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HomeMy WebLinkAbout0021 FLICKER LANE - Health 21 Flicker Lane A= 013-033 \ Marstons Mills a TOWN OF BARNSTABLE 1LOCATION �o �-' ` �;1��,� o�P SEWAGE# VILLAGE(����.ay.•c (1'1, Ll�, ASSESSOR'S MAP&PARCEL Gl_� d33 'S NAME&PHONE NO.� —S� � � SEPTIF TANK CAPACITY k(Z3C-_)® LEACHING FACILITY.(type) l—GQ G�. �'�j (size) l Oc-i-d gAJ NO.OF BEDROOMS OWNER_J Vw Vy\© 1` S 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 of leaching facility) Feet FURNISHED BYYr, \k-Ci- Q,—, , \A \ 9, J � A� ��s G S � Ccccr B 3 OY r TOWN OF BARNSTABLE �LOCATIONd/ l rcVie, SEWAGE# Z012—/ `( F .yILLAGEA 4644 Aill� ASSESSOR'S MAP&PARCEL /3 3 INSTALLER'S NAME&PHONE NO.��ip�cn►ac+� EI'!' i+�rQS LLJCam ��yP7l`�77 SEPTIC TANK CAPACITY _/OOP + ' H LEACHING FACILITY: (type)cam,AX,A W-, H-ao (size) o75' x i, 5 NO.OF BEDROOMS OWNER 3-e,r,-pS, W. el+nc/ PERMIT DATE: Sl-( q- 'Lo I-- COMPLIANCE DATE: Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility A/D /000 4; eet Private Water Supply Well and Leaching Facility(If any wells exist on !ot® site or within 200 feet of leaching facility) /1/ . Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) L , Feet FURNISHED BY 6Vew j A ` � N A-Ird to A_q-=55 3-µ-3v ° 4 I No. g-o Fee f)THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es ftplitation for Zisposal 6petrm Construrtiou 3pPrmit Application for a Permit to Construct( ) Repair()1 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. .1 'P6i CIG LO Nj,NI a Owner's Name,Address,and Tel.No. :XAAt'�S b Hev,;;sF, € Assessor'sMap/Parcel m4P 33 y T'. LAM Mac &I :x Installer's Name,Address,and Tel.No. S'DR-477- 727'7 Designer's Name,Address,and Tel.No. P !:6 aSS GRAN b" c.t_A&&VA Type of Building: Dwelling No.of Bedrooms Lot Size ;1 I,C)J20 sq.ft. Garbage Grinder( ) Other Type of Building ��c��ztr�l _No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33o gpd Design flow provided 3 55.j— gpd Plan Date 50-1®";.O 1 X Number of sheets Revision Date Title 1 F[.I cel(gIZ L 0605 XcAegzyUS 14I LC. Size of Septic Tank 1000 Q4 LC,QL) Type of S.A.S. 20 44C 316 QtQj0tFFQ_sQ2_C Description of Soil ►'11�/ (�' 0 ( E� �_ S��w S �L64x-) Nature of Repairs or Alterations(Answer when applicable) U.SF, F be�*l 4X-t `gyp(5 e_d ) :Se�Tt� -t44j� ao .4kC- it, A r-o 7WA) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' d A Date 5 1I -eZfj l Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 2.G[-X , 1 Date Issued ---------------------------------------------------------- d r No. ")-o I - L0 I Fee ho ,.- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es `-.,PUBLIC HEALTH DIVISION -TOWN Of�BARNSTABLE, MASSACHUSETTS Zipplicatton for Disposal Opstem Construction Permit Application for a Permit to Construct( ) Repair()� Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ;L 1 F4l-0,eG7G LO ?.M � Owner's.Name,Address,and Tel.No. =A** Assessor'sMap/Parcel M0 13 L 33 w S L Aj MAC bl Installer's Name,Address,and Tel.No. 5'02•►477- $$7-y Designer's Name,Address,and Tel.No.508 a,-13-01-1.7 U, CZ a8 GR C.La-ftSMAW Type of Building: Dwelling No.of Bedrooms .3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building la, «&�j:zljtj No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ,�3© gpd Design flow provided 3 SS.Z. gpd Plan Date S-1 D-;Lot;I. Number of sheets ' Revision Date Title FLI 0 L�4ME GLCs4QSrp�US u/ILLC ,Size of Septic Tank 1 1.000 G 4 L(-cXJ Type of S.A.S. 20 412C 3(. I cab/FFc�Sc�2� Description of Soil --cAc M —try 76," — S E5 KA 1 Nature of Repairs or Alterations(Answer when applicable) U.SS�F.�(hT r u✓� .. ap 40_ nv�1 Date last inspected: ( ( t Agreement: r The undersigned agrees to ensure the constriction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' d Date {j it -eZ01 Application Approved by 0 Date S7-/V-2 y/2 Application Disapproved by Date for the following reasons Permit No. 2 G 1 a lye Date Issued S _/V- 2,1 ; ------------------------------------------- ---------------------------------------------------------------------------"----- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS ' Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) '~ Abandoned( )by dA PeZ_,tz1)6 el,,I _QIS95 L4,s_- at r11 F(.1 CAC,- L.AA.)r MA8 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. v( I( dated Installer GA0FA&)1DF BdT _:?4l5L% LLCM Designer SC #bedrooms -3 Approved design flow ��.�. gpd The issuance of this permit shal not be c nstrued as a guarantee that the system w . Date � Z�� Inspector -------------------------------(--------------------------------------------------------------------------------------------------------- No. v ! 