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0058 HUCKLEBERRY LANE - Health
58 HUCKLEBERRY LANE Marstons Mills A= 102- 141-002 l 7 TOW Of+f�ARNSTABI.E LQCA'I'it?I"I v �1 1,e '� L— SEWAGE# ASSES OKS INSTALLI EPVS s ".Ho"E'q. f sEP'I'[C ZM' CAFAtTfX I3EAC1•IING FACI '� tom) is �UII.�ER OR O�rtER PET DATE Cflgdfl,tANC,E DATE:'. $cpa sacm D sWnce getween Fi�c Feet Maxunum AdUustecl Groundwater T b to the Bottom of leaching Faci�Zty Private'Wat�er:Supply Well 2n4L ding FBc ti t (ff anY welts exist des, on site ar uun?Aff to Ies�lung fad) Edge:o£�leand end°I.eaung Faa'1�ty(If any ►vetlarids extsi Feet_ vr�thlst 3(l0'Eeet �leech�ti�f � ,} r �. ck / ® O 123 a ^r a 7 i Town of Barnstable P# I r. eel, Department of Regulatory Services MAM Public Health Division Date �A 16639- ��� 200 Main Street,Hyannis MA 02601 rfoi a /3 �a Date Scheduled ! . Time Fee Pd r . r Soil Suitability Assessment fop Se e Disposal �1 PerformedB : -IZ r -y Witnessed By; ��� LOCATION<& GENERAL INFORMATION Location.Address ��� HQ ck le be{i-. L,I Owner's Name :0a� Mvk'rv,fl M G rs j V 1 17i Address P'0Q Tax 15T O57 W��f-,T t/fS m�tt.-I i� Zen bid' Assessor's Map/Parcel: /6 2_1Lj j_00 Z Pngineer's Name NEW CONSTRUCTION aa REPAIR Telephone# � � jf— y'77��j Land Use' P t� (`es�.. R-t+'rL Slopes Surface Stones sU6/t.2 Distances:from: Open Water Body��s� ft Possible Wet Area ft Drinking Water Well-;;,� ft Drainage Way >led ft Property Line —1 S� ft Other ft SKETCH:(Street name,dimensions of jot,exact locations of test holes&perc,tests,locate wetlands in proximity to holes) �7 -Z O —W-r 3 Parent material(geologic) ( t S f l o AJGr-e Depth to Bedrock " d Depth to Groundwater. Standing Water in Hole: Weeping from Pit Nee A � Estimated Seasonal High Groundwater. 7-72/ Z f� DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: . Depth Observed.standing in-obs.hole: in. Depth to soil mottles: In. _ Det th to weening fmm ide.of ohs.b.ole:.___, _, itt. Ornuntl'v'oter At!Lssttrreor -_ _____ fc. fIndex Well# ReadingfDate: Index Well level^,,:,,,�,,,. Adf,faetor �T r Adj.Croundwater l cvel PERCOLATION TEST Date Tune Observation Hole# Time at4" Depth of Perc. �8 g 2a�5�\ Time at'6" Start Pre-soak Time© (( nme(9"-6") liR M End Pre-soak, t M:ti Rate Min:/Inch L , Site Suitability Assessment: Site'Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Bole Data To Be Completed on.Back ------ **If percolation test is to he conducted within 100' of wetland,you must first notify the Barnstable Conservation Division gt least one(1)week prior to beginning. Q:\.SEPTICIPERCr-oP, 1.DOC DEEP OBSERVATION HOLE LOG Hole# r�^ Depth from Soil Horizon Soil Texture Soil Color 'Suit, Other Surface(in:) (USDA), (MunselQ. Mottling (Structure;Stones;Boulders. n i ten ravel A. c��� q�L- 5 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,:Boulders. Consistency,% rave ®1-02 sly' G e o I(— b ew- )0`7 t2 3 I Z DEEP.OBSERVATION HOLE LOG Hole# ' Depth.frorn Soil.Horizon Soil Texture Soil Color" "Soil- Other _ Surface(in.) -- - -. _(USDA) (Munsell) a Mottling (Structure,Stones,Boulders: Consistency,%Gravel)._ I DEEP OBSERVATION BOLE LOG: Hole Depth from Soil Horizon Soil'Teiture Soil Color Solt Other t Structure:Stones,Boulders,_ unsell Mottling ( , Surface(in.) _., ._(USDA)_. (.. . _ M _ _._ onsi ten ra , Flood Insurance Rate Map: Above 500 yearflood'boundary No Yes` ' Witlun 500 year boundary No Yes Within 100 year flood boundary No Yes c Depth of Naturally Occurring Pervious Material Does at least four feat of naturally mcuiting pervious material exist;n all.areas observed throughoutthe area proposed for the soil absorption system? If not,what.is the deptb of naturallyoccumng pervious matcrial7. Certification.., l�14S-' a.- p. ' I certify that on 1( (date)I have assed the soil evaluator examination approved by the i Department of Environmental Protection.and that the above analysis was .performed by the consistent with -the required training expertise and experience described in 10 CMR 15.017. r Signature: Date Q%S,E"ICTERCFORM.DOG ' TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE Jh/J r M i, h &A SESSOR'S�pMAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I6PD LEACHING FACILITY: (type) a r ,(h"- (size) 4-71,2 S..k: NO.OF BEDROOMS t; OWNER J(M PERMIT DATE: J 3/I!J 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 AZ 2.1'., z r A 5 zb c POO �33 0P4 $� �'b No DI �' OV Fee 00 of THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplILalIOTC for NI!6pDsaY 6pstetU CDUStCUCtIOtt i9PrItttt a Application for a Permit to Construct( ) Repair( ) Upgrade XAbandon( ) ❑Complete System Xndividual Components tL� Location Address or Lot No. ( I h, Owner's Name,Address,and Tel.No. M P'LI Assessor's Map/Parcel 1, . Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms e_ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.require ) gpd Design flow provided . gpd Plan . Date Number of sheets 02 Revision Pate Title 1 Size of Septic Tank Type of S.A.S. Description of Soil ' — Nature of Aepairs or Alterations(Answer when a plicable) 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 Boaz o e th. SION Datej 3 . Application Approved by Date ,3 r Application Disapproved by Date for the following reasons Permit No. '2 6 j�—®?q_ Date Issued_ 310119 i No. � �� � � Fee ( O V d THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Al Application for ti.!np aI *pstem construction Permit Application for a Permit to Construct(' ) Repair--("') ) Upgrade , Abandon( ) ❑Complete System ridiVidual Components '`A # I 3f= Location Address or tot'No. .�; Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel � , (/�(i1 Yoh du(k14 ` Installer's Name,Address,and Te.No.' Designer's Name,Address,and Tel.No. r U i nh� Xf VA11 ► `7'1 q 4 b- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers,(• .) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date ' s Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. f U Description of Soil MIdlimS Nature of Repairs or Alterations(Answer when applicable) 1 ' v / d-AiUnh Date last inspected: e 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 Boar. o 4 alth. / Sigm d1 Y Date 3 Application Approved by Date Application Disapproved by Date for the following reasons f Permit No. :2 p/GJ- 0 _ Date Issued 3 / / ------------------------:-------------------------------------------------------------------------_------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) UpgradedX ) Abandoned( )at �P //l ivP i1 Jivf / 1/1 . has been constructed in accordance ✓V �.y I a- with the provisions of Title 5 and theeJor Disposal System Construction Permit No. d{ -U 1 dated 3 !�i Installer �,�q r�f�S �)(P k fj Designer � #bedrooms '� Approved desi ow gpd f The issuance of this permit shall of be construed as a guarantee that the syste ecto will tr signed. Date �e� Inspr ' i No. 1�� 9 Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is herebyranted to Con ruct Repair �r fir•a c g ( ) p ( ) liJpgrad ) �-Abandoif( ) System located at o La and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date ��� 1, G� Approved by Town of Bafnstable �pF tHF TQ� r ti Regulatorv,Servrres H �T Richard V. Sca.li,.Interim Director BAff,NSTABLE, . ""s i6g9.4 Public health Division Gp `�b ArfO A�, Thr3nias McKean, Direct(it 200 Main Street,Hyannis,)MA 0260.1 Office: 508-862-11644 X. a03=7+30-6304- Installer &D.esil er"Certitication-`Form Date: Sewage Permit# Assessor's Mapl?arcel Proms- c � ee Designer: r,5 IvIQ Installer: l,a ;,n 3-5 .�V_ s � _- Address: `3 (2 e9 Address:. iZ 1n1 C � l.c/ ��_ _.__._ ___ .. On _ ``�` `� £t✓+ +_ ��as rssueti a l�erri�it to install a (date) (installet) septic system:at v-c,•l ti��-a.C�y�y y,,, based on a design cli a��n by _ (address) l ]cs/jcs,.l �_ dated Z 2t t"=i f l certify that the septic: system referenced above was installed: substantially-according to the design, which niay include ininor approved changes such as lateral relocation. of the distribution box and/or septic tank. Strip out (if required) was inspected;and the soils Were found satisfactory. I Certify that the septic system re:ferencecl Above was installed with major elianges 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. Strip out(If required) was inspected and the soils were found,satisfactory. I C011 fy t 111e. sy:stern referenced above leas constructed in r. with the tarns of'the ters (if applicable)" � gw S4 , 00 (Installer's Signature) �Nt1 ,. t10.35108 �RfGISSE�r,�`• mes.ignei s Signature) (Aftix.I7esigne ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALT14 DIVISION. CERTIFICATE OF CONIPLIANCE ILL NOT BE ISSUED U14TIL, BOTH THIS FORM AND AS BUILT CART) ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU, Q°,Sehtic••;Desir,nerCertification Form Rev 8-14-13.doc Engineers note:This certi;cation is limited to an as built inspection of system components as installed prior to oackfill.Tile engineer did not supervise construction of the systern.'The installer assumes.responsil iNy for all materials .vork:r.anship,backiilfing to specified grades with proper compaction and setting risers'covers as sinown on the design plan, Town of Barnstable Barnstable Inspectional Services aatutbvrast�. i t q� M" . Public Health Division i639 `� m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 9477 February 6, 2019 MARTIN, JOAN M PO BOX 1505 MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 58 Huckleberry Lane, Marstons Mills, MA was inspected on 01/16/2019 by Shawn McElroy, 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: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1) year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH omas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\58 