HomeMy WebLinkAbout0009 HI RIVER ROAD - Health 9 Ili River Road
Marstons Mills
A = 059 003
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1
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
+- I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments €`
9 Hi River Road
Property Address :
James&Julia Holler
Owner Owner's Name sir
information is Marstons Mills Ma 02648 10-2-19 `
required for every ,-_.''
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information
on the computer, Brett Hickey
use only the tab
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
374 Route 130
Company Address
Sandwich Ma 02563
City/Town State Zip Code
(508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above;the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑■ Passes
2. ❑ Conditionally Passes
, 3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
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a®teMe�Ey B-tlN1 J
Brett Hickeya�- -�e ����B 10-2-19
t5et..2BIB t00J B>'%:t]LIVO'
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
: regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
TC'e
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
« fi t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
io Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3,or 5 and all of 4 and 6.
1) System Passes:- .
4
❑■ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
The system was in working order at the time of inspection.
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
III the Board of Health, will pass.
Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND(Explain below):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18
�`\\ Commonwealth of Massachusetts
(P Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
a '
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR .
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
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r
Commonwealth of Massachusetts
� Title 5 Official Inspection Form
I o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will 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.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or
El M clogged SAS or cesspool
99 P
El ❑
Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
c � Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1°
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ o Liquid depth in cesspool is less than 6"below invert or available volume is less
than '/2 day flow
❑ Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ El Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ El 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 water supply
well.
❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ El 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 2000 gpd-
10,000 gpd.
❑ The system fails. I have determined that one or more of the above failure
El
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
.a; necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
El ❑ 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
Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection
El Area—IWPA)or a mapped Zone II of a public water supply well
„r.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
s
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered"yes"to any question in Section CA above the large system has failed.The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
Yes No
❑ 0 Pumping information was provided by the owner,occupant, or Board of Health
❑ 0 Were any of the system components pumped out in the previous two weeks?
❑ El Has the system received normal flows in the previous two week period?
El El
Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ElWere as built plans of the system obtained and examined?(If they were not
• available note as NIA)
❑ El Was the facility or dwelling inspected for signs of sewage back up?
El ❑ Was the site inspected for signs of break out?
El ❑ . Were all system components, excluding the SAS, located on site?
El ❑ 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?
❑ 0 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 SAS stem Absorption S on the site has
P Y (SAS)
been determined based on:
0 ❑ Existing information. For example, a plan at the Board of Health.
❑ ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable)[310 CMR 15.302(5)]
t5insp.doc•rev.7/2 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
Commonwealth of Massachusetts
1- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Hi River Road.: ..
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
5 4
Number of bedrooms (design): Number of bedrooms(actual):
642/GPD
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Description:
0
Number of current residents:
Does residence have a garbage grinder? ❑ Yes 0 No
Does residence have a water treatment unit? ❑ Yes Q No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No
information in this report.)
Laundry system inspected? ❑ Yes ❑ No
Seasonaluse? ❑ Yes (E No
See below
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
F
***WELL WATER***
4 Sump pump? ❑ Yes [E-1 No
. -^' Last date of occupancy: 1 year agoDate
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
,Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(9Pd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Owner- date of last pump is unknown
Was system pumped as part of the inspection? ❑ Yes ❑■ No
If yes,volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
c Commonwealth of Massachusetts
�. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
y (p
u
"9 Hi River°Roatf'
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
El Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no)(if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach'a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed(if known)and source of information:
1997 per plans
Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
. a - 21611
r•F.
Depth below grade: feet
Y �
Material of construction:
❑ cast iron 0 40 PVC ❑ other(explain):
' Distance from private water supply well or suction line: >100' from well to SASfeet
xf
Comments(on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
Commonwealth of Massachusetts
9 Title 5 Official Inspection Form
1a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
116"
Depth below grade: feet
Material of construction:
❑■ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
1
Dimensions: 500gallons
211
Sludge depth:
3411
Distance from top of sludge to bottom of outlet tee or baffle
On
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
measured
How were dimensions determined?
