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0049 HIGHPOINT ROAD - Health
49 Highpoint Road Marstons Mills p 028 044 -- - - W Town of Barnstable P# 114b6,6 Department of Regulatory Services BAMaTARM Public Health Division Date � � D a,n I MA93. �A e'6gg. 200 Main Street,Hyannis MA 02601 l x � Pfl)A0.P't A Date Sclieduled— 6 Time Fee Pd. $l 0_0 eAll Sail Suitability Assessmentfor Sewage zip®sal l Performed By: MICNgE- P1mENI-el E.t.aS•�, Witnessed By: ✓` LA�. J �r/I LOCATION& GENERAL INI+'ORNIA`I'ION Location Address l p1? Owner's Name�9 I�[ C�N�d{Nr ". Address /^ rr� MCxHf'otvr Wo Mai Assessor's Map/Parcel: ' Vc)-L`i l�q / Engineer's Name(WswtV6 6�`rp�{$f:j G 00 d NEW CONSTRUCTION REPAIR _ Ins Telephone Land Use '0 2�3-03.7 �i EStOEr4r1AL (14,diid1F Slopes 96 '2- 16 iy � P ( ) Surface Stones + fi Distances from: Open Water Body ft Possible Wet Area 7�bC'�,' ft Drinking Wafer Well �3�)' it Drainage Way ft Property Line > t® ft Other ft SIM'TCH.'(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) Ov�w�sH Parent material(geologic) P44) Depth to Bedrock >(14161 C3GS Depth to Groundwater. Standing Water in Hole: Weeping ft'otn Pit Nice illy, GAS Estimated Seasonal High Groundwater 91,�y DETERMINATION FOR SEASONAL HIGH WAIIR TABLE Method Used: 01VU-C —2({-tl -- g I Depth Observed standing in obs.hole: �,r3 S •-.-. )q, Depth to soil mottles., Depth to weeping from side of obs,bole: tI, M• _ In, Groundwater Adjuotment 1l. Index Well tr Reading Date:- Index Welt level Adj.Netor Adj.Groundwater Level w, PERCOLATION TEST Date'Wv is Time 2L,:B0 Observation a Hole Time at 9" "., Depth of Pere eq`t®2" -r Time at G" Start Pre-soak'I'ime @ it 1 it 1 Time(9"-6") _ End Pre-soak Rate Min./Inch d Site Suitability Assessment: Site Passed [✓ Site Failed:, Additional Testing Needed(Y/N) Original: Public Health Divis;op,„t Observation Hole Data To Be Coinpleted on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the, (Barnstable Conservation Division at least one(1) week prior to beginning. Q:NS RPT1C\PERCFORM.DOC DEEP.OBSERVATION BOLE LOG Hole# i Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) USDA i ( ) (Mansell) Mottlingl (Structure,Stones;Boulders. onsistency,%Gravel) EE DE E P OBSERVATION HOLE LOG Dole# Z- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ousisten % ra 6 Flo` louse DEEP OBSERVATION]MOLE LOG Dole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION DOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. --Consistency, ]+lood Insurance Rate Map_: Above 500 year flood boundary No— Yes Within 500 year boundary No ✓ Yes _ Within 100 year flood boundary No_ Yes _ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? 65 If not,what is the depth of naturally occurring pervious material? Certification 199� I certify that on Od, (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertis and perience described in�10 CMR 15.017. Signature Date 5, Q:\S.EPTIC\PERCFORM.DOC Q TOWN OF BARNSTABLE LOCATION 1 i4`C_�ATQ t U T VPN E SEWAGE# aO 15J V.�t- VILLAGE_tAA15MQS NJ(u5 ASSESSOR'S MAP&PARCEL as INSTALLER'S NAME&PHONE NO. (�A'PC-ix)ING FAgE 1 5dS SEPTIC TANK CAPACITY 1 I ®®o Ge4Cd..1J pJ LEACHING FACILITY:(type)��� Sc o CA- ON size) 1 a. NO.OF BEDROOMS 0 OWNER RvPd ZZT 7R(19T A "T 6 MRr— PERMIT DATE: .5 COMPLIANCE DATE: 5 !Y, Separation Distance Between the: 1V p 6D,0Ut.*WW4, Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on LA site or within 200.feet of leaching facility) Al Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) f Feet FURNISHED BY yf0G � ���� ch �`� J 13AC 4 A-i C-3 = 23.51 Q-t - IS.(,' 13-4 i°1.5` Town of Barnstable Regulatory Services Thomas F.Geiler,Director z Public Health Division HAM 639, Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 5.27"15 Sewage Permit# 2 0 1 a - 2 I Assessor's Map/Parcel Z Instafler&Designer Certification Form Designer: SG Erg \(nee-((0�� , T'.)c Installer: Ga(�ewic�. E,�Fer�reszS Address: zb$4 C Cnnbtrrx I 4iv nt Address: 1 .5s Covymm e;ct'o l S{re,-i eoe1 W,0r61nom� t1A 01538 HAS`neee MR OZ(c 1 ,ob•7,73•0>77 On S� S " 20`� CQQeAx3tAc. &Mere< 5e s was issued a permit to install a (date) (installer) septic system at `Y 9 &5 h eom- 6 d od based on a design drawn by (address) S C En5zne_-e_c'cn5 , -Toc- dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. 4w I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) ected and the soils were found satisfactory. JOHN L, CHURCHILL ler's Si attire) IVIL ` 4160 Aloor— i signer s Signature (Affix De Here) PbASE RETURN TO ARNSTABLE PUBLIC REAL DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT E ISSUED UNTILO T S FORM AND AS- BUILT CARD A�tI,�S RECEIVED BY M. TABLE PU13 IC HEALTH DIVISION. THANK YOU. gAaffice forms\designercertirication form.doc No. �� 1 I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(pplicatiou for Misposal 6pstrm Construction permit Application for a Permit to Construct( ) Repair(x) Upgrade( ) Abandon( ) X Complete System ❑Individual Components Location Address or Lot No. if 9 14 16OPO4V7 Rb M M Owner's Name,Address,and Tel.No. p (tOeaxj- i TR+STA ToKAR,Z Assessor's Map/Parcel O;k O ®qq 411 N164©frc! P.Tj H,4 57 p&6 m i L-us Installer's Name,Address,and Tel.No. 509-Zt71—827 7 Designer's Name,Address and Tel No.508—;t'7 3 a 63 7 7 C-4,06U t-P& 6;jU7Z%PAjISE�S(✓CSC:. TG GNC1�cci:�C�t Z`nB� 4v E, Type of Building: Dwelling No.of Bedrooms Lot Size ;L*),Oo;Lsq.ft. Garbage Grinder( ) Other Type of Building j2CS(1?