Huckleberry Lane Marstons Mills.doc a Town of Barnstable • r • 1ARrT8fAB1E. Regulatory Services Department yPubli-Health-Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 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 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 of 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 t Commonwealth of Massachusetts /�r� I yl`OOoZ Title 5 Official Inspection Form r-1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name rx information is a0 required for every Marstons Mills MA 02648 1-16-19 page. City/Town State Zip Code Date of Inspection i•„I rsj`1 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. A. Inspector Information 51 3 5 1;1� Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 , Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty 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 1-16-19 In pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. 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 Title 5 Official Inspection Form b't Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner - Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1 System Passes: ® 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: 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 t Commonwealth of Massachusetts Title 5 Official Inspection Form ! IQ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms 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 El ❑ ND (Explain below): ❑ obstruction is removed ❑ Y El ❑ 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 Commonwealth of Massachusetts II Title 5 official Inspection Form Y Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS.and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No".to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or 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 Title 5 Official Inspection Form ' 'F�'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 page. City/Town 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 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 groundwater 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 god to 15,000 god. 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 P Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills i MA 02648 1-16-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "Yes"'or"no"for each of the following for all inspections: Yes No ® ❑ 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? ® ❑ r 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? ® ❑ Wasthe 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 Commonwealth of Massachusetts r� ,w Title 5 official Inspection Form- ? i.'l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r a 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 1 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 Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? - ❑ Yes ® No Last date of occupancy: 1-2019 Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 r i, Commonwealth of Massachusetts J Title 5 Official Inspection Form %r. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 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: Owner--pumped 2-3 yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 � 1 Commonwealth of Massachusetts p Title 5 Official Inspection Form ' ri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,,� ry 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 page. City/Town 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: 1987. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): . Depth below grade: 24"feet Material of construction: ❑ cast iron ®'40 PVC ❑ other(explain): Distance from private water supply well or suction line: p pp y feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Y Commonwealth of Massachusetts ,w Title 5 Official Inspection Form irt. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: ' years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" Distance from top of sludge to'bottom of outlet tee or baffle 20" 1 Scum thickness 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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 i bl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _ 9 p Y rY 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 page. City/Town 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 r Commonwealth of Massachusetts $1 - 3 Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No' Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box had water at working level with stain lines and signs of overflow above inlet invert. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts r-� Title 5 Official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 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* 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: ® leaching pits number: 1-1000gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ in 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 Title 5 Official Inspection Form ► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is' Marstons Mills MA 02648 1-16-19 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit holding water at 12" below top of tank.with stain lines above top of tank and into riser. Inlet invert enters into riser. 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.d6c•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts 11� ,w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 page. City/Town 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 li Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 ' page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 12 .� TT ra t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I �I Subsurface sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 page. CitylTown - 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 9 you established the high round water elevation: Y 9 USGS and town maps show groundwater at greater than 20'. 1 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 A Commonwealth of Massachusetts 3 Title 5 Official Inspection Form r �, Subsurface Sewage Disposal System Form =Not for Voluntary Assessments .. 58 Huckleberry Ln Property Address Joan Martin Owner Owner's Name information is required for every Marstons Mills MA 02648 1-16-19 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 ..16 or attached 9 P Y P9 For 15: Explanation of estimated depth to high groundwater included y t5insp.doc•rev.7/26/2018 Title 5 Official Inspection ForM;Subsurface Sewage Disposal System•Page 18 of 18 EL. 3S� TOP OF FOUNDATION ' •• ,CONCRETE COVERS CONCRETE COVER �.' ' 4 , ••7„7.7„q,,�,.;n,7,7 "CAST AST IRON12 MAX.. ,' r"""r-''• E� fs- a OR SCHEDULE 40 12"MAX, " '• ' P.V.C. PIPE ' 4 SCHEDULE 40 PV.C.(ONLY) ..,,1 I • PITCH I/4"PER.FT PIPE — MIN."PITCH 1/4"PER.FT LEACH°'• PIT INVERT PRECA_ � '•• EL.s/X7�... �y �LEACHIN.. °'• SEPTIC TANK INVERT DIST. INVERT o . 141 a:� PIT OR • INVERT EL.S.lX.3,�, EL.S./Xl.. ' ; _ >z EQUI`• '•' EL.,./. (.4-., GAL. INVERT Box a �. ELd%X.�G INVERT k o : 3/4°•To 11 ,/ EL.S21,V. .:. U. WASHEI l00000 PROFI LE OF A/*V GROUND WATER TABLE. SEWAGE DISPOSAL SY<STEM NO SCALE SOIL LOG WITNESSED BY : DATE TIME. . ... .. .. . BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ELE.V.E4 ELEV. .. .. . . . . . . L : _;` A, OZ3h, ,�;.E c Gi; ENGINEER o_ r° 1.2537 �-`2i.V ES I G 1 DATA NUMBER OF BEDROOMS 3. . . TOTAL ESTIMATED FLOW . .3;3 Q. . . . GALLONS/DAY BOTTOM LEACHING AREA 7 , ,p,f'T. /PIT SIDE LEACHING AREA . . . . 1• .i.. . . SO.FT./ PIT GARBAGE DISPOSAL . .i✓.Q . . , (50%, AREA INCREASE) TOTAL LEACHING AREA . SO.FT 6A ys Xo PERCOLATION RATE'114 - •.2 MIN/INCH �P. .WATEft ENCOUNTERED LEACHING AREA PER PERCOLATION RATE .. . . ... SQ.FT'. NUMBER OF LEACHIN PITS O'.✓t APPROVED �`tR. Z_ : !`���s, . 7$.�. = 7� 6 Ao • • • BOARD OF HEALTH / l) DATE. . . 2.ZZ..�Pr/: .` �.�1 .�;J�y� , 4.6 AGENT OR INSPECTOR l �� To WA/ wA% iQ A 1,9,w9e e, S�0 AL �co UPPERCAPE• ENGINEERING P.O. PDX 616 0. 1 f PETITIONER E: SANDWICH, NIA 02537 •3b2w6231 �` " EALIN L-O�G A T ION SEWAGE PERMIT NO. /3® //uC-l<!eAL/snZ IA 1- 1 L L A G E tt s , s� ASSESSORS MAP NO: e/O r _ �,5ry Nf ill/S PARCEL NO.: L I N S T A LLE 'S NAME IL ADDRESS / O Ulf C B U I L D E R OR OWNER DATE PERMIT- I SUED DATE COMPLIANCE ISSUED 91 jBIS6 -T, M �- 19 i�e` i THE COMMONWEALTH OF MASSACHUSETTS Application is hereb made for a Permit to Constr Repair an Individual Sewage Disposal S s 0 uctxor Owner Type o Building Size Lot.,f,.rO...........Sq. feet Dwelling—No. of Bedrooms Other—Type of Building _A------:.......... No. mpersons........................... Showers ( ) _ Cafeteria ( ) ~ Other —0121 '- Seepage Pit No.����±� /'�/ ' � �, og. ft�° �� OtherD �ouot box'( �� � � Bc �a��-�����^^~�^^~^ Test Re ~^~^^^~~ -°~----------- �'-------' -''----r'--~-------'� 04 Test I`� l�o. l'>+-'��--.no�oot�a of TestPi�..����----' Depth to ground nm�r-����--_-_. ���t I`� No. 2L-------'o6outes of Test I`iL-_------- Depth to ground water........................ ---'--''-------'_------------------'--'---'-----_---'......................................................... / 0 Description c6 Soil........................................................................................................................................................................ -----`----''--`----`----`-`----`----`----------------`------`---`---`-----------------`-`-`----`------ t� ----_--..--_--'-_-'__--_-'_-_--_-_._'--___---__'_------_'__---_-------------'------_'----- L) Nature of Repairs or Alterations--Answer when applicable-.—_.--'---..----.---'------.-..