16 Fee UU - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Nsposal 6pstrm Construction 3permit Permission is hereby granted to Construct( ) , Repair(x) Upgrade( ) Abandon( ) System located at A 1 k(.1 d_(UoV2- LANE I A95rWS: Awl" and as described inthe above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. s Provided:Construction must be completed within three years of the date of this permit. {' Date �- ry - /2 Approved by e e ` f av ar d j,fq( U�f �1 k 1 Efy,�F�f U�jpPI J 1 Town of Barnstable P# ' Departinent of Regulatory Services I .,►MUMBLA i Public Health Division Date 7/ MASS. �Fn.79. � 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. v Foil Su itabilit Performed B y Assessment fog Se7f sp � \t� � f , tC IT GSC 1 Witnessed By: LOCATION& GENERAL INFORMATION Location Address a t Owner's Name • �l'N^'S 1M.1't� Address S�� r Assessor's Map/Parcel: 0 i 3/ C 4e•e y;t),< �vtt��� +�e�. �G cv,5m�n NEW CONSTRUCTION ttt REPAIR V/ Telephone# 3 -7•, 50,8"273 ,6 37 Land Use:_5Q181e Slopes % 2 - `/ - P ( ) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ., ft Property Linc 7 la ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands In proximity to holes) Parent material(geologic) dUEWaS� Depth to Bedrock Depth to Oroundwater. Standing Water in Hole: Weeping from Pit FAce Estimated Seasonal High oroundwater 7 12.0 DETERNUNA71ON FOR SEASONAL HIGH WATER TABLE Method Used: DLCZC, &Se4aa�(t Depth Observed standing in obs.hole: 7 1 2 In, Depth to 5g11 mottles: Dcpth to weeping from side of obs,hole: In, Groundwater Adjustment Index Well# - Reading Date: "' Index Well loVCl � Actj,factor — Adj,C3roundwater Leval PERCOLATION TEST bate `1-30-12 Thne /o r rl Observation j' Hole# Time at 9" a v _ Depth of Pero t 7 Y Time at 6" Start Pre-soak Time@ /6'05AY1� Time(9" End Pre-soak /0: 11 h,'l Rate Min./Inch 2 Site Suitability Assessment: Site Passed �ES Site Failed: Additional Testing Needed(Y/N) N Original: Public Health Division Observdtiw Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you'miust first notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:\S EPTIC\PERCFORM.DOC D] i B' SERVATION HOLE LOG Hole# t 2 Depth from Soil Horizon Soil Texture .Sdil Color Soil• 0(�er Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, i ten:y,%'Gravel) © -1(7 16- 12. q L S 1a Yr 3f� LS y�-36 G I Silk Loom 2.5 11/( s6-I 20 c-2 �u�-c am z.� 7 `'/� /L pv�k DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%G e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil• Other Surface(in.) (USDA) (Munsell) 'Mottling (Structure,Stones,Boulders. Consistency, Gravel) DEEP OBSERVATION MOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones'.Boulders. Cositn Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes ._ Within 500 year boundary No lr Yes Within 100 year flood boundary No.✓ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? Y�5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on ��r 7^ ?9 (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 and exper' described in 110 CMR 15.017. Signature Date S- 0-(2 QAS.EPTlMF-RCFORM.DOC r 4 Town of 13arnstable Regulatory Services Q. Thomas F. Geller,Director a MAM. Public Health Division •` Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 O ffi ec: 508-862-4644 Fax: 508-190-6304 Date: 5-22'i Sewage Permit# Z o i L-10 Assessor's Map/Parcel Installer& Designer Certification Form Designer: 'Tor-, Installer: Gc.'Pew;& elik"fcise-S Address: lti5 H Crc n14crfx k-!�nW! Address: eah\ q A 07,538 �OJ2� VM ,,ob-z73.Os77 On NW0,I),e5 lc was issued a permit to install a (date) installer septic system at 2 l 'F�ieker Gav►er based on a design drawn by (address) 5 C En5i(teerC6n ) , 7,ne_ dated Mai ld, 201 2 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) ected and the sails were found satisfactory. ,N JOHNL.CHURCHILL (In t er's Signature i�'L 41ac esigner s Signature (A �x a gn Here) ASE RETURN TO ARNSTABLE PUBLIC HE DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIT. BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLEYUI!LIC HEALTH DIVISION THANK YOU. q\office fortnsldesignercertification form.doe M c f•`- r Ln IIU J U Ln y c� ? Postage $ /!r rl Certified Fee ] l gg,nn77 gr �,�,, t3 Return Receipt Fee l �+}3►+ 7 z Hew p (Endorsement Required) ere O Restricted Delivery Feed (Endorsement Required) f���/ O Total Postage&Fees N Mr. & Mrs. James Morse i 5 South Street Ashland, MA 01721 Certified Mail Provides: ® A mailing receipt i • A unique identifier for your mgalpiece-j m A record of delivery kept by the Postal Service or two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. m Certified Mail is not available for any class of international mail. to NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. c For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery".'' ■ If a postmark on the Certified.Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:�Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 1 a SENDER: COMPLETE THIS SECTION:- COMPLETE THIS SECTION ON DELIVERY,, ■'Complete items 1,2,and 3.Also complete A. signature item 4 if Restricted Delivery is desired. 