Loading...
HomeMy WebLinkAbout0005 HIGH VIEW CIRCLE - Health 5 HIGH VIEW CIRCLE MARSTONS MILLS -- A= 030 - 023 - r I % No. '' Fee \� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for -MispoBal 6pstrm Construction permit Application for a Permit to Construct( ) Repair(,/) Upgrade( ) Abandon( ) ❑Complete System ✓❑Individual Components Location Address or Lot No. 5 H*1wiew C:rLIQ, Owner's Name,Address,and Tel.No.$uso n L:cnLbucner- mckr"CAOns M•,U s Assessor's Map/Parcel 030- 07-3 S H4, Vitw C:r c le_ Mgcsk-anS A'%kks Mc� Installer's Name,Address,and Tel.No. Qj 115 SY r_GN0Aio,% Inc. Designer's Name,Address,and Tel.No. Q,no,:neoct noJ�nJorkS 3�y Ro04__ 13o 5andw,0-% 509• y7'7-0toS3 IZ W. Grossf:2ld P,d. Ga[askd�lt 1"�0� Type of Building: Dwelling No.of Bedrooms 3 Lot Size 3S, 300 sq.ft*c- Garbage Grinder(p1o) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 330 gpd Plan Date 11 - IZ 19 Number of sheets 3 Revision Date Title Size of Septic Tank Sx�SVC %000 <V / Type of S.A.S. (Z) S-00 ocxkka , t Qgc,�, Cho cnbc[S Description of Soil rjGe. 0R S Nature of Repairs or Alterations(Answer when applicable) I tl Sk-eAk Soo -A0 n 0M C�p be(- d,-box Qnd SAS. Conna6 +o 1060 Qejon }i c Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. , S' ed ���.. Date (a.LP' 2 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. I ic Date Issued ('� �t?�' No. -a�i�r`1 J '" ,(/ 11 ! ' 4 Feec `~ I THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION" kTOWN'OF BARNSTABLE, MASSACHUSETTS ' 2pplitation for Disposal �. stern Construction. 3permit p Application for a Permit to Construct( ) Repair(/) Upgrade( ) Abandon( ❑Complete System ❑✓ Individual Components Location Address or Lot No. 5 H•r�rwi e,w C,r c 19, Owner's Name,Address,and Tel.No. SUsa n L%me b.v r n r Assessor'sMap/Parcel bhp_ OZ-1 S 1-{'rco, tr,rcie, M. ckrskon; A11s a Installer's Name,Address,and Tel.No. p} {1 i v c cojo ti un Designer's Name,Address,and Tel.No. ry ,n v er t nod�Jur K; 3��t (�r,va� 13U Sanc4w�C�-, �ofi• c{�'�'t�LSS ��. �I• C.t'nw:f,�lc�.. Y,ct. �tit�`.�Glc.iC l�c,. E Type of Building: Dwelling No.of Bedrooms Lot Size �J S, 3 00 sq.ft+r- Garbage Grinder(9(3) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 330 gpd Plan Date 11 I2 • {LI Number of sheets 3 Revision Date Title Size of Septic Tank E z; :-k i n 10 d-U p r-"V ! Type of S.A.S. Z) `�00 tw.il 0 Ck C t, Description of Soil See, C1 rA - J P 'lll 9 --` Nature of Repairs or Alterations(Answer when applicable) �n S5 ,li •S00 gcwtko rr Pump J,a b(,( D !mr) , n tn(rr) 6- box , On6 `iha. Crnne(.l io eY r,tilnR (QOQ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5.of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. i Signed ""_ t� ) Date (c'//��0" Lt//� Application Approved by .. ~� Date t1/J ,y Application Disapproved by Date for the following reasons 1 G7��� Date Issued Permit No - 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 1P) t, at "!7 �i;v,a ,r c I e, has been constructed in accordance J q, r with the provisions of Title 5 and the for Disposal System Construction Permit No 7 tWated Installer b 1 . .., �x CnUC- c�� I,�t . Designer ner ,n v n-?.�f,n „Irrk y #bedrooms Approved design flow gpd d The issuance of this permit'shall not be construed as a guarantee that the system will funV as designed. Date '�. 0 Inspector No `a,—_6'... tl Fee r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Disposal 6pstem Constraction ermlt Permission is hereby granted to Construct( ) Repair( V) Upgrade( ) Abandon( ) System located at a 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 musube completed within three years of the date of this permi' t. Date t(; r Approved by`�, TOWN OF BARNSTABLE LOCATIONS F4;oJ✓iLLJ ( :rc)c SEWAGE# 2-0-o v 17F VILLAGE �►, ,�; )�.