-_--_--_-'------- ------------------------------ -----'---------------'-----''----'-----'---'--- Agrccoznut: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisionsof TLITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................... ' ---------- ' Application Approved By' ---d�����--����--�����c���ApplicationApplication ate te Disapproved for the following reasons:.............................................................................................. -------- ------ - ------------------_--'--------__--------------'-----_'--------------------_------------_—_-------- � Permit No No...................... .1 Fim THE COMMONWEALTH OF MASSACHUSETTS B4O1ARD .OAF`, E L LA ............. ......OF................................................... .................................... Appilration f r Bispasal Works T Vomitrurtion "tratit Application is hereby made for a Permit to Construct Or Repair an Individual Sewage Disposal ........................................................sys�- 1 . . ........... ........... ..........................................- Location Address or Lot No. a4. ................................................................................................. ....... ----- ----------............Owner Address .............. ............—,4079ma..... ... . .................................................................................................. Installer Address . Type VoBuilding Size Lot.,,i .....................Sq. feet U Dwelling—No. of Bedrooms Z.........3 .....Expansion Attic Garbage Grinder (44 Other—Type of Building ................ No. of persons............................ Showers Cafeteria OtherfixtuFes ...................................................................................................................................................... Design Flow........._...............................gallons per person 33............................gallons. jer day. Total �ily, flow...... 9 Septic Tank—Liquid cavacity/Z/ ..gallons Length.Y,..t ... Width..' Diameter....... Dwh7---------- Disposal Trench—No------------------ Width......7---------- Total ....................* Total!lea�ching area......i�............sq. f t. �9 AIC w inlet-------12.- Seepage Pit No..................... Diameter..../0......... Depth below ........ Total leaching area. ft. Z Other Distribution box ( LIK bosingf)taa Percolation Test R Its .............................................. Date'...... es� -Perfornied by.. ... .. ......................... !r * , /, .Depth� �.4C of Test Pit...Z�..... Depth to ground' wat/er..A/21............. Test Pit No I .__!''.-_--minutes per Test Pit No. 2................minutes per i Depth of Test Pit..............._._.. Depth to ground water....._......._...._..--- L !�/..................................................................................................................... ............................. 0 Description of Soil........................................................................................................................................................................ W ------------------------------------------------ --------------*----------------------*------------------------------------------ ------*-----------------*------------------- ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.__.... _._....:. ..... .................... .......................... D te *Tllzq 344� ....------ ate Application Approved By.... 5L,11""*Z. ........................................ ..V Application Disapproved for the following reasons:.............................................................................................................. ................................................................ ...........:f:-........... .......................................................................................... Date Issued . .................................................... . Permit No---- .........4 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD jlr EA�WTH ...........................OF...................................I.................................................. (9rdifirate of T—nurpliattv THIS IS TO CERTlb That the Individual Sewage Disposal System constructed or Repaired by ...................../ Nl�,�- Q)\Jt ................. ........ ........ ...�------------------- has ............................... aller.. --- -been installed in accordance with the prow' ions of TITLE 5 of The State Sanitary Cod described in the C' ......... application for Disposal Works Const ctio .ermit No..7�. -"'72.a..y... dated---......�'-7- THE ISSUANCE OF THIS CE ICATE SHALL NOT BE CONSTRUED AS A GUAR ZITEE THAT THE SYSTEM WIL4 FUNCTION SATISFACTORY. DATE.......1-01/ ............................................ Inspector........... A.............................................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD�OF HEALTH,"' ...OF.....L ..... .......................................................... 