Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0028 LADY SLIPPER LANE - Health
�- !28•Lady 3Iip`per Lane b! ---ttA--0442017 —001 r` t Marstons Mills TOWN OF BARNSTABLE LOCATION Zg Elk Sl iPn{� SEWAGE# Z 612-- 0 5 0 VILLAGE arS s �I s ASSESSOR'S MAP&PARCEL 44- 0(7-'C'O 1 INSTALLER'S NAME&PHONE NO. 13 r"yn Yfn RA.046"s¢ - 37d8-Z7¢.g7S3 SEPTIC TANK CAPACITY /000 �2 g12c 3Gc ' LEACHING FACILITY:(type) � (size) �F� �O NO.OF BEDROOMS 3 OWNER E M.A PERMIT DATE: �j S l Z 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) IVA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within o 300 feet of leaching facility) Feet FURNISHED BY 41 _ 40.2' A?- - 4Z. o / P A A4 A 57 134. 9 37.5 �4 - 82. 3 -jZeA;2- boo is ppP-X- No. 2-V h Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplicatlon for Misp sal 6pBtem Construction permit Appliceion for a Permit to Construct( ) Repair( ) Upgrade(✓Abandon( ) ❑Complete System Mnndividual Components Location Address or Lot No. 26 L AEI SLOW— Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 44� -- D 1-7- po/ (0,M l��' FM A j /V M , Installer's Name,Address,and Tel.No. �LY_ 9:'-sy Designer's Name,Address,and Tel.No. �t1an RV, e� �(L • n/frLt CONT� 1p t ? Type of Building: ¢� Dwelling No.of Bedrooms Lot Size 3i s- sq.ft. Garbage Grinder(/0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)/ '3© gpd Design flow provided 73 Q.S gpd Plan Date ���/f Z Number of sheets �- Revision Date iyl Arta �� 'Oi - f I Title Size of Septic Tank AM D Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer whenapplicable) �pIact �oCiSi'tn LekC p W l+h NP"v C.ock,n `t';cncb e S 2 n��iin►n I-Z- iZC 3G ChAn\�i ,r3 f I SDI-j t c>zjc.I►7feY 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. \ d � t"rr Date S 2 Application Approved by Date �- Application Disapproved by Date for the following reasons Permit No. 01 a 0_�o Date Issued S �.� n i4 No. 2 o 2 — Fee Q(J THE COMMONWEALTH OF',MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 2pprication for ;Bispasal-6pstem Construftion 3permit Application for a Permit to Construct( ) Repair( ) Upgrade(/�Abandon( ) ❑Complete System Ondividual Components Location Address or Lot No. 2 G ADj S L d PF01- Owner's Name,Address,and Tel.No. 4 Assessor's Map/Parcel 44— 0/7- 0 / M nn '/1, r—m A F N M A Installer's Name,Address,and Tel.No. _� � j:7-Sj? Designer's Name,Address,and Tel.No. Type of Building: ,-/ Dwelling No.of Bedrooms Lot Size /3, sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) © gpd Design flow provided :j 4 S gpd Plan Date A 1/2 Number of sheets Z- Revision Date M r t t 4k Title Size of Septic Tank I d o Q Type of S.A.S. Description of Soil Nature of Repairs or Alterations Answer when a licable #�� �,r .�i 1 i n r\ c(n `'. r L,? r 4-11 ,t/ P ( PP ) �' S LP . � /LP Cr�,cl.inti Trrcr,(ke +�A A%PC\ IZ AbS 1 VqC ;c, Ch�y✓��a,z�' 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. Sphed '/ Date S Z- Application Approved by_ ,J1 ��,� Date 3 cf' . Application Disapproved by -Date for the following reasons r Permit No. 1 — 0 CO Date Issued / 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 �--- at ag Lt,An O,OaP r M I A",— 1 has been constructed in accordance I with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 U dated �� Installer Designer " .f� #bedrooms 2 J Approved design flow 3.3 gpd The issuance of this permit shall not b construed as a guarantee that the system w 1Nncion as4de igned. Date `� /� 22 a, Inspector --------------------------------- No. OST Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS ]Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at 4 vl C IA r AA. An !I C r . and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty tc comply with Title 5 and the following local provisions or special conditions. Provided:Construct* n must be completed within three years of the date of this permit Date l/ Approved by V 1, 6 / v r / Town of Barnstable Regulatory Services Thomas F. Geiler,Director HAMRABEZ 9�A HAS& �,� Public Health Division '639. Thomas McKean, Director 200 Main Street,Hyannis,INLk 02601 Office: 508-862-4644 Fax: .508-790-6304 Installer & Designer Certification Form Date: 3 A - 171 Sewage Permit# Assessor's Map\Parcel /J/7 Designer: e0 � U C,• Tnstailer: I` 2t�1 ty Address: FOY Address: Ll u C ,t, 14. - f. f*iVWYa 1-fg �, MA Q?,�,S3(o On was issued a permit to install a (date) (installer) septic system.at U 1111- L"e- based on a design drawn by (address) G� ViVL V '1 Vv��'Vl �S_ dated 3 �Z (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 andior septic tank. AI 