1,�' Agent ■ Print your name and address on the reverse X ri V GV't Addressee so that we can return the card to you. /, Received by(Printed Name) f elivery ■ Attach this card to the back of the mailpiece, / I?- or on the front if space permits. I V Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Mr. &Mrs. James Morse 5 South Street . Ashland, MAC 3. Service Type ' I ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise j ❑Insured Mail ❑C.O.D. _J1 4. Restricted Delivery?(Extra Fee) ❑Yes I 2. Article Number ; x : -— =7011` 0470l 2001 i:.4525= 6768 (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 10259"2-M-1546'1 UNITED STATES POSTA�,ySW1 ' ola e eesNiid I • Sender: Please print your name, address,an ZIP+4 in this box • I I I (Town of Barnstable I Public Health Division b I 200 Main Street I Hyannis, MA 02601 i I T l I _ I M I I +�1�?!}ll;1Dtlt13l!}DfFIDi�11fDD�lf73iItD444F1"FIIliF1�IDFl�1l�D'�il i �1 I 9 Town of Barnstable Barnstable INE Regulatory Services Department I�"a�F li BARNRrABLE,r - _ m MASS, Q� Public Health Division- - QjA � l D MAt 200 Main Street H annis MA 02601 _007 , y Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #701 1 0470 0001 4525 6768 April 30, 2012 I Mr. &Mrs. James Morse 5 South Street Ashland, MA 01721 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at 21 Flicker Lane,Marstons Mills MA,was last inspected on 4/09/2012 by Patrick T. Sullivan, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: C .System is in Hydraulic Failure - You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with in the deadline period will result in future enforcement action. PEZ RDER OF THE BOA OF HEALTH as McKean, R. . CHO j Agent of the Board of Health i I Q:\SEPTIC\L.etters Septic Inspection Failures or Future Eval\TOB Itr �I i Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=391 L Logged In.As: Parcel Detail Wednesday, April 25 2012 Parcel Lookup Parcel Info Developer Parcel ID 013-033 Lot LOT 103 Location 21 FLICKER LANE I Pri Frontage 208 Sec Road I Sec Frontage Village MARSTONS MILLS I Fire District C-O-MM Town sewer exists at this address No I Road Index 0549 Asbuilt Septic Scan: 013033_1 Interactive Map ' l I-- 013033 2 - Owner Info Owner MORSE,JAMES H& HELENE I Co-Owner Streets 5 SOUTH ST I Street2 City ASHLAND I State MA zip 01721 Country - Land Info Acres 0.48 use Single Fam MDL-01 I zoning RF Nghbd 0105 Topography Level I Road Paved utilities Septic,Gas,Public Water I Location " Construction Info Building 1 of 1 Year Built 1983 Struct Roof Gable/Hip I Wall Ext Wood Shingle Living Roof AC I DK13 Area 1056 ( Cover Asph/F GIs/Cmp I Type None _, 1 Style Ranch I Int Drywall I Bed 3 Bedrooms I 14 os 'aV �3 Wall Rooms 10 1 Model Residential I Int Carpet I Bath 2 Full 18 sns Floor Rooms GAR 8Mi -4?q �p Grade Average I Heat Type Hot Air Total Rooms 6 Rooms I 14 as Stories 1 Story I Heat Oil I Found- Poured Conc. Fuel ation Gross 2628 Area Permit History http://issgl2/intranet/propdata/ParceiDetail.aspx?1D=391 4/25/2012 �c �' � ^�� �y�!� J V e a � ?�� Commonwealth of Massachusetts Title 5 Official Inspection Formcopy . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is Marstons Mills MA 02648 April 9 2012 required for p 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 filling out A. General Information , forms the computer;use 1. Inspector: (n only the tab key l V� to move your Patrick T. Sullivan use the return cursor- not Name of Inspector key. Ready Rooter, Inc. Company Name P.O. Box 371 Company Address Sandwich MA 02563 '�"" Citylrown State Zip Code 508-888-6055 SI 12843 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 maintenanc"f on Vie sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15340 ofi Title 5(310 CMR 15.000). The system: , ❑ Passes ❑ Conditionally Passes ® Falls ❑ Needs Further Evaluation by the Local Approving Authority 4 �--� April 13, 2012 - Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. I t5ins-11/10 Title 5 Official Ins pection orm:Subsurface Sewage Disposal System•Page 1 of 1 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is Marstons Mills MA 02648 April 9 2012 required for p + every 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: 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," pleEse explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/4 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rf 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is required for Marstons Mills MA 02648 April 9, 2012 every page. City(Town State Zip Code Date of Inspection B. Certification (cons.) 