0........................ FEE........................ Niquisal 1#0,rks Tonstrudiatt "Pamit Permission is hppeby i� �granted. ? :1.6 uf -- ........................................................................................... �Dis.osal System to Construct L.,)� r/Rep�r,( an 0"", --"? ) C Ividual Lor .........................................................................................................................at No......... Street 777 2 as s06n on the application for Disposal Works Cons uctio Permit No ------------'Date .......... .....................................(��. ............................. 0 It" DATE- ..... ....................... Board of e It .... ......... ...... -- ----- FORM 1255' A. M. SULKIN, INC.. BOSTON TOWN OF BARNSTABLE v LOCATION SEWAGE #061 — VILLAGE Nall- !IS' 11.1,11s ASSESSOR'S MAP & LOT�4 INSTALLER'S NAME & PHONE NO. r 610 f - 7J SEPTIC TANK CAPACITY LEACHING FACILITYA ype) r-ji(size) X-1 G NO. OF BEDROOMS PRIVATE WELL OR PugcC*W BUILDER OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No t9 31 �, ram -- �•�.� .......� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiuu for Diupuml Workii Tomitrurtiun rumit Application is hereby made for a Permit to Construct ( ) or Repair be_) an Individual Sewage Disposal System at ........ ........................ ------ ---------- ••--.s •.."-='-'-.........------. . Location-Address] or Lot No. �.. J ...... Wit- 1<'J .....9 W U A �. Address , L�S Installer Address Type of Building Size Lot............................Sq. feet ... Dwelling— No. of Bedrooms------------ __________________ Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures --------- -------- - - - ------------------------------------------- -•------------- -------•-•---•------••------•-----•--•••••---••-•--••-••-•-•- W Design Flow--------------- .................gallons per person per day. Total daily flow-..._--_-___.-7-3 0.................gallons. WSeptic Tank—Liquid capacity/.�__I?..gallons Length________________ Width---------------- Diameter---.._-_._----- Depth................ x 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. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water-._-_-----_-_---_-_--_ frq Test Pit No. 2................minutes per inch Depth of Test Pit_----------------- Depth to ground water..--__------•_-_•------. 9 --•----------------------------------------•--------------------•--•------------••--......-•................................................................. ODescription of Soil........................................................................................................................................................................ x w x ••••-------•-------------------------------•----•••-----------------------------------•-••---------•----------••------------------•----------•------•-------•••••--•---••-•--•••--••-••......••.......•. U Nature of Repair or Alterations—Answer when applic ble.---./.!v:_��_!'U-_.__�_---.- a_--_---S)F _ 7�...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the i system in operation until a Certificate of Compliance h s be n issued b the_board of health. Signed ........... ... . -------- -------- ------- ...... � Application Approved ---_Y .... .. .......... ... "Z Date Application Disapproved for the following reasonr: ... ......................... . ...................... . ...................................................................-------------------.......------------------------ ---------------- . ........................................ Date Permit No. ..:.----- ---."'J��^� Issued ...- .. � ��� -- ---------------- Dare r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Dili-pot3Ml Ourkii Tonitrurtion rrrntit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: Cf ' - �� sal ................................ y_..._. •------_._... -••••--------•--••.•�•-•--'-I--J-•-t--l--_-S--•--------••--•-----•-•-•-•---•------------•••--......-•-••--- Location-Address, or Lot No. f ®U►nJ `7:K..--...? .C/_!c E S3 � � J i'7'J t ✓J/1 l aY_S _.._.... -----••----••----•--•----- --•-•----••---•-•--••-------•---••••-•••....•-•---••----••..............••........................ Owner —7 ,g Address CAI/bl � Q S ••-•---•---........-•-•-•------•---------•---•-•--•----•----•--------------••-••-•--•••-•-........ ---•...--•---•----•......-----•..............._ r Installer 9lddress d Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms................ _______________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building No. of ersons____________________________ Showers � YP g ---------------------------- P ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------ ----....................................................---------------------•-----•--•...