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HomeMy WebLinkAbout0054 HAMBLIN'S HAYWAY - Health 54 Hamblin's�HaywayH, A.--. 045 = 005 Narstons'Mills -- ---- -- --- -- Commonwealth of Massachusetts ------ Title 5 Official Inspection Form sf Subsurface Sewage Disposal System Form Not for Voluntary Assessments 54 HAMBLINS HAYWAY Property Adiress- CHERYL JONES---,- Owner Owner's Name information is required for every MARSTON MILLS MA 02648 OCTOBER 28, 2011 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab I. Inspector: key to move your cursor-do not MARK L WHITE use the return key. Name of Inspector A.B. CANCO Company Name 350 RT 28 Company Address WEST YARMOUTH MA 02673 Cit /-Tbwn state Zip Code 508-775-2820 S-13381 A Telephone Number License Number 51. r-n aj B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: Z Passes 13 Conditionally Passes Cl F _jiiA 0F ❑ Needs Further Evaluation by the Local Approving Authority MARK Cps 0: WHITE m,I a 01 No. -Ai 11—-ov. OCTOBER 312011 f �S13381 c,3 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Appr (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 DER 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. age I . i I . t5ins-11/10 Title 5 Othoial inspection Form.Subsurface 9 agel)ispOsa Page 1 of 19 <�N Commonwealth of Massachusetts -�_ _ r.#—N f TME Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 54 HAMBLINS HAYWAY Property Address CHERYLIONES Owner Owner's Name information is required for every MARSTON MILLS MA T 02648 OCTOBER 28, 2011 -o _e - page. Cityrrown State rip Z Date B. Certification (cont.) Inspection Summary: Check A,B,C,D or E always complete all of Section D A) System Passes- I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 13) 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, NO) 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 eAltration 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, 1:1 Y 0 N El NO (Explain below): t5ins-11/10 Tf(te 5 Officiat Inspection Form:Substifface Sewage Dispose)System-Page 2 of 19 X Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface sewage Disposal system Form -Not for Voluntary Assessments 54 HAMBLINS HAYWAY Property Address----_ -.._...... ....-- --..._.. ... -- - ._...-..1.._...-_--- --_,..-. ---- - ._ CHERYLJONES Owner - ---- - - ------....-. Owner's Name information is required for every MARSTON MILLS _ MA 02648 OPTOBER 28, 2011 page. City/Town state Zip Code Date of Inspection B. Certification (cunt.) 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): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 19 l Commonwealth of Massachusetts Title 5 OfficialIris cti n Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments - 54 HAMBLINS HAYWAY erty Prop Addr..ss...------ e CHERYLJONES Owner ---- ----- -......_......_..._.. .__.. Owner's Name — information is required for every MARSTON MILLS W MA 02648 OCTOBER 28, 2011 page. City/Town - - .- _.......-- State Zip Code Date of inspection 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 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. t5im•11/10 Title 5 Official InspWion Form;Subsurface Sewage Disposal System-Page 4 of 19 Commonwealth of Massachusetts _ Title 5 Official Inspection. r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 HAIViBLINS HAYWAY Property Address CHERYLJONES Owner ..__ _.-_-.._._. owner's Name information is required for every MARSTON MILLS _ MA _ 02648 OCTOBER 28, 2011 page. Cityfrown State Zip Code Date of inspection 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 ❑ M 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 ❑ Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ d Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow B. Certification (cont.) Yes No ❑ D Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑x 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. ❑ ❑x Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. t5ins•11110 Title 5 Official Inspection Form:Sutsaface Sewage Disposal System•Page 5 of 19 Commonwealth of Massachusetts Title 5 Official inspection For -- - Subsurface Sewage Disposal System Form Not for Voluntary Assessments .'° 54 HAMBLINS HAYWAY Property Address CHERYLJONES Owner ---__.._ _..._....------._... Owner's Name information is required for every MARSTON MILLS MA 02648 OCTOBER 28, 2011 page. Cityrrown State Zip Code Date of Inspection ❑ 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 DER 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ d The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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 [] a the system is within 400 feet of a surface drinking water supply ❑ ❑x 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 11 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. C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No x❑ ❑ , pumping information was provided by the owner, occupant, or Board of Health ❑ 0 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? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 6 of 19 [ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 54 HAMBLINS HAYWAY Prop"Address CHERYL ��nn ------------'- -'---------' - - — - information is required for every MARSTONMILLS MA 2011 page. City/Town State Zip Code Date of Inspection Were ms built plans uf the system obtained and examined? Ufthey xvenanot ` available note aoN/A)N/A Was the facility or dwelling inspected for signs of sewage back up? Fx� 0 Was the site inspected for signs of break out? | � E [] Were all system components, excluding the SAS, located onsite? 19 Fl Were the septic tank manholes uncovered, opened, and the interior oil the tank inspected for the condition of the baffles or tees, material ofconstruction, dimensions, depth of liquid, depth of sludge and depth ofscum? � �� [] VVaathe hacUityowYnwr(and occupants if different�omocxmnehprovided vv|Ul ^� 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, o plan at the Board of Health. �� [l ` Determined in the field any of the failure crite ria(� � ^~ approximation of distance is unacceptable)C310 CK8R 15.302(5)] D. System Information � � ��m��mm��� F��nv��m�y��m�' � . � Number of bedrooms kdemig 3 n\� ----'---- Number of bedrooms kaotua0: 3 [)E�|(3N �o�bom�don31D<�K8R15�2O� �orexarnp�$� 11Ogodx#ofbodr��nna)� 330 � D. System Information | D"s^ 'p"~ ^ � Number of current residents: Does residence have a garbage grinder? [] Yes No m�aon�ym�m��npm�u�ommwu*��owm�/s�u�'p�°rm`n a�'�nm | Commonwealth of Massachusetts ' --- W. °�����N�� �� �����0 0�������&^��"���� ����0�U��| Q ��Q�� �� q��� ���r���� �� n�����*���N��mn �-��mnnw Subsurface Sewage Disposal System Form Not for Voluntary Assessments -4WAY ' '-- '''`^-'------- -�-------'-------------'--'--'----------CHERYL Owner ope ss owner Owner's Name ----- information i's required for every MARSTON MILLS MA 02648 C>CTO8ER28 2O11_________._ ��e� ����n 8�� Ziponu* oo�,xmspmct*n Is laundry on a separate sewage system? [if yes separate inspection required) Z Yen No Laundry system inspected? Cl YeuC3 No Seamono| uoe? Yen [] No Water meter readings, if available(last 2 years usage(gpd)): OO GAL Sump pump? [� YesO No CURRENT Last date ofoccupancy: Date -----'------- Commmem:iah0mdmstrial Flow Conditions: Type of Establishment: -------'' - -�------'--'—�----------- Design flow(bam�don31O<�K8R| 1��03)� G��� �'--------- --------- '--- | ` � � �xooy0Pq � Basis of design flow .ft., atc): -- � ---------- --------- - ---- Graasebmppnwoent? 13 Yee [] No Industrial waste holding tank present? � 13 Yea [] No Non-sanitary waste discharged 10 the Title 5 system? F� Yea 0 No Water meter readings, ifavailable: ----'-� --�-------' ------------- D. Syw"~exou voxoo""""==~~n (°°'°') � Last date ofoocupanoy/uma: ���� ---------'-- -------- '-- Other(describe bebowA: �momo�mm"m�.oa��"�om°wwo�O=uor�m'p�vam� xm�^��no Official � � / Commonwealth of Massachusetts Title 5 Official Inspection or Subsurface Sewage Disposal System Form Not for Voluntary Assessments 54 HAMBLINS HAYWAY Property Address CHERYLJONES__ Owner Owner's Name information is required for every MARSTON MILLS MA 02648 OCTOBER 28, 2011 page. Cityfrown State Zip Code Date of Inspection General Information Pumping Records: Source of information: OWNER 8/11/09 Was system pumped as part of the inspection? 0 Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system Ca Single cesspool ❑ Overflow cesspool ❑ Privy. Cl Shared system (yes or no) (if yes, attach previous inspection records, if any) 0 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 C3 Tight tank. Attach a copy of the DEP approval. F-1 Other(describe): D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 9/22/09 t5ins-11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 9 of 19 f Commonwealth of Massachusetts -- - Title 5 Official Inspection Form Y Subsurface Sewage Disposal System Foram-Not for Voluntary Assessments 0 54 HAMBLINS HAYWAY Property Address CHERYL JO_N_ES Owner owner's Name - information is required for every MARSTON MILLS _ MA 02648 OCTOBER 28, 2011 page. City/Town State Zip Code Date of Inspection Were sewage odors detected when arriving at the site? ❑ Yes Q No Building Sewer(locate on site plan): Depth below grade: 1 FOOT 7 INCHES g feet Material of construction:. ❑cast iron Z 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet— -- Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tanis(locate on site plan): Depth below grade: 12 INCHES feet Material of construction: Z concrete G' metal ❑fiberglass ❑ polyethylene ❑other(explain) 1250 GALLON TANK If tank is metal, list age: year.s---- --- _..-.. --- Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) Yes ❑ No Dimensions: Sludge depth: 3-INCHES- _.