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is required for Marstons Mills MA 02648 April 9, 2012 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ®• ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6° below invert or available volume is less than day flow t5ins•11110, Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is required for Marstons Mills MA 02648 April 9, 2012 every 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 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•11/10. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is Marstons Mills MA 02648 April 9, 2012 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? El ® 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: 3 Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). 490 GPD t5ins•11/10" Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is Marstons Mills MA 02648 April 9, 2012 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No " Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2010=227 GPD g ( y g (gPd))' 2011=254 GPD Detail: Sump pump? ❑ Yes ® No Current Last date of occupancy: 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? El Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owner's Name required for is Marstons Mills MA 02648 April 9, 2012 required for every page. Cityrrown 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: Ready Rooter records: Pumped July 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 ❑ Priory ❑ ShEred system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 8 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is required Marstons Mills MA 02648 April 9, 2012 for p every page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 37" Scum thickness 3" at outlet 4" at inlet 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 10° How were dimensions determined? Tape measure and dip tube. Comments(on pumping recommendations,,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet PVC tee and concrete outlet baffle in place. Liquid level at outlet invert. Signs of high water staining over outlet invert. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness 'Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is l Marstons Mills MA 02648 April 9 required for p , 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons -Design Flow: gallons per day Alarm present: ❑ Yes ❑ No •Alarm level: Alarm in working order: ❑ 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•11110 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 11 of 11 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is required for Marstons Mills MA 02648 April 9, 2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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.): One inlet, one outlet. Heavy solids in d-box. High water staining over outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 12 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is Marstons Mills MA 02648 April 9 2012 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: leaching pits number: 1-6'X 6'w/T of. stone. ❑ 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, etc.): Liquid level in leach pit at top of pit. Inlet enters concrete riser. Staining present over invert in riser. Leach pit is in failure. 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-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is required for Marstons Mills MA 02648 April 9, 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids ,Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation„ etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is required for Marstons Mills MA 02648 April 9, 2012 every page. cityrrown State Zip Code We 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 i l ��s*SSG =r L 7 � " �33- 3'7 3 O t5ins•11ho Title 5 official traped ion Form:Subsudaae Sewage Diw System•Page 15 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �r 21 Flicker Lane Property Address Jim Morse Owner Owner's Name information is requi red for Mar's p tons Mills MA 02648 April 9 2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >5 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: 08/04/1983 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: ma.water.usgs.gov terraserver-usa.com You must describe how you established the high ground water elevation: Test hole to 12'elv=85.4 found no ground water(1983). Base of SAS at elv=90.Accessed local ground water contours and topo mapping. No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Tide 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 16 , Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 21 Flicker Lane Property Address Jim Morse Owner Owners Name information is required for Marstons Mills MA 02648 April 9, 2012 every page. Cityfrown 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 Y t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 'LOCATION SEWAGE PERMIT NO. Lot 103 Flicker Lane 83-681 VILLAGE ply --U33 e I N S T A LLER'S NAME i ADDRESS Robert B. Our Co. Inc. Great Western Rd. North Harwich • UILDER OR OWNER McKeon Custom Homes DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED/o/I - � /� � 1 1 � 3 OU No ... 