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. �����, OF _Mgss9� �., DA R N M. y � - M'' (Installer's 11, ature' SA#ITht\P ' (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARN BLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-264doc i Town of BArasta.ble. P# Department of Regulatory Services ' earl : . ublic Health Division ]P Bate ��Ono s63y ems$ 200 Main Street,Hyannis MA 02601 Date Scheduled Fee Time Fee Pd. A ' i oil Srxitability Assessment for S Disposar Performed By: V e-� Witnessed By: • .. i LOCATION & GENERAL INFORMATION Location Address 1 AT� � pp % O �°shame a M (1�p . l I l M� l. I 13 Address ��l� ) I� Assessor's Map/Nrcel: 0 y� �`7 I Engineer's Name j>,M/\'Me NEW CONSIIZUtON REPAIR '° j Telephone Land Use � S 't/ r'� �Slopes`(96) ! � 1 v " Surface Stones ' �1�Y12 Distances from: Open Water Body }�� ft Possible Wet Area�:/J D ft Drinking Water Well �ZV� ft i 1 Drainage Way' 0-0 ft. Property Line > ft Other ft SKETCH:($treet name,dimcnsiodS of lot°exact locations of test holes&perc tests,locate wetlands in proximity to holes) 1 ;- r -- - g 1 s I Parent material(geologic)� I Depth t0 Bedrock ' Depth to Groundw#er. Standing Water in Hole: l Weeping from Pit Ppee Estimated Seasonal11igh Groundwater I ! DtTERMINtTION FOR SEASONAL HIGH WATER TA 3L Method Used: In. Depth dbperved standing in obs.hole: -_ in. Depth to Sall atottlea: n Depth to;weeping from side of obs.hole: ! in. ©roundwater Adjustment ! A .faetor.,�,_,.� Adj.Groundwater Level— Index Well# Reading Date Index Well level -- dr ' I PERCOLATION TEST . Date—e----a T��' Observation , I Time at 91, Hole# 11 ' Time at G" Depth of Pere l Start Pre-soak Time.@ 1 t Time(91'-6") -- End Pre-soak 1 Rate MinAnch Site Suitability Assessment: Site Passed - Site Failed: Additional Testing Needed(YIN) Original:.Public F141th Division Observation Hole Data To Be Completed on Back . �• . .wetland,.-you must first notify the ' ***If percolation test is to be conducted within 100' of wetland,;y Barnstable C4#servation Diszsion at least one(1)wedk prior to beginning. 4 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel t tj I1 • �� IAL 1 La DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel) P 112' C, 2- 7 - DEEP OBSERVATION HOLE LOG Hole# Depth from' Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) • (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons istencv.%Gravel � I T DEEP OBSERVATION HOLE LOG Hole# A, Depth from Soil Horizon oil Texture Soil Color Soil Other Surface(in.) (OSPA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten Gravel) t Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes _ Within 500 year boundary No ) Yes Within 100 year flood boundary No J 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? If not,what is the depth of naturally occurring pervious material? Certification I certify that on id el (date)I have passed the soil evaluator examination approved by the Departmen f Environmental Protection and that the above analysis was performed by me consistent with the require trat in , xpertise nd experience described in 3.10 CMR 15.017. 1 Signature ` Date �' Q:\SEPTICVERCFORM.DOC i SECTION'�ENDE'R.'COMPLETE THIS SEC bOjV COMPLETE THIS ON DELIVERY o Complete items 1,2,and 3.Also complete A. nature t item 4 if Restricted Delivery is desired. X �. ent a VJI,s_ g 1© Print your name and address on the reverse ❑Addressee .` so that we can return the card to you. Re ei ed P ted me) C. Da of elivery o Attach this card to the back of the mailpiece, ! ® I , or on the front if space permits. C Y.D. s ell address different from item 1? ❑ es 1. Article Addressed to: delivery If YES,enter delivery address below: �l o 1 David Dolt Real Estate I ' 1533 Falmouth Road Centerville, MA 02632 3. Service Type A�),ertified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise q ❑Insured Mail ❑C.O.D. �t 4. Restricted Delivery?(Extra Fee) ❑Yes 2. ArticleNumberifl ?} ,, .;i , :I 7011 0470 0001 4525 55324,,, (Transfer from service)abed is+ /ems tYl'l i PS Form 3811 February 2004 Domestic Return Receipt 10259502-M-1540 �, a } ru t.r) ru to � Postage $ Certified Fee O Return Recelpt Fee Postmark M (Endorsement Required) (JAN 3 1 M i p Restricted Dellvery Fee (EndomemeM Required) C3 Total Postage&Fees $ US . r� r- a David Holt Real Estate 1533 Falmouth Road Li Centerville, MA 02632 Certified Mail Provides:,,- .a A mailing receipt to A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mails or Priority Mail®. a Certified Mail is not'available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. to For an additional fee,a Return Receipt maybe requested to pprovide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS,Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required.