HomeMy WebLinkAbout0117 LAKE SHORE DRIVE - Health — Lea'
117 LR1;&hoTA��y�
A=030-026
Marstons Mills
{
i
o T35v
No. C3 b f ., Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for W5poeal *p!tem Cow5truction 3permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 11? LAim :514a,K 09-, Owner's Name,Address and Tel.No. DiE;FaG.6c;
Assessor's Map/Parcel O-g 6 _ OZ(a 0
i
Installer's Name,Address,and Tel.No. QA_3�6 Qc AY-AT►at) Designer's Name,Address and Tel.No. FNb�N�Sa.IN6 W a2K�S
Q, 6 8 CR ss9Is- D
(s6B)qZ?-q s6V F0n1Z_10A ro -tAA, Cs '77 - S311
Type of Building:
Dwelling No.of Bedrooms rZ- Lot Size 2,7 800 sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 3 d gallons per day. Calculated daily flow ZZ 0 gallons.
Plan Date ZIG.—ylb Number of sheets Z Revision Date
Title
Size of Septic Tank�-, t taEMNG 1cYCM ,Ql Type of S.A.S. A 16 N CAP AC,►i Y 1Nf=ttZR�i 1LS
Description of Soil &5M5 PvAIJ ZO)L 1 cam
Nature of Repairs or Alterations(Answer when applicable) R-EPA-A a 1= V14"Zo `SYS`Tyml-�
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 Environ taI Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued byA' Bo of He .
Signed ^� a Date 0
Application Approved by Date
Application Disapproved for the follow g reasons
Permit No. �d �'Date Issued
aooW,3SZ fb�
No. ��/"* Fee `
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppfication for Zitpool *p5tem Construction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ( LA ICE Siq MG Oft- - Owner's Name,Address and Tel.No. ptf an 6�
Assessor's Map/Parcel O3 6 - O Z(v 0
Installer's Name,Address,and Tel.No. PMToaP'16 Qc_AVA-rCt. Designer's Name,Address and Tel.No. 19361 MPL IWU W aIL KS
9, 6 8(--4 I-L%S 1 Z w. C vLoss F rBLD
Fa„`b�TD�a�t; M� . (S00q? g3c5"0 Fanvs�'or�c� ►-�w, �5 �1-77 - S11'7
Type of Building:
Dwelling No.of Bedrooms Z— Lot Size 7-7. 00010 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 3 3 O gallons per day. Calculated daily flow ZZ. 0 gallons.
Plan Date Number of sheets Z Revision Date
Title
Size of Septic Tank F�t5;i N i Ql Type of S.A.S. H 16 N GAP Ac.i T Y I Nr-I LTR-A'16►1S
Description of Soil 5 iX V►_A"N SOIL L O t�
Nature of Repairs or Alterations(Answer when applicable) Q_1GPA)9_ o F yw lzb
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b=11* ard'of Health
Signed 'l i Date
Application Approved by Date
Application Disapproved for the follow' g reasons
Permit No. goo 5 Date Issued r
_ — —————————
(� cJ�(j� THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
3p Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( / Repaired ( )Upgraded( )
Abandoned( )by P -faCC.ra V tc)l
at r'1? �w_ 3 been constructed ik acccgr. ance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 0
Installer ?A`!5TTV'5; ce.Ii�iA d W Designer
The issuance of this permit shall not-be co strue a'a guarantee that the systt�-r-n-fwa�"�uu/nctt aft a�J designed. W o �
Dated � L�- W /
Inspector
'100 ^3�.�
No. ------ -------Fee {VV
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Zi!6po5a1 *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon
m located System ocat d at � -7 ��?� Sl-1 � �.� M, M ILLS
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must bf completed within three years of the date of this p titer
Date:_ D r y 0 Approved by
r
09/09/2008 15:55 5084775313 ENGINEERING WORKS PAGE 01
Town of Barnstable
Regulatory Services
1 Thomas F.Geller,Director
Public Health Division
'somas McKean,Director
200 Main Street,Hyannis,MA 02601
Off w: 508-8624644 Fax: 508.7904304
Installer&Designer CCertiflggi"Form
Date: sewage Permit# Assessor's MaplParce d 0 0 z(o
Designer: fAa l a egnA oRA-5 �n e. Installer: '`�S'1Zn`Q c�..J v.}-t a�--.