3........... Fm3...... v...�.�-. THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH .... FW-tJ.................oF...��.�RN.S11�.�C....----------.............--------- Appliration for Diipooal Workii Tonarnrtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .... - .......................... / .ems.k A 1-1 .............................................._...... Location- ddress or Lot No. .c.....�M �c . ..... ..................................... .... ...... r1 ......... 1 Owner Ad res ....----..(?�.Q................................................ ...AZ T Installer Address dType of Building Size Lot..��f��?.�........Sq. feet V Dwelling.—No. of Bedrooms...`RF...t'" KIE..................Expansion Attic (•)- Garbage Grinder (N'Rj '4 Other—Type e of Building p� yp g ...../!1A................ No. of persons.......AlA.........-... Showers (it/.� — Cafeteria (MA) a4 Other fixtures .................................. W Design Flow.........................5..5...........gallons per person per day. Total doily flow......3.5®...........................gallons. WSeptic Tank—Liquid capacity/ ....gallons Length..!'=6.�.. Width. P Co Diameter/Of:..-. D�e,�th...5._-8 -. x Disposal Trench—No.......1".4 . Width...1f.�....... Total Length...../v'1¢_..... Total leaching area...l.[Ce4:.........sq. ft. Seepage Pit No........i........... Diameter....../.0......... Depth below inlet...... Total leaching area...d� .....sq. ft. Z Other Distribution box (v--)- Dosing tank Xk1 Percolation Test Results Performed by... � TAco61............................. Date...... ���8�........_ a a Test Pit No. 1. ......minutes per inch Depth of Test Pit....112�-......... Depth to ground water.. . .............. LTo Test Pit No. 2.."-.a`......minutes per inch Depth of Test Pit.....!!..'.......... Depth to ground water-----AM.......-.-. 9 / .....r..... . .................................................................................. .............F.1.�...............................--........ O Description of Soil....0.-.1. ®rL_ : ...................... x c, 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 TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued *Ib�y the board of health. Signe ............. ,v` '^. ...... Date Application Approved BY -.�C .......--•---...-----•............................................. Date Application Disapproved for tleef ollowing reasons: --••••--•------------- ....................•---••--••--•--------------•.....-•-•---•--------•----...-•----------...........................................----....-•-••--•-•--•-•---•--------•--•--•-•••••---••-----........... Date PermitNo.... ..............................................._ Issued_ ----••---•-•-------------------------- Date No......................... Fmc.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................OF... �. i�I• �'-l ` .. ApphrFation for Uiipoii a1 Workii Tonitrnrtion ermit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......Lr"A-ia........................... Location-Address or Lot No. jZ .tA••.C_.... ............................................ W A d 001Z.... s ----•....................•----......_...... �� __ Owner Installer Address / UType of Building Size Lot_.�:j__ �,�1........Sq. feet Dwelling—No. of Bedrooms_... .-Ct~...................Expansion Attic Garbage Grinder (v,4) `k a Type of Building Other—T n>,g .....A/d4_................ No. of persons.......__�t-------------- Showers — Cafeteria �� (tip) dOther fixtures ................................---•--------...---•---......._.....--------•-------------------------------- ---•-................... ... W Design Flow........................z!),=.. ...... per person per day. Total daily flow......9-3p__._---_--•-------•---------gallons. WSeptic Tank—Liquid capacity/,,00.....gallons Length Width4V _,toy' Diameter.,!¢...... Depth._S_:$". x Disposal Trench—No. ..... ...... Width.../4/4......... Total Length.....�/,4....... Total leaching area..,_..........sq. ft. Seepage Pit No......../............ Diameter......�o _...... Depth below inlet.....1,�........... Total leaching area...aly .....sq. ft. Z Other Distribution box (�) Dosing tank (All) `"' Percolation Test Results Performed by... r1?12�.A?C err,9G96.L............................. Date.....5///'.3......_......._. Test Pit No. 1.�_r .......minutes per inch Depth of Test Pit..../.-3.L. Depth to ground water..WA............. rX4 Test Pit No. 2_4-9a.......minutes per inch Depth of Test Pit.....t!_:.......... Depth to ground water-----AM........... a •--•---•--••--•.............