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank was in working order at the time of inspection.The tank is not in need of pumping
at this time but should be pumped every two years for maintenance.
15insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 18
Commonwealth of Massachusetts
�M Title 5 Official Inspection Form
11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1'
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 10-2-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
NA
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments(on pumping recommendations, inlet and outlet tee or baffle.condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
NA
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u
j 9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level_' Alarm in working order: ❑ 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
9. Distribution Box(if present must be opened) (locate on site plan):
Orr
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
The d-box was in working order at the time of inspection.
t5insp.doc-rev.7/26/2018 Tide 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts -
�� Title 5 Official Inspection Form
'f Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Hi River Roatl
. . . .
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber,condition of pumps and appurtenances, etc.):
NA
I
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
- (2)with 3.infiltrators each
0 leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 18
t
Commonwealth of Massachusetts '
Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
L
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS)(cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
The SAS was in working order at the time of inspection. Leaching was dry when viewed.
12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
NA
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil signs of hydraulic failure, I v el of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/2 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
s Title 5 Official Inspection Form
I o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (coot.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑■ hand-sketch in the area below
❑ drawing attached separately
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• t5insp.doc•rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection. Form
i9 Subsurface Sewage Disposal System Form Not for Voluntary Assessments
RHiRiver.Roadl
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
Materials of construction: NA
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
9 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Me 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
�■ A. Inspector Information: Complete all fields in this section.
■� B. Certification: Signed& Dated and 1, 2, 3, or 4 checked
❑■ C. Inspection Summary:
1, 2, 3,or 5 completed as appropriate
4(Failure Criteria)and 6(Checklist)completed
❑■ D. System Information:
For 8:Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
r I
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
9 Hi River Road
Property Address
James&Julia Holler
Owner Owner's Name
information is Marstons Mills Ma 02648 10-2-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑■ Check Slope
❑■ Surface water
0 Check cellar
❑■ Shallow wells
Estimated depth to high ground water: No GW @ 13'feet
Please indicate all methods used to determine the high ground water elevation:
0 Obtained from system design plans on record
1-7-97
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation.hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
A plan on file at the local Board of Health was used to determine high groundwater.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Health Complaints
05-Oct-04
Time: 10:56:00 AM Date: 10/5/2004 Complaint Number: 17763
Referred To: DONALD DESMARAIS Taken By: DENISE WITTER
Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH
Article X Detail: UNSANITARY CONDITIONS
Business Name:
Number: 9 Street: Hi River Rd
Village: MARSTONS MILLS Assessors Map_Parcel:
Complainant's Name:
Address:
Telephone Number:
Complaint Description: Anonymous letter and pictures about trash at
this location. See attached letter.
Actions Taken/Results:
Investigation Date: Investigation Time:
�
Barnstable Board of Health
Barnstable,MA
September 18, 2004
To whom it may concern:
I LIVE IN MARSTONS MILLS ON RIVER RIDGE ROAD .WHILE WALKING THROUGH
THE WALKING PATHS IN MY NEIGHBORHOOD, WITH MY SISTER AND OUR DOGS ,
MY DOG DECIDED TO GO OFF ON HIS OWN WE WENT LOOKING FOR HIM. WHEN
WE FOUND HIM WE CAME ACROSS A SITE THAT WAS VERY DISTURBING TO US.
IT APPEARS THAT SOME ONE IS STORING AND DUMPING HAZADOUS MATERIALS
IN TO THE ENVIROMENT IN WHICH WE LIVE .AFTER READING MANY ARTICLES
ABOUT THIS,ESPECIALLY AT THE MILIARTY BASE IN OUR AREA I AM QUITE
CONCERNED ABOUT THIS.I BELIEVE THE ADDRESS OF THIS PROPERTY IS 9 HI
RIVER ROAD MARSTONS MILLS .I HOPE THAT THIS MATTER CAN BE LOOKED
INTO AND THE NECESSARY STEPS BE TAKEN TO STOP THIS .