Address: rz- W• Gass Q aA (CA Address: q 0• !2
-�cihArt,,Ce MA
on r4t54-rff- b^ was issued a permit to install a
(date) ((installer)) 1
septic system at 11'7 "4,0— S^ ^
f� !:, 1`f l M based on a design drawn by
(address)
(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
distr�tion box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State&Local Regulations. Plan revision or
certified as- by designer to follow.
P�SN OF 1W48,
F'FTER
a
Mct.N7�F U)
(In 's Signatuue) CIVIL
No.35109 p ,44,
(Designer's Signature) (Affix Designer's Stamp Here)
PI;i RETURN TO BARNSTABLE PUBLIC UALTH DIVISION. CERTIFICATE OF
COMPMANt:E. -WILT. NOT BE ISSUED ODL BOTH ]MIS FORM AND AEBUII.T 9M ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.
Q:Ilaaltri/Sgme/Desiper Cemficauae Form 3-26-04.doc
f 7
Town of Ba�rtabe
Department of Regulatory Services
: Fublicealtih Division Date C3
i3��9. �� 200 IyIatn Street;Hyanms MA 02661 {
Dat Scheduled G c
Time Fee>Pd
Soil Suitability A sessment for Sewage Dlspscl
Performed y Wimessed By '
: . I��l!:C,A`��C�►N+� �� :'�.�Lt1V�'(.J.�.��C1��.1T . . . ;
Location Address Owner's Name
uy is De
Address
Map/Parcel:
Assessor's Ma . Engineer's.Name jPeA-f_ �
NEW CONSTRUCTION REPAIR ' ' . Telephone#
Land Use — eS v1 �� \ Slopes(%) d Surface Stones d�//�
Distances from: Open Water Body / Cl ft Possible Wet Area 715V ft Drinking Water Well ft
Drainage Way ft Property Line 7_0 tl ft Other ft
SKETCH:(Street_name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
Parent inatenal(geologic) � _®. /—�N0.i Depth to Bedrock
6 V
Depth to Groundwater: Standing Water in Hole: // Weeping from Alt Face
Estimated Seasonal High Groundwater l_
VETSORNATION FOR SKASONAL.MG19 WATER
Method Used:
Depth Observed standing in obs.hole: in. . Depth t0 soil mottles: in.
Depth to weeping from side of obs.bole: in. Groundwater A*stment
Index Well# Reading Date: Index Well level Adj.factor ,,,_.w Adj.Groundwater Level I
KIM
Observation
Hole# Time at 9"
Depth of Pere. u Time at 6"
Start Pre-soak Time 0 0 Time(9"•6")
End Pre-soak 1
Rate Mip1lach �'Z,
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:\SEPTICTERCFORM.DOC .
DEEP(T�SERVA�TTON FI{}LF I:OG Role* — �
Depth from Soil Horizon Soil Texture Soil Color Soil' Other
Surface(in.) (USDA) . (Munsell). Mottling Other
(USDA) Boulders,
Zy
G iM-c CX,,A -Z 5`t 61 ( :,
'
' ` 'OB I VAT QP f QLE L.06 # z
� - Depth from Soil Horizon Soil Texture Soil Color ��
Surface(in.) :.
Soil i
e Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders. .
•stenc
LCI Y
L 125-11
' z�sL�14
Depth from Soil Horizon Soil Texture Soil Golo
Surface(in.) Soil
USDA) ,a ^ Other
(
(M r�unsell) Mottling (Structure;Stones,Boulders.
vel
i
DMIOAURVA.. N HOLE LOG Dole:#
Depth.from Soil Horizon Soil Text Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
7�1-
Flood`Insurance Rate Mai):
Above 500 year flood boundary No— Yes
Within 500 year boundary No Yes
Wttlun 100,year flood boundary..,:No Yes
Depth of,`N ullov Occurring Pervious-Material
Does at least fosar feet of naturly occttrrmg pervious material'exist in all>areas observed throughout the .
are, proposed for the soil absorption system?