$ ASSESSOR'S MAP&PARCEL 030 - Q Z 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /DOD LEACHING FACILITY:(type) S00 5p.) L cC (size) /O x Z9 x Z NO.OF BEDROOMS 3 OWNER Sc�Snc% U rnr-,5,irncC' PERMIT DATE: G•I2-ZO COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �. J;;7- A Al- REAR A3 os ' ZS�L Riser DL' 13 ° / TRANS. NO..: CITY/TOWN: 25 APPLICANT: 3 ADDRESS: DESIGN FLOW: gpd REVIEWED BY: , DATE: _ N/A OK. NO GENERAL Legal boundaries denoted [3.10 CMR 15.220(4)(a)] �✓ Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided 310 CMR 15.2204(t Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4, Easements shown [310 CMR 15:220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required 31.0 CMR .15.412(4)] Location of impervious surfaces (driveways, parking areas etc.) ✓ 1310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15220 4 (c)] Location and dimensions of system components and reserve areas. [310 CMR 1'5.220(4)(e)] System Calculations [310 CMR 15,220 4 daily flow se tic tank capacity (required andprovided) soil absorption ti:on system (re Lured anal rovided) whether system designed,for garbage grindej North arrow [310 CMR 15.220(4)(g)] ✓ Existing and ro osed contours 310 CMR 15.220(4)( )] Location and log of deep observation holes(existing grade el. on each test) [31.0 CMR 15.220(4)(h)] v Names of soil evaluator and BOH representative [310 CMR 15220(4 h and i ] Location and date of percolation.tests (performed at proper elevation.?) [310 CMR 15.220(4)(i)] Percolation test results match loadin .mate? [3]0 CMR 15.242 Certification statement by Soil Evaluator[310 CMR 15.220(4)(j)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR .15.220(4) n Address Sheet 1 of 7 NSA OK NO Location,of every water supply;,public and private, [310 CMR within 4'00 feet of the proposed system location in the case of surface water supRlies,and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case / of private water supply wells t/ Location.of all surface waters and wetlands located up to 100 ft. n �, beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lanes and other subsurface utilities located [310 CMR 15 220(4)(m)] (if water line cross see 310 CMR 15.211(l)[1']) Profile of systern showing invert elevations of all system components and the bottom of the SAS 310 CMR15.220(4)(o)] stomp of designer.[310 CMR 15.220(1).and;31.0.'CMR 15.220(2)] Stamp of Reggistered Land Surveyor(required if construction / activities within 5 ft..of lot line) [310 CMR 15.220(3)] r/ Test Holes,adequate(two in each of the primary and reserve unless trenches as permitted in.310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k) Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? 31:0 CMR 15.1033] Benchmark within 5045' of system 310 CMR 15.2200)(9)] Materials specifications.noted? [various sections of 310 CMR 15.000'1 System components not>36" deep(unless Local Upgrade Approval or LUA requested) 310 CMR 15.405 1 b ] Address Sheet 2 of 7 N/A OK NO SEPTIC TANK Sizc OK? [310 CMR 15.223 1 Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth. [31.0 CMR � 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR. 15.227(4)] ✓ Note regarding installation on stable compacted base [310 CMR 15,.228(1)] �C� Separation between inlet.and outlet tees (no less than liquid ✓. de th) 3:10.CIvIR 15..227(2 Inlet/Outlet elevations at least 1.2" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades grades under LTJA [310 CMR 15.405(1)(k Minimum cover 9" (Tanks buried more than 9"must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232 3 (f)] Three access covers (inlet and outlet must be:20" or greater) - middle access at least 8" (by 7/07 310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<I 000gpd, two fors stems>1000 gpd. [31.0 CMR 15.228(2)] All at-grade covers.secured to unauthorized access? [310 CMR 15.228(2)] > .10 ft from building foundation [310.CMR 15.211(1)] Buoyancy calculation.Required/Done [310 C.MR 15.221(8)] 14-20 Where a ro .riate? 310 CMR 15.226 3 . Setbacks from:resources [310,CMR-15.211 Ntultt fCompartmen�Tanks �` �`�3„ �� Required when other than single-family dw:ellmg,or flow>1000 d[310 CMR 15..223 1)(b)] First compartment 200% daily flow; Second compartment 100% l daily flow [310 CMR.15.224`2)and(3) w "U" pipe through or over baffle,outlet of each compartment with as baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OK NO BUILDING SEWER ANU®THER PIPJ<NG Located at least ten feet from any water line? [3.1.0 CMR 15.222(2)] Disposal piping,at least 18" below water line(when water and sewer cross, see 310 CNM 15:211(1)[11) Cleanouts re aired/ rovided ? 310 CMR 15.222(8)] Thrust blocks specified in force.mains? 310 CMR 15.221(6)(c Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR. 1.5.222(6)] Proper pitch on all runs?