-V-r1 A-C_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 c) gpd Design flow provided b 49. gpd Plan Date !q " ac�—3L®t5 Number of sheets i Revision Date Title qq j4l6 fC7DfI6.7 ()WA.;6 MAe_ �iLLC Size of Septic Tank &A•.L— Type of S.A.S. (a) 5oo 6X4- 6H Description of Soil C d AQ_S t ®t-t[ (7g? !2 q of /S eg Q LAO Nature of Repairs or Alterations(Answer when applicable) <ti l lj -56TTl G 'T%j `30 h2 0t) H-d o 0 -g?QK?U Cam) i-I-a S oQ 464 "106r 6We45 S CO C4+ q vewr z>y 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. ASid - Date Application Approved by Date Application Disapproved Date for the following reasons Permit No. Z01 S- IZ1 Date Issued ��yTJZfrl F t`.< •f l � . t, ' io 1 No. Fee E THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4pliration for Disposal �pstem Construction Permit - , Application for a Permit to Construct( ) Repair(A) Upgrade( ) Abandon( ) XCompleteSystem ❑Individual Components Location Address or Lot No.if 9 (4i6APoi07 ILb lei M Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a g Q P.a R�-T s TT?'S TA "CO KAR c Installer's Name,Address,and Tel.No. gp$-ct-77_n77 Designer's Name,Address,and Tel.No.,508_��3 0377 04,06W & &JU760USES _T L =W C.a GF 044NO Type of Building: Dwelling No.of Bedrooms 3 Lot Size n,0 Z_ sq.ft. Garbage Grinder( ) Other Type of Building fM(D1,MA_L__ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3"a 4 gpd Plan Date Z9{-3L42(5 Number of sheets I Revision Date Title 1. Q k 1 sio l(7Zx1T ()Z11X-:� M A& 4t-f I l.t..l; Size of Septic Tank � 00 64L_ Type of S.A.S. (9 pp ��{.*"As r. Description of Soil— 0 Aa 6_54jje <�rz q ll / Q[A Nature of Repairs or Alterations(Answer when applicable) „S6 IGV15-[1 IL AGg1no; kA od 5t✓ry c M4#j C_ Ag a a 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. Signed Date 5 —5_- 2 p 9 t Application Approved by _ Date Application Disapproved Date for the following reasons Permit No. ZOl ti - lZ► Date Issued � b --------------------------------------------------------------------------------------------------------------------------------------- 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 !mw io t✓&piqalua�s LLS; at y j f4t&H Pe)(L Tr Igb M M has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.,s --1Z( dated 3A jot F- , Installer Cj"ELgADC E�I-A59L J_!QM L.L.C- Designer #bedrooms Approved design h 3�' n gpd The issuance of is permit shall not be construed as a guarantee that the system w' li fundtio as designnd. Date �7 i '� Inspector I ( c,c No. Q — Fe e � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS -isposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(A) Upgrade( ) Abandon( ) System located at 449 Hj QH j1)_t)( 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:Co tru tion must be completed within three years of the date of this permit. Date 5 Zoi Approved by 4@ . DATE__a/2 V_0_4__ PROPERTY ADDRESS:_49 aisLb_2,oint-8.o.ad Marstons Mills, MA 02648 ------------------- On the above date, the septic system at the above address was Inspected. I RECEIVED This system consists of the following: 1-1000 gaiion aept.ic tank SEP 1 5 2004 1- di-A/L.igut.ion &ox 04VN OF pARNsTABLE 1-1000 dif on .Q,each.ing 12•it Based on inspection, 1 certify the following conditi nS: HEALTH DEPT. 7h.iz .'h a t.itee dive "Pt- c '3"tem (78code) The �e/�tic..�,yhtem ,in naope2 wo&k.ing oadea at th:e pae,39-nt time. lJaht e wat ea eve .in J.each:ing .12 it wa.6 51" to :inve2t P.il2e. SIGNATURE:--------------- Name:---- —----- Company:_JQaeph _P_M ub-erL &-&an, inc. Add ress:___E._o_-.Box-4&----------- Ifs t . -'ARCE L ®ei-'�' Centerville MA 024-12nn66 • 2 Phone:---- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY . Emil JOSEPH P. MACOMBER & SON, INC. Tanks-Cesspools-Leachfields Pumped & Installed Town sewer Connections P.O. Box 66 775.3338 rvi�75 6 02632-0066 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICYOF ENVfmNMENTAL AFFAIRS a DEPARTMENT'OFR+NVII.tON]VIENTAL PROTRCTION ^�p - TITLE 5 OFFICIAL INSPECTION FORM-NO.T.FOR VOLTUNTARY ASSESSMBNTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART-A CERTIFICATTION. PropertyAddresk', 49 High pr%jn;L DsaQ MA Owner's Name: _ Rpm a i a lie Butte Owner's Address: c me Date of Inspection: Name of Inspector: (please Company Name; , , P.Aacomleit-, & 11,on lric. Mailing-Address: Can 44V-i P_, a� ,-02632 s Telephone Number: 5 0 8-7 7 5-.,3 3 3 8 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system,at this address and that the.informationraported below is true;accurate and complete as of the time of the inspection.The inspection-was performed based on my training and experience in-the proper function and maintenance of on-4ite sewage disposal systems.I am a DEP approved system inspector pursuant to=5ection.15:340.of Title 5(31.0 CNIR 15:000). The system: xx Passes -Conditionally Passes Needs Further Evaluation.by the Local Approving.Authority Fails Inspector's Signatare: Dater The system inspector shall submit a copy of this inspection repoifto the.Approvinp Authority.