If not,what is..the depth of-naturally occurring pervious material? ,��; ..
Certi�afion s
I certify thatui .
on l l' (date)I have passed the soil evaluator.examination approved::<by
Department of Environmental Protection and that the above analysts was.perform'ed by me eonMstent;wwth r
the required tra expertise and experience desenbed In 310::CMR 13 017.
".
g Da
Q.ISEPTIC�EBRCFOItM DOC
S - -
R
Town ,of Barnstable Barnstable
ti
° Regulatory Services Department XlAmedcacfr
BkvSTAB 1 ►
pq, b 9 Public Health Division m
�FD"4A 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
August 6, 2008
Michael Deforge
10 Clark Street
Norwood, MA 02062
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 117 Lakeshore Drive, Marstons Mills, MA was last
inspected on June 26,2008,by Patrick M. O'Connell, a certified septic inspector for
the State of Massachusetts.
The inspection of the septic system showed that the system "Failed" under the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
Pit was found half full at time of inspection, observed a high stain line over inlet pipe
leaving pit in hydraulic failure.
You are ordered to repair or replace the septic system within sixty(60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
R O R OF THE BOARD OF HEALTH
Donald R. Desmarais, R.S.
Agent of the Board of Health
CERTIFIED MAIL#7006 2150 0002 1041 7613
Q:\SEPTIC\Letters Septic Inspection Failures\]17 Lakeshore Drive.doc
f
Commonwealth of Massachusetts
1 Title 5 Official Inspection Form ,
t Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
117 Lakeshore Drive, Marstons Mills MA 02648 �
Property Address Michael Deforge _ o3co
Owner Owners Name
information is required for 10 Clark Street, Norwood MA 02062 June 26, 2008
every page. City/Town State Zip Code Date of Inspection
LInspection results must be submitted on this form. Inspection forms may not be altered in any
v way.
Important:When filling out A. General Information
forms on the
computer,use 1. Inspector:
only the tab key
to move your Patrick M. O'Connell
cursor-do not Name of Inspector
use the return
key. Septic Inspection Services Co.
Company Name
t� 189 Cammett Road .
Company Address
Marstons Mills MA 02648
City/Town State Zip Code
508-428-1779 SI 12855 I
Telephone Number License Number >>
B. Certification
s _
U? o'
I certify that I have personally inspected the sewage disposal system at this addrescsOand that-the �'
information reported below is true, accurate and complete as of the time of the insp c:ion. The inspection
was performed based on my training and experience in the proper function and maintenance Qfon site
sewage disposal systems. I am a DEP approved system inspector pursuant to Se tion 15.340 6JPII
Title 5(310 CMR 15.000). The system: cn rn
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
June 26, 2008
Inspector's Signatu 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 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.
08-177 Deforge.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15
' Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Deforge
Owner Owners Name
information is required for 10 Clark Street, Norwood MA 02062 June 26, 2008
every page. Cltyrrown 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:
❑ 1 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.
Answer yes, no or not determined (Y, N, ND) in the ❑ 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.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
08-177 Deforge.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u 117 Lakeshore Drive Marstons Mills
MA 02648
Property Address
Michael Deforge
Owner
Owner's Name
information is
required for 10 Clark Street, Norwood MA 02062 June 26, 2008
every page. Citylrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ - distribution box.is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
ND Explain:
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
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.
08-177.Deforge.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Deforge
Owner Owner's Name
information is required for 10 Clark Street, Norwood MA 02062 June 26, 2008
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ 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 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:
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
❑ ® 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.
08-177 Deforge.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of Massachusetts
H Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Deforge
Owner Owner's Name
information is required for 10 Clark Street Norwood MA 02062 June 26, 2008
every page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® 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-
10,000gpd.
❑ ® 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
❑ ❑ 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
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.