I HAVE ENCLOSED SOME PICTURES TO SHOW YOU
A concerned neighbor
CC: DEP
Cape Cod Standard Times
AsBuilt Page 1 of 1
"'N ur I$AKN3IADLL n
^�TION �bT ft� Qi"OZ ZAPSEWAGE# l/�
/7 VILLAGE 10ARSTcNS M 14LS ASSESSOR'S MAP&LOT MAf'S9 1st:
INSTALLER'S NAME&PHONE NO. m f/Dcc�72 — 833'637�
SEPTIC TANK CAPACITY /S06 9�
LEACHING FACILITY: (type) - 4,P1i-7 io2 (size) lv�� 6PD
NO.OF BEDROOMS 5'
BUILDER OR OWNER M CMt c E2
PERMITDATE_ .3 'ZS r 97 COMPLIANCE DATE: �— "9 7
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist 18 q
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 fa iGty) / Feet
Furnished by on
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'TOWN OF BARNSTABLE 100 ,
LOCATION eD� ��✓ ��� SEWAGE # q1
VILLAGE MA-IZmm; A91"_6 ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /6W 9�
LEACHING FACILITY: (type) Z,1JP1e-Trz4}ro/L (size)
NO.OF BEDROOMS S `
BUILDER OR OWNER
PERMIT DATE: .3 " Z S e 9' COMPLIANCE DATE: — 6 0 9 7
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist q
on site or within 200 feet of leaching facility) l8/ Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching f/aifility) A11A Feet
Furnished by
y
A•C K 6� !-�a u5,�
1
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ASSESSORSMAFN
No. PAR b CELNO: G3_ �. Fee—�- _
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
0(ppfication for Migogal 6pgtem Cougtruction Permit
Application is hereby made for a Permit to Construct(>O or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. M1 Owner's Name,Address and Tel.No. 5 99_8?40_ 3�
oT usE 9 f�' �,v 1 eA,ev�2 v21✓E
Installer's Nam ,Address, d Tel.No. �g—M 3g�c� Designer's Name,Address and Tel.No. a g— og- /o 4Z
ZJA-Me L -& — zz Zyweor31 Cr+fm. G14)
61 CA-eve DR-1✓I;r 4(.T M A-1 N s-:
VJ l eA Y'V%ft 6 25Z 3 PA-LM DUT M
Type of Building:
Dwelling No.of Bedrooms ld Garbage Grinder(Al®)
Other Type of Building No.of Persons Z Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow a gallons.
Plan Date 5-/(. Number of sheets Revision Date
Title
Description of Soil s 04J-fL`� rOi�.SclL !7-"-3� SL18 S 0 1 3� —/.��a� /k&_DI U M
-To "A-2-S67 9A-%1b **Z 0"-12-" -rip/'SOIL /7_`1-36 4" SUSSC IL /3z
/u-�i cl r►? TO' �A-t2.Srr ,Sq�7J1)
Nature of Repairs or Alterations(Answer when applicable)
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 Certifi-
cate of Compliance has been issLiAld by this Board of Healt . /
Signed Date Z_b` 9
Application Approved by
Application Disapproved for the following rea6l
Permit No. Date Issued
——————————————————————————————————--——
.T'"'+ .:..�' s- �. -`; ». ..✓ Y �'T7t+gkrt... orq'�• ...�' � -...,.. 1�� ec. » M
00 r P ` Fee
No. Go 3 ,�..
- THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS _
0[pplication for Mtgont *pgtem (Cougtruction permit
r
Application is hereby made for a Permit to Construct(>6 or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. A'Nl�R S"T41�s M/la Owner's Name,Address and Tel.No. �8—gee 3$S�
�07 2 uSE 9 ft� P1vim. ' II ILJ13 DalVE oZSZ3
Installer's Nam qf Address, d Tel.No. $0$—f&'� 3&5-4 Designer's Name,Address and Tel.No. Sbg- 54$- 4,4Z
It �� <<E{i? ;:n ZIWC-081 (nto, 814)
1 I CA-ev b7L Drzt✓� 46 S M A-1 N$T
*• Sf�MOVOtC1-� 0NA 02S7o3 5'i FALrvtouT 111
Type of Building: ./
Dwelling No.of Bedrooms to Garbage Grinder(No) W
' Other - Type of Building No.of Persons 2 Showers( ) Cafeteria( )
Other Fixtures
s Design Flow 5s gallons per day. Calculated daily flow 4 4 io 5 �gR lons.
Plan Date $-/ 9 S Number of sheets Revision Date 1 r-r., `l
` Title
r
Description of Soil d�l-a" 'rop so/l- /Z`/-3G `/ sa a sok 3&47- /5$i/ A4e-DI u»7
--To COA-2SE -C -0.0 Z 0"—/70 Tot0saa /Z 36 SuBso�L �-3G /3z''
Are S>r SA'N
/u ED 1 u To 6o 9
G Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement: a
The undersigned agrees td 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 Certifi-
cate of Compliance has been iss d by this Board of Healt .
Signed Date 3 Z_ 9 `
Application Approved by 9
E Application Disapproved for the following rea
d
Permit No. l Date Issued
+. --- — �———rf------.-- -- --moo----
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
— --- Certificate of Compliance
lTjHIS IS TO CER� ',that the On-site Sewa a Disposal System installed r rrepaired/replaced� )on
x9 '7 by \-i / fi�t�l � for
as has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. /T dated
Use of this system is conditioned on compl n e with the provisions set f rt below:
s t
No.
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS
Mizponl bpgtem Cori,5tructiott permit
Permission is Pereby granted to v
to construct(ftnL=
S ag y located at i l
4
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
C All construction must be completed w' h'ptwo y jrs of the date below.
f.
i Date: -- Approved
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No, Fee-l;-- --------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-*rVell Con0ructionA3ermit
Application is hereby made for a permit to Construct (✓), Alter ( ), or Repair ( )an individual Well at:
OT-2 -- 'i✓E7L _7Zoq_ la+¢ftonl�l�c4S -- - ------ -- - -- ----— - -----
Location Address Assessors Map and Parcel
-7� Owner Address
---------_V _A A. Gr�J y Eu - ------— ------- o cc1Dv i�1 ......... t 1/p6 _/I�l/�-------
- --
Installer Driller Address
Type of Building
Dwelling Stive'LE F*MliV-
Other - Type of Building-------------------------------- No. of Persons---___z-----------------------___________
a D2r u.�-n lt�
Typeof Well--------------------------------------------- Capacity------------------------------------------- -
Purpose of Well---� !_Q (T!A
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate .of Co pliance has been issued by the Board of Health.
Signed - — — - -- - -___-- - /3 SFa'P 1 S
------------------------
f� date c�
Application Approved By. �3 -____--___— `3^1,5---__
date
Application Disapproved for the following reasons:---------------------------_—_------
________-__—__—___—_____—_
-------------------------------------------
------------------------------------------------------------------
-----------------------------
p q date
Permit No. --- -L �_ ---— -- Issued---_1-q="-13 -/ - --- — ----
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of (Comphance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
by--------' ---------------------------------------------------------------------------------- --- -----
Installer
at------ 4 e c -- - �� ------------------—---------------—-- - --
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. ____Dated---I--------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE --- --- ---------------- ------ Inspector---------------------------------------— -- ---
"� r } 1 f
No.-- `; -- - � Fee- ------
BOARD OF HEALTH
TOWN OF BARNSTABLE
���[ication,�or�eC[ �ongtruction�erntit �'
Application is hereby made for'i`aprtiift`t"oCns�tf$ t ( V), Alter ( ), or Repair ( )an individual Well at:
Location - Address As Map and Parcel
I - �lA-r►�E-S J u��A K, —ou� /l ea z VG DR S'A-A"'-J'V-1 M__A
- - --- - - - ----- - -- - --- r
t Owner Address
TD. A. S CA
;
-ON ELL - ----- -BID /� �D------------ -------- --------�-A--S---h-/--P-
Installer - Driller Address
Type of Building
Dwelling-- S/Nloc E FAN7/Ly
f
— -- -
Other - Type of Building ---- No. of
Persons-----
Type of Well -2---------------------______________
Capacity-----------------------------------------
Purpose of Well---� !b6V 7-1 A-L
I Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate .of Co pliance has been issued by the Board of Health.