(Board of Health or within 30 days of com letiog this inspection.If the system is a,shared system or has a design flow of 10,000 DEP P X gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP.The original should be sent tom system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This'report only describes conditions at the time of inspectidb-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. Oft VIVO page 1 . Page 2 of 11 OFFICIAL INSPE,CTIONYORM—NOT:FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FONT PART A CERTIFICATION(continued) Property Address: 49 High Point Road Marstons Mills., MA Owner: Rnna 1 el T-in R1 am Date of Inspection: R/9 3.4(La Inspection Summary: Check A;B,C,D or.E/ALWAYS complete:all of Section,D A. System Passes: NO 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 exis jjAny failure criteria not evaluated are indicated below. Comments: Septic byatem .ih .in /220/2e/L b)oILUny o/Lde2 at ,.the 12aehent t.ime. B. System Conditionally Passes: NO 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. r Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. NO • 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.3he existing tank is replaced with'a complying septic tankas nppproyed 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. ND explain: NONE 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. . obstruction is removed distribution box is leveled or replaced ND explain: NO 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 obstruction is removed ND explain: Page 3 of 11 OFFI'CIA.L INSPECTION FORM-NOT IFOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART A CERTIFICATION'(continued) Property Address: 9_ H i Qh. Pn i n+ .R nad Ma,-�tr,� �4��•�s•�--�4� Owner•. T - Blanc Date of Inspection: C. Further Evaluation-is.Required by the Board of Health: NO Conditions.exist whiehrequirefurther•.evaluation•by the•Board.ofHeaith;in-order to;determine ifthe system is failing to protect public health,safety or the environment. 1. System will pass unless Board ofiiealth determines:in accordance with 310.CMR 15:303(1)(b)that the system is-not functioning in.a-mariner which:will•protect public health,safety-and t e..environment: no Cesspool or privy is within 50 feet of asurface water n oo Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2. . System will fail unless the Board-of Health(and Public Water Supplier,`if any)determines that the system is functioning in a manner.that protects the public Health,safety and environment: n o 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. no The system has aseptic tank and SAS and the€SAS is within.a Zone 1 of a-public water-supply. n o The system has aseptic tank and.SA&and the SAS is within,50 feet of a private water supply well. no 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 v.i..sua P "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from-pollution from that facility 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-tl}is form. i 3. Other: NONE Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FORYOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 49 High Point Road Marc# nnc Mi 1 1 MA Owner: RnnaI rl.� I in Al ADC Date of Inspection: u 12 Z /n 4 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to.each of the:following1or all inspections: Yes No ,g x Backup.of sewage:into facility,or.system component due.to overloaded or clogged SAS or cesspool x Discharge:or ponding of effluent to the surface of the:ground or surface waters due to an overloaded or x clogged SAS or cesspool x Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool x Liquid depth in-cesspool is less than.6"below invert or available volume is less than'h•_day flow x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number x of times pumped x Any portion of SAS,, cesspool or privy is below high ground water elevation. _ z Any.portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. x Any portion of a cesspool-or privyis within a:Zone l•of a.public well.. x Any portion of a cesspool or privy is within_50 feet of a private water supply well. x Any portion of a-cesspool or-privy is less than i 00 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution;:from.that facility 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 niust be attached to this forte.] ND (Yes/No)The system fails. I have determined that one or.more,of the:above.failure::.criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner.should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the:system must.serve a-:facility with a design flow of 10;00.0 gpd to 15;000. gpd• You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ z the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply " x the system is located'in a nitrogen sensitive area(1Tnterim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant.threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D sha11 upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional.office of the Department. d Page 5 of I 1 OFFICI•AL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS WDSURFACE-SEWAGE DISPOSAL`SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: , MA Owner:. Date of Inspec ion: w BZ nc , Check if the following have been done.You must indicate"yes"or"no"as to each.of the following: Yes No -d x Pumping information was provided by the Owner,occupant,or Board of Health x Were any of the system components pumped out in the previous two weeks? x Has the system received normal flows in the previous two week period? x Have large volumes of water been introduced to the system recently or as part of th�inspection? x Were as built plans of the system'obtained and examined?