` o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement'Restricted-Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 • Town of Barnstable Barnstable MIKE r, Regulatory Services Department I I-ftedc aI.,Cfty > DARNKMBLE, 9 MASS. g Public Health Division. - �A 1,639•. � rFaM"� 200 Main Street, Hyannis MA 02601 Zoos Office: 508-8624644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 70110470 0001 4525 55532 February 2, 2012 David Holt Real Estate 1533 Falmouth Road Centerville, MA 02632 RE; 28 Lady Slipper ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 28 Lady Slipper, Marstons Mills, MA,was last inspected on 1/20/2012, by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system" Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Hydraulic Overload. 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 with the deadline period will result in future enforcement action. r PER ORDER OF THE BOARD OF HEALTH 14• om s cKean, R.S. CHO Agent of the Board of Health �i Q:\SEPTIC\Letters Septic Inspection Failures\28 Lady Slipper Ln.,MM.doc / � r /�y���� �';/u re Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 11 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the, information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CM 15.000).The system: o ❑ Passes ❑ Conditionally Passes ❑ Needs Further Evaluation by the Local Approving Authority O' .- -'n Dpa zo//� 1-21-12 e Inspector's Signature Date %0 C The system inspector shall submit a copy of this inspection report to the Appro ing Authaty (J;—Mrd of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts ' W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) 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 y 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. k El Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City(rown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): t C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR. 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments ' M 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other:. y D) 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 ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool' ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M , 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 2000gpd- 1 0,000g pd. ® ❑ 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 10,000 gpd to 15,000 gpd. For large systems, you must indicate either`yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply Elthe system is located in.a nitrogen sensitive area (Interim Wellhead Protection 11 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 shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner, Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City[Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no"as to each of the following: Yes No '` ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ® ❑ Were'all system components, excluding the SAS, located'on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ " Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan afithe 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)] D. System Information Residential Flow Conditions: ' Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t + t5ins°11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No 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 12-2011 i r Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): i x l General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (f 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): t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City,Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (f known) and source of information: 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): , Depth below grade: 42"feet (Material of construction: '❑ cast iron ® 40 PVC' ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 36"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" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official- InspectionForm Subsurface Sewage Disposal System Form =Not for Voluntary Assessments �M 28 Lady Slipper Ln t Property Address Bank Owned (Contact David,Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" 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. 