(.005 within gravity-distributed trenches j and beds) 310 CMR 15.251,9 and 310 CMR 15,252(2)(c)] Siphonproblem/ leachfield below pump chamber ) ndea s or vent manifold s" "ecified? Size and orientation of discharge holes specified? (not,sm.aller than 3/8"not larger than 5/8")[310.CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 1.5.251(5) specifies various pipe t:ypes allowed =DIST'RIBUTION BOX Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] ✓ Splash plate or baffle tee required on inlet/provided? (when / pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] .Inside minimum dimension 12 310 CMRA 5.232(2) b ] Minimum sump 6" [310 CMR15.232 3 (e)] Watertight cover if<2000gpd);waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] P�U7VIP�CIAMBERS ,, ; � z CMR Capacity (emergency storage above working=design flow)? [310 (2 ] Proper setbacks 310 CMR 15.211 (same as septic tanks)] Watertight 20-in im.mum access manhole at least 20" MUST BE / TO GRADE [310 CMR 1,5.23](5)] T/ Sen• ee components accessible (not too deep with piping, j disconnects accessible) (/ Alarm floats- alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. 310 CMR 15.23.1.(6) and 8)] Stable Com acted:Base 310 CMR 15.221 Buoyancy calculations needed? Provided? '310 CMR 15.221 8' Address Sheet,4 of 7 Gil N/A OK NO SOIL ABSrURPrTION SYST>�MS (SAS)}GENERAL Calculations correct? ,/ 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(l)] �✓ Re aired separation togroundwater? 310 CMR 15.212) Aggregate specified as double washed[310 CMR 15.247(2)] System Venting required/provided? (system under driveway or / >36" deep) [310 CMR 15.241] c/ Inspection ports specified and within 3 final grade. [310 CMR 15.240(13 Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and. Guidance Document] GAILER7#ES�PI T`S.7 CHAMBERS 310#CMR,i5:253 .)Z.,,. . Chambers and Gal.. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253 6 f Each structure with"one inspection manhole(if>2000 gpd.must be tograde) 310 CMR '1.5.253' 2 Aggregate I' minimum-4'maximum. [310 CMR 15.253(.1)(b)] v' 2' sidewall credit maximum 310 CMR 15.253 1 a] In bed confi ration, irdetevery40 sq. ft.. [310 CMR 15.253(6)] CJ 1CRENCHESu31Q CM]R.�15 251 Width 2'minimum 3' maximum [310 CMR 1.5.251(l)(b)] 100 feet-maximum length [310 CMR 1.5.251.(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between:trenches) [3.10 CMR 251(1)(d)] Situated along contours [310,CMR 15.251(2) Breakout.OK? [310 CMR 15.2I1(1)[41 and Guidance Document] d f bB� M 40077minimum distribution lines [310 CMR 15.252(2)(a)] Maxiinurn separation between lines 6' [310 CM RI5.252 2 (d)] Maximum separation between lines and outside of bed 4' [31.0 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6" minimum, 12" maximum. 310 CMR 15.252 2)( )] Separation between beds 10'mini.mum. [310 CMR 15.252(2) ] Bottom area used in calculations only[310 CMR 15.252(2)(1)] Address Sheet 5 of 1 NIA OK NO DIn THE,PLAN�INVO]LVE,'; Pressure Dosed System ? Provided pump and piping calculations,as required 31.0 CMR 15.2M 4 r) Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used it gravelless system-make surejet is directed as.not to scour soil.interface [Guidance Document Inspections once per year(systems<2000 gpd) or quarterly (>20g0 dgood to note on plan [31,0 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the.s ecifieat on.of 310 CMR Impervious barrier and/or retaining wall? [Guidance Document] Impervious barrier 'installation must be supervised by designer[310 CMR 15.255(2)(b)] Retailing wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side.slope not exceed 3:1 ? 310 C.MR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance.Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 2 (e)] Grrvell`ess.Sys#em jI/A Approval Letters] r Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge / to scour soil interface Alternatcve Septic.System 17! Ap�rvval Letter�j" Was DEP Approval Letter provided and/or have you. reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions`? Is there a note on the plan regarding the requirement for m l perpetual maintenance agreement? �V Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has a plicant submitted a copy of a maintenance Variances` Are the variances listed on the plan ? [310 CMR 1.5.220 (4)_( ) RLS Stamp necessary on plan if a component is within five feet of property lane 31.0 CMR 15.412(4)] New construction or increased flow proposed - [Refer to 310 CMR.15.414] Address Sheet 6 of 7 r N/A OK NO. Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214,310 CMR 1.5,215 and 310 CMR 15.216- also refer to Policy regarding upgrades of such' existin systems] �S �J�✓`� Is the system proposed on the same lot as served by private well 7 . [310 CMR 15.214(2) Are the nitrogen.loads proposed in compliance? [310 CMR 15.216 1 1Vliscellai�eous Pumping to septic tank ? 310 CMR. 1.5.229 Shared System [31.0 CMR 15.290] Address :Sheet 7'of 7 I'ONVU of BArii&table, Re i1latt)ry Services vnatrt,rAi�tc Richards 1. Stali,filteriin Il reetor y 61A3S: Pablie Health Division. ThOmAs.*Kean,-Director, .200 tl� ain.Sfreet,MY-aanis Y1.4<02:Ci01 0IT'ICe: :50R-862:4644 fax; a0�-70-f:3,t14 I❑staiLer S Desioriert.'ertificate n;Tf'tse=na Date _ 0 0. 1'77 Assessor's 2tilap\Parcel �� Designer: r1Wl+ l.nstkl.ilet': Address, 12 ail, C r�SS L�e ld l� -- —Ts2 q` Q 1�•r _tpennit:to install a (installer) l optic systpn1 at f+a C based'on a°design,&,aw-n by --;�-- . 3ddxe�,):,_ _ e 'r esr _lnlar�L�sF1 dated; �t�j�Z�, (di;gner-) f ' f ceitify ih,lit the Septic system reft;crtce.cl above��as itl5falled,substarttially accciidifi tL� tiie d04ari,.wtitclt ttiay include minor appro'vtd.chrn s:aids as.lateral relocat'ioti of isle tli�tribution:.box and/or septic lank, Sfri,lr out (i:f:i :tltrirsd �vti's a spected an t�erE Toriud:satisf t�iy _ _ l,aerttty that the seltae s98relp Mfgtenced ab6.N1e w<is installed With major than es (ie: greater than 1 Q' lateral iclocati5n bftiie S-AS ,a any vertica,f.relacaGion'of'a,ny Coiiiponea"t of the, cel•tif7e9 de0, c w a� L , . iPoioa or as-Eaualt by(,ie.si'gnc.r t0 fallow; Strip aat.(if requi'r-cd)tivtas inspected'and the soils Nvere.found,sati.sfactuiry: 1 cettify tltat the sy eizz ce£er.enccd above was constructed in �b viCh-t11e teri l5 of the.T1A a�i'laroval'It uer5{ii'.appli4tble) - �bSN PATER E ... (lristgler s Si'g'iita tic' Mct:�?TE &VIL typ,351051 is Desi.�irer's�i�?izature)�-- � , (A ITA Desi=rate er PT Lt1SL' RC l'C7Riti:;IU I3FIEZNS'I'AIiLi? Plili'IC. I3EzT Tkf I>TtrtSltO\. � R i CFJGG .TE-PL CC}1411'LTAIV L W(T L"NIOT ]3E:ISSLrLI? >1l;VT1L Bt�1'Ti T1EfI5 TnRll AND ;AS- BUT`L1 CARTS A[2 CtD�GI�fD;BY C'EC3 ,Bi�R'ISTAEi1,T P'C7B LC tL4T TI' DI'VTSlOir', otj Q`.SLftu D--08,iizi Certirtcalion Form Reu Y•I --I:'s;doc Eng?noers note.This csrtrtleaiinn ts.limtYefl to ert buiff rhspeclion of system comp orerts.ac io•talid'd-prior;io backfiil.The cngin r dsd no'supe vise con trust on_pf the syste The igs.alror assumes resppnsib I ty rci all materials,worhn ah hip bacpifll0,zg io spoc fied gradee w lh,pfapsr Ov npacban.and sett ng users coversa's she•r omtile eign.plan: TOWN OF BARNSTABLE LOCATION s l�;o�✓icy. :ram 1� SEWAGE# � VILLAGE r1. /n; I J.$ ASSESSOR'S MAP&PARCEL 03p - p 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY Q LEACHING FACILITY:(type) .si�•��.��c Z� (sue) NO.OF BEDROOMS ' OWNER $ 5,ar% LIrn r Surncr' PERMIT DATE: G.I Z-ZO COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and LeachingFeet I Facility(If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leachin Facili Feet 8 ty(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY I I Ax- I �wv 81 - 31 + 3 A A2 'i& 3q + .6 RE 6Z, R A3.3$G Puw•Q C' 6o�.�cr fl veagc r4 - 4q Ll u .Dy '33 CS -39 5 G JS ' ZS+G n Riscr DL" 13 10 ��sTti Town of Barnstable Inspectional Services Department BARNf4TA8LE, "" i6 sq. Public Health Division �� Ufa"ma's 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 0954 October 15, 2019 LIMEBURNER, BRYAN & SUSAN 5 HIGH VIEW CIRCLE MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 5 High View Circle, Marstons Mills, MA was inspected on 09/30/2019 by Chad Hathaway, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360—20h). You are.ordered to repair or replace the septic system within two (2) years from the date I you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH OARD OF HEALTH n, R. ., CH Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\5 High View Circle Marstons Mills.doc Town of Barnstable BARNSTABM MASS 63 ,�� Inspectional Services Department AT fD MA'S� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation o a driveway due to H-10 components, etc) Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc 673 0/ LOCATION SEWAGE PERMIT NO. ,6 F-.