(If they were not available hote es N/A) x Was the facility or-dwelling inspected for signs of sewage back up? x — Was the site inspected for signs of break out? x Were all system components,- cluding the SAS, located on site? x _ Were the septic tank manholes uncovered,,Dpened,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? x _ Was:the facility owner(and occupants if diff6rent 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 deternrined based on: Yes no • x — 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 approximationof distance .. is unacceptable) [310 CMR 15.302(3)(b)J Page 6 of 11 OFFICIAL U1TSPEC'FI0N:-1FQ.RM`-NOT FOR V0LUNTARY ASSESSMENT'S SUBSMACE SEWAGE OISA,OSAL:SYSUMINSPECTION FORM PART.0 SYSTEM INFORMATION Property Address: 49 High Pn i n♦- Road marctnus Mills, MA Owner: Pnnald Le 81anc Date of Inspection: 814214-04 , FLOW CONDITIONS RESIDENTL4 L Number of bedropms(design):_,< 3 . - Number of.bedrooms•(ictual): 3 DI;SIGN`.flow based on-3ID CE4R 15.203'(for examples'110 gpd z#ofbedrooriis)i Number of current residents: .? Does-residence have a garbage grinder(yes br no): n o Is laundry on a separate sewage.stem.(yes or.no):. o [if yes separate inspection required] Laundry system inspected(yes or no): h o Seasonal use.-(yes orno):ao lJe2� Glutea: I,,' cve�� hays not been Water meter readings, if available(last 2 years usage(gpd)). Sump pumR(yes orno):no Rapt yea2' it must Last date of occupancy: n o P,e done at t h.ia time.- SEE p g 6 4 9/3 COMMERCIA•IUSTRIAL - Type of es.. " ,. nt: NA. . Des'. n flow,, on 310 CMR 15.2'6)i. N4 s;ud Basis.of d si` ow(seats/persons/sgR,etc.):, N4 Grease trap`resent(yes or no): N4 Industrial waste holding tank present.(yes or no): Non-sanitary waste discharged to the Title 5 system•(yes or no): N.4 Water.meter readings, if available: NA Last date of occupancy/use: . 14 OTHER(describe):. N4 . GENERAL INFORMATION Pumping Records Source of information: !uml2ed at time o f .in 3/2ect.ion Was system pumped as part of the inspection(yes or no):__q e,3 If yes,volume pumped:15 00 Qallons--How was quantity pumped determined? MO-a's rLa v-r] a x Reasonfor.p..umping: Pumped `102 ma-inta-inaaca TYPE OF SYSTEM Septic tank,distribution box,soil absorption system . . o Single cesspool no Overflow cesspool n-n Privy Shared system-dyes or no)(if yes,attach previous inspection records,if any) a o Innovative/Alternative technology,Attach a copy of the current operation and maintenance contract(to be obtained from system owner) no Tight tatik. n a Attach a.copy.of the DEP.approval fr. no Other(describe): N4 Approximate age of all components,date installed(if known)and source of information: Tn,tfnQQ,d 4/17/1987 �ve-e Tnr/nn,;A Were sewage odors detected when arriving at the site(yes or no): no 6 _ Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 4 9 H i c1h Pn i n t Road Maretnn Mill Owner: MA Ronald LQ Blanc Date of Inspection: - 8 i z r h , BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction:_cast iron N 40 PVC_other(explain): Distance from private water.supply wQ9,or suction line:_10 0 f,fit Comments(on condition of Joints,venting,evidepce of leaka ao iota a�Rea2 tight no evzaenee o fe'P P2 kage.• Syztem iz . . venterL thaoug 20o van SEPTIC TANK:Le Alocate on site plan) 15 0 0 ga e i o n. Depth below grade:20 Material of construction: X concrete— —fiberglass fiberglass_polyethylene _other(explain) N�1 If tank is-metal list age: NA Is age confirmed by a Certificate of Compliance(yes or no);—(attach a copy of certificate) Dimensions: 10' 6"LX 5 ' 8%)X 5 ' 7"K Sludge depth: 72 a c e Distance from top of sludge to bottom of outlet tee or baffle: t 2 a c e Scum thickness: t a a c e Distance from top of scum to top of outlet tee or baffle: t a a c e Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined. N e a.z u 2 e d Comments(on pumping recommendations,inlet and outlet tee or baffle condition, as related to outlet in structural integrity,liquid levels vert,evidence of leaks um tank every 2yeaa s.• gNeM &outiet teen ate in 12iaee. tank ie 2uc u2a y roan . GREASE TRAP:NA (locate on site plan) Depth below grade: Ng , Material of construction: N Aconcrete NA metal Nja-berglass N__polyethylene other (explain): N A Dimensions: Scum thickness: NA Distance from top of scum to top of outlet tee or baffle: N A Distance from bottom of scum to bottom of outlet tee or- ffl—ba a:—#-4 Date of last pumping: NA m Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural as related to outlet invert;evidence 1 rote liquid nce of leakage,etc.): �h'� levels tea n 0 12 2eZent Title i T++onPn*inn Form AM si)nnn 7 Page 8 of 1 I OFFICIAL IN'S-PECTION FORM—NOT FQR VOLUNTARY ASSESSMENTS s� I FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 49 High Pni nt Road Mar-steFis „R. , , , MA Owner,.- „—Ra a Ter Ler ,,, f Date of Ibspection: A .A•N TIGHT or MOLDING TANK-/NA (tank must be pumped at time of ihspection)(locate on site plan) Depth below.grade: NA Material of constructio— n:/�R concrete NA metalNR fiberglass NA polyethylene N,4 other(explain)-N,4 Dimensions: NIL _ Capacity: NA gallons Design Flow: • NA gallons/day Alarm present(yes or no): N4 Alarm level: .ALA A farm..m working.order(yes or no): Dot;of last pumping: Comments(condition of ai.arm and float switches, etc.): 7.iyh.t oa ho ed.in.g .tankz ¢ze not ?2ezen.t., DISTRIBUTION BOX:ues (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:n.one 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.): Di-1.L,z P,u.t.ioa 'Pox hens nne jnfvnrrp_,No ev-idence o� zo Udz ea22.y ovea.� No z.ignh o,e .leakage .in o.