•-------...-----•-••--•---.............-----••..........._...:______...___---__.•-- ............................................ 0 Description of Soil---O.`-pi C.>1.1..t....�_��SiL =�I1z?.t`►./`c�l�...... `.....5oLh.:..-•---- x UW ---------------------------------------------------------------------......................................- ; --------------------------------••----------------------.....-------•-••••••••••.... Nature of Repairs or Alterations—Answer when applicable._./v...................................................................................... -----------------------------------••-----••----•-•-----•--•---------------•------------•----.-......---....------------------------•---------------•---------------•---....................._.......... Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the s stem i operation until a Certificate of Compliance has be iss ed bIv\ oard of health. g p g3 Signed•-- ..................... .. ✓1 Date ApplicationApproved BY........................................................:::....•••••---••--..._.................• ........................................ Date Application Disapproved for the following reasons-------------------------------••----•--...------..._....------•---------------------------=-----------•--__•.. ----------•----------•---------------•---••----------------•••---•-----------•._..-...--•------.....•••••.---.........--••--•--------------------------•--............................................... Date PermitNo......................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L 11 OF....... ................................... (9rdifirate of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( �_<Or Repaired ( ) by..... ��1�>�c2 -----©Ufa........ --- - ((-•._ _._--____-•----•----••.............................. ...........•........................................................................................................ at r-••-LT......-b .-•L-_1���-r•Z......--I�->n..tc .. ---i" 5 --- t 1, f ------ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WIL FU TION SATISFACTORY. DATE.....1 .�i .A;----------------------------•----------•••-•-••-- Inspector••••... __. THE COMMONWEALTH OF MASSACHUSETTS BQARD QF HE TH �•� >J A i�N-3T 1�b, r No......... FEE........................ Difivolial 'Rorks, on tion hermit Permissionis hereby-.-ranted......................I.......................-----•---......---•--•-----.....-----------•-----------.....................................-:. to Construct o air � an nd' . al Se e� 's$er& t �i11 , : --------------------------------------------------------•-------------------............. Street as shown on the applicati n for Disposal Works Construction Permit No..................... Dated.......................................... -•--•••.............•---••---•-------•-------•---•-----------------------•---....----•------••.....------ ............................................. -••.......................••-•-- Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON • r I FAO' A�. ,C_ r•r �� /� �� ( -'7 A5c_.vU�.� PW�.,Fr-i 7:^b..a i vrl:l:.�:�a �'"!, / [i. ! 'L- F{. ( (, crlhPT _rLr c r.'-;-'rr 5 ty GAY m us ./o Fr• , �--- 61 0 uA 7 ELD Cq; ,; r LEA�MINE� DiT loll on cn 2s74 c LEGE D CERTIFIED ' P OT LAN EXISTING SPOT ELEVATION 0„O v� - , EXISTING CONTOUR -- O ___ 40 , !�= FINISHED SPOT ELEVATION 4� ;� A� `yN �//� <�' Tc M IL L ' FINISHED CONTOUR 0 0 SE IN -. APPROVED BOARD OF HEALTH No.10951 9.O •' ) }J 90 G l5 T 5G'n7 16 �FSs�oNni:� SCALE ./",- 3 n ' DATE B 3 . DATE AGENT LOREDGE ENGINEERING COl IN /�I lCeow a CLIItNT.4_.,._... I CERTIFY THAT T.HE PROPOSED EGISTERE REGISTERED JOB No..... _ BUILDING SHOWN ON TH13 PLAN ILAND CONFORMS TO THE ZONING '-LAW1&NCtlV_EER OF BARNSTA E + t� �oi{a 712 MAI N,`STFtEET CH. BY� I- 8 �q.83 tO: LAND SURVEYOR NYA.NNIS,, MASS. . SHEET OF �-:. DATE R + No /F EJTMER :AVA5 TJC 7,4Ntc OR ?O FT. J`�J/K J '_EAC.r,IiNG PiT :4-,tE MORE TsaA:'/ /29EL0iy, .!Q �'T MI/V. � � �.R�4 OEM A 24 •O/A,�?F T�R ='J.NC.��Tc- CG✓E,P '` SiWALL ®.F aROua q ro i.?,4 DE. q•PYC PJP� _ CO/VC.R4rrA F i trE4vy C^ ST /RO.v C ✓�.? ',�.q L r3c S�J MIN PJTCN I ` /F/IV DR:✓=r 14 y corFAs /a pFR Fr iA - - � .'. - / , ,..�• of � Lpu Q LEYEL t. "1N11V.OlXllf 6A4. dp 1! • • • • o • • > WA 51yP0 57�NE • i,. .`'IC D/ST. • • • • • • is • , 2r r �A r ,,` "'' A[L l'F� • • r • eFFPECT/y G • • — WA5,iED STJNE �j - •' DEPTi/ i u b _ G[.9Y TPstf3 s o • t • • • • •► i J• o , -`� is >r�=loin • • • • t • • • • r, ,' o • . • A PREG�.S T SEWAGE X 3 • s. • . • • • • • • • • i- a•'o ?/7 OR r aeLgVAT1 ONS /�/T G �r4�.�y ata `�0 G.4L�D�r. i �• ! • • �� 9 0 IJVYEJAT A 8Uit0lNQr O FZ �* ' � � * �� �" 3 �Z,`FT 3 � �'tSF� TA9UL�T10/V> x z aM GROUNI? ATER TA6L.E INLETOlST/4®l/YPQA[ 1,W�ZETDISlR1�NX/O/V dQ .sue P+Ck3i+4 taatt,�r � � py�► , x 7' JULA l01 PfT "%W t!