--- D. System Information (cons.) t5ins,11110 Title 5 Official tnspectiw Farm:Subsurface sewage Disposal system•Page 10 of 19 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 54 HAMBLINS HAYWAY Property Address CHERYLJONES__ Owner Owner's Name information is OCTOBER 28 2011 required for every MARSTON MILLS MA 02648 page. CityfTown State Z;:;Code— Date of—Inspection- Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 2 INCHES 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 SLUDGE JUDGE, TAPE MEASURE How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap(locate on site plan): Depth below grade: Material of construction: El concrete 11 metal F7 fiberglass 7 polyethylene 0 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 Titio 5 offiCial inspection Form:Subsurface SOWE&W Disposal SYStOM•Page 11 of 19 t5ft•11/10 Commonwealth of Massachusetts Title 5 Official Inspection or s subsurface Sewage Disposal System Foram Not for Voluntary Assessments 54 HAMBLINS HAYWAY Property Address - CHERYLJONES Owner O--_......._._ .. - wner's Name information is required for every MARSTON MILLS MA 02648 OCTOBER 28, 2011 page. Cityrrown State Zip Code Date of Inspection Date of last pumping: pate D. System Information (coat.) 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 bolding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: El concrete L7 metal ®fiberglass 0 polyethylene ®other(explain); Dimensions: Capacity: gallons Design Flow: - -- W� gallons per day Alarm present: ❑ Yes 0 No Alarm level' Alarm in working order: CJ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): _.......... -- -- --- t5ins•11110 Ttle 5 Official lnspeotion Form:Subsurface Sewage Disposal System Page 12 of 19 Commonwealth • 1 of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 HAMB_LINS HAYWAY Pro perty Address CHERYLJONES Owner Owner Ow 's Name _.__...__ _.... •---- information is required for every MARSTON MILLS w MA 02648 _ OCTOBER 28, 2011 page. Citylrown _..._ -- ---... State Zip Code R34e of Inspection *Attach copy of current pumping contract(required). Is copy attached? C Yes ❑ No D. System Information (coat.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert AT INVERT Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D BOX IS IN GOOD SHAPE _ Pump Chamber(locate on site plan): Pumps in working order: 11 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): t5ins•11110 Title 5 Official InspWion Form:Subsurface Sewage Disposal System•Page 13 of 19 Commonwealth of Massachusetts -- Title 5 Official Inspection For Subsurface Sewage Disposal System Form Not for Voluntary Assessments 54 HAMBLIN$ HAYWAY -- - -- - Property Address CHERYL JONES Owner Owner's Name information is MA g2648 C�CTOBER 28, 2011 required for every MARSTON MILLS - ---_..- -- _...--- page. Cityrrowri State Zip Code Date of Inspection If SAS not located; explain why: D. System Information (cant.) Type: Cl leaching pits number: ❑ leaching chambers number: - �— leaching galleries number-22/50{3 GALLON GALLERIES ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ----- Q overflow cesspool number: a system stem Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration tsins•11/10 Title 501ficial Inspection Form'.Sudsurface Sewage Disposal Systom•Page 14 of 19 Commonwealth of Massachusetts � Title 5 Official Inspection r ASystem Form Not for Voluntary Assessments , Subsurface Sewage Disposal Sys a rY 54 HAMBLINS HAYWAY Property Address CHERYL JON_ES_ — ._._ ........ - Owner Owner's Name information is Iq 02648 OCR OBER 28, 2011 required for every MARSTON MILLS - ------ ._ ..__- -- page. City/Town _ ^ State Zip Code Date of Inspection 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 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•11/10 Title 5 Official Inspection Form:subsurface Sewage Disposal System•Page 15 of 19 Commonwealth of Massachusetts CL Title 5 Officiala r Subsurface Sewage disposal System Foram Not for Voluntary Assessments 54 HAMBLINS HAYWAY ...... Property Address CHERYL JONES Owner Owner's Name - information is MA 02648 OCTOBER 28, 2011 required for every _MARSTON MILLS__ - page. City/Town Mate Zip Code Date of inspection D. System Information (cant.) 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: Cl hand-sketch in the area below FX1 drawing attached separately Title 5 official Inspection form:Subsurface Sewage Disposal System•Page 16 of 19 t5ins•11110 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 54 HAMBLINS H AYWAY Oi&jo�eMd—re-S-S--- CHERYLJONES Owner Owner's Name information is required for every MA 02648 OCTOPE'R,28, 2011 page. City/Town State zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope Surface water t5ins-11110 Tille 5 official kspoction Foffm Subsurface Sewage Disposal System-Page 17 of 19 Commonwealth of Massachuseft Mt�Y Title 5 Official Inspection Form t a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - -` 54 HAMBLINS HAYWAY Property Address CHERYLJONES Owner Owner's Name information is Mp, 02645 OCTOBER 28 2011 required for eve MARSTON MILLS , - - page. Cityrrown State Zip Code Date of Inspection (� Check cellar n Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: FX-1 Obtained from system design plans on record 9112/09 Dat ee If checked, date of design plan reviewed: . ❑ Observed site (abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: F� Checked with local excavators, installers-(attach documentation) SGS database-ex Q Accessed U lain:p You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next Waage. Title 5 Official In$peotion Form Subsurface Sewage Disposal System-Page 18 Of 19 t5ins•11f10 Commonwealth of Massachusetts --_ Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 HAMBLINS HAYWAY Property Address CHERYL JONES _ -_-- ----- Owner Owner's Name information is requi red for every MARSTON MILLS MA 02648 OCTOBER 28, 2011 _.._._.. .._._ page, Cityrrown _ state Zip Code Date of inspection E. Report Completeness Checklist 9 Inspection Summary:A, B, C, D, or E checked FE Inspection Summary D (System Failure Criteria Applicable to All Systems)completed Z System Information—Estimated depth to high groundwater Ej Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file Tale 5 offxial Inspection Form:Subsurface Sewage Disposal System•Page 19 of 19 t5ins•11/10 s'(C> �1 F 13. 3 fib' http://town.bamstable.ma.us/Assessingll-iMdisplay.asp?mappar=045005&sect=2 10/24/2011 TOWN OF BARNSTABLE .LOCATION � �, /'��•� ��/N-S ftAJ SEWAGE# 0 ^VILLAGE /ar fps ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. f t4L.I s'o d� SEPTIC TANK CAPACITY LEACHING FACILITY.(type) a-c, ; (size) NO.OF BEDROOMS OWNER - PERMIT DATE: •-j is COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Talile to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any we s exist on site or within 200 feet of leaching facility) Feet Edge'of Wetland,and Leaching Facility(If any wetl s exist within t;300 feei of leaching facility) Feet FURNISHED BY B' 7 No. o�—3®-z' i . ' Feel /00, i THE COMMONWEALTH OF MASSACHUSETTS }Entered intcomputer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Disposal *p8tem Construction permit Application for a Permit to Construct( ) Repair(14) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Abdtrg�Sr of Now+'r S �S I S O n am Ad ress�and Tel.No,,1 ._' -(p 631 ssessor's Map/Parcel 5`7 Oy 1 14 Installer's NXne,Address,and Tel.No.�-7115--�17`7(o Designer's Name,Address,and Tel.No.�9 16 4-0 eY LiEf tic, T3 cam• Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided S 30 .d Y gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ��S` Qom. a_ �neA j'T i !s �e&ej , 5�- f 1 (14�1 Q lQun� T l a S - 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 an of to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed `1L Date 9 Application Approved by �. ��.S, Date Application Disapproved by Date for the following reasons Permit No. LVy ' -3©Z Date Issued �— .,,. .. �... ..^.^,rv,•.i.�v.�r+5,�• ...r r ;,,,�'4:,.,r•T.R..;tsi+.-�,..r�,i,;`7'«n++W,+�..«.....N+"'" ..,�;�-w��VK,. ,�;ia��r...^y-,y ,,•`*..^-1 C ..a-......_r�. .. � .�.... . ..•--;.._... ,.r. ._ L" / soZ Fee ` THE COMMONWEALTH OF MASSACHUSETTS 'Entered i i�'omputer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE- MASSACHUSETTS Yes 2pplication for Misposal Opstem. Construction-])ermit Application for a Permit to Construct( ) Repair M Upgrade(' ) Abandon( ) ❑ stem Complete Sy stem y ❑Individual Components Location pAddrpss or Lot No. I Owner's Name Ad e s and T .._.Tel.No a� •(g7J5 Assessor's Map/Parcel Li T j o5 5,1 "62 45 ;(S pa-q 4Ya-Ioarz, 5 Installer's N�ttnne,Address,and Tel.No 7 7 5-�'7`>(o Designer's Name,Address,and Tel.No.,r5D$--36 y-0&9 9 4 tr E. i'N"i N S", Sr SZ c, LO—--ToC.(1 Ll) b" 1Qq% CaQ4tiQ4t1-- I W-5 -T Z I Q-1 0C- 0 'k rL�e Qk Type of Building: Dwelling No.of Bedrooms z Lot Size sq.ft. Garbage Grinder(OP, Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 J Q gpd Design flow provided 3 Q ,Q L f gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Aj Nature of Repairs or Alterations(Answer when applicable) CQ ne,-u "T', $- e- 5 C . 3 v � Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code an not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed ' �``"+ate ��+� '� Date Application Approved by .S, Date Application Disapproved by Date for the following reasons Permit No. -3 Z Date Issued 9 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 W^` E Rutn'� L. at rj4 NS V�Qul been constructed in accordance with the provisions of Title 5 and the for Disposal System Constr 3o? dated CI ` 16— 0f Installer �2_U?__i oSo N Designer eL p — T I c 1-A #bedrooms Approved design flown.3 So gpd The issuance of this permit jshall not be construed as a guarantee that the system w I fu cti�ol�Jas designed. G, Date Inspector - ------- --------- ------ -------------- ------------------------- No. ZOOl— 302 Feeq THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at �� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit./, Date l �� y Approved by ham-- 4 ���. Town.of Barnstable -/,;L 70 ,XY~ Department of Regulatory Services • ST HAMM Lr, : Public Health Di vision t 2 26d Date�P t619 ,b� 200 Main Street,Hyannis MA 02601 Date Scheduled ' Time Fee Pd.' -` - - Soil Suitability .A,.ssessmentfor.Sewa e :his os �� p g P al' Performed By: a Cv,f6 M ,,,Wy AQ i Witnessed By: -�irtt4��l LOCATION & GENERAL,Location Address �j INFORMATION n y �S mr Owner's Name(/ylf, i y�r Address. Assessor's Map%Parcel: ('" t Engineer's Name 0%11/4 covl CIllgwr NEW CONSTRUCTION REPAIR r rJ �[ - , Telephone# D 3W/¢ -0 T Land Use Re5e1a ctorOl� �(4ftrn Slopes(%) o Surface Stones V1 0 �e Distances from: Open Water Bodytoo ft•} 100 + Possible Wet Area ft". Drinking Water Well (0 6 ff[ .r Drainage Way �0 4 ft Property Line D__ft I Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in Proximity ty to holes) y f: ,s 0 0 --� ' GROUNDWATER ADJUSTMENT I r I EXISTING GROUNDWATER LEVEL' BASED ON TOWN OF BARNSTABLE /�Z - ®T® Im 1t GIS DEPARTMENT RECORDS. - 4 TP I1 11 2 ti INDICATED GW 52.08 INDEX WELL SDW-253 ml ZONE B READING DATE AUG 2009 t I READING 49.7 ADJUSTMENT 3.9 ADJUSTED.GW 55.9 Parent material(geologic) rorala a I DV 1 Depth to Bedrock C Depth to Groundwater. Standing Water in Hole: U)oRe n�,�, r,, Weeping ti•om Pit Pnee Kati Estimated Seasonal High Groundwater ;Ce CIYJ©�e DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 5?ee 4190 U Q Depth Observed standing in obs.hole: Depth to weeping from side of obs.hole: tn, Depth to soil mottles: Index Well# In, GroundwaterAdjdstment f . Ad,factor Reading Date: Index Well level� ft - AMj.Groundwater Level , TEST bate q 1!'Ioq Time, Observation PERCOLATION TE • Hole# I ` Time at 9" G y Depth of Perc -�7 —`— Time at G' Start Pre-soak Time @ Time(9"•6") End Pre-soak — Rate Min./Inch pl Site Swtability Assessment: Site Passed f Site Failed: Additional Testing Needed(YIN) — �'t Original: Public Health Division Observation Hole Data To Be Completed on Back--- s �. per testis to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC TEST 'LOG' .,. . , � O G =DATE' OF ,TEST: SEPTEMBER 11."2009' . SOIL EVALUATOR: DAVID' D. COUGHANOWR. R S. .,-,' SOIL WITNESSED; BY: , DONALD DESMARAIS. HEALTH DEPTk - PERC NUMBER: 12703NO TEST PIT I PAARENOTUNDWATE MAATERIA ENCOUNTE PROGLACA LED OUTWASH--' PERC AT 72 in - 2 MIN/INCH IN C :SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE ' (MUNSELL) - MOTTLING 104.20 0-9 Ap SANDY LOAM — -10 YR 3/3 NONE , FRIABLE 9-45 8 LOAMY SAND _10„YR .5/6 NONE FRIABLE 100.45 - - - 45-136 C, MED-COARSE SAND 10 YR 6/3 NONE LOOSE 92.70 NO TEST PIT 2 PAARENOTUNDWATE MAATERIA ENCOUNTE PROGLACALD OUTWASH 2 MIN/INCH IN C SOILS i ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 104.10 (INCHES) HORIZON TEXTURE_ - (MUNSELL) - MOTTLING _ 0-B Ap SANDY LOAM. 10 YR .3/.2 NONE FRIABLE 1 6-42 B LOAMY SAND _ 10 YR 5/6 NONE FRIABLE 100.60 42-132 C MED-COARSE SAND 10 YR 6/3 NONE LOOSE 93.10 s DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i5tency,3' Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.)' (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, I I� Flood Insurance Rate Map: Above 500 year flood boundary No— Yes z Within 500 year boundary No 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? _ye S If not,what is the depth of naturally occurring pervious material9 Certification I certify that on S (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consist the required training,expertise and experience described in 310 CMR 15,017. N OF�Ss9y Signature '"� I Date SPpq 20 DAVID c�N D. " COUGHANOWR coo �O ��CENSEO Q. QAS,BPTiCT RCFORM.DOC ,� E VA LU N' Town of Barnstable �00HE. L Regulatory Services ' Thomas F. Geiler, Director ASS.MASS. x Public Health Division y M °rf019. A Thomas McKean, Director 200 Main Street, Hyannis,:MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: ~� 2�G Sewage Permit# gG Assessor's Map/Parcel L45, (OS Installer& Designer Certification Form Designer: e� Installer: L)r" IE� �p��J��vw �tC_ Address: �� �(Zi Csw•q`e. C��rl� Address: G&\4exy,I.U_ On � ate � was issued a permit to install a (date) `� (installer) septic system at 59 NO.A-Alo� based on a design drawn'by (address dated (designer) 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 require inspected and the soils were found satisfactory. NOFMA� DAVID D. (Installer's Signature) COUGHAN01NR No. 1003 C�1 �—S �i TAR1!' (Designer.'s Signature) (Affix Desig3 tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\desio ercertification form-doc Sewage Permit No. Location: ;-r Village: r� Installer's Dame A Address: - Z xrA };l ; � O-e A/ Builder's Name c& Address: j4rMG Ae,0/�� Date Permit Issued - j% 14 Date Compliance Issued •� � � ���� ,% !`��S< , � � '� � / '�, � ® L��x �a`T _ �,; �. a !� r ti 1vo.Cl.!..�J�aJ:. � •' � Fps.....-..:`�....;a y O O THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH b `[ ► ...............oF........ 5 . A11.0rattun for Dtsituuttl Works Tian trurttun Prrutit Application is hereby made for a Permit to Construct ()oe) or Repair an Individual Sewage Disposal a( ) g System at: Location-A dress or Lot No. ...1 ?. t ?-S--•----•---------- --------------------------------------------- ....................................... �yvner ��` Address a •-----•...........................•••--••••••fj/__.d1�, "1"__'._.............._.....---... ---......--•---•---------------------•----•-•----....---•-----._.....