¢ ou.t o- gox,' PUMP CHAMBER: NA (locate on sife.plan) Pumps in working order(yes Or no): NA Alarms in working order(yes or no):N,4 Comments(note condition of pump chamber,condition of pumps and appurtenances, ett:.): um12 eham9e2 .t s no t R2e�en , 8 Page 9 of 11 OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INNSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 49 High Point Road Marst-ons mills , MA Owner:. Ronald jp ni anc Date of Inspection: sty 2?A/__ng4 SOIL ABSORPTION SYSTEM(SAS):ye-3 (locate on site plan,excavation not required) If SAS not located explain why: Located Type u es leaching pits,number: I no leaching chambers,number:_a_ no leaching galleries,number: 0 no leaching trenches,number,length: 0 no leaching fields,number,dimensions: no overflow cesspool,number: 0 n o innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Soy ih Uazte watea waz 51" to .iave2t pipe .in .9eaeh.ing fit. CESSPOOLS:n o (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 0 Depth—top of liquid to inlet invert: na Depth of solids layer: na Depth of scum layer: na Dimensions of cesspool: na Materials of construction: n n Indication of groundwater inflow(yes or no):n Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Cezj ooiz ate not 2ezent., PRIVY: no (locate on site plan) Materials of construction: na Dimensions: na Depth of solids: na Comments(note.condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): l 2-ivy_ ih not 2eZent. 9 Page 10 of 11 OFFICIAL INSPEC-TION'FORM NOT TORVOLUNTA Y-ASSESSMENTS SUBSI-REA:CE SEWA.GE-DISROSAL SY'STEMINSPECTION ORM ;— PART C SySTEM INF-ORMATI.ON(continved)' Property. Address: 49 High Paint—Road Owner: Rnr)a 1 ri r.a .a;and Date of Inspection:_ Q� SKETCH OF SEWAGE -DISPOSAL SYSTEM "ovide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells.w�thin 100 feet.Locate where public water supply enters.the building. kIN �°/` E 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM A PART C SYSTEM INFORMATION(continued) Property Address: 49 High Pn i n t Road Maretnna MA Owner: R n n a 1 d La R l"c Date of Inspection: $Ta „10- 4- SITE EXAM Slope Surface water Check cellar Shallow wells s Estimated depth to groundwater 7 a feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: y� 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: llzed.gahe2.ty and mi.eeea mode.e 12116194 canound /Z aeov Ae¢ e Up Ll�sed:7echnccgi &u.e.ee.tin 97-000- 1 pynfo#'? 7�rnunni� 999� AnnnnO /Ignge.b o;d alzound wrrfan ePeuaf16n6 e j© High Groundwater Adjustment 1 .8 per Frimpter Method Therefore, the vertical separation distance between the bottom of the ► 1� leaching pit and the adjusted ground- water table isSYq Z`feet. WARD OF IiE�ALTII 'I'OWN OF SUMS FACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION . V. I W, -i'[tT,tITRt?T.t<4'STTT.IrRr:TP"Tr'T•-1!•�••� ..t_T':-:: ��.liT.".�TTT..Tf'R.'T:TI'�'{1r.T.ZTt'1Ti'TTtT.•.'I TltiTR:'it�.S'1T14Y/�T�7'��s •� -TYPE Olt PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 49 fl iuh 20 ant 1?d ASSESSORS MAP, DLO,,CK AND PARCEL # 028-044 , OWNER' s NAME Ronaed Le' Hanc PART D - CERTIFICATION NAME OF INSPECTOR ,3auc Rar-aUa/ttea COMPANY NAME a• p,'Racomfea and ,bon fc: Box 66 Cent eaviiie Na.- 02632 COMPANY ADDRESS --street Townor city State LIP COMPANY TELEPHONE ( 508 J 775 - 3338 FAX ( 508 ) . 790 - 1 578 R tR CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate, and omplete as of the time of .,inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on site sewage disposal systems . Check one: XX Systeui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 ► Any failure . .criteria. not evaluated are as stated in the FAILURE CRITERIA section of this. form . "w System FAILED* The inspection which I have con iTcted has found that the system fails to Protect the jiublic health and the environment in accordance with 'Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART,.,C -_..FAILURE CRITERIA of this inspection form . Inspector Signature % 7 Date copy of this certification must be provided to the OWNER, the BUYER One where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, th'e owner or operator shall up.grade ' the system. within one year of the deite of the inspection, unless allowed or requi..red otherwise as provided in 3.,10 CNR 16 . 306 , partd.doc SEWAGE INSPECTIONS o I.vCAMN DATE I��Lo VI'LADE �fA f° l S ASSESSOR'S MAP & LOT'J t� NSPFC'POB ion inc . SEPTIC TkNK CAPACITY !do 0<:) LEACHING FACILITY: (type) IL E (size) P(o©V NO. OF BEDROOMS BUILDER OR OWNER NOMLA J7njiC OWNER MAILING ADDRESS �, 1 TOWN OF BARNSTABLE LOCATION 4117 ,; ' kp ,��,I SEWAGE # 7 l • u VILLAGE f�f' Tdr�,-� .`!� ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY /TVV L• LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL OR U C BUILDER OR OWNER DATE PERMIT ISSUED: ?u ATE . COMPLIANCE ISSUED: r. VARIANCE GRANTED: Yes No -� �P�f'4 � � - ��S +`�S" _k �! 1. ,, M�- .� � -�s� �.���. _ - ,, e , �� � (�% � � s� .. t --. G ASSESSORS UP THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - OF...................................... . ................................................ Applira#ioo for Dispooal iftrkfi Tunfitrurtiou Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ... .................................................. ..........................••-••••--�o ----•••. --------...._._...----- ocation- ddres or Lot No. ...............................................�3 ` C _._.......-•-•-------- Q%W a Address Installer Address d T ding Size Lot-4.0�__._�9.0 ...Sq. feet U Dwellin No. of Bedrooms.......... ___________________________Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building Lva r!rye No. f persons.......... _._ Showers ( ) Cafeteria ( ) Other fixtures . .........5 v —' o'` iiN WDesign Flow............._..............................gallons per person per day. Total daily flow............................................gallons. R' Septic Tank—Liquid capacity..._........gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .....'_............. Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No-----------_-------- Diameter-------------------- Depth below inlet____________________ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit____-_______________ Depth to ground water.-_-_-_.-___________-.-. Test Pit No. 2................minutes per inch Depth of Test Pit__-__-___-_________- Depth to ground water---_____-:___________-__ n+' ---•...............................................................................................................................--........................ ODescription of Soil......................................................................................................................----•----•----------------...................... ----------•-----------------------•-•-••-----------•------------------•-------..._...------------•---••-•----•--•--•--------------••-----------•--------------------•---------------- ----- U Nature of Repairs or Alterations—Answer when applicable._/Wn ........................................................................................................................................................................................................ ------•----------------------•--------•---------------•--•---------•----------------•------•----•-••---------•-------•----------------•---•-----•------•------------••-•----••-•----•-••---------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT .,=. p S of the State Sanitary Code—The undersi furti er agrees not to place the system in operation until a Certificate of Compliance has been su the bo rd o h Signed. = --- -r �� ApplicationApproved By............................. -•------- •----•--...._----•-------•-----•------- ,, ate Date Application Disapproved for the following reasons:-•--------••--•----•--•-----------------------•-•-----------•-•--------•-----•-•------------•-------------_----- ..-•-----•-------------------•--•••--------------------------._...--•--••--------------------•-••-•.._...._ Date Permit No.... - r. __... - Issued - " �� ... .---------•-•-•---- Date yG� FE$....a.0..........- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -..............._--- ------------------OF........................................................................................ Appliration for Elispaa al Works Tonotrnrtirrn rjermit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: I� �Q 0 /O `_ / / LotNo. . ... ...... .................... ............... yC' O / Address Installer Address VTy ing Size Lot.P2.09....16-a...Sq. feet UI Dwellin No. of Bedrooms.......... Expansion Attic ( ) Garbage Grander ( ) �`4 Other—Type e of Building W c^ �-a-r+ yp g ..........................P No. f persons....__._. Showers ( ,) — Cafeteria ( ) d Other fixtures ---- 7;L/9.�........5•-v --- ......Z�?.,4...-•--•_"_ `.x� Y`J f hJ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ Disposal Trench—No..................... Width.................... Total Length...._............... Total leaching area_...................sq. ft. x Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......... --------- -•---•---------------•---------•-••-------------•---• Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-___-____-_--___---_____ 04 , ---•............................................ ,..... 0 Description of Soil...............=........................................................................................................................................=......--_------ V .....•-••-•••-•-•---•-••----•--•-••-----•-•••---•-•---------•...............•-------•-••--••-•••-•-•-----•-------•-----------•-•-------•••------•---•••--•-------•------••---------------•-----•-----••-. --------------------------------------------------------------------------------------••-•-----------------------------------------------------------------------------------------. ..... V Nature of Repairs or Alterations—Answer when applicable_°"e ---�.e7 ,-___- ............. ...•---------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT.iE 5 of the State Sanitary Code—The undersigned ed further agrees not to place the system in r � .�� operation until a Certificate of Compliance has been • su , y the bojrd�pf health r Signed =yam. J-- Date Application Approved B / D Date Application Disapproved for the following reasons--------------------------------------------------------•------------------------•------------•-•----------..._._ ..............•---------.....-•--------•--•-•-••••--------•-------•---••••--•---------•••....------•---••-•-----------•-------•-----•••----••-•••••----------••----•-••-••----•------••••---•--•----••-- Date Permit No.----- 7 ...................... Issued_........ �-----------•---•---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........OF.........../.. cK: ....: ............................... Tntif iratr of ToutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (>} by............ --- !rn - ---- ----------------------------------------------------------------------------------------------------------------------- Installer has been installed in accordance with the provisions of T iT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit NTo..... .i ......... dalted_-------3 G__-____ _ __________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. �^ DATE------...--- ............................................. Inspector..... _1. ................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH fit.crr.f -..........0F........P=& ............... "ispais al Workii Haan unction rrmit Permission is hereby granted------.