_m- :,' alJ►fFivs/�Ju A 3 /rT DES/6N`"CFI/TFl�t `" - D/J►JE�ar3/mJV ��— •. I 3 GJa-ft'r7V5/®M Ntl.MllER,OF'�ED�RGO�S� , . , G4-ga tGf D/SPOSAL UAfJT ✓'w SO�t LOG Solt TE.�T- TO7A' 1. e-Trj ►'i�TED F!_+dt�V 330 C:.4t.IA4 SO/L TEST,*/ SOlC TFST�� XUJtifBFR a LOACNIN& P/TS_ � �'Lrtc'Y. �T A, -EL!•K In-o DWiT� OF SO/L TgST x:. SLOE LG`AGiI/NG PER P/T S/ fT RESULTS ivJTNESSED BYJ�� -c"�� jarro/w 4.64CNJNG PER,PIT Z�4 S4• FT M ReTCOLA7 A.4Tff r_cs Mj"1lNCN TOTAL j.Z4CN//VG AREA SA. fT. c�A-f GL�,�COL.4TJGN R.ATE.,+k2 �---`1/�. J'NCf�► L.: l.` ham; :a Es�RVE LE,4CIyJN6 ARE/ Z-b 9� SQ. FT. �c�l3 OF AL � ' G - `> ,s.fir.r'�e C' -1 I '�Ct�l.� �'•�li'� •`� u j �-•�:�fj w` �Y� - /-�� c� o M SE H 0-1o95t p " EL Or?EUGrr �1/G/N q/h/G COSINC. M4 0 pD FG/STsQF 4�1 O C 41 0L 7/2 J►fA/N ST. Q/STE��p� AiAI SU a IT EL 6N.N . . 33 I 4"SCHEDULE PROP.4"VENT WITH CHARCOAL T.O.F. EL.= 99.8 ± FINISH GRADE OVER D-BOX= 97.2'�' 40 PVC MIN: SLOPE 1 % FILTER TO ABOVE GRADE FINISHED GRADE OVER BIODIFFUSERS= 97,2 - 98•0 GENERAL NOTES PROVIDE EXTENSION RISER SLOPE @ 2/o MAIN. INSPECTION PORT WITH WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER ACCESS BOX TO WITHIN 3"OF 1• UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISH F.G. (ONE PER OUTER ROW)ED GRADE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.= 98.6'± F.G. OVER TANK EL. = 98.0'± 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. N. 5.10 MAX. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL EXISTING 4' PROPOSED 4" 36"MMI (SEE NOTE 21) TOP OF SAS/B.O. = 9Z.90 SEWER PIPE SCH.40 PVC SYSTEM UNLESS OTHERWISE NOTED. SEWER PIPE 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6 3 3"DROP MAX - PROVIDE WATERTIGHT ELEVATION =92.90' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A " " 3" 9" L - 21 ± 2"DROP MIN MIN.SLOPE @,% JOINTS P. 1.33' 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 10" ( 4"PVC IN FROM " 14" f �*95.9'± SEPTIC TANK 4`PVC OUT TO �P') 10.75"'TYP 16 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE LEACHING FACILITY 0.90 . i ) o SPECIFIED DROP BETWEEN 5. SLOPE ALL SOLID PIPE AT 1.0 /o MINIMUM. " " 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. INLET AND OUTLET CONTRACTOR CONTRACTOR SHALL � OUTLET TEE 94.2T MIN. 6 94.10 ( ) SHALL VERIFY SIZE 48" VERIFY CONDITION OF , 92.4T 91 .5T laid flat 2.875'(34.5") 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE N (TYP.) AND CONDITION OF EXISTING TEES GAS BAFFLE 5.0' NOTIFIED PRIOR TO BACK 6"CRUSHED STONE (TYP.) 5'MIN. 11.5' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY REQ'D NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE 25.0' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 100.00'ESTABLISHED ON A TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= *51 .0'± BIODIFFUSERS (END VIEW) CHISELED SQUARE ON A CONCRETE PAD AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE HID LEVEL. BIODIFFUSERS (PROFILE) Based on water elevation of Long Pond;Also G.W. EL. =53'± I 9• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION (BY INFILTRATOR SYSTEMS, INC.) per Town of Barnstable 1992 Groundwater Contours Map. a` THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW E ,4„ � 4-0 . �°�rrr 5 ay\S �• 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES DISTRIBUTION BOX DETAIL t > ( ) pp Z,00 sr',_ TO THE DESIGN ENGINEER. *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE ARC 6 H C #3616 B D B I O D I F F U S E RS \ -2O 1 m Q ae;a�"�,` 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES H TO ANY WORK& NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE JJu �` firJ� U S SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM NOTES: i PERC NO. 13626 APPROPRIATE AUTHORITY. 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH ,f 1 y _ INSPECTOR: Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS "` t LOCATED UNDER PAVEMENT DRIVES OR TRAVELED WAYS IN WHICH CASE SEPTIC SYSTEM COMPONENT. *� 3 E.I.T. x , > �?O EVALUATOR: Michael Pimentel, ti t s y THEY SHALL WITHSTAND H-20 LOADING. 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE a c� r C.S.E.APPROVAL DATE:: Oct. 1999 PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA MAP 130_6. k ' r 1� DATE: April 30,2012 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF Y SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. ALSO,CONTRACTOR SHALL LOT 38 _"` •, f TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE >> p_ MATERIAL IN AREA BENEATH AND FOR 5 FT.ON ALL SIDES OF LEACHING FACILITY. EXCAVATE A TEST PIT IN THE LOCATION OF THE PROPOSED SAS AT TIME OF ; w ELEV TOP= 97.50' INSTALLATION TO ENSURE NO GROUNDWATER IS ENCOUNTERED ABOVE EL. 86.571. MAP 13 :fi; REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, LOT 32 " ,: au ` ELEV WATER= <'87.50' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION �� x 15. CONTRACTOR H 3.) ENTIRE PROPE OC 1 �' �_ r:: z• '� ,�. PERC RATE_ <2 min./inch SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN OVERLAY DISTRICT AND THE ESTUARINE WATERSHEDS. Ss ! ¢ d�,' SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. DEPTH OF PERC= 56"-74" 16• PROPOSED PROJECT IS LOCATED WITHIN: 4�. F TEXTURAL CLASS: 1 ASSESSOR'S MAP 13 LOT 33 a - ` � 3 OWNER OF RECORD: JAMES H.