---------•---•---......------ Installer Address d Type of Building Size Lot_7- ...Sq. feet U Dwelling No. of Bedrooms.___._______ .......................Ex ansion Attic� g— p (�.. Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons......._.................... Showers ( ) — Cafeteria ( ) dOther fixtures ----------------------------------------•------------..--.-••---------------------------...---------------- /}� w Design Flow.................55_____.___...____.gallons per person er day. Total daily flow_�"_X__��d.____'X-��___.gallons. W Septic Tank—Liquid capacity_�`,�_gallons Length__:7 Width__ .._ Diameter__ p ' !' x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No.....7i--------__ Diameter.__.__.......... Depth below inlet... .._________ Total leaching area__.4911�n__sq. ft. z Other Distribution box Dosing tank ( ) �� aPercolation Test Res Performed by ,�t ��-___. ____________________ Date____ `____ _. ,.1 Test Pit No. 1________________minutes per inch Depth of Test Pit---J________-____._ Depth to ground water..../J__________ f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-------------------.....................................------•---• ---------•-----------•---------••---------------•---------••--•----...---•------------ 6 ' L 6?¢y.1 0- 'S $�t� O Description of Soil ------ �--•----------•----•-----•---------------•--------------------------•--------...................................................... UNature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------------------------------------------------•--•-----•------•---••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Co e—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee sued by b rd of health. ed ----•- _..._ .. _ --- D ApplicationApprove - -•-- ----------------------•--........----- ..._.._..._.....--------------------•. - --- -------- Date Application Disapprov or following reasons_____________________•____________•_____________________•___-----------._____________-_.--__..._.__............._ .....................................•------------...--------....._........-----.....__.....-------------.------------------------••---------------------••-•------------••----•---------•-•----•-••----- Date PermitNo......................................................... Issued........................................................ Date ------------- I` No :! . '..:. FE$...`:....... ................. ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................... ................................................................ Appliration' for Disposal Norks Tonstrudion Prrmit Application is hereby made for a Permit to Construct (y) or Repair ( ) an Individual Sewage Disposal System at: ........................................................ Location-A_ddressj ..`? '� �� 1- or Lot No. _.................. _._..._........._....... ............ ....... ......... W Owner Address a --------••-•..............•--------•-......------------•---.........__.........._................ •-•-•--•-•----------.._.._..__._........... Installer Address Type of Building Size Lot .. ......Sq. feet I—, Dwelling—No. of Bedrooms............. ___________________________Expansion Attic ( •) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow.................. .......................gallons per person per day. Total daily flow.x__���.__'_. :1_U......gallons. WSeptic Tank—Liquid capacity4Z-5,Pgallons Length_—P" Width. _�. __ Diameter...- _______. Depth.�5_ 2_, x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.---.?------------- Diameter___.R_1......... Depth below inlet---f_.`.......... Total leaching area.:Ab.Q"----sq. ft. Z Other Distribution box O,Q Dosing tank ( ) �' � Percolation Test Results Performed by.____�/f?) =_____ ........................................ Date----_••----------- --••---•-•-----•- Test Pit No. 1_G_4�__-_.___minutes per inch Depth of Test Pit... %__.__._____ Depth to ground water..-l...Crr) __. fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil..................._- 22 I..._ '�` � � �� -' V .._...••---•••••--••••---•---••----•--•---•-•---- ..'----�'-.-.--...G alt/'4-`7L� J/17"�3[7 L`1� '11x,( ,_- Ll�?.I�ZIIS-�•-•-- W ----------.. •--••••----•••--------------•------•-----••------••••--•••---------•-•••--------•••------••'•.............................. ---------•••-----•••----•-••••••--••••••--•._...•--•-••--••-•......-------- 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 TME 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 by the board of health. ned..................................................... - Application Approved y. -- ---------- ==`�'; Date Application Disapproves f or ollowing reasons:............................................................................................................ Date PermitNo........................................................ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF Trr#if iratr of Tomplianrr THIS IS TO CERTIFY, That the Indavid al Sewage Disposal System constructed or Repaired ( ) by................. --- P►> { •..4? e" ..l...... Install.r .............