�Ylx .�-IrA . -. .-------•--------•--------------------------------------------------------------- to Construct ( ) or Repair �>e) an Indiv'du 1 Sewage Disposal System atNo. 9 N , = -------------•----.---------.....------------..--- Street as shown on the application for Disposal Works Construction Permit No.�_Z\_-/ __ ._ Dated.....3..- 6.77...... --------- ..-J.��e. ---- 42 Board of Health DATE----3 7•--------•--------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS a7� 4 f . 3,9 6 $ 26 a � �o / A mid L yq H;,� Aol,ol -t-vtw- itu 8 23 d "' n I N a.N 13 8.00 In 03S6-E h = aiC�1SE 12 3 ;~ 0; p �( u = N Q 4ce'a�'3eu1:9 24 Ct _O 22 n 15945 -/ lF N $ o � 147.81 14605 m�Nosslz w , 4 S so ea Err r � � �61 � � 0 I Og •' - 8 r r Q 25pS " 2/ , tJlvw;16w Q9 '� ,Q 0 b Ni a ��SGi 06f ` Q� s _ � n 155.81 w o " t 20 O Z to L� 0 I _ 2 LL �6! N �w ' Ala3 SG 3'�oUQ,. -� aa1 /�• �� 1 � I II ppt �p IT7.74- / 6 � o'rO T.� p / S t�- 'I O0 N !A /9 � A .oQL ..A 19. Ln u I - n ,n .. J 251.7I �5 'r C I IF a2 zt'st 4G�'25 oow c � lGO.00 - " NO / �. 7 $ sue •„ 2 p l 8 � 3ICo.zB i s� I(o0.00 O wG�'2� oou� '� 8 �. O sci 22 iralsF o Q. O0 tti 17 i 29 _N 3 ,,d i 4G7'�S d �- o 9 O • 0 '��, ZQ:L6 � 415 0 3 ` Nh 0 �L T ! b o 30 `�4 �< � Z �°` co .� /0 ti 42 s 47 _ /3 � �g s 12 Subdivision of LandI Shown on Plan 34846A Filed with Cert. of Title No. 41591 4 / Registry District of Barnstable County Separate certifcates of title may be issued for /and shown hereon Aad-_Qn_S_h���`_ -�2.LQ�`�_l�fzr�r 4 7 Copy of art of plan By the Court. n7 n LAND REG/STRA RON OFFICE O,AC1WAE.e Olfc7 _ _ _ _ (__ Scale of this plan/" t�eet to an inch �CFNBEQ/9/�? - .` -j �N Recorder C.M.A.ndlerson:Engineer for Court v,, FINISH GRADE OVER D-BOX= 91.51± FINISH GRADE OVER CHAMBERS= 91,rj' _ 92.0' PROP.VENT WITH CHARCOAL FILTER TO ABOVE GRADE GENERAL NOTES T.O.F. EL.= 92.3'"F - ° 3/4 TO 1-1/2 DOUBLE WASHED PROVIDE'EXTENSION RISER SLOPE @ 2/o MIN. OVER SYSTEM STONE TO CROWN OF PIPE REMOVABLE WATER-TIGHT COVER OVER 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION WITH COVER OVER INLET& RISER TO WITHIN 6"OF FINISHED GRADE 4"SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL FINISH GRADE OUTLET TO WITHIN 6"OF F.G. ° �"OF 1/8"TO 1/2"DOUBLE WASHED @ FND. EL.= 91.8 ± MIN SLOPE 1/° BOX TO F.G. (SEE NOTE 21) I ' F.G. OVER TANK EL. _ 92.0'± 5"DIA. OUTLET(S) STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE TOP OF SAS= $7"00'* PLACE RISERS ON ALL DESIGN ENGINEER. " 4.10 MAX. CHAMBERS WITH EXISTING 4" � PROPOSED 4 SEE NOTE 22 , 5.00 MAX. " � 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE SCH. R PVC 8IL 6.00 SEE NOTE 22 BREAKOUT EL= 86.50' INLET PIPES TO 6 OF SYSTEM UNLESS OTHERWISE NOTED. SEWER PIPE � FINISHED GRADE ---.-.--- __..--=� 3"DROP MAX " " � �+ 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN - 6" 3" L=33 _ -- _ 2"DROP MIN 3 9 MIN.SLOPEA1% PROVIDE WATERTIGHT ELEVATION =86.50'FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A ( 10" 4"PVC IN FROM JOINTS(TYP.) �� 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" � $T,3'-� SEPTIC TANK 4"PVC OUT TO 0 0 O 0 0 0 (� 0 0 0 0:) 0 0 O 0 0 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. CONTRACTOR TO PROVIDE LEACHING FACILITY oo o� � � � � � � � � � 00 � � � � � o 5.� SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. � SPECIFIED DROP BETWEEN " INLET AND OUTLET CONTRACTOR " CONTRACTOR SHALL OUTLET TEE 86.40� M N. 6 86.23' 2' �o o o a �' op 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48 VERIFY CONDITION OF " 00 0'o o� 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK l AND CONDITION OF EXISTING TEES GAS BAFFLE 6 CRUSHED STONE FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION.SYSTEM IS � EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY ' o� °° _ p NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY (TY ) - 14.0� 4.83' 4•0� AND DESIGN ENGINEER. , COMPACTED BASE cJ 4.0' 8.5' P --- 4.0' OUTLET DISTRIBUTION BOX 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM. BENCHMARK ELEVATION OF 94.00 - - TO BE INSTALLED ON A LEVEL STABLE 25.0' (NP') ESTABLISHED ON A NAIL SET IN AN OAK TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 84.00, GROUNDWATER ELEV.= < 79.00� 12 83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT n 2 - 500 GALLON CHAMBERS 5'MIN• CHAMBER END VIEW EXISTING 1,000 GALLON CONCRETE SEPTIC TANK 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES CROSS SECTION VIEW I *CONTRACTOR TO VERIFY EXISTING SEPTIC TANK PROFILE TYPICAL CHAMBER PROFILE *Top of SAS is lower than the slab elevation (i.e. TO THE DESIGN ENGINEER. u ELEVATION PRIOR TO ANY WORK& -20 DISTRIBUTION BOX DETAIL H-20 CHAMBER DETAILS SLAB=89.0't),therefore minimum setback required 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE from house to SAS is 10; proposed= 11.3'. I SWING-TIES �+ 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TE�JT PIT .,DATA APPROPRIATE ATE AUTHORITY. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM DESCRIPTION HCA HC-2 " PERC NO. 14655 David W.Stanton, IRS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS CORNER OF STONE(1) 23.7 11.4 j VALUATOR: Michael Pimentel, EIT LOCATED UNDER PAVEMENT,DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. CORNER OF STONE(2) 31.8' 24.2' r Oct. 1999 M iC.S.E.APPROVAL DATE: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. C E APPRO E: CORNER OF STONE(3) 24.5' 35.8' L DATE: April 10, 015 TEST PIT#: 2' 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE CORNER OF STONE(4) 12.0 28.8 pia MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ELEV TOP= 91.10, REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). .