///��/���� C/,� duo - 6n 71 VILLAGE INSTALLER'S NAME i ADDRESS o rIR - R U I L D E R OR OWNER f T.� oz DATE PERMIT ISSUED f17/ _ DATE COMPLIANCE ISSUED lz __........... r i Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive ;. Property Address Limeburner Owner Owner's Name / information is required for every Marstons Mills Y Ma 02648 9/30/19 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, use only the tab Chad hathaway key to move your Name of Inspector cursor-do not H PS use the return Company Name key. P.O.Box 151 Company Address , Forestdale Ma 02644 City/Town State Zip Code 774 274 2581 12866 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 9/30/19 Inspector's Signaomita Date The system inspector shis inspection report to the Approving Authority (Board of Health or DEP)withig this inspection. If the system has a design flow of 10,000 gpd or greater, system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts �n 11P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. City(rown 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: ❑ 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: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems Information on care and do's and don't's can be found at town health dept or mass ov 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 cam, Commonwealth of Massachusetts jn - ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. Citylrown 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 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts 1� ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a'surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. Cityrrown 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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the.system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue ® ❑ approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): oo design Number of bedrooms (actual): 3 file DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts fF - Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No 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: pumped in june 2019 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? unknown Reason for pumping: backing up t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 8 of 18 Commonwealth of Massachusetts rn - Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1970s' Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: El cast iron 2 40 PVC 3.25' ❑ other(explain): Distance from private water supply well or suction line: 2 fe eett Comments (on condition of joints, venting, evidence of leakage, etc.): none t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 'Ohl Commonwealth of Massachusetts �n = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 3'feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gal. H10 tank riser on inlet. concrete baffles in place If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'x5' Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 0" Distance from bottom of scum to bottom of outlet tee or baffle oil How were dimensions determined? 0" Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): inlet and outlet are concrete baffles no visable cracks, decay or leaks. riser on inlet side. Staining in riser when tank over fills during peak use t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: 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 4 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owners Name information is Marstons Mills Ma 02648 9/30/19 required for every page. Cityrrown 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): 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.): no Box t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts (F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 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* t Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: . 1 ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts r= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 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.): pit is full. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts ,d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �n 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below !1, ❑ drawing attached separately 14 (-:,7 � F r � t5insp.doc-rev.7/26120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts r - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 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: sloping lot to pond. bottom of pit is 10' below grade 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 Commonwealth of Massachusetts r - ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 High View Circle formally 183 Lake Shore Drive Property Address Limeburner Owner Owner's Name information is required for every Marstons Mills Ma 02648 9/30/19 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 LEGEND --20 -- EXISTING CONTOUR 1 .� >O 84.81 x 20.98 EXISTING SPOT GRADE PROPOSED CONTOUR • �GW-- UNDERGROUND WIRES / ` 4,� W EXISTING WATER SERVICE �, k ROOF OVERHANG tilG�� \ \ \ \ G EXISTING GAS SERVICE '� Q (TYP.) a9L, W6 98 O WETLAND FLAG "� Y TEST PIT �,, • a _� � 4 � T SO,�O .�`0. C \ \ e6 \ �l v BENCHMARK D Y Q O/� �GBF,Q \\ x 7�.�s\ ♦�` `�t \ 1 6 a7 PoVemP 4 �9ti �F \ \\ \ .♦ a n/ PROPOSED S.A.S. A. �q \ \ ♦ 76.32 � x 81�a� 87.85 SURROUNDED WITH STONES n \W.76 25 7a.71 �'N DOS\ N NO.3e C , SHED �� I� \ 5 •� \\ % , \ LOCUS MAP 1.6 ., � l82.01 \ x 88.65 NOT TO SCALE \ \ I N \ \\ \\ \ .`(a.141�,���` x 69.26 71.89 ♦ ��, R 7'a.48 \\ � % x 87:8\ GENERAL NOTES: N � \ \ \ \ �. ♦♦ 7 �� 75,34 \ .y Co �' \ �� \ ♦ R �� VENT 7�38 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL GARAGE ��� SPIK x 2,89\� I BOARD OF HEALTH AND THE DESIGN ENGINEER. \Bvwl-2 Q�� �� �b.6$x�\ \ +67. EXISTING ��"r, • �„�6,,7s' p 1 I I 7'39 �j 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS _�.27 �� \ \ i c� K OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE ��� 5N20 \ \ \ HOUSE(#5) • 7e 1 L1J 6? E LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: \ \ \ \ \ 44 w �T.o.F.=76.2f ��_ -TP ' .: ��� �35,3OfS 6. 6 v� 3 \ \ �' j •• o -310 CMR 15.405(1)(b): 0. 5�09� 59\C \ \ +j ;`� CELLAR FL=68.7f 76.7 a�52: ?o.1.1,. .::. , \ 75.6 / \ � "\' � ,. ,. , •,. �z \ \ I � 1) A 5' variance, S.A.S. to garage slab, fora 5' setback. \ \ \64.72 \� + . . ,•.. T 07 \� I o -LOCAL REGULATION Chapter 360-1, Location of Components with I o Respect to Water Body's: CONCRETE..`'` I c + is \ x�9.i� , O 77.811 I 2) A 25' variance, pump chamber to closest wetland resource / \ \ L)R/VEWAY' I a area, for a 75' setback. MADEP Title 5 requirement is 25'. 09 .75s1::: •ti.:.. 7 /_ �• \ \ \ \ ® , /,;.. •. 7 4" RAVIl� S WE Q a 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR $4,� / TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE CK a�7 DESIGN ENGINEER. 48.83'+ 1 \ \ \ \ \ (a ove),.�' �',6771 ' "ter / 86.26 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING I i \ \ \ \ 67 6 7j'99 r 2" FORCE TO 4" GRAVITY PIPE t / FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Lon and I \ \ \ \ I ;y \ 4" INV.=77.5t AT HIGH POINT ENGINEER BEFORE CONSTRUCTION CONTINUES. / WATERS FACE EL.=48.9 ` s�.70\ V 7.66 x 52 0 \ ` +67.74 I 7e a 9.9 a.23 I 85.60 : 86.14 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. OCTOBER 17, 2019 1 aa.ea+ 1 x 57.7 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 67.4p N82 T.: O HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. /ox V) PK SET ^ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. ! ` s\ 7 9.�s� # 6 .94 1w� t O�G \\ �\ \ \\ o e5.75 ` 1 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 54.36� x / ft \ \ \ \ IP+/ !$1.39 ` �\ ` / 2 73,01\ �� 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 48.86 / , 61. 5 `\ �\ 77 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE / O 1 \ DIRECTED BY THE APPROVING AUTHORITIES. avw2yl 75' Q_• \ 52.ZZf i 7 ( f, oG W i 3 16a. 1 1 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY ffj�i1, I ► a 85.81 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. avw2-2�,f / J ; (m I ; W } SAW CUT PAVEMENT 54.12 V 0 7 J J j WORK LIMIT-SILT FENCE OR MOLE UNDERNEATH 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS % p ���~O ' IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND ' m� REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 3046 00„ w O� ��� BE NCHMoTR oo c P\ � OF MASsgC 12. AREAS INSPECTED BIRI DESSGNIPO GIN�ERUPRIOR UNSUITABLE BACK MATERIALS SHALL BE s �9 i EL.