH 40 64.84 a. • _ ' EL.65.25 s EL.64.26 � `\ S=.02 ---- 13 L14 S=.01 a I,-•� 44 Qj EL.65.00 . , ,, 00 Y W GAS 6 CRl1SFl Sl N . , r EL.59.50 , � ,,� ,�,� EL.63.76 ►-� x� x o BAFFLE EL:64.41;. _; ti N g EL64.75 » M. 609 -3 4 TO 1 1 2 uj 10 MIN REIN. CONC. DIST. BOX WASHED STONE co r, TO BLDG A. , .<:.,: W/10 OUTLETS z O _ 6 CRUSHED STONE r--I Qj , 00 20 MIN 30 10 MIN. z 1500 GAL. (MIN.) PRECAST CONCRETE v * F _ X SEPTIC TANK W/2 PVC SCH 40 TEES -) a �` Sri a GROUNDWATER EL= 58.76 J N 0 N LOCATION MAP (NOT TO SCALE) �� �. SUBSURFACE SEWAGE DISPOSAL SYSTEM FROM MOTTLING) u tl3 ASSESSORS L0� 21 (NOT TO SCALE) w 00 r' C7a a N,F GEORG 7126 jz Qj z zoa0 13>78 \ z S E PTI C DESIGN (NOT DESIGNED FOR GARBAGE GRINDER) W °` 1, DESIGN DAILY FLOW: 4 BR. x 110 GPD = 440 GPD 0 2, SEPTIC TANK: 440 GPD x 2 - 880 GAL. USE: 1500 GAL (MIN) 52.. .. �, �� \ a i 3. LEACHING FIELD: P.R. < 2 MIN/IN CLASS I USE: 1 -30' LONG x 20' WIDE x 6" DEEP LEACHING FIELD j.DT 2 !. TITLE V LOT AREA = 55,679f SF. � � '' PROPOSED AREA: 30 x 20 = 600 S.F. / CAPACITY: 600 S.F. x 0.74 GPD/S.F. = 444 > 440 GPD(D.D.F.) f � SEPTIC NOTES 1. PROPERTYLINE DATA FROM PLAN OF LAND IN BARNSTABLE & WEST BARNSTABLE, CIO BARNSTABLE, MASS. PREPARED FOR AILI P. JARVI, DATED NOVEMBER 8, 2000 BY DOWN CAPE ENGINEERING, INC., YARMOUTH, MASS. 90 .r r 2. TOPOGRAPHIC SURVEY BY GRADY CONSULTING MARCH 15, 2001. s . 6 c5? 5 _ .. ., 58 � I 3. SOILS TESTING BY GRADY CONSULTING WITNESSED BY GLENN HARRINGTON, MARCH 15, 2001. � ° I 9 60 I I \\ 4. CALL DIG SAFE 1 -888-344-7233 AT 'LEAST 4 DAYS PRIOR TO COMMENCEMENT f ~ OF CONSTRUCTION. con ,� 6 5. NOTIFY TOWN AND GRADY CONSULTING PRIOR TO BACKFILLING OF SYSTEM. N 94.4t - _ 4 \ w ,, fi , 15 MIN .ter-- ....: - -- `: '. _ . � NO, KNOWN WELLS EXIST WITHIN 200 OF THE PROPOSED SYSTEM 2s.o' I ;. \ 7. THE SITE IS NOT LOCATED IN AN AQUIFER PROTECTION ZONE II. � y I3R(�ROSED " . GARAGE b \ ( , , ) ( » ), ' W 8. EXCAVATE ALL' MATERIAL A B LAYERS TO SAND C LAYER 30 f 5 AROUND ►--� z CO �, o I. ND 'SYSTEM. - N _4.. .. .. .._ - o N SLAB EL N (n _ ___ REPLACE WITH CLEAN COARSE SAND IN ACCORDANCE WTH 310 CMR 15 255(3). EXCAVATIONx,� =65.5a o z r. TO BE INSPECTED BY GRADY CONSULTING L.L.C. AND TOWN PRIOR TO SOIL REPLACEMENT. '�C 0 <[ 0 coon 0 10 +65.0 , .' 