Signed `
date
Application Approved By --- -- ------- ---- —� _� ___
date
Application Disapproved for the following reasons:-------------- -----
l
AL - date
Permit No. - -"=-� ---- --- Issued—
date
'�, --=
date
�e�mn.A...�.ece_�..00®.o�,e.�.�.�.��o.®.-�.�e....®..•a.a�se...w�..��....o.+...e...�.wpm.�.�.w..�.0.ms��oi�.,�......�.e.s m...�nr�...o�.�..+.w.+rs..®m.�sens sw�.�o-
I
f
BOARD OF HEALTH
TOWN OF BARNSTABLE
rtifuate Of Com rtapsc
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired( )
by-------- - _ -------------------------- ---------------------- - -----
Installer
at --- ' ,- -- `` - - - 7- ------------------------ ----------------------
--------------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit.No. �Y '_+��--=-Dated----------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE -- -- - - -—— — - ---- =- -- Inspector------------------------------------------—------ --- ---------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Mrit Construct ion permit
Fee---x ct-'.'�-------
Permission.is hereby granted- --- .a�t�l'+2 -'��---- - --- - ---------------------
-- -
to Construct ^Alter ( ), or Repair ( )•an Individual'Well at:
No. - -- -- -�- ��-- -�- too --C'' -s- r-�—----- -- - — ----------------------- -----.
street
as shown on the application for a Well Construction Permit
y
No. - �+'y= ---= ----.---- --- Dated------¢- =-�-P�-= -------------------- ------
------------------ -------------------------------------------
Board of Health
DATE --
1
i
A 4"
ENVIRO'T'EGH LABORATORIES, INC.
MA Cert. No.: M-MA 063
449 Rte. 130 . Sandwich, MA 02563
(508)888-6460 . 1-800-339-6460
FAX(508)888-6446
CLIENT: Jim Holler LOCATION: Lot 2
ADDRESS: 11 Carvel Dr. HiRiver Road
Sandwich, MA 02563 Marstons Mills, MA
SAMPLE DATE: 9-20-95
COLLECTED BY: D. Pennini/Scannell Wells DATE RECEIVED: 9-20-95
TIME: 2:30PM LAB I.D. #: E9-265
JOB TYPE: New well SAMPLE I.D. #: 13
WELL SPECS.: 63`
RESULTS OF ANALYSIS:
Parameters Units Recommended Limit Result
Coliform bacteria/100ml (MF Method) 0 0
PH pH units 6.0-8.5 5.52
Conductance umhos/cm 500 81
Sodium mg/L 28.0 9.4
Nitrate-N mg/L 10.0 0.88
Iron mg/L 0.3 IT 0.05
Manganese mg/L 0.05 0.029
Note: Volatile Organics report to follow.
COMMENTS: Low pH indicates high corrosive characteristics.
Yes No WATER IS SUITABLE FOR DRINKING PURPOSES F0 PARAMETERS TESTED.
RX% r, Date U y3f
Ronald J. Sa i '
Laboratory Director
LT Less Than
ENVIROTECH LABORATORIES, INC.