--------- W Design Flow................. ...............gallons per person per day. Total daily flow.,..___..___.- 3............_..._...gallons. WSeptic Tank—Liquid capacitv/U!!P__gallons Length................ Width---------------- Diameter.-.------------- Depth................ x Disposal Trench—No. .................... Width..................... Total Length.................... Total leaching area....................sq. ff. 3 Seepage Pit No........ -------- Diameter-_--_._-/V-_.... Depth below inlet...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 9 ----•-----------------------------------------------------------•-••------------•-------•--......---......................................................... 0 Description of Soil........................................................................................................................................................................ x U w ........ •- ----------------------------•-•----•--------•-------------------------...••• ---------------------------•--•--------•••------•---•-•-••••-----••-•...--•----•-----•--•--•-.............•-- U Nature of Repair or Alterations—Answer when applicable__- ___------�u)o ......�! G...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ......_�%..Lx " ..._!-/L --✓... /7/y✓... s.�. Application Approved BY—~ z---- ----- '---------------------------------------- ------1 .:...�...� i Date Application Disapproved for the following reasons: .................... ....................................................... ........................ ................................................................................................................................................................................................. .........................*.............. Date Permit No. ' /�.... Issued -...---- -- - - --I-- ---........ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#ifi a e of (fu>c plian e THIS IS TO CERTIFY,That the Individual Sewage Disposal System constructed ( ) or Repaired (� ) b � ��r"1� fr-�'' _.-�;J sits 11-i ... .. __.......... --......... ....... Y ------------------------------------------------------ h,tadiet at ------------------------------------------------y K �C1 :L .c L/L2` .. ........ - / ---- = has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ��� -----� .. dated.'`....: ... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT T E jl SYSTEM CWIILL FUNCTION SATISFACTORY. DATE..../..' ' .; Inspector - ....- ----------------------------- --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No............ . FEE.--7G. ... Diuposttlr_k/o �un�trrtionlerutit Permission is hereby granted.......................V--G� ��._________�......... �-'�...'J ------ to Construct ( ) or Repair (V.). an Individual Sewage Disposal System at No. 1CJL :L c/C,L /--'J [ CS •----.-.-------•-------------•------------ ...�� ` j Street�'06'-?-"?,"��I�_ -P7]Dated as shown on the application for Disposal Works Construction Permit. .._ ` ��! r� - i Board of Health DATE -- ------------- FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS !:f LEGEND N ® Locus - gg -- EXISTING CONTOUR PB 13B/PG 25 x 100.98 EXISTING SPOT GRADE 0 EXISTING SEPTIC TANK -�.H. -- OVERHEAD WIRES _ (TO REMAIN) G EXISTING GAS SERVICE ° TOP OF TANK, EL.=107.46E W EXISTING WATER SERVICE z INV.(OUT)=106.13E fi r r o r o Shubael TEST PIT N ° ° Pond BENCHMARK Calvin Ha lin LFlini St TO BE PUMPED, FILLED WITH EXISTING LEACH PIT oa SAND & ABANDONED ! o F ,N 03-00'00" E fence Ilse LOCUS MAP �c 110,03 / 8. O NOT TO SCALE 0 -----_ 110.05 _o TP-2 TP-1 GENERAL NOTES: 1` --25'_ 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL :'.PROP S.A.S T BOARD OF HEALTH AND THE DESIGN ENGINEER. 109.48 `� O ry I'. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS ao OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE i LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: . SHED 10 -310 CMR 15.405(1)(b): 109,56 O 0108.99 _ 108.60 1) A 7' variance. s.a.s. to cellar wall(bulkhead), for a 13' setback. 2) A 3' variance to the 3' maximum cover requirement, for up to 109,28 cp 6' of max. cover. S.A.S, if required. shall be H-20 and vented. BENCHMARK 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR x 109,17 ORANGE DOT/DECK PATIO TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE EL.=110.86 9.34 BH ' DESIGN ENGINEER. w 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 109.3Y4`. Y �- FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 0 0 x O ENGINEER BEFORE CONSTRUCTION CONTINUES. O „ C1 .EXISTING1 107�91 0 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 0 o PAVED;':.:. r o y HOUSE(#51) i Q 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF av DRl1/EWAY'. T.O.F.=110. 