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 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ��M y 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or 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 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 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 clear signs of back-up with stain lines above inlet invert. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r . Commonwealth of Massachusetts Title 5 Official . Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ 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.): Leach pit had clear signs of hydrolic failure with water level above inlet invert. 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ' a 28 Lady Slipper er Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills. MA 02648 1-20-12 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: i : Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspecton Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City1rown State Zip Code Date of Inspection D. System Information (cont.) 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 I I I D �27' ao t5ins-11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 l e Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-96672448)' Owner Owner's Name information is required for every Marstons Mills MA 02648 1-20-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: , ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells , Estimated depth to high ground water: 20'feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 28 Lady Slipper Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every N;arstons Mills MA 02648 1-20-12 page. City(rown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater i ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BA,i<2NSTABLE LOCATION f; SEWAGE VII:.LAGF r5 , 1 s ASSESSOR'S MAP& LOT _ ]NgTAI..L.ER'S NAME&PHOME NO. `SEPTIC TANK CAPACITY v { . ! LAC]iING FACIL]TY: ( ) f' _ aze 22 NO.OF'BERROOMS bUIL DER OR OWNER. PERMIT®ATE:__,, COMPLIANCE DATE: I'! Sepamdon Distace Between the, 4 Maximum Adjusted Groundwater Fable to the Bottom of Leaching Facility Feel Private Water Supply Well and LeacWn,g Facility (If any wells exist on site or within 200 fe4t of leaching facility) Feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet oHeachins facility) FCe lied by� crG✓ �.. 6 13 � D F r . F i / Sewer Permit No. Name L J 0 '4'✓b W Locatioa SMIA- N, Iastaller'e'Name and Address Builder's Name and Address �— Date Permit Issued: Date Compliance Issued: e �i r � Fov i R ' No...._...6_3:.G 11 _001HE COMMONWEALTH OF MASSACHUSETT'S D I BOARD OF HEALTH - ......... - r' Appliration for Uiipuiittl Works Tonstrnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (k-Ir an Individual Sewage Disposal System at: • 1Y` m.......-----.......... ---/�-�...... .....................•----•---.....--------... ocation Address or Lot No. Owner S A dress, a aGifa�.--••......................................•-•- ............i.G. .__..............................._..._. p. Installer Y Address d Type of Build-ing 1 Size Lot.... ........`� ...Sq. feet U Dwelling—No. of Bedrooms-._. ............. ..........Expansion Attic Garbage Grinder a Other—Type of Building -------------•-•-----------• No, of persons._...�----....--•-•-•-- Showers Cafeteria ( ) Other fixtures .................................. ...... Design Flow.......... .-:!f ...................gallons per person per day. Total daily flow.......4Y.P.......................gallons. 1:4 Septic Tank—Liquid capacity/,_gallons Length................ Width................ Diameter................ Depth............... Disposal Trench—No._.�7______________ Width.................... Total Length.................... Total leaching area.....................sq. ft. Seepage Pit No.. �' . Diameter./.�-....... Depth below inlet.... C........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank �/� Percolation Test Btesults Performed by.._---��.. l�.l�-•--.....---•-_ ........................ Date..........-----•-_•--------........-... �a Test Pit No. 1 ..R_.minutes per inch Depth of Test Pit..... l_._. Depth to ground water..AV 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----------•-•--------------•--------..........._............._..._..-•--•---._..._••-••••=•--•--...•- ---••----• O Descri ti n of Soil �z. $.tgi. ...�..--•--Z•-•�'--- ! �!-----j L4. ---•-_----- P g.._ p U •" ...------•...-•--------------------------•-•-•-------•--•--._........--•..------•--......._..---_/__....---.. W --------------------- ----- -----•----------------------------------••--•--•-----•-----.....-•-----•----.._._.