08-177 Deforge.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
r
Commonwealth of Massachusetts
Title 5 Official Ins
pection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
w 117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Deforge
Owner Owner's Name
information is 10 Clark Street, Norwood MA 02062 June 26 2008
required for ,
every page. Cityrrown 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 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)]
08-177 Deforge.doc-08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 6 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Deforge
Owner Owner's Name
information is required for 10 Clark Street, Norwood MA 02062 June 26, 2008 _
every page. City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 2 —
DESIGN flow based on 310.CMR 15.203 (for example: 110.gpd x#of bedrooms): 330
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)): —
Sump pump? ❑ Yes ® No
_
Last date of occupancy: UnknownDate
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:
Last date of occupancy/use: Date
Other(describe): —
08-177 Deforge.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
I
117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Deforge
Owner Owner's Name
information is requires for 10 Clark Street, Norwood MA 02062 June 26, 2008
every page. CityrTown State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Tank pumped two years ago.
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) (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)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
Compliance date: 4/21/87
Were sewage odors detected when arriving at the site? ❑ Yes ® No'
08-177 Deforge.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Deforge
Owner Owner's Name
information is required for 10 Clark Street, Norwood MA 02062 June 26, 2008
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
4' _
Depth below grade: 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.):
Septic Tank(locate on site plan): n
- _
Depth below grade: 2'
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: 8.5' long x 5.2'wide- 1000 gal. _
Sludge depth:
2"
Distance from top of sludge to bottom of outlet tee or baffle
28"
Scum thickness 2„ —
11
Distance from top of scum to top of outlet tee or baffle 6
12"
Distance from bottom of scum to bottom of outlet tee or baffle —
How were dimensions determined? Measured _
08-17 7 Deforge.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Defor e
Owner Owner's Name
information is required for 10 Clark Street, Norwood MA 02062 June 26, 2008
every page. Citylrown 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.):
Liquid level was found at bottom of outlet invert tees intact and clear.
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.):
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):
08-177 Deforge.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts
H Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Deforge
Owner Owner's Name
information is required for10 Clark Street, Norwood MA 02062 June 26, 2008
every page. City[Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.)
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
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert —
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
08-177 Deforge.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°w 117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Deforge
Owner Owner's Name
requiretifo is 10 Clark Street, Norwood MA 02062 June 26, 2008
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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:
Type:
® leaching pits number: One 6x6 pit. —
❑ 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.):
Pit was found half full at time of inspection, observed a high stain line over inlet pipe leaving pit in
hydraulic failure.
08-177 Deforge.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Deforge
Owner Owner's Name
information is 10 Clark Street, Norwood MA 02062 June 26, 2008
required for _
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
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.):
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.):
08-177 Deforge.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15
r
(� Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 117 Lakeshore Drive, Marstons Mills MA 02648 _ —
Property Address
Michael Deforge
Owner Owner's Name
information is 10 Clark Street, Norwood MA 02062 — June 26, 2008
required for State Zip Code Date of Inspection
every page. City/Town
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch 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.
Lakeshore Drive
44
2
29
35
Commonwealth of Massachusetts
= Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
117 Lakeshore Drive, Marstons Mills MA 02648
Property Address
Michael Deforge
Owner Owner's Name
information is 10 Clark Street, Norwood MA 02062 June 26 2008
required for ,
every page. Cityrrown State Zip Code Date of Inspection,
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar '
® Shallow wells
Estimated depth to ground water: N/A —
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:
s -
08-177 Defcrge.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
THE Town of Barnstable
�q Tp�
Regulatory Services
BARNS ABi,e, > Thomas F. Geiler,Director
A,f1 39. A Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS
DISCLAIMER
This septic system inspection report was completed by a private inspector who is certified by
the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original or copy of the report;
this Division does not warranty the functionality of the septic system in the future nor does
this Division agree with any technical observations and interpretations contained within this
report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual number
of bedrooms approved at a particular property would be listed on the "Disposal Works
Construction Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
Q:\S'EP'f]C'\Disclaimer Private Septic Inspections.DOC'
iC
TOWN OF BARNSTABLE
y4-OCATION hel SEWAGE#
`'ILLAGE it v fir.,(`-ao rts•�� �: SE S OR'S MAP&PARCEL
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY l� _
LEACHING FACILITY:(type) . . CL (size) X l 1
NO.OF BEDROOMS fa _
OWNER got mot- eyvna-/"` rs�
PERMIT DATE: COMPLIANCEbATE:
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
Isle
_C-.= '&�
A-p=
(1
ASSESSOR'S MAP NO. 36 PARCEL 10 7,7
' �-4c-0 CATION SEWAGE PERMIT NO.