•----------......-----•........•..... ^_^_--^-...----..- ` A� has been installed in accordance with -le prov> Lyw_..5 ol�T Tate Sanitary Code as described in the application for Disposal Works Con tructi©n I mit i T ._ ! J dated________________________________________________ THE ISSUANCE OF THIS CE ICAT SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............... ....... '1 :- ........ Inspector......... , ' le.�..-------------...._........------.....-------•------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C ..-.......OF.......... ...... No., �. FEE.__...... ......... Disposal Works ons r Vvrrutit Permission is reby gr,,a ted.__.. ----- ---------------•----........................................................ Construct. ore a/i>r ( )fan, dividual Sewage Disposal System at No 2,.: -r`:. 4�------------------.•-••-----------•-••••-'-••••-••--•-- ---------------------------------------------------- /�r- ^- is c. Street as shown on the applicatio for Dispos Works Construction Permit rNo.c'`"-`_"�_____ Dated.......................................... 7 Board of Health DATE...........__-�.._�-----------------•----------- FORM 1255 A. M. SULKIN, INC., BOSTON . •r .. x'y i •reM1 ..pf ! t - i1 - ;j({ �• �/��//,}�% /y.�. x; .;F ..• . `SFr a f� rp��.A�f * Q r=. j •. /ij���,�./ "-w� („9 '•t i•(`¢` ,a�x ';f t 3. /per .. `i' (' ��y//� '•(" w' - .. >d• Try d • •q S �}•.*• f.f-x :.n' ` ;. 1 '�1' ; ! � x"i 1 - ` �� n ! December,21 19 78 �e... x sis 7' *?• i .,,i i. 4. .:S ,.�. ,'° t:. . r`r�.. TR. : .a, Mr. Eari Haines �k`'F P. 0• Box 1 0 a y * s x r East F De'rinzs; Mas:sachuset'ts '0264I Re T, L'ot� 20 ` Hamblin's Ioi�.ow, Marstons Mills Dear Mr:` Haines. - Your nre� ue •t� �~ °4x ^ * r y q s for, an, extension of Mime"tfor.�theµvar ances;pre- - ,,, viously,,granted .you to install a sewage system` 10.U, feet from' Y- a{ well in lieu of " e requ�red i ISQx feet on Lot 20, iamblin s H611ow; -Marstons: MlY1s fs granted. '- f Ths, extension'- eXpires December 1, 1979: '' All, ;other `conditansX ` r outlineel in ou M r etter to youdated November .17, 1977 .` apply Very truly yours °' a • y e y ... �'.�,t '/ �,s"s x '�'`` •a. W3 � `r � ,: is 3 � r•y - - .: ne ••h i * "R �t '�,i.v a¢ hC • iw fx� A an ES au xrman S,. t Robert' . eniias a� M `stata 11 M, D.� � '� °� f• "+ ,, ,L1 _ � �:y BOXIRD 'OF ;HEALTH'�, � :1,, � - � $ ._�,j � `���;� ,} ,�;;F•F - � x,- = TOWN OF„` SRNSTABI,E •3 r. bi Y. It y k. s, }'• Ste. � '� « `�- ..�•. .. T� A ,wai s .•; - y •'� }`" -( ,+.y - ,4f a' � ' ie-,r ti � ¢— o / � �^�h4 c� I it � � TOWN OF BARNST<•ABLE t, OFFICE OF .L { 111 6 " , ill,•. BAHalTABL a 9 BOARD OF HEALTH 307 MAIN STREET ; w# HYANNIS MASS. oaaol ti S ;, November 17 19 77 , she:. k, o � �. •, n:..i.1, Mr: Earl 1 Haines i t 1 I { Ilfti' M i'4 J �F 1 r t r P. 0. Box 409 East .D Dennis, Massachusetts 4' ik t r I 4 Dear Mr. Haines. , ye You are'°granted 'a conditions var.i �. e; td . nsta�.l�.,;'aewage;,., leaching facility, 100 feet fr..,Om a well! in,.lleu__Qf_thP__rc , _ _ l50 feet on Lot°2-0, Hamblin' Ho w • __ s ns,Mills s lho Mar to � _qt. '. P {; ;irV t ', a The varyance is contingent on the „site assiri P g`percolation`, q° fir tests imsthe ' area` sewage dill be' iristafled, = An. engineering" '" q 4 4 plan meeting all: other;;,Town of Barnstable Health regulations '�. a+ ' and regulations ,.containedT in' Title 5,.::pf the S,tafe Environ �`'" e;1 4 q mental ,Code must be approv ed prior to���anY construction. � k ti Th ri°ance, expires', Dec t 14 T918 V ry, t my your r r rl� R er hills , Chairman k , Ann Jan Eshb g4 . Mandelstam, M; D. A, BQA RD.:OF HEALTH a 'JMK/mm f r 41, It r" ... a n , �1 r �. ^.. ,. •}> ;1:>I�r I.. # F r ''`fit E. j i , ' a �',..ao➢nf rY�i'k, .I�q{� ,U�p�►aar"sl..l,.,.� sswT...—+.e.�....,a....^-_____. ,s :.r. .a.,i .Id .i:. 104 , 198.62�Ft -104 ROAO G SCHOO I � � a SHED SHED (\ N ° -LOCUS I I I u I = HAMB�INS B I \ I J HgYWigY cDL � \ � 24 Ff. x 12.5 FL x 2 FL ROA � � M W I L E�1 CHING G.�L L ER Y= \ I ARSTONS MILLS. MA �J 102 I GATE STON DRIVEW/1 Y I I LOCUS 0 ►�/� C� (_ S I I AP IWATER G,1S\ NOT TO SCALE \ GATE LINES \ / : BENCH MARK 11 km 30 Ft \ PAINT SPOT ON LEGEND LIVE ® BULKHEAD CORNER EXISTING I m �al C3 m ® TP-2 ELEVATION = 184.90 N 1250 GALLON ��- n �rn O O BARNSTABLE GIS DATUM SEPTIC TANK C) TP-1 rn N�� � O � Q C\\] I EXISTING LEACH I -Ti F � \� �I6-O I PIT/CESSPOOL � \ I + O ' O 103 Z Z O / TEST PIT D-BOX O � 1 0 m \ \ \ DECIDUOUS CONIFEROUS TREE o00 TREE d4012-M �12-P O I I \ dpb I07� 1 R1 -NUMBER REFERS TO DIAMETER IN \ \ I INCHES. LETTER DENOTES TYPE. 100 LOT 2PJ D I ` O-OAK M-MAPLE P-PINE C-CEDAR I � - \ \J \I \ C>O_c�/ AREA = 24500 --F' +- c I \ c16P IB-O 102 I GARBAGE GRINDER \ IS NOT ALLOWED WITH THIS DESIGN. -- J 100 195.78 Ft FLA \ CONTOURS ALL PIPE ESPECIFIED ARE INVERT F-L_OW PROF-IL_E EXPRESSEDLATIONS INV DECIMAL FEET NOT FEET AND INCHES.TIONS EXISTING - - - - - - - 50 TOP OF FOUNDATION RAISE COVERS TO WITHIN SIX INCHES OF FINAL GRADE � SCALE: 1 1n = 20 FL MINIMAL GRADING PROPOSED ONE INSPECTION RISER FOR LEACHING GALLERY TO EL = 105.71+- WITHIN 3 INCHES OF FINAL GRADE AS INSPECTION PORT. - �: 20 0 20 40 �® = pEO SEWAGE DISPOSAL SYSTEM PLAN 104.20 � -TO SERVE EXISTING DWELLING 0 10 20 EST. TIMOTHY & CHERYL PECKHAM ALL PIPE TO BE i /D-BOX MAX SCHEDULE 40 PVC OWNERS OF RECORD 3 DROP �l AND TO .PITCH AT - 1/8 to/ft MIN. y d 54 HAMBLINS HAYWAY FLOW LINE � 101.20 OFIy 10-- 14. !