MA Cert. No.: M-MA 063
449 Rte. 130 . Sandwich, MA 02563
(508)888-6460 • 1-800-339-6460
FAX(508) 888-6446
CLIENT: Jim Holler LOCATION: Lot 2
ADDRESS: 11 Carvel Dr. HiRiver Road
Sandwich, MA 02563 Marstons Mills, MA
SAMPLE DATE: 10-9-95
COLLECTED BY: D. Pennini/Scannell Wells DATE RECEIVED: 10-9-95
TIME: 2:30PM LAB I.D. #: E10117
JOB TYPE: New well SAMPLE I.D. #: E10117
WELL SPECS. : 63'
RESULTS OF ANALYSIS:
Parameters Units Recommended Limit Result
Volatile Organics See enclosed report.
EPA 524 ug/L None detected.
Yes No WATER IS SUITABLE FOR DRINKING URPOSES FO PARAMETERS TESTED.
R%%
- Date
Ronald J. Sa ri j
Laboratory Director
r
IT Less Than
LAPUCK
LABORATORIES, INC.
50 Hunt Street CHEMICAL ANALYSIS
Watertown,MA 02172 BACTERIOLOGY
(617)923-0300 WATER ANALYSIS
FOOD ANALYSIS
SPECIFICATION TESTING
REPORT - LAB. NO. 53563
---------------------------- ----------------------
Mr. Ron Saari October 19, 1995
ENVIROTECH LABORATORIES, INC. Sample Received: 10/12/95
449 Route 130 Client ID : Cotton Holla
Sandwich, MA 02563 Sample I .D. : Hy River
------------------------------
Volatile Organics - p P. b. (ug/L )
Method *624
Acetone N.D. t-1 , 2-Dichloroethene N.D.
Acrolein N.D. 1 2-Dichloro r o ane
P P N.D.
Acrylonitrile _
N.D. c 1 _3 Dichloro ro e
p p ne N.D.
Benzene N.D. t-1 , 3-Dichloropropene N.D.
Bromoform N.D. Ethylbenzene N.D.
Bromomethane N.D. 2-Hexanone N.D.
Carbon Disulfide N.D. MTBE N.D.
Carbon Tetrachloride N.D. Methyl Ethyl Ketone N.D.
Chlorobenzene N.D. 4-Methyl-2-Pentanone N.D.
Chloroethane N.D. Methylene Chloride N.D.
2-Chloroethylvinyl Ether N.D. Styrene . N.D.'
Chloroform N.D. 1 , 1 , 2 , 2-Tetrachloroethane N.D.
Chloromethane N.D. Tetrachloroethene N.D.
Dibromochloromethane N.D. Toluene N.D.
1 , 2-Dichlorobenzene N.D. 1 , 1 , 1-Trichloroethane N.D.
1 , 3-Dichlorobenzene N.D. 1 , 1 , 2-Trichloroethane N.D.
1 ,4-Dichlorobenzene N.D. Trichloroethene N.D.
Dichlorobromomethane N.D. Trichlorofluoromethane N.D.
1 , 1-Dichloroethane N.D. Vinyl Acetate N.D.
1 , 2-Dichloroethane N.D. Vinyl Chloride N.D.
1 , 1-Dichloroethene N.D. Xylene (Total ) N.D.
cis-1 , 2-Dichloroethene N.D.
N.D. = Not Detected
Method Detection Limit = 1 ug/L
Analysis Date = 10/19/95
Analyst = Dr. Xu
Recoveries of Internal Standards and Surrogate - %
Bromochloromethane 112 1 , 2-Dichloroethane-D4 103
P-Bromofluorobenzene 90 2-Bromo-l-chloropropane 90
Toluene-D8 108 1 ,4-Dichlorobutane 104 '
D.E.P. -MA 061
4es
ontenarosa, Lab Manager
Consulting & Testing Services
for over 20 Years...
This report is rendered upon the condition that it is not be be reproduced wholly or in part for advertising or other purposes over our
signature or in connection with our name without special permission in writing.Total liability is limited to the invoiced amount.The
results listed refer only to tested samples and/or applicable parameters.