----------•---------------------•---•--------------------------------------••-•••--•••••-• UNature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------------------------------------------•-------•------------•------------•--.................._.....----------------------•-----•-••-------------------------------------._.._..•--...:.---- Agreement: The undersigned agrees to install the aforedes e I)idividual Sewage Disposal System in accordance with the provisions of LITLL 5 of the State Sanitary .. — T ndersi d further agrees not to place the system in operation until a Certificate of Compliance has b ue the bo of Health. Signed_ -. ----•------ ......�..•-------•...............•-- ................................ Da ` Application Approved BY ..a� =... � �� .� 3- f Date Application Disapproved for the following reasons:___________________________________________________•_-.......................................__. .............. .......................•-•----._._.._.._......__....--------•--------------...._.._...............--••---•-••-•--••--•----•-------------------•-•-------•••••---...-----•-------•--•-•••--••---...._.... Date PermitNo......................................................... Issued........................................................ Date r _ No........ FEs.....�. .......... THE COMMONWEALTH OF MASSACHUSETTS QOAIRD OF HEALTH ..........................................OF..-................................-...- .............. ................ Appliration for Diipoiittl Works Tonsirur#ion ami# Application is hereby made for a Permit to Construct ( ) or Repair (\-'r an Individual Sewage Disposal System at: ... : .; z,� ,- .. u .....-- ....................... ..... .� ........................... •--------- Location-Address ----or Lot No .......................................................... Owner et ..._..........-•-•--••-----•---•---- Installer Address UType of Building Size Lot....OF_...`_4�3...Sq. feet Dwelling—No. of Bedrooms......... .............................Expansion Attic ( '�"" Garbage Grinder (ko aOther—Type of Building ............................ No. of persons...._.3....I------------ Showers ( o-4-- Cafeteria Other'fixtures ...................." 4............... Design Flow.......... .. ....................gallons per person per day. Total daily flow....:_..0... ......................._gal wE ; Ions. R: Septic Tank—•Liquid capacity/,M gallons Length................Width:_.........._. Diameter._'r_'._._ X Depth................ Trench,..t'�10. -.""�................ Width................... Total Length___....�....r...._...._-Tbt•al.leaching area..___.__....____....sq. ft. Seepage Pit No.___ .. Diameter., .... Depth below inlet....6.t....... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank / , ►, y.a. ~' Percolation Test Results Performed by--.... ,Q.../1�_f... ......:................................. Date......... ..... Test Pit No. I ALAI '..minutes per inch Depth of Test Pit..>_. ... Depth to ground water---1 4., Test Pit No. 2.. .::.........minutes per inch Depth of Test Pit.................... Depth'to,ground water........................ r,/ t' 8., L ............ ................................... O Descri h n of Soil j .q 46 ,�* • '.. .!+ram N _ .. ,.....0-f--Y-,-�-vC-...........- p , - 1 .S .. 1 -- -----X Poo-- -------- _ ._ -. .... ...j�y.. ....•-•. ..-•----.......-•-------••-•••..... w . t.;r, U Nature of Repairs or Alterations—Answer when;apph�cable...._._.--___ t. '......................... 1J,Pr Agreement:`n The undersigned agrees to install the aforedesc • e Individual Sewage;Disposal System in accordance with the provisions of iITLL 5 of the S.tat6 Sanitary —;T nderI d fi'rtherjagrees notao;place the system in operation until p,a Certificate of Com`lian ,6s,be e the boa of health. .y alWy ,r - Signed. --- -- --•-•- ..........................1+ ............................ ................................ Da Application Approved By..................................-----. �..._.'''^ ...... °'� ---�q-........ Date Application Disapproved for the following reasons:__...--••...--••----•----•-•--••••••--••...•--•••----------------••-•----•-••••----•••--......--••-•---........ ....•-••--•-•-----••-••-•-•---••---•-•----••--------•...-•-...--•-•-•--•••--•---•--•----••......---•---•----•--••--------•-----•...-------•----•--•--••--•---------••••--•-----.._..-•••---••-••--•--... Date PermitNo......................................................... Issued....................................................... Date, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF. ..................................... ` Tertifiratr of Tontpliatta — THIS„,,tFr. 0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) '............................................. ....... .................