=74.61 � y�`� y� o PETER T. �, 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND McENTEE NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. BENCHMARK-1 PROPOSED PUMP CHAMBER CIVIL `n WETLAND CONSULTANT TOP OF RET. WALL INFILTRATOR IM-540 No. 35109 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 2ABA I, INC. Ln EL.=67.72 , '�E/ST���\�`� 5 HIGH VIEW CIRCLE, EXISTING S.A.S. MARSTONS MILLS, MA Pocosset, MA 02559 EXISTING SEPTIC TANK (APPROXIMATE LOCATION) , TO BE PUMPED, FILLED Prepared for: Susan Limeburner, 5 High View Circle, Marstons Mills, MA 02648 (508) 563-5349 (TO REMAIN-SEE NOTE 14) WITH SAND & ABANDONED 1\ (1 Z1 '°- TOP OF TANK, EL.=64.97 Engineering by: SCALE DRAWN JOB. NO. MAP N0. 25001 C0564J FLOOD ZONE DESIGNATION INV. Engineering LIMEBURNER, BRYAN & SUSAN 9 (OUT), EL.=63.64.t OWNER OF RECORD En iin Works, Inc. 1"=30' P.T.M. 267-19 EFFECTIVE DATE: JULY 16, 2014 5 HIGH VIEW CIRCLE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. ZONE X (NON HAZARD) PARCEL ID: 030-023 MARSTONS MILLS, MA 02648 (508) 477-5313 11/12/19 P.T.M. 1 of 3 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL. 73.5 EXISTING SEPTIC TANK & FOR A DISTANCE OF 15' AROUND THE PROPOSED PUMP CHAMBER PROPOSED D-BOX PERIMETER OF THE S.A.S. PROVIDE RISERS & COVERS AS DESCRIBED: INSTALL RISER & COVER PROPOSED S.A.S. 1) SEPTIC TANK INLET COVER SET TO 6" OF GRADE. SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND 2) SEPTIC TANK 20" OUTLET COVER SET TO GRADE SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT. 3) PUMP CHAMBER 24" ACCESS RISER/COVER SET TO GRADE F G EL=75.9t F.G: EL.=75.2 to 75.9t COVERS SET TO FINISH GRADE SHALL BE SECURED . . . VENT MAINTAIN 2% SLOPE OVER S.A.S. EXISTING F.G. EL.=67.7(EXISTING) F.G. EL.=66.9(max.) mow HOUSE(15) L = 17' L = 23'f GAR4GE " SCH 40 PVC @ S=1% (MIN.) p S=1% (MIN.) 24° DIA. 2 4"SCH40 PVC L = 34' PROVIDE THRUBSTNBL CKS 4"SCH40 PVC 2" LAYER OF 1/8" TO 1/2" TOP=63.91 AT ALL DOUBLE WASHED STONE ) , S=1% MIN.), a� 4 ( �� s. Limf(c R APPROVED FLTER FABRIC) 4"SCH40 PVC 2' EFF. N INV.=77.50 DEPTH 3/4" TO 1-1/2" DOUBLE e a 14" PROPOSED 2.6' 4.8' 2,g' WASHED STONE �A'A.4�' INV.=73.47 INV.=73.30 DECK vo N ADD floots Yi ie<a � EFFECTIVE WIDTH = 10' NN EFFLUENT DEPTH 3 OUTLETS INV.=73.00 m FILTER INV.=63.30 H-20 2-500 GALLON LEACHING CHAMBERS WITH STONE 39,36.6' o INSTALL INLET TEE AROUND AND BETWEEN CHAMBERS AS SHOWN EXISTINt--1o'--t INV.=63.64f H-20 RATED INSTALL PIPE SEPTIC TANK EXISTING BOTT.=59.36 BETWEEN CHAMBERS (FIELD VERIFY) See Pump Detail Sheet 3 of 3 TOP CONC. ELEV.= 74.1 t PROPOSED 500 GALLON PUMP CHAMBER BREAKOUT ELEV.= 73.50 ease as SEPTIC LAYOUT INV. ELEV.= 73.00milli NOTES: INFILTRATOR IM-540 GALLON PLASTIC TANK aaaaa ease® 66a B aBaa eases aaaa 1) PUMP CHAMBER & D-BOX SHALL BE SET LEVEL AND BOTTOM ELEV.= 71.00 TRUE TO GRADE ON A MECHANICALLY COMPACTED 6' 4' ENDS 8.5' 4' CRUSHED STONE BASE, PER 310 CMR 15.221(2). 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 29.0' 2) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL GROUNDWATER 3) MAX. COVER TANKS, D-BOX & S.A.S. SHALL BE 36". 5' ABOVE 4) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS LEACHING SYSTEM SECTION PRIOR TO CONSTRUCTION. NO GROUNDWATER, EL.=65.2 - 3/4" TO 1-1/2" DOUBLE CE� E3EOE3 0 5) EFFTEELASNT FILTER SHALL BE MANUFACTURED BY ZABELLLED ON OR EQUAL. FILTER WASHED STONE ®®®®E3 E3®®E3 E3 37„SHALL BE INSPECTED AND CLEANED ANNUALLY, OR AS3" LAYER OF 1/8" TO 1/2" 't wREQUIRED TO PREVENT BACK UP. THE HOMEOWNER IS DOUBLE WASHED STONE N z ®®®®®® RESPONSIBLE TO SCHEDULE CLEANINGS. SEPTIC SYSTEM PROFILE (OR APPROVED FILTER FABRIC) SOIL LOG 102" DESIGN CRITERIA DATE: OCTOBER 22, 2019 (REF#TPT-19-188) 4" KNOCKOUT NUMBER OF BEDROOMS: 3 SOIL EVALUATOR: PETER McENTEE SE#1542 20" DIA. COVER WITNESS: DAVID STANTON R.S. HEALTH AGENT SOIL TEXTURAL CLASS: CLASS I ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH 4" KNOCKOUT / 4" KNOCKOUT 58" DESIGN PERCOLATION RATE: <2 MIN/IN 75.2 0" 75.3 0" 0 DAILY FLOW: 330 GPD FILL FILL DESIGN FLOW: 330 GPD 4" KNOCKOUT 74.2 12" 75.4 1 1" GARBAGE GRINDER: NO C C LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF PERC 500 GALLON CAPACITY, H-20 