N\'� LQr XF LhA-E Am-f 9
VILLW7
I N S T A LLER'S NAME A ADDRESS
Al co&,q-- a
S U I L D E R OR OWNER
" &,=-el
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED _ L1 Sr �
J
® Box
o
!Oco Gx, PIr
SSESSORS POW NO: 30 �
'OARCEL GAO.:
No..lJ. ...... ....... Fps..........................
THE COMMONWEALTH OF MASSACHUSETT ,w' Y
`'' Atl-QTI`�'� AND CERTIFY IN WRITING `
0�
. BOARD OF H EA LT FEE SYSTEM WAS INSTALLED IN STRICT
Q trp,LACCORDANCE TO PL,qN,
'TAW ---------------OF.........C:
Appliration for Bi-spas al Workii Tomitrurtion Prrmit
Application is hereby made for a Permit to Construct (%-J or Repair ( ) an Individual Sewage Disposal
System at:
F nn
i........!!.._.!t�l l[_L ..�• ld '35• ®'t - --
Location-Address or Lot No.
----••---- .---•. i.... •-
Owner Address
p� -D
Installer Address
d . Typc of Building Size Lot_�7a_g ._..Sq. feet
Dwelling—No. of Bedrooms...........................................Expansion Attic 40) Garbage Grinder (wc)
Other—Type T e of Building E-+ _f� —yp g _._...._..j_______________ No. of persons_____..H.jA.__..._._. Showers (wjA) ,Cafeteria (kp)
a' Other fixtures .......)--44A___-------_- _-.............................................
W Design Flow........LIP..........................gallons per person per day. Total daily flow.......�a®..........................gallons.
R; Septic Tank—Liquid capacity.loo4?..gallons Length.A��. Width..''!? . Diameter-_�Z6..... Depth_57
Disposal Trench—No._J.-II ........ Width _L.4A`...... Total Length....'-fA....... Total leaching area-_-� -------sq. ft.
Seepage Pit No----------I---------- Diameter___ _._ _...._ Depth below inlet.....4a-........... Total leaching area.i��.._._..sq. ft.
Z Other Distribution box (V< Dosing tank (i,/A) P-
Percolation Test Results Performed by E1-L-iS_.._ '`-..!-.... ........... Date..s.:_-S--�.:.8��..............
Test Pit No. 1_G 2.....minutes per inch Depth of Test Pit......!...._... Depth to ground water__�!�"? __-_.
(i Test Pit No. 2.L -.....minutes per inch Depth of Test Pit......0......... Depth to ground water---j4C*-r0-___-
a' ------------------------------------------------------------------------------------------------•---..........................................................
0 Description of Soil..... .__..._-®- ... 1A^ im_ - -7.5 MM-D �'-C.aAleL�
.... 1-- _ ' (
v a...... cork Ali✓--��'''� ��ate -�- � �`��� � 2 " o
-------------- ----- -
x i�A-A4. _ ._aver--j---.............................................` �, L_ �__-i I_,_AAEEEE0 ��� - ►.� cAJTV- i o 'a
-- -- ---- /-------------------------•----
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
--------•-----------------------------•-----------------------------------------------.............----_....-'-s IA...-------------------------------------------------=---------._..........----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'THE is 5 o#.the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Com li 'e has en issued by th bot
rd of h
����./��_ ��f.-
r l v�'v""v"� Signed `� ... ... . ----- ``�'"�-- -- 0
Date s
Application Approved By. Da
. •.
te
Application Disapproved for the following reasons-----------------------------------------------------•-------------------------....--------------------........_
---.--.---•----------------------------------------------------------•----.----------------•------------•_-------------•--------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued--.............------...- ............................
Date
1 -
Y'n f
No.. �?.......� .... Fmc............._............_
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...........................................O F...........-........--................-----------------•---...._..-._....._......__....._.