. —-----------------� '
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' GENERAL NOTES
NOTE: 0+0 to 3+0 NOTE: 0+0 to 2+0 3j>o
Pavement should be sloped 2' wide, 4' deep trench filled r 1. ALL ELEVATIONS SHOWN ARE
0 4% from the left gutter with 3/4" to 1-1/2" washed, U.S.G•5. VERTICAL DATUM.
to the right gutter. crushed stone. Place 2' off 2. ALL PIPES IN THE SYSTEM TO BE
r, of right side of 14' wide 0' CAST IRON OR SCHEDULE 40 P.V.C.
g' 1 traveled way. o aom SOILS LOGS
�36.3 RC�1^ 3 46,` 4 5d � '� .ems° N/A 3. REMOVE ALL UNSUITABLE MATERIAL „ 63.1 PIT 1 "64.7 PIT 2
TM` P P 5p 48.33 Oci BENEATH THE INVERT ELEVATION 0 0
; 52- FOR A RADIUS OF AND BACKFILL 12" 62.1 TOPSOIL 12„ 63.7 TOPSOIL
W CLEAN COARSE GRANULAR MATERIAL.
.' S6 --..._ "--�-�_._ �_ �' i / SUBSOIL SUBSOIL
58 "` -- r,° 3�88 4. ALL BACKFILL SHALL BE CLEAN 36" 60 36" 61
60 9y` `!Q �� 8' t COARSE GRANULAR MATERIAL' FREE
��- 1? • FROM DEBRIS & LARGE� STONES.
'Y N 6' '`�k°� 5. CHRISTOPHER COSTA & Assoc. MEDIUM
6+8 ...� MUST BE NOTIFIED WHEN THE MEDIUM TO
TO
0� ��' /50 2`6 SYSTEM IS INSTALLED PRIOR TO COARSE COARSE
/ / 6 � 41 S BACKFILLING FOR INSPECTION. SAND
/ > 3 ry 5
�' 3>30 SAND
O 58 6 r .20 6. UNLESS OTHERWISE NOTED ALL
._..._._6 SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH
71•6� �x � I 62 r' `� MASSACHUSETTS TITLE V SANITARY 138" 51.6 NO WATER 132" 53.7 NO WATER
SEWER CODE AND AGE 6A J 65.>> •� -i MAY BE APPLICABLE ICABLECAL U LES
WHICH N A <2
#1 PERCOLATION RATE = MIN./INCH
6 26 __% �• WORKMAN-LIKE MANNER.
J .1 / w 1S O - N C
X 2
PERCOLATION RATE - C2 MIN./INCH
1, H
�k5° 8 ,�,�DRp,�SZ 7. THIS LOT 1S NOT IN THE FLOOD PLAIN. : ED BARRY /Co _�0.2g �� �� {/'r /'� R,36 8. A GARBAGE GRINDER WILL NOT BE OBSERVATIONS BY. _
rn 5.9g/ Op, INSTALLED ON THE SYSTEM. DATE TESTED: 9 15 94 j
' �,� k0o ?� ''� S 4 35• ; L`4 7 G 0 S
tia S2 3 / S ? 9. NO CHANGES SHALL BE MADE T THE PLAN NO. P-8290
WITHOUT PRIOR APPROVAL FROM CHRISTOPHER
c0 COSTA & Assoc.