-........................................................................... • Installer at. ._ ._... i , y._,.*fir......I n----•�,rR', ' ( 7---------------------------•---•-----•-----------•--•---•-------- has been installed in accordanc with the provisions of TITLB 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.........R.-'_-"..�........... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION �ATIScc�FACTttg�ORY. EDAT .-•-•-- .................�..-.t::•- ••�.............. Inspector........................ f .c... ............................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q .......................................... ................................_.•-•-•-------........................ No..... .5?,,F..� OF............... FEE........................ Is la al� �rk��°Taut'.5trur#ion rrntit Permissionis hereby granted------------------------•-•--•---....------•------•----•----•----•--••--••-------...---••••••--••-••--•••---....------•............_••..••••- to Construct ( or Repair ( ) a Individual S .wage Disposal System Street as shown on the application for Disposal Works Construction Permit No......... Dated.......................................... d.�DATE.................................... ��Z---•- 1 ............. Board of Health FORM 1255 A. M. SULKIN, INC.. BOSTON le O I Wood )0 a n.i q i O r` s U-b- oi ' Lot- �� l�/ ; ` ✓ n'.8 I �'1 r;UU i /C fX) Are .F%,�.�aie i ANT R. )`ess pan j �Y-1c W I�� i bo "Uediu m ' Sa nd. i i I � Of y�S No H;,O No HZ 0 H RY yG Tested �II.Z�IgZ, EA 61-- F . �, Ke l l ANT w e.26575 ,0 F i H. f EL, I Oo.Or i Top oc Wa II FAN GR. EL, cj8, O' E✓r'�3 O/ - -..__ 4 k167,,NCy xxx I xxx I i y PVC ne ccled> i Grp C Co n Cellar )cor i I �P.C.Cor-I EL gl,?&/ , t; O� �� �o z t _ vvashec-� s+or; e lager on i`o i I y Horn, 1 to �c e� looi Vert, ioo _ P o l L E� of D15PoSA V-STEA 1`Iote: Disposal sVs-f-em �o be cons+ruc-l-ed ��� �tri cf a ccord arice ass. E n v i ron , eaIe 1 % f le 1, , `Sobn Powc1�►\ See. c e. 0 �tN OF y 2 HA E 1� 0.26575�� fir C�STElk �SS�ONAL DES IGN S ; ngle �'an 1y (Awe 11 \t n9 u/1.4 bed roorns, I-o gacba &, di 5�0-s .S � 40 G.P, D , � � o G.P• p . �C I , � = 6 �o G,4�. , D is.p osa1 Us� pP, + � Jtoy)c .DrsiGNED BY : 6. 0 ' 1-,AAl7-,E'FZV SOC , e'a P'-f-y Tr- x X i z x 6 x z o 9 D `� �, Sa nd W C h, A . x Z x (oz x 1. O GA ks, Dw C- W, - Px- go �v ti ell OD w -P I w 5nt fi� t,s oo C2(. . TtStz_. lb,� eye ti o L FL (00 o _ *��O of Gr1t�- A )3y rAf,, Qsct�. L•�v.1� tjrv!y Otis � AR Y ti L/�NTE (Ly �4 �soc. by CJ..ia�d E. N<t,llcy 1 � � � E3�c. -SAS YAr-N . - jAtt.r\ Rt - L. .26575 If . Sand vd I L�1 ►^CIA. Pc,-. 7L Znt� Surety by 57*'Ne . Fss IsT fL A 3 ONAL D 3 o'9 ` jp 3 r LO C A T I O I I� _4Q T- -�=�- - - �J E`lti;��,�'/v- - /?_;5- . _. - - - - NO. P - - V I I.1.A`j E -- .' �''�-- ----- - -- - -- ---- - - -- - - - --- ----- - -DATE_ APPLICANT C,) 7L _ 'i SS (-�Z --- _ - -- FEE_ a S_✓ ADURE:SS /`la-z:sTZ•�-� /`7 �L-C � _ _ T)•:LE:!•'kkONE NO . (Non-refund,)h' ENGINEER ��1�/h-77 L'-/l Z-C-�--4' /T S TE1,E:PH0t E NOS.-- - DATE SCHEDULED_- — (Applicant' s signature) . . . . . . . . . . O . . . . . . . . . O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P/yisiv , SOIL LOG SUB-DIVISION NAME to i N/4- AL,ele- >95 74 DATE- % ��' --TIME `- EXPANSION AREA: YES NO - 2. a2nds ���y L' /lc �1�/ ENGINEER TOWN WATER PRIVATE WELL_,, 1 ---- - ----- BOARD OF HEA! tEXCAVATOR SKETCH : (Street name , etc. ,dimensiot, exact location of test holes and percolation tests , locate in proximity to test holes ) NOTES : ,1 ; - . s� -f Jr, 7 tiny � w, PERCOLATION RATE :' /71. TEST HOLE NO: V ELEVATION:, TEST HOLE NO: ELEVATION: 1 wc, Jcz•3r� )1--. 1 2 j ----- s, 1 3 2 ----- 3 ---- 3 - -- --- S --- s a�n .v.1-7/ 5 - ---- 6 6 -- - - - 8 _ 8 - 9 9 --- 10 - ----- :7 c�� 10 - -- --- 11 S D 11 -- - -- 12 ----- 12 13 13 --- - 14 14 —.---.. 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE : LEACHING FIELD LEACHING PITS ` LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE . N0'1,K ENGINEERING PLANS MUST SHOW NUM[3ER ASSIGNED ON PERC TEST APPLICATION CO`ti'I,E:'l'E:U TN "r.:'�'I' f Ky:'PY-- R . P . E' , AN[) FE:'1'llK`:` I) 'I'O Et(�.1Kf) OE' 11FA[,'I'}[ LEGEND SCALE 1"=40 MARSTONS MILLS 0 ( • PROPOSED CONTOUR O 4 o= ® PROPOSED SPOT GRADE -- 98 -- EXISTING CONTOUR - PARCEL ID: 045/046 30 912 ON PARCEL 10: o , + 96.52 EXISTING SPOT GRADE �'. 