Appliration for DiiipniiFal Works Tnnitrnrtiun rrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................__......_...................................................................... .....•------------•---------------•.........--------• ---------------......._._................._
Location-Address or Lot No.
......................—.......................................................................... •-••••--•------.....-•-•---....-----•----••-•••..................................................
Owner Address
W
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons____________________________ Showers — Cafeteria
a
• .Other fixtures ------------------------------------------------•--•----•--------------------------------=-------•--••------•--•--•-------•--------------------------
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
P4 Septic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................
xDisposal'Trench—f\To_____________________ Width................... Total Length..................... Total leaching area....................sq. ft.
Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_____________________-_.
fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
••-••••--•••----------------•••••-•-••••--•-•••--••-••••----••--•-----•-•-------•---•••••••••._..............................................................
Descriptionof Soil..........................................................................................................................................................................
w
UNature 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—1 T:1,: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compli ce has been issued by the board of health.
o� Signed...................................................................................... ..........................
Date
Application Approved BY - - .- w ._`...................................
.. ......................... -�
Date
Application Disapproved for the f ollowinC easons;•••••-•••---•••-••••--•-••-•----•-••--••••--•-•- ----------------..
•--------------------------------------------------------------••------.....-------------....------------•••---•---•---•-•-•-----•---•-•---•-•-...••-•••-••••-••••••--••-----------••-••-•••-•---_...•-
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............._OF...........1� ;2...TVs. ....................
�rr�ifirttte laf=�unt�li�anr�e
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (�) or Repaired ( )
by----------- ------ -1;1 �i �� `--•-- ---�-------____------:___---_-Installer------_____________-____---•------•-----------------•---------
has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. ._-_�_C__ __ ______________ dated------ _. _�___.�_ .__-_ ?._ .....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................. ....................... Inspector..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
l..V.o:�I..J��.....:..:..:..OF..--....t. .�. ..:_, ._ _
.....'.................................. FEE _..... .1
DispaoFal Vorkv Tons w irrn amit
Permission is hereby granted______________________________________ f a._
to Construa yi( ) or Repair ( ) an Individual Sewage Disposal System
Stree♦�'� I -
as shown on the application for Disposal Works Construction Permit No =/. _ Dated.._. ___/_ __.—. ....
y ........... [ems'. .__-_-_--- - r ...................
Board of Health
ATE
\
FOR 1255 HOSES & WARREN, INC*:iPUBLISHERS
t
4
r
}
b
LEGEND
Aso Mei
EXISTING CONTOURV CD
Rd s Rd
I _ x 100,98 EXISTING SPOT GRADE tOke Woodcrest
d
BENCHMARK w WATER LINE FROM WELL u, o
TOP CONC. BOUND G EXISTING GAS SERVICE z o
f
EL.=100.00 (Assumed)
-�I-{yd--- OVERHEAD WIRES o �uc`ti n Rood
_..w.._._._x 99.41 U UNDERGROUND WIRESCD
a
\v� f_.......
... - ® TEST PIT Coke �00
CB/dh S O
104.55...x.. 2.0>J. g .. m 3
7 � _ T O
fco
,604 f= LOCUS
c>� .. R-�2�0 42 re-� #o k"95.92 L ✓
j� �i
cn ai' � .5 ti 97.,�U / • �TP-1'� ,-VENT
J 105.60 x
104,75f' r�TP 2 �,�� , �'� LOCUS MAP
H c , 4�v4..._ � �. i4 ._ �... SCALE
^Y�( 1032 M• i
�/ _. S ;'' o° y� NOT TO
-_
N" SHRUB / f r
102.85 i s :4,rr. =' GENERAL NOTES:
d x xr bV,1, ."..""Y^ .,�j a f`^....,,.., 1 r e, 90.50 .,'"M
d <7.32 ....
i ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
BOARD OF. HEALTH AND THE DEIGN ENGINEER.