1E i ' THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF cn HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 108.22 _ ; 108,03 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 108.29.: 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. iq 4 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS x 1u6. .4' .;. 107 9 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. ---106---- 107.91 c9 x 106,57 1 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY X -------- " THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING _ 0 LOT 130 CONSTRUCTION. ---- -� '• ° 9800±SF 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 1. 4.1� \., t IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 102,26 � ,d03,97 _�� REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). '- - - _ 103,27 *...- V-- 98.00� r 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 11 IP FN S 03'0A'0O" SN_ - `- INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND -i<T0 ---^ - IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 100,09 � 99,69 edge of pavement 99,29 99,01 � 99,56 OF Mgss9�yo 100,60 ` PARCEL ID: 102-141 -002 M�NTEE N HUCKLEBERRY LANE' � PROPOSED SEPTIC SYSTEM UPGRADE PLAN CIVIL 58 HUCKLEBERRY LANE MARSTONS MILLS, MA No. 35109 b 100,00 r PK SET ' RfG/S�ER� i Prepared for: Joan Martin, 58 Huckleberry Lane, Marstons Mills, MA 02648 F /ONAL E '\ Engineering b SCALE DRAWN JOB. NO. � OWNER OF RECORD 9 9 Y� MARTIN, JOAN M Engineering Works, Inc. 1"=20' P.T.M. 123-19 P.O. BOX 1505 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. MARSTONS MILLS, MA 02648 (508) 477-5313 2/20/19 P.T.M. 1 Of 2 r i NOTE: TO' PREVENT I BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=105.5 FOR A DISTANCE OF 15' FROM THE EDGE SEPTIC TANK PROPOSED D—BOX OF THE PROPOSED S.A.S. INSTALL RISERS & COVERS,OVER INLET & INSTALL RISER & WATERTIGHT PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH'GRADE COVER SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND EX/STING T.O.F.=110.1t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT HOUSE(#58) F.G. EL.=109.0 ./ F.G. EL.=109.2t F.G. EL.=109.0f F.G. EL.=109.0f VENT IF OVER 3' OF COVER T.O.F.=1 10. l t MAINTAIN 2% SLOPE OVER .S.A.S. Q 5=172(MIN.) ® S=1% BN 1(MIN.) 2" LAYER OF 1/8" TO 1/2" 1 4"SCH40 PVC 4"SCH40 PVC s" 1 DOUBLE WASHED STONE #EFFEC-nVE as (OR APPROVED FILTER FABRIC) o. 1o"I 14" i 8" aaaaa �-3/4" TO 1-1/2" DOUBLE C�EXISTING 48" VEL WASHED STONE (5am LEVEL ADDINV.=105.30 PROPOSED INV.=105.134.8' 4'GAS BAFFLE WIDTH = 12.8' INV.=106.13t D—BON EXISTING INV.=105.00 PROP. S.A.S. ! i 2-500 GALLON LEACHING CHAMBERS Co EXISTING SEPTIC TANK - ��_ ___ _ SURROUNDED WITH STONE AS SHOWN • I---25' -I H-20 RATED NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP CONC. ELEV.=106.1 f INVERTS, PRIOR TO INSTALLATION. BREAKOUT ELEV.=105.50 SEPTIC LAYOUT INV. ELEV.=105.00 Baa®a 2) D-BOX SHALL BE SET LEVEL AND TRUE TO 6a0Ma006 W GRADE ON A MECHANICALLY COMPACTED SIX lowsasses®a 100 INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.=103.00 4' 2 x 8.5' = 17.0' 4' 310 CMR 15.221(2). 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = f25.0' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W. AS MANUFACTURED .BY TUF—TITE, ZABEL OR EQUAL. LEACHING SYSTEM SECTION SECTION ®®®® 0 NO G.W., EL=97.8 — ®®®®®® ® ®®®® 37„ SEPTIC SYSTEM PROFILE N > ® Ea Z ®�®®®® ® ®®®® N.T.S. 102" DESIGN CRITERIA SOIL LOG DATE: FEBRUARY 13, 2019 (REF#15,899) 4" KNOCKOUT NUMBER OF BEDROOMS: 3 BEDROOMS SOIL EVALUATOR: PETER McENTEE PE SOIL TEXTURAL CLASS: CLASS I WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT 20" DIA. COVER DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP— 1 DEPTH ELEy. TP-2 DEPTH 4" KNOCKOUT 4" KNOCKOUT " DAILY FLOW: 330 G.P.D. 108.8 A O 1,09.0 A 0„ 5$ 0 SANDY LOAM I SANDY LOAM DESIGN FLOW: 330 G.P.D. 10YR 4/2 10YR 4/2 GARBAGE GRINDER: NO—not allowed with design tos.1 B g" 1;I B 7" 4" KNOCKOUT SANDY LOAM I SANDY LOAM LEACHING AREA REQUIRED: (330) = 445.9 S.F. 10YR 5/8 10YR 5/8 1os.s C1 24" loss C1 29" :74 500 GALLON CAPACITY, H-20 LOADING , EXISTING SEPTIC TANK: -1000 GALLON CAPACITY SILT LOAM SILT LOAM CHAMBERS 105.8 10YR 5/3 361, 1052 10YR 5/3 46 PROPOSED D—BOX: 1 INLET, 3 OUTLETS, H-10 RATED c2 30„/48 PERc . . C2 „ USE 2-500 GALLON LEACHING CHAMBERS IN SERIES , PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES M-C SAND M-C SAND 58 HUCKLEBERRY LANE, MARSTONS MILLS, MA 2.5Y 6/6 2.5Y 6/6 SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: Joan Martin, 58 Huckleberry Lane, Marstons Mills, MA 02648 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:................. 471.2 S.F. 97.8 132" 98.0 1 132" Engineering Works, Inc. N.T.S. P.T.M. 123-19 PERC RATE 2 MIN/IN. 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD NO GROUNDWATER ENCOUNTERED (508) 477-5313 2/20/19 P.T.M. 2 Of 2 c: I �e f b ` , z e 98, 00 ti N f 1, 130 , ov o u f � : � 3 l a. 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