hQ�
0 36 56
68 90
9' � 1
/
�
o 690 � �� �o PROPOSED DRIVEWAY PROFILE
62.32
HORIZONTAL SCALE: 1"=30'
w °- m c„ 2•S
\ �' VERTICAL SCALE 1 =10,
� LOT ' 4
' 6
4 �` •5$ 8•>g
•83 4.96 acres
62 9 70 --
N 2.0
.7 2�
0-) 0_1 65 - - -
rn Oa 6
•35
Z T.B.M. TOP 0 STAKE ( _
ELEV. 68. 3 60 EXISTIN CEN ERLI E
0 PROPOSED CENTE LINE f ,
co 55
84
o , 63 3 65.6
�o o
O /
o ,0 6 7 0) 50
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8.44 cL °-
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DATUM �-j zF
62.51 G� 61 OF��•o ,���° 62. ' EL.=38.0 0 r� 0 $ r� r) 0 0 a M o o to ( C � o o � r` co o co M m o
(6 `C] h: 03 M el a) O `C) .= O 0) 0i � - t< u1 (6 �'') tt N rj IX) 61') �••. N hry W M 10 N7 h!
c0 It- to r Co (0 (0 cp t� t 0�f fr h C w cD cD c0 (0 (0 to cD <D (0 u) LC) tf) Lo U-)
+50 4+0 +50 3+0 +50 2+0 +50 1+0 +50 0 I
#1 m 6
#2 ` �5 Q
g 63 64.69 66 4 12.94'
TOP
t 06' Un• .4-9•26 FOUNDATION 71.5 '
6CO 1. 1EWAGE SYSTEM PROFILE & DETAILS
Cn rprp Cp -� to ►V F.F.F.F.=72.5
I
1 0) tov' o Co °' NOT TO SCALE
9,00
FINISH GRADE= 64.0 FINISH GRADE FINISH GRADE FINISH GRADE 63.4
R D
66,�7 OVER TANK= 63.8 " "BOX= 63.6 CAPS 0 ENDS OF
OVE
�,. 62.12 _ _ _ EACH DISTRIBUTION LINE
_ C.F.=64.0 -.
+1 rl RISERS & CONCRETE COVERS TO
PARCEL % WITHIN 12" OF FINISH GRADE 3" PEASTONE
10"TEE
14"TEE _ _
62.0 INV. -I- 0 4" PERFORATED PIPE
`I\6 .
61.25 3„ 4.0" 1 60.58 SLOPE a 0.005/r-T.
LIQUID) DISTRIBUTION 3/4" TO 1-1/2" CRUSHED,
LEVEL. 60.75 BOX 60.4 SET LEVEL WASHED STONE
470'±- �1� - 1500. GALLON SEI.PTIC TANK
----� SET LEVEL t
�_ -�-- BOTTOMS ..
�. 58.4
-- __
/--�' ROAD APPLICANT: JAMES HOLLER
/ o P E N SPACE --- PROPOSED D WELLING LOCATION
�-' `� DESIGN CRITERIA PROPOSED SEWAGE SYST. EM LOCATION
r
NUMBER: OF BEDROOMS 6
PERSONS PER BEDROOM 55 DA2 R , �R R 0DAILY F""LOW PER PERSON L 0 ".
LEACHING REQUIRED 891.9 SQ. FT:
���of ti o�����H �F LEACHING PROVIDED 900 SQ. FT.
-PLAN VIEW 'n CALCULATIONS B.ARNSTABLE, (�rARSTONS MILLS) MASS.
�`� y o CH t TOP -'
_ Q) C c STn
<� (DEPTH+DEPTH+WIDTH)(LENGTH)SCALE: 1"-30' J. �
JAC° SCALE: AS NOTED DATE: 5/16/95 HOLLE--L2 j
LEGEND o
6 X 150 900 SO. FT.
PROP. SPOT ELEV. 71 XO A No. � ' c �yo
�oF �tfcl � �� , v DRAWN BY: J.A.B. CHECKED BY; C.C. JOB NO.:
EXIST. SPOT ELEV. -= 60.79 F 68 CHRISTOPHER SION -
PROP. CONTOUR = .�-- CHRISTOPHER COSTA & assoc.
EXIST. CONTOUR = ,.-- -66 MAP NO. 59 LOT N0.
2 -HOUSE N0. 9 ✓��
P.O. Box 128 / 465 Main st., East Falmouth, Ma.
- I
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