rl �/ A/ fj 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
CB/dh ; , x 102.9 J r ; EXISTINGf.';f W qa -
1 � �� HOUSE (#117) ' fj ��'� r r S.3d'xry OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
1 1 ? � J `' 4 .F LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW:
1 � f.�jr r f T.0 F 105.1 t r J �, s
98 31.A9B"`"� P�/s / t r x 96.37. f ' 310 CMR 15.405(1)(b):
-H „� 1) A 2' variance to the 3' maximum cover requirement, for no greeter
" 97.52 x j f ` `t r ez�a x r I `n thon 5' of cover. S.A.S. shall be vented and H-20 Rated.
f% DECK ;, f . 6' t° 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
�rx 9677 PAVED off/ %r' - 0 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
DRIVEWAY �. ✓ 95.11
" x ssgr N DESIGN ENGINEER.
r 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
95.97 x..3__.... ENGINEER BEFORE CONSTRUCTION CONTINUES.
..
" RK 5, ALL ELEVATIONS BASED ON ASSUMED DATUM.
x 91,71 EXISTING SEPTIC TANK
• AN 1 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
TOP OF TANK, EL.=94.96t
INV.(OT 3 4 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
t HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
EXISTING LEACH PIT
SHED' TO BE PUMPED, FILLED W/ 7. WATER SUPPLY PROVIDED BY PRIVATE WELL.
SAND & ABANDONED t. 8. THERE ARE NO PRIVATE WELLS WITHIN 'I50' OF THE PROPOSED S.A.S.
s 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
�"op. Sao AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
\iQ1 LOT 78 �+ DIRECTED BY THE APPROVING AUTHORITIES.
APN 030-026 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOF� TO VERIFY THE
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
27,800t (RECORD) CONSTRUCTION.
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
IN THE AREA BENEATH AND ON ALL SIDES OF THE S.A.S. AND REPLACE
WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
�� OF Mass 12, AREAS REQUIRING STRIPUUT OF UNSUITABLE MATERIALS SHALL BE
INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL.
o PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN
y 2 McENTEE - - -
v CI VIL
No. VIL 117 LAKE SHORE DRIVE, MARSTONS MILLS, MA
Prepared for: Pastore Excavation, P.O. Box 1289, Forsestdole, MA 02644
OWNER OF RECORD si �G` Engineering by: SCALE DRAWN JOB. NO.
LOUIS & ROSEMARY DEFORGE I �� Engineering Works 1"=30' P.T.M. 208-08
177 LAKE SHORE DRIVE
MARSTONS MILLS, MA 02648 �(C (�� 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
U (508) 477-5313 8/26/08 P.T.M. 1 of 2
--- 4
r� M
NOTE: TO FINISH EGRADEIS ALOLUNOT BE < E :9E0 0 3
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
PROPOSED D-BOX1 5-4" POLYSEAL OUTLETS
SEPTIC TANK PROPOSED S.A.S.SAS. ,
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL INSPECTION PORT OVER END UNIT CHARCOAL 2" 2' t-4" POLYSEAL INLETS
T.O.F.
OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE VENT
F.G. EL:. 93.3 (MAX.)
EXISTING F.G. EL.=97.3t F.G. EL: 92.0t _ O O
MAINTAIN 2% GRADE (MIN.) OVER S.A.S. Ln
cI�
Ln
INSPECTION 1 0
L 21' L 7'(MAX) PORT
@ S=1% (MIN.) U S=1% (MIN.)
4"SCH40 PVC 4"SCH40 PVC -
N Top View Section
10 14„ 6' 11.3" TO D--BOX
INVERT
EXISTING 48" LIQUID I --
LEVEL ADD INV.=90.67 PROPOSED INV.=90.50 r4 ROWS OF 4 UNITS AT 6.25'/UNIT = 25.0'
GAS BAFFLE D-BOINV.=93.63t � INV.=89.94 SOIL ABSORPTION SYSTEM PROFILE)
EXISTING 4 OUTLETS (MIN.)
EXISTING SEPTIC TANK ADD INLET TEE
ESTABLISH VEGETATIVE COVER 75"
BACKFILL WITH"ftEAN NATIVE OR
PERC SAND TO TOP OF CHAMBERS
NOTES: 1) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE
ON A MECHANICALLY COMPACTED SIX INCH CRUSHED TOPAKOUT ELEV.=90.33
STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2).