� - ZONE 2 ELEV WATER= <79.10' , t x 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND N PERC RATE_ <2 min./inch �\ s SITE CO THOSE SHOWN PRIOR TO CONTINUATION OF WORK. U 1 r \ � i`�'x � � L` �� v" fir • � I F ..n CONDITIONS FROM HO WN \\ \ 7H/j DEPTH OF PERC= 84" 102" 16. PROPOSED PROJECT IS LOCATED WITHIN: w . ; ASSESSORS MAP 28 LOT 44 TEXTURAL CLASS: 1(v OWNER OF RECORD: ROBERT W. &TRISTA D. TOKARZ j \\3. FAST/ G CO aly OROp \ ! x k �+ tI 0" 91.10' ADDRESS: 49 HIGHPOINT ROAD z Off, /NG ! Q \\ MARSTONS MILLS, MA 02648 0 x \. a r HC-1 • FEMA FLOOD ZONE X COMMUNITY PANEL# 25001CO537J " \ \ ! 17. L.C.C. 1 61 (4) w x Fin DEED REFERENCE L C 743 HC-2 ' . 18. PLAN REFERENCE: L.C. PLAN 34846-B(SHEET 1) (FND. CNR) 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. (3 �_ Ow lI .� , 3, �.;,,. .. a..w_ .. ,. Co - «, � �� ;.,� , ,,�, O � .,;;,. �' ����� 20. PROPERTY LINE INFORMATION IS-ONLY APPROXIMATE THIS PLAN TO BE USED ONLY" � t ., I FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY' - .<v + I z, FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. Y MAP 28 ry - �2) -.. : ", `. ." . k, ' ' 102,. 82.60' 21. A4"PERFO do RATED SCH.40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A PARCEL 49 �� co _MAP 28 " Coarse Sand DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3 OF FINISH GRADE. A PARCEL 44 . MAP 28 C 2.5Y 6/6 REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. EXISTING 1,000 GALLON SEPTIC TANK = Ss Loose 20,025#`S.F. 'S rSN 22. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE TO BE UTILIZED IN THIS DESIGN 222• PARCEL 43 LOCUS PLAN 582. F I APPROVALS ARE REQUESTED FROM 310 CMR 15.221 (7): (3)12"OAK /i 1.) A 2.00'WAIVER 3.00'-5.00' FOR THE MAXIMUM COVER OVER THE LEACHING FACILITY. SCALE: 1"= 1000' " (2.) A 1.10'WAIVER(3.00'-4.10')FOR THE MAXIMUM COVER OVER THE DISTRIBUTION BOX. .i .. CHIMNEY ai 144 79.10 \� \,\ 2'OVERHANG �OkFSE� No Mottling, Standing or Weeping Observed DECK \�\ \ \ \ Cqs O DESIGN DATA TEST PIT DATA LEGEND Benchmark \` ! �� \ �,PQo PERC NO. 14655 50x0 EXISTING SPOT GRADE Nail in Oak Tree 12"OAK ! \ �' V�`' \ INSPECTOR: David W.Stanton, IRS \' '49 \ ! / \ / NUMBER OF BEDROOMS(DESIGN) 3 - 50 -- - EXISTING CONTOUR Elev. =94.00' FX/ ! \ \ /J A prox. M.S.L. 1s"OAK \ 38F STING w-,_� / i90 \ \ EVALUATOR: Michael Pimentel, EIT a°OAK d 0 \ O Oh' ! DESIGN FLOW 110 GAUDAY/BEDROOM 50 PROPOSED CONTOUR a 1s°oAK \ / C.S.E.APPROVAL DATE: Oct. 1999 a \`\T0�� iUGM / �w ! TOTAL DESIGN FLOW 330 GAUDAY Aril 10 2015 2 \ ! �.'- /\ �, / / DATE: p 50 PROPOSED SPOT GRADE 10"OAK S`'ye 9 3` � w LP �\ 89.0 x / I / / = TEST PIT#: 2 s"OAK O� ( \ / v i / / DESIGN FLOW x 200 % 660 GAUDAY GAS EXISTING GAS LANE MAP 28 �� \ , �� / ! USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP= 91.00, PARCEL 112 i \ \ \\t\ \ ! // \ 9P ��w /`"' A' �. / !2 ❑/H/W EXISTING OVERHEAD WIRES tv - 79.00' s' OAK PROP. H-20 <EXISTING LEACHING PIT TO BE PUMPED, � . \ D-BOX - TWq �q _ J/ ��o / AFF PERC RATE W W EXISTING WATER LINE FILLED WITH CLEAN COARSE SAND PER �\ \\\ . < / / ry cry !k 310 C11�1R 255(3)&ABANDONED / 14"OAK \ p x / 0� Gqs �� yo Co. p DEPTH OF PERC= TEST PIT LOCATION SHED \ INSTALL 2 - 500 GAL. CHAMBERS w/ AGGREGATE \ / ft 9 x0 w ... ., Ggs 00 TEXTURAL CLASS: 1 ¢ / / / 4 SIDEWALL CAPACITY Q a EXISTING 1,000 GALLON SEPTIC TANK \ / , k // (2)s^o�K ���S ��' �� (LENGTH + WIDTH) (2 SIDES) (2'HIGH) (0.74 GPD/S.F.,) = GAUDAY 18"OAK ; // \ / , 25.0'+ 12.83')(2 ) (2') (0.74 GPD/S.F.) = 112.0 GAUDAY 0" 91.00' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE PROPOSED \\ 92 � ,. TP 1 � ) ,� N. 91 x1 \ O � INSPECTION PORT � � O PROPOSED H-20 DISTRIBUTION BOX 2"OAK 1 / A.. 30 BOTTOM CAPACITY PROPOSED 2-500 GALLON / (3)12"OAK ) �0� / .� Q- H-20 LEACHING CHAMBERS 12"OAK / / y�� / ! O� (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY I �O PROPOSED 500 GALLON H-20 LEACHING CHAMBER WITH AGGREGATE a"O - / SO (25.0'x 12.83') (0.74 GPD/S.F. = 237.4 GAUDAY �. �o Fill . r PROPOSED 4 PVC VENT PIPE; EXACT LOCATION PER OWNER �� / / �� Ns " 14"OAK / REV. DATE BY APP'D. DESCRIPTION MATERIAL 2 22�--' - -- / / o,� TOTALS REMOVE ALL UNSUITABLE MATE 7g. / / / may, TOTAL NUMBER OF CHAMBERS 2 DOWN TO TOP OF"C"SOIL AND ) 6�7q, w w�` / ! TOTAL LEACHING AREA 472.2 SQ.FT. PROPOSED SEPTIC SYSTEM UPGRADE REPLACE WITH CLEAN COARSE SAND ) _ / / 0� PER 310 CMR 15.255(3) _� .� ,. ¢` / q`�' h% TOTAL LEACHING CAPACITY 349.4 GAL./DAY � 84.00' PREPARED FOR: U.P. CAPEWIDE ENTERPRISES r � MAP 28 EXIST.WELL PARCEL 45 / C Coarse 2 5Y 6/6nd LOCATED AT Loose MAP 28 49 HIGHPOINT DRIVE PARCEL 38 MARSTONS MILLS, MA 02648 NOTES: 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF SCALE: 1 INCH = 20 FT. DATE: APRIL 29, 2015 144" 79.00' 0 10 20 40 80 FEET EACH SEPTIC SYSTEM COMPONENT. No Mottling, Standing or Weeping Observed �H oft 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF s �e JONN L. 9y� PREPARED BY: THE PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST RESERVED FOR BOARD OF HEALTH USE CHURCHI R. ,1 PIT DATA SHOWN ON-THIS PLAN. REPORT TO ENGINEER AND LOCAL JC ENGINEERING, INC. BOARD OF HEALTH IF SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. CCU,' A NO_ 807 2854 CRANBERRY HIGHWAY °F�FG TER ,/ EAST WAREHAM, MA 02538 3.) ENTIRE PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 11,THE SITE PLAN S.1 V.a� GROUNDWATER PROTECTION OVERLAY DISTRICT AND THE ESTUARINE 508`273.0377 WATERSHEDS. SCALE: 1"=20' Drawn By: BSM Designed By:BSM Checked By:JLC JOB No.3046 i