4 } X J , o ` { o +66.0 e o 0 i o 8 0'` 6& I O 20.0 W O CollLEGEND a C s o I PROPOSED DWELLING o TOP OF,.FOUNDATION ; I i \ ELEVATION\= 67.50 ¢ i` E.1'fST/MG' PROPOSED "_i o SLAB ELEV. 60.50 N, I PROPOSED f ? a c z' M ,.. 1500 GALLON 100... __ ._._ ... .__ ..,_ ..__-_ , 10'MIN SEPTIC TANK _.. _,... _.. ..°_ ..._ .__ . ._ .._. 2 CONTOUR 100 - I ROP. a 3s.o' ��_°yA 0, ��,� D-BOX G' I 499.8 SPOT ELEVATION +100.50 a Z 1 PROPERTY LINE q - - - - - - EDGE OF PAVEMENT 15 TO BREAKOUT 67.E _ 1 W _ WATER LINE W �HOF,Hss i 1 - H. ELEV. 64.84 r 0 � w }' ( $ o�� RICHARD cy ' --- ---- � w TEST HOLE J. a_ o GRADY T.H.f1 i II No. 072 1 1 100% EXPANSION AR 5' �W d 2 SOIL LOGS ' '+ o.z t CNN\ 1 N 5 ; ., 2-10' WIDE x 30' LONG ___ ___ _______� _ / x 6" DEEP LEACHING FIELDS 0-1 Loc ^w o / T.H. 1 T.H. 2 T.H.#3 uj m 0 t° / EL. 65.16 EL. 64.81' EL. 65.26 i _ z i 19.3 t z �+- u. 6 0"-6" 0"-6" o"-$" APRIL 26, 2001 �0-- - ,i / A A A 8 -AE24-3� 10 '1' 4.42 59"W �55 49' '` LOAM LOAM 64.31 LOAM » , 64.66 _ 64.5g SCALE: 1 = 20 6 - 6"-30" 8 - _.w ....... �AT 1 _ g B JOB N0, 01 016 CURB BOX NOT INSTALL -� 3 EXISTING EDGE OF TRAVELLED WAY(U/Y bA�ED,► SANDY LOAM SANDY LOAM 62 31 LOAMY SAND ZONING DATA TIME OF SURVEY CONTRACTOR TO \ 1 0 62.66 PERC 62.93 LATEST REVISION: { LOCATE AND CONNECT ', I I $ENCHMARK d J O H N M A K I I I R O A D o NAIL IN 12" CEDAR TREE PERC 30"-84" " PERC DISTRICT: RF ' (UNDER CONSTRUCTION)I g ELEVATION = 74.20 ® C1 P R 2 EXISTING EDGE OFTRAI/ELLED WAY(Ul1/PA�EL - - - - _ ____ ;' F SAND » MIN\IN " _ 30"-132 /f " 28 -120 „ " - .- q5 - -- - - - - 36 »54 57.81 36 -54 MINIMUM REQUIREMENTS: N s, �� - C 2.5 DROP IN 30 MIN C P.R.<2 SANSY LOAM ABANDONED 84"-108" MEDIUM SAND MIN\IN LOT AREA 43,560 S.F. C2 LOT FRONTAGE 150 FT SANDY LOAM 55.81 108"-132" 55.26 FRONT YARD 30 FT SIDE YARD 15 FT 20 0 20 40 60 - ,- " 54.1s SAND D=10'-0" p 11 0 53.81 NO WATER REAR YARD 15 FT NO WATER D=11'-0" ►� _ MOTTLING NO WATER MOTTLING Scale 1 20 ® MOTTLING ,0 I 8'-0" +� 6 -6 (EL.=57.16) T-o" (EL.=58.76)(EL.=57.81) SHEET 1 OF 1