&HELENE MORSE Co # x'f Y _ 7 r.- - - ky L� , r ADDRESS: 5 SOUTH STREET m A a O 1 a on 97.50 MAP 13 a 'r k ? Fill ASHLAND,MA 01721 #, 0 " 96.67' LOT 33 / c ll ZONE A Loamy Sand 10 21,060 S.F.± c� v rr, i � " , s, �, 10Yr 3/1 96.50 FEMA FLOOD ZONE C MAP 13 r COMMUNITY PANEL# 250001 0015 C Loamy Sand H 1 4;, B 3/ R 10Yr 516 17. DEED REFERENCE: DEED BOOK 3945, PAGE 75 LOT 37 I� / y;=; � ' r a �• ,�\ 48" 93.50 18. PLAN REFERENCE: P.B.284, PG.91 Silty Loam C-1 2.5Y 711 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. /Q M • *; ; ; �\ �'� « 56" 92.83' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY Y FOR SEPTIC SYSTEM UPGRADE:-JC ENGINEERING WILL NOT ANY LIABILITY 0��.. .,,u,; Li. �,�; • ,,%t,� .-lf '�'2°,m.. ",.„.{,�'c- hi�" M1 °*"'k"".' ,�^s'4�� a " a; �e .� , / ���• ` Y ��-1 �` ' x t 74 91.33 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. and Med.-Coarse S C-2 2.5Y 6/6 v F 21. IN ACCORDANCE WITH 310 CMR 15.401 - 15.405`�fiHE FOLLOWING LOCAL UPGRADE (10%Gravel) APPROVAL IS REQUESTED FROM 310 CMR 15.221 (7): O Q�w �/ ?S0 PAVEMENT (1.) A 2.1'WAIVER(3.0'-5.1')FOR THE MAXIMUM COVER OVER THE LEACHING SYSTEM. EXIST. 1,000 GAL. SEPTIC TANK '� a� wv LOCUS PLAN TO BE UTILIZED IN THIS DESIGN \ \ j - 41 NOS SCALE: 1"= 1000' 120" 87.50' No Mottling,Weeping or Standing Observed / DRIVEWAY O #21 \ �� DESIGN DATATEST PIT DATA LEGEND EXISTING cp 3-BEDROOM PERC NO. 13626 1 INSPECTOR: Donald Desmarais, R.S. MAP 13 , �V ��� DWELLING x50.0' EXISTING SPOT GRADE TOF=99.8'± l EVALUATOR: Michael Pimentel, E.I.T. LOT 36 � ' � I NUMBER OF BEDROOMS (DESIGN) 3 - `9d>� DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E.APPROVAL DATE: Oct. 1999 - 50 - - EXISTING CONTOUR DATE:-_- April 30,2012 EXIST. LEACHING PIT(approximate TP 1 = -s:' y GARAGE / TOTAL DESIGN FLOW 330 GAUDAY 50 PROPOSED SPOT GRADE o ,'sr r, - I cn TEST PIT#: 2 location only)TO BE PUMPED, FILLED 97x5 DECK o = 660 50 PROPOSED CONTOUR w/CLEAN SAND &ABANDONED - TP 2 w DESIGN FLOW X 200 /o GAUDAY ELEV TOP= 97.50' / v` USE EXISTING 1,000 GALLON SEPTIC TANK ❑/H/W EXISTING OVERHEAD UTILITIES 9 �- �? $ ELEV WATER= <87.50 S `� L / m PERC RATE= W W EXISTING WATER LINE MAP 13 ° � -X-X-X-X-X- EXISTING FENCE LINE SWING TIES p�� DEPTH OF PERC= INSTALL 20 -ARC 36HC #3616BD BIODIFFUSERS H-20 1� TEST PIT LOCATION SCALE. 1 -20 LOT 35 � ' l / ( ) t ) TEXTURAL CLASS: , 1 x97.7 DESCRIPTION DC GC PROPOSED Benchmark 3 97.2' - SYSTEM CAPACITY - 0 EXISTING 1,000 GALLON SEPTIC TANK DISTRIBUTION BOX �6• 97 5'x Chiseled Square on Pad BIODIFFUSER CORNER(1) 29.5' 50.9' Elev. = 100.00 (TOTAL L.F.OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.) GPD (100.0)(4.8 SF/LF)(0.74 GAUSQ.FT.)= 355.2 GAL_ LEACHING/DAY 0" Fill 97.50' BIODIFFUSER CORNER(2) 18.5' 46.5' 96.8 x Approx. M.S.L. ' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE 97.2'x NSO°06'Q0"E 10" 96.67' BIODIFFUSER CORNER(3) 25.3' 23.5' Loamy Sand PROPOSED TOTAL 20 ARC 36HC x97 8' 13p 00 MAP 13 TOTALS: 2 10Yr 311 96.50 _ O PROPOSED DISTRIBUTION BOX BIODIFFUSER CORNER(4) 34.2' 31.2' (#3616BD) BIODIFFUSERS (H-20) IN " TOTAL NUMBER OF BIODIFFUSERS: 20 Loamy Sand 0 PROPOSED ARC 36HC(#36166D)BIODIFFUSER(H-20) A FIELD CONFIGURATION PROPOSED 4"PVC VENT PIPE; LOT 34 TOTAL NUMBER OF COUPLINGS: 0 B EXACT LOCATION PER OWNER 10Yr 5I6 . TOTAL LEACHING AREA: -' 480.0 PROPOSED INSPECTION PORT TOTAL LEACHING CAPACITY: 355.2 48" 93.50 REV. DATE BY APP'D. DESCRIPTION WITH ACCESS BOX(TYP OF 2) C-1 Silty loam 2.5Y7/1 PROPOSED SEPTIC SYSTEM UPGRADE #21 NOTE: 56" 92.83' PREPARED FOR: EXISTING EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE CAPEWIDE ENTERPRISES 3-BEDROOM 4 DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LIETTER DWELLING F "MODIFIED APPROVAL FOR GENERAL USE" ISSUED TO INFILTRATOR Med.-Coarse Sand TOF=99.8'± SYSTEMS, INC., DATE OF ISSUANCE OCTOBER 3,2003 (LAST MODIFIED C-2 2.5Y 6/6 LOCATED AT MARCH 14,2012). TRANSMITTAL NUMBER=X235253. (10%Gravel) 21 FLICKER LANE o GARAGE MARSTONS MILLS, MA DECK SCALE: 1 INCH = 20 FT. DATE: MAY 10,2012 120" 87.50` 0 10 20 40 ao FEET DC N o No Mottling,Weeping or Standing Observedv��P jN 0. r"Assn G 2) ti ti C JOHN L. P, PREPARED BY: (3 RESERVED FOR BOARD OF HEALTH USE CHu CHIL JR. JC ENGINEERING, INC. 31 IVI .4 807 2854 CRANBERRY HIGHWAY p EAST WAREHAMI, MA 02538 TER T (1 25.0' SITE PLAN 508.273.0377 4) Drawn B i9By:' SCALE: 1"=20' y: BSM Designed MCP Checked By:JLC JOB No.2212 III i