� � �j� Assgc �Z"OFMASSy �� 1995 MARSTONS MILLS. MA PRECAST a �02 DAVID yGs o'�� ID csa ����� PROPERTY ADDRESS 48" GAS F .� D. a �. BAFFLE DRYWELL o -+ D. -+ BOTTOM OF v N v ASSESSORS MAP 45 PARCEL 05 101.95+- STON LEACHING COUGHANOWR COUGHANOWR 43 TRIANGLE CIRCLE EXISTING 100.60 LEACHING G,''�LLERY No. 1093 SANDWICH MA 02563 PLAN BOOK 206 PAGE 135 EXISTING 100.77 BASE 'QF Fib s 11 O Q 506 364-0894 EXISTING GALLERY c,s eR o, CeNSE o DATE, SEPTEMBER 12. 2t�Jt�JJ EXISTING 1250 GALLON 100.45 (END VIEW) 98.45 5.00 ft * 3q I A ` EV VP� / �� JOB #ETE-3225 PAGE 1 OF 2 VERSION: SEE DETAIL ON REVERSE (-- THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED EXISTING SEPTIC TANK 15 ft al 5 ft 12.5 ft. SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM bl 12 ft feV4ber i 2-00 7 DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING ADJUSTED SEASONAL-Z- S5.90 PLACEMENT OF ADDITIONS. SHEDS, FENCES OR SWIMMING POOLS. OWNER HIGH GROUNDWATER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. ATE OF TEST: SETEMBER 11. 2009 SOIL T.E S T O D DO L E ALUATOR: DAVID D. COUGHANOWR. R.S. DESIGN CALCULATIONS WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. PERC NUMBER: 12703 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD NO TEST PIT 1 PARENT UMAATER AL NDWATER ENCOUNTERED OUTWASH SEPTIC TANK: AE EXISTING 250 GALLON SEP6TIIC TANK 60 O IF SOUND STRUCTURAL PERC AT 72 in - 2 MIN/INCH IN C SOILS CONDITION. IF NOT INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER DISTRIBUTION BOX: USE 3 OUTLET D-BOX. (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 Ft LEACHING GALLERY CAN LEACH 104.20 A6ot = ( 24 x 12.5 ) = 300 sf 0-9 Ap SANDY LOAM 10 YR 3/3 NONE FRIABLE Asdw = ( 24 + 24 + 12.5 + 12.5 ) x 2 = 146 sf 9-45 B LOAMY SAND 10 YR 5/6 NONE FRIABLE Atot = 446 sf 100.45 Vt 0.74 x 446 = 330.04 GPD 45-138 C MED-COARSE SAND 10 YR 6/3 NONE LOOSE 92.70 USE A 24 Ft x 12.5 Ft- x 2 FL GALLERY. Vt = 330.04 GPD > 330 GPD REQUIRED NO TEST PIT 2 PAARENOTUNDWATE MAATERIA EPROGLACIRALD OUTWASH 2 MIN/INCH IN C SOILS ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER L EA CHID)G GA L L ER Y (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING USE SHOREY PRECAST 500 GALLON NOT TO 104.10 LEACHING DRYWELL (H-10 LOADING) SCALE 0-8 AR SANDY LOAM 10 YR 3/2 NONE FRIABLE 8-42 B LOAMY SAND 10 YR 5/6 NONE FRIABLE CONSTRUCTION DETAIL 100.60 42-132 C MED-COARSE SAND 10 YR 6/3 NONE LOOSE DRYWELL UNIT STONE 93.10 - 2 4.0 FL m � GROUNDWATER ADJUSTMENT � ;� LO EXISTING GROUNDWATER LEVEL DISTRIBUTION BOX BASED ON TOWN OF BARNSTABLE m� G I S DEPARTMENT RECORDS. DIMENSIONS AND DETAIL USE SHOREY DS-3 H-10 m c. INDICATED GW 52.00 3.5 Ft 8.5 Ft- 6.5 f t 11 .5 t INDEX WELL SDW-253 24.0 f t ZONE B READING DATE AUG 2009 NOT TO READING 49.7 SCALE MIN ADJUSTMENT 3.9 500 GALLON DRYWELL ADJUSTED G W 55.9 f FROMTANK < < TO DIMENSIONS AND DETAIL � SAS0 USE H-10 UNIT INSTALL ONE INSPECTION 6 1n STONE BASE RISER TO WITHIN THREE 1INCHES OF FINAL GRADE IS , CROSS SECTION VIEW AND INDICATE LOCATION ON AS-BUILT PLAN 5 NOTES 00 33 1) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. oa��oo��oo� OOp�� In 2) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED 000aooaoaao FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. �g 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS 101? In OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND;,UTI LIT IES CROSS SECTION VIEW BEFORE EXCAVATING FOR SYSTEM. a{ "-� SEWAGE DISPOSAL SYSTEM PLAN 51 EXISTING LEACH PIT TO BE PUMPED. COLLAPSED,hANO+'.FILLED- OR REMOVED. 2ln PEASTONE 2 to PEASTONE 6) ALL STONE TO BE DOUBLE WASHED AND FREE OFI IRON! FINES;AND DUST IN PLACE. -TO SERVE EXISTING DWELLING 7) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTAL' L'ATION Of LOW FLOW FIXTURES 24in TIMOTHY & CHERYL PECKHAM 28 3/4 u, TO EFFECTNE 3/4 u, TO 26 AND APPLIANCES. AND BIANNUAL PUMPING OF �THEaSEPTIC' Tl_ NK. In -v2,,c vEl DEPTH -/2,,c AVEi In 6) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICUL''ARI OADING. DO NOT -`" ;; , 54 HAMBLINS HAYWAY MARSTONS MILLS. MA PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM:• '<" �' ,� i •� 46 in 58 In 46 In ECO-TECH ENVIRONMENTAL 9) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL 150 in STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND, ON-TO WHICH INSTALLER MAY SUBSTITUTE AN APPROVED GEOTEXTILE 43 TRIANGLE CIRCLE SANDWICH MA 02563 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED`TO' MINIMIZE` UNEVEN SETTLING. FABRIC IN PLACE OF THE 2 in. PEASTONE LAYER SPECIFIED. 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