044/014 3 LOCUS W— EXISTING WATER SERVICE ��Sv,+^ ti z AL pYSU1PP TEST PIT �1"E LN POND N80 42 PARCEL ID: �J z 044/017-001 AREA=93,365f S.F. 151 WAKE BY OAD P � 20" G LOCUS MAP 6� T�J s�9 S� JO� ns p�^�s QAK . ti, LOCUS INFORMATION pp 67 12„ PLAN .REF: 375/56 TITLE REF: 12525/174 D„ ` OAK PARCEL ID: MAP 44 PAR. 017-001 PARCEL ID: ^ \ O ZONING: "RF" FLOOD ZONE: "C" 029/032 68 `` �,` � TRI COMMUNITY PANEL: 250001-0015—C DATED:08/19/65 a y \ XtfOAK ..■a .. �� DECK TP 14,. EXIST. LEACH PIT SEPTIC SYSTEM AK NOTE 10 REPAIR PLAN ` - LOCATED AT: #28 , so EXIST. I ,000G 28 LADYSLIPPER LANE ! �,, SEPTIC TANK 0) / DWELLING „6� ,� MARSTONS MILLS, MA. TOP BASE. U OL I SILL- 63.64 62 INS ���� PREPARED FOR 12"-_____ ' UTILITIES AK___ 63 .. F A N N I E M A E AKA FEDERAL 6'6, '' - DECK -_---- 20" \ AK..... 64 -- NATIONAL MORTGAGE ASSOC. GENERAL NOTES: ___ _----- 65 MARCH 05, 2012 AS—BUILT: MARCH 9, 2012 OAK 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL - r ------- 66 "� BOARD OF HEAL?H AND THE DESIGN ENGINEER. A ^-" 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS V O D) `� �'� TBM: 6-� OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE OF Mq LOCAL RULES AND REGULATIONS. Q o�� CDR. GONG. SHED ' ,) RIOR PAD EL=63.00 (GIS±) 3 TOEINS ECTIONIAND APPRSAL OVAL ALL BY THE BOANOT RD OF HEALTHAND THE �? D X DESIGN ENGINEER. 4 FROM THOSEOTTHOSE0SHOWNOHE ONDSHALLNBECREPORTECDn�O THE DESIGN " Plo. 1140 ENGINEER BEFORE CONSTRUCTION CONTINUES. ALL ELEVATIONS BASED ON ASSUMED DATUM. Q % _ 8. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF '�G/STERN 6� _ 6O1 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF sq �P� - J HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. NI TAR .0 ------ \ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. I 60 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. (� Y 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING h� CONSTRUCTION. MEYER & SONS I N C. � 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE V. � ! 11. 48 IIOUR NOTICC FOR ENGINEER CERTIFICATION P. O. BOX 9 81 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY R_250.00 L=100,36 Rom, 13. NO PRIVATE WELLS WITHIN 100 Fr. OF PROPOSED LEACHING S 14. ALL PIPING TO BE 4' SCH 40 0 1/8-/FT (UNLESS SPEC.'OTHERWISE) EAST SANDWICH, MA.- 02537 . 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW rw L A D YS L I P P E R SS2so PARCEL ID: 16FOR THE USE OF A GARBAGE GRINDER (5 0 8)3 6 2— 2 9 2 2 . NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 044/017-002 LANESYSTEM TIES ON AS—BUILT CARD SUBMITTED BY RANGER CONSTRUCTION SHEET 1 OF 2 J#14maw 11 i NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:54.44 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. T.O.F. EL.=63.64 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. F.G. EL.=63.Ot F.G. EL.=62.5t F.G. EL: 58.75f F.G. EL: 58.5(MAX.) �F �Assq � c G 9" MIN COVER/ DA yEg1R s rT L = 10't 36" MAX COVER L = 50' L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.) 0 S=1% (MIN.) EL. m 60.06 0 S=1% (MIN.) 0 S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 10" s 11.2" TO SAN I TW 14" INVERT • INV.=59.06 4B' uoUID �INV.= 58.81 cEVELPROPOSED GAS elV=FLE D BOX INV.=54.5 1 TRENCHES OF 12 UNITS AT 5.00'/UNIT 60.00'/ROW INV.=54.7 DR-5 INV.= 54.00 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1.000 GALLON SEPTIC TANK RESTORE VEGETATIVE COVER EXISTING SEWER OUTLET XT TO TOP WITH CLEAN PERC SAND _ TO TOP OF CHAMBERS I. 60" NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ; :.',: PIPE INVERTS PRIOR TO CONSTRUCTION - _ EXISTING SUITABLE 2) D-BOX SHALL BE SET LEVEL ,AND' TRUE TO BREAKOUT=TOP ELEV.=54.44 MATERIAL INV. EL .= 54.00 GRADE ON A MECHANICALL COMPACTED SIX EV - N =T N A AS SPECIFIED I - INCH CRUSHED STONE E BASE, BOTTOM L V. .11 B 0 E E 53 310 CMR 15.221(2) 2.88' 3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF TANK WITH 1500 GALLON SEPTIC TANK T.P. EXCAVATION OR G.W. USE 1 ROWS OF 12 16"-ARC3616 HIGH IF FAILED, DAMAGED, OR UNDERSIZED. (6.51' PROVIDED) CAPACITY ADS BIODIFFUSER UNITS-NO STONE 4) INSTALL INLET & OUTLET TEES W/ ZABEL BOTTOM OF TEST HOLE EL.=46.6 _ FILTER AND GAS BAFFLE AS REQUIRED 5) PLACE SANITARY TEE IN D-BOX. SEPTIC SYSTEM PROFILE • TYPICAL SECTION 16" N.T.S. N.ra DESIGN CRITERIA SOIL LOG P#: 13562 NUMBER OF BEDROOMS: 3 EXISTING BEDROOM - NO INCREASE IN FLOW PROPOSED DATE: MARCH 5, 2012 SECTION 10.75. SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE #1614 INVERT DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONALD DESMARAIS, BARNSTABLE BOH HEIGHT END CAP - DAILY FLOW: 330 G.P.D. ADS - ARC 36HC CHAMBER (H20 LOADI DESIGN FLOW: 330 G.P.D. Elev. TP-� Depth Elev. TP-2 Depth 57.60 0" 1 58.10 0" MODEL ARC 36HC GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) FILL FILL PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY 56.44 14" 56.94 14" LENGTH 63„ NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT A LOAMY SAND A LOAMY SAND EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY 1OYR 3/2 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. 