2) INSTALL INLET & OUTLET TEES AS REQUIRED. INV. ELEV.=89.94
3) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM ELEV.=89.00 III�IIII®IIIII�II
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. ABOVE BOTTOM OF 2 83 I"' 76
4) CONTRACTOR SHALL VERIFY ALL EXITING PIPE 5 MIN. ABO EFFECTIVE WIDTH=11.3'
PROFILE
INVERTS PRIOR TO CONSTRUCTION. T.P. EXCAVATION OR G.W. EXISTING SUITABLE
NO G.W., EL=84.0 = MATERIAL _
4 ROWS OF 4 - 16" (H-20) ADS BIODIFFUSER UNITS
RATION BETWEEN EACH ROW & NO STONE
SEPTIC SYSTEM PROFILE WITH NO SEPARATION 16"
TYPICAL SECTION 11.2"
N.T.S. ".ts
SOI L LOG 34"--�
I'?k. \1\OF� DATE: AUGUST 12, 2008 (REF#12,312) SECTION
DESIGN CRITERIA END CAP
1�E H U
SIDE OF HOUSE SOIL. EVALUATOR: PETER McENTEE PE
WITNESS: DONNA MIORANDI R.S. 16"" HIGH CAPACITY�H-20) BIODIFFUSER UNIT
NUMBER OF BEDROOMS: 2 BEDROOMS I HEALTH AGENT
SOIL TEXTURAL CLASS: CLASS I ELEV. TP- I DEPTH ELEV. TP-2 DEPTH
0" MODEL 16" HICAP
DESIGN PERCOLATION RATE: <2 MIN/IN ;� 95.0 q 0 94.0 A
� � N SANDY LOAM SANDY LOAM LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
DAILY FLOW: 'L2U G.P.D. 0)' v 101'R 4/2 10YR 4/2 EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE, PRODUCT DETAIL MAY
DESIGN FLOW: 330 G.P.D. 94.5 6" 93.5 6" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
GARBAGE GRINDER: NO t U 6 E SIDE WALL HEIGHT 11.2"
� '? � SANDY LOAM SANDY LOAM
ai OVERALL HEIGHT 16"
LEACHING AREA REQUIRED: (330) = 445.9 S.F. P 1UYR 5/8 1UYR 5/8
� 93.0 ' 24" 91.7 28" OVERALL WIDTH 34" 4640 TRUEMAN BLVD
74 1 Cl Cl HILLIARD, OHIO 43026
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY i , 3g" CAPACITY 13.6 CF •
• 'o ' (101.7 GAL) ADVANCED DRAINAGE SYSTEMS. INC.
PROPOSED U-BOX:: 1 INLET, 4 OUTLET (MINIMUM), H-10 RATED '�'yNo �` + PERC
" 50" M-c SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN.
USE 4 ROWS OF 4 - 16" (H-20) ADS BIODIFFUSER UNITS 1 17 LAKE SHORE DRIVE, MARSTONS MILLS, MA
M-(. SAND 2.5Y 6/4
W/ NO STONE FOR AN S.A.S. WITH DIMENSIONS 11 .3 x 25.0' �13 2:15Y 6/4
(HIGH CAPACITY INFILTRATORS MAY BE SUBSTITUTED) Prepared for: Pastore Excavation, P.O. Box 1289, Forsestdofe, MA 02644
SIDEWALL AREA: NOT APPLICABLE 85.0 ) " 120" Engineering by: SCALE DRAWN JOB. NO.
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.7 SF/LF OF BIODIFFUSER) S.A.S. LAYOUT 120 84.0 Engineering Works NTS P.T.M. 208-08
16 UNITS x 6.26 LF x 4.7 SF/LF = 470.0 SF PERG RATE <2 MIN/IN. ("Cl" HORIZON) 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO.
DESIGN FLOW PROVIDED: 0.74 x 470.0 = 347.8 GPD NO GROUNDWATER ENCOUNTERED (508) 477-5313 8/26/08 P.T.M. 2 of 2
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