LOADING .74 GPD/SF 30"/48" EXISTING SEPTIC TANK: 1000 GALLON CAPACITY CHAMBERS PUMP CHAMBER: 500 GALLON (INFILTRATOR IM-540) PROPOSED D-BOX: 1 INLET, 3 OUTLET (MIN.), H-20 M-C SAND M-C SAND USE 2-500 GALLON LEACHING CHAMBERS IN SERIES WITH 2.5Y 6/6 2.5Y 6/6 PROPOSED SEPTIC SYSTEM UPGRADE PLAN I STONE AROUND AND BETWEEN CHAMBERS (10.0' x 29.0') 5 HIGH VIEW CIRCLE, MARSTONS MILLS, MA SIDEWALL AREA: 2(10.0' + 29.0') X 2 = 156.0 SF Prepared for: Susan Limeburner, 5 High View Circle, Marstons Mills, MA 02648 BOTTOM AREA: 10.0' x 29.0' = 290.0 SF Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:..............................................................446.0 SF 65.2 120" 65.3 120' Engineering Works, Inc. N.T.S. P.T.M. 267-19 PERC RATE <2 MIN/IN. "C" HORIZON 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(446.0 SF) = 330.0 GPD NO GROUNDWATER ENCOUNTERED (508) 477-5313 11/12/19 P.T.M. 2 of 3 NEMA 4 JUNCTION BOX CORROSION RESISTANT PROVIDE WATERTIGHT 24" RISER WITH & LIQUID—TIGHT CABLE CONNECTORS SUPPORTED SECURED FRAME & COVER TO GRADE BY 1-1/4" PVC CONDUIT. JOINTS TO BE MADE (INFILTRATOR TW RISER SYSTEM OR EQUAL) WATERTIGHT. AN SJE RHOMBUS—JB PLUGGER OR EQUAL IS RECOMMENDED. PROVIDE ENOUGH WIRE SLACK TO REMOVE PUMP A A INSTALL 1' PVC CONDUIT TO HOUSE FOR WIRING HOISTING CABLE 7x19 STAINLESS STEEL WITH WATERTIGHT JOINTS. WIRE HIGH WATER ALARM t 1/8" DIAMETER. / 1,760 LB. STRENGTH.--,,,,,,. WI.D.DW FLOAT TO SJE RHOMBUS TANK ALERT XT ALARM PANEL (IF QUICK DISCONNECT NOT USED) ON CIRCUIT SEPARATE FROM CIRCUIT TO THE PUMP. INV.(IN)=63.30 2"SCH. 40 DISCHARGE (THROUGH RISER—SEE PROFILE) — — 2" BALL VALVE (FIELD ADJUST FOR 20 GPM RATE) O ALARM ON EL: 60.87 (INSTALL QUICK DISCONNECT FOR EASY REMOVAL) ' 2" 90' ELBOW W/ 1/4" WEEP HOLE PUMP ON EL: 60.62 FOR SELF-DRAINING FORCE MAIN " 2" SWING CHECK VALVE BOTTOM OF PUMP OFF EL: 60.04 18j 15" t 1 8" 2" SCH. 40 PVC DISCHARGE PIPE ELEVPUMP� ��ROF TANK, EL.=59.36 WALL THICKNESS=0.2" ADDITIONAL 3/16" VENT HOLE (MIN.) ABOVE PUMP FLANGE PROVIDE 2 FLOATS: (TO PREVENT PREMATURE PUMP BURNOUT) 64.9 [1,648] EXTERIOR LENGTH FLOAT NO.1: PUMP ON/OFF-POLYLOCK FLOAT PROVIDED WITH PUMP LIBERTY LE40 SERIES PUMP .4 H.P. 115 V FLOAT NO.2: ALARM ACTIVATION FLOAT-PROVIDED WITH ALARM PANEL WITH 2" DISCHARGE, OR EQUAL TOP VIEW (ON SEPARATE CIRCUIT FROM PUMP SPECIFIED) PUMP CHAMBER, PUMP & ACCESSORIES AVAILABLE AS A UNIT CAPE WINWATER WORKS CO., HYANNIS, MA. (508) 862-0166 0 NOTE: APPROVED ALTERNATE MAY BE SUBSTITUTED. PUMP DETAIL . _j N.T.S. tA 54.6 111 if -1-11 MIR M1,387] E TERIOR HEIGHT 1 1-4" POLYSEAL INLET 3-4" POLYSEAL OUTLETS 22' BUOYANCY CALCULATIONS 4' 4" NOT REQUIRED, TANK IS ABOVE WATER TABLE END VIEW 4" f NOTES: N I 1. ALL DRAWING DIMENSIONS IN INCHES[MILLIMETERS]OR AS NOTED. N 2. EXTERIOR OR ACCESS OPENING LID INCLUDES THE FOLLOWING WARNING IN N ENGLISH,FRENCH&SPANISH:"DANGER DO NOT ENTER:POISON GASES." m 3. TANK MARKINGS WILL INCLUDE:MANUFACTURING NAME,MODEL NUMBER,LIQUID 4„ 4 CAPACITY,DATE OF MANUFACTURE CODE,MAXIMUM BURIAL DEPTH,INLET,AND OUTLET. MAXIMUM BURIAL DEPTH IS 48 in[1,219 mm]. WIGGIN PRECAST CORP DB3H2O 1 4 r & MINIMUM BURIAL DEPTH IS 61n 1152 mm]. CROSS SECTION PLAN VIEW 6. TANK IS FOR NON-TRAFFIC APPLICATIONS. DOSING & STORAGE REQUIREMENTS 8. NOMINAIRSPAL CE IS H—20 LOADING s. NOMINAL WALL THICKNESS IS 0.20 In[5 mm]. DESIGN FLOW: 330 GPD SECTION PLAN INFILTRATOR IM-540 TANK DOSING REQUIRED: 4 CYCLES/DAY (SAND) SPECIFICATIONS 330 - 4 = 82.5 GALLONS/CYCLE 1.) CONCRETE STRENGTH 5,000 PSG ® 28 DAYS. PROPOSED SEPTIC SYSTEM UPGRADE PLAN DISTANCE REQUIRED BETWEEN PUMP 2.) CEMENT, PORTLAND TYPE II PER ASTM C150-81 ON AND PUMP OFF FLOATS: 3.) REINFORCEMENT PER ASTM C1227-93 82.5 GAL/CYCLE --1-- 138 GAL/FT = 0.6 FT/CYCLE (USE 7 4.) 15" RISER SECTIONS AVAILABLE 5 HIGH VIEW CIRCLE, MARSTONS MILLS, MA ") Prepared for: Susan .Limeburner, 5 High View Circle, Marstons Mills, MA 02648 STORAGE REQUIRED ABOVE WORKING LEVEL: 330 GALLONS DB-3 Engineering by: SCALE DRAWN JOB. N0. STORAGE PROVIDED: INV.(IN) EL: 63.30 PUMP ON EL: 60.62 2.68' DISTRIBUTION BOX: 3 OUTLET Engineering Works, Inca N.T.S. P.T.M. 267-19 - = STORAGE PROVIDED = 2.68' x 138 GAL/FT = 369 GALLONS WIGGIN PRECAST CORP., BOURNE MA. (800) 564-6774 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 11/12/19 P.T.M. 3 Of 3