74 LEACHING AREA REQUIRED: (330) = 445.95 S.F. 55.85 B 21" 56.43 B 10YR 3/2 20" SIDE WALL HEIGHT 10.75" LOAMY SAND LOAMY SAND OVERALL HEIGHT 16" DISTRIBUTION BOX: DB-3 (3 OUTLETS (MINIMUM)) 10YR 4/6 10YR 4/6 OVERALL WIDTH 34.5" IN 4640 TRUEMAN BLVD PRIMARY S.A.S. 53.85 C 45" 54.35 C 45" 10.7 CF e HILLIARD, OHIO 4JO26 10qX USE 1 TRENCHES OF 12 - ADS ARC36HC UNITS WITH NO STONE PERC 0 52.35 A MEDIUM SAND MEDIUM SAND CAPACITY (80.0 GAL) ADVANCED DRAINAGE SYSTEMS, INC. 2.5Y 7/3 }, 2.5Y 7/3 TRENCHES: (GENERAL USE APPROVAL FOR 7.79 SF/LF OF CHAMBER PROPOSED SEPTIC SYSTEM/SITE PLAN (CHAMBER UNITS) 12 UNITS x 5.00 LF x 7.79 SF/LF = 467.40 SF 46.60 132"'i 47.10 132" 28 LADY SLIPPER LANE, M. MILLS, MA TOTAL AREA = 467.40 SF Prepared for: Ranger Construction a. PERC RATE <2 MIN/IN. (-Cl- HORIZON) DESIGN FLOW PROVIDED: 0.74GPD/SF(467.40SF) = 345.87 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN DATE: DARRENM.MEYER,R.S. MacDougall Survey NTS D.M.M. 03/05/12 • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR.15.017 p0 BOX 981 (508) 419-1086 to conduct soil evaluations and that the above analysis has been performed by me consistent with the REV. DATE: CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam In October, 1999. EAST SANDWICH,MA 02537 sos-3s2-zs22 03/09/12 D.M.M. 2 of 2 TL Nli A NOTES. L 12 .*_}� `t" `` Al 1. CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS & DIMENSIONS IN THE FIELD' kh. 2.) CONTRACTOR TO VERIFY ALL INTERIOR& EXTERIOR MATERIALS, If, _1-J, DETAILS, & FINISHES IN THE FIELD WITH OWNER 3.) ALL LVL LUMBERIBEAMS TO BE 1.9e U480 LOAD EXIST. 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS STATE BUILDING CODE, 8TH EDITION & IRC2009 DECK 5.) 110 MPH EXPOSURE B WIND ZONE VERIFY NEW DECKING &RAILINGS W/OWNERS 6.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL SIMPSON COMPONENTS 7.) ALL CONCRETE USED FOR FOUNDATION WALLS, FOOTINGS & SLABS TO BE 3000 PSI 8.) VERIFY ALL PLUMBING & ELECTRICAL DETAILS W/OWNERS ON THE SITE f L� DURING FRAMING CONSTRUCTION SINK I D-f 9.) ALL DECK CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS REMODELED STATE BUILDING CODE, 8TH EDITION & IRC2009 PRESCRIPTIVE RESIDENTIAL EXIST. � KITCHEN 0 WOOD DECK CONSTRUCTION GUIDE MUDHALL I I j (VERIFY KITCHEN RAN EXIST. i t LAYOUT W/OWNER) O DINING ` b 4'.0" LRE 1 _ — 12 EXIST. EXIST. HALL NEW 2-1 3/4"x 7 1/4"LVL BEAM NEW 2-1 3f4"x 14"LVL BEAM ABOVE ABOVE W/6 x 8 FIR WOOD BEAM Wf 6 x 8 FIR WOOD BEAM(FLUSH) DN. UNDERNEATH — _ UNDERNEATH- 12 EXIST. li t U 6x6 EXIST. \-ANTIQUE FIR POSTS BEDROOM 3.SIDED i NEW 2 1 3/4"x IN' FIREPLACE LVL BEAM(FLUSH FRAMED) 2 x 8 JOISTS 16"o.c. y t NEW 6 x 8 ANTIQUE EXIST. EXIST. FIR WOOD BEAM FOYER O Q LIVING NEW 6 x 6 ANTIQUE UP EXIST. FIR WOOD POST r REMOD. LIVING KITCHEN VERIFY NEW DECKING &RAILINGS W/OWNERS 2 x 10 JOISTS 16'o.c. 2 x 10 JOISTS 16'o.c, P.T.2x ft a 16"o.c. NEW 3-P.T.2x 12's EXJST.W10 x 30 STEEL BEAM Al INSTALL P.T.2 x 8 BLOCKING AT M[D-SPAN NEW P.T.6 x 6 POSTS W/ EXIST. ' INSTALL(2)LEDERLOK AZEK CASING&1 x 8 BASE BASEMENT SCREWS AT EACH FIRST FLOOR PLAN JOIST SAY MARK A. �= LEGEND: EXISTING WALLS SP0NAL �s �dAL CONSTRUCTION TO BE REMOVED y A BUILD NG SECTION LIVING/KITCHEN CM NEW CONSTRUCTION � �` Al VERIFY FOOTING UNDER EXIST.POLES IF NOT ADEQUATE,INSTALL NEW 12"DIA. CONCRETE SONOTUBES TO Vr BELOW GRADE.USE SIMPSON A$U66 POST BASE& _/AC6/ACES POST CAPS THE DESIGNER SHALL SE NOTIFIED IF ANY SCALE : DRAWING NO. : ERRORS OR OMISSIONS ARE FOUNp ON THESE DRAWINGS PRIOR TO START OF COTUIT BAY DESIGN LLC ICIEW REMODELINFOR: CONSTRUCTION.THE BUtLDINGCONTRACTOR 11 - 1 {'CFI /) ROAD WILL BE RESPONSIBLE FOR THE CONTENT 1/4 .—V 43 BREWSTER I\VAD -- — -- IN THESE DRAWINGS IF CONSTRUCTION MAS H P E E ,MA. 02549 SORBELLO RESIDENCE , COMMENCES WITHOUT NOTIFYING THE (�Q 7/( r� (� DESIGNER OF ANY ERRORS OR OMISSIONS. DATE . P H. 5 V V 2 r '7` ! �/� THESE DRAWINGS ARE SOLELY FOR THE USE A OF THE OWNER NOTED.ANY OTHER USE OF FAX (50 539-9402MARSTONS 'THESE DRAWINGS REQUIRES THE WRITTEN 5/23/20'12 Al ` ) 2 S LADY S L! PPE R LANE CONSENT OF THE DESIGNERHTPROT CTI ARCHITECTURAL COPYRIGHT PROTECTION 'J ACT OF 19W.