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0304 MISTIC DRIVE - Health
304 _MISTICJ)-(\V .MARSTONS MILLS r I . TOWN OF BARNSTABLE SEWAGE # � NgLLAGE ; 41//3- �— ASSESSOR'S MAP& LOT U, INSTALLER'S NAME&PHONE NO. �. A�, M7 SEPTIC TANK CAPACITY e Of�l�.�j�l L` 'sf,'`S LEACHING FACILITY: (type) �"3`b�� 'f. �'/GarS (size) 3 3, 5 NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE:Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I� 3 f , No. 0 — 03� ,.. FEE /00 COMMONWEALTH MASSACIIUSI:TTS Board of Health; 2i MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PFRMIT Application for a Permit to Construct( ) Repair( ) Upgrade(/AAbandon( ) - ❑Complete System ❑Individual Components Location Q A 71M Owner's Name Map/Parcel# Address 3 P 1A Lot# Telephone# Installer's Name Designer's Name +� Address — /_ Address 42 CANTERBURY LAN2 Telephone# �o Telephone# $WT �54a, 2534 Type of Building Lot Size—,A- -f A0 sq.ft. Dwelling_ No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) $raj gpd Calculated design flow dAAD Design flow provided gpd Plan: Date Number of sheets Revision Date Title Sawn, Description of Soil s) ►V L--tJ Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation 1P DESCRIPTION OF REPAIRS OR ALTERATIONS A > > A► The undersi;,rned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees of to place the system in operation.until a Certificate of Compliance has been issued by the Board of Health. Signed Date al���-7 Inspections r No. 2 00'I - 03� .: , .,._.. ,- ,;. FEE / V COMMONWEALTH OF MASSAPUSI TTS C-C- Board of Health MA. APPLICATION LOP DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( Repair( Upgrade(IvAbandon( - ❑Complete System ❑Individual Components Location 0 ` C ' ZZ Owner's Name Map/Parcel# Address -3PA \,A;C+4 ' y kA , 1— 4IIrL Lot# ti. Telephone# Installer's Name Designer's Name rC, Ar^ � STEPHE\ s� b Address Address 42 CANTERBURY LAN'. Telephone# I /v Telephone# 508/640-2534 Type of Building Lot Size / ® ft. Dwelling No.of Bedrooms Garbage grinder O Other-Type of Building No.of persons Showers ( ),Cafeteria( Other Fixtures Design Flow(min.required) 4 40 gpd Calculated design flow AAQ Design flow provided A� gpd Plan: Date �� 'A,\ t��� / Number of sheets Revision Date Title V-TN! I�AiP?.� t-�r•12, '1�'o laa tin D y'' al�l4e?'l l V��w Description of Soil(s) � ,, ,t , � �, �6►L.. j,,,..pGa (.r Soil Evaluator Form No. Name of Soil Evaluator -11�= .,A lj- . Date of Evaluation lol�' f DESCRIPTION OF REPAIRS OR ALTERATIONS I The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a.Certificate of Compliance has been issued by the Board of Health. Signed InsP ections No. UO 7' V�tJ COMMONWEALTH FEE (JU OF MASSACHUSETTS Board of Health, F,,-vt 54 /e MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: J. C, A, It, at _-� 01-/ A4. ;7`,'C f has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.12O-7-- 0�4 , dated Approved Design Flow YAO (gpd) Installer a) Designer: Inspector,.___. Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. 200-1- D 7� FEE �U COMMONWEALTH OF MASSAC14USETTS Board of Health, ./?/.,rvt ,f"./4A ter" , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair(V) Upgrade( ) Abandon( ) an individual sewage disposal system at 7? 0 V A4.' S -T"C !fir r'e f- r as described in the application for Disposal System Construction Permit No. �0o 7-o z.6 ,dated D Provided: Construction shall be completed within three years of the date offt this �permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 2 I )1)t1-7 Board of Health �ttte A u w an u11 Da rnstame P# Departiment of Regulatory Services nuaNer,�e,8, : Public Health Division nue1 Date_ ©l ta79 200 Main Street,Hyannis MA 02601 a rFO MKS� . Date Scheduled 113 1/2 Time Fee Pd. P(9 or ewaO� ,a ll� J Soil Suitability Assessment ' ,f a Dls osa� Performed By: f=�lii=�..� n./ Witnessed By. LOCATION& GENERAL INFORMATION Location Address - 0 M. Owner's Name `��t t ci Z- "' \1 o►.`7 M�A�►mil I �� �� Address Assessor's Map/Parcel: 0 1,�0-0, 0, 11 gineer's Name �. �a V (� NEW CONSTRUCTION REPAIR Telephone# ' D Land Use f����;�a��� Slopes('%) Surface Stones Distances from: Open Water Body l C) ft Possible Wet Area iO-0 ft Drinking Water Well _ft Drainage Way O ft Property Line �j_J ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands hen proximity to holes) lk ,ta \4 f-1 i �1 �v.f 06 l � � a na J Parent material(geologic)_�at,�� Depth to Bedrock Depth to Groundwater Standing Water in Hole: M0j Weeping from Pit Pace �i Estimated Seasonal High Oroundwater ZGf i t� D ERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: �'17 Depth Observed standing in obs.hole: in. Depth to soil mottles: 'in, M JL Depth to weeping from side of obs.hole: in. Groundwater Adjustment Index Well# Reading Date: Index Well level,fin Adl,factor�-_.- Adj.Oroundwa er Lgvel PERCOLATION TEST Hate Time �0 Observation l Hole# Time at 9" _.s.a-._..._ Depth of Pere Grir' �I Time at 6" start Pre-soak'nme @ tv:vV - Time(9"-6") End Pre-soak ©`�Y `Z Rate MinJlnch Site Suitability Assessment: Site Pass 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:ISEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG- Hole# Depth from Soil Horizon Soil Texture Soil Color Soil ther Surface(in:) (USDA) ,: (Munsell) Molding (Structure,Stones;Boulders. n i tent ,vel D u /a+ ' u DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil r Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ns' en a J ti L. 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) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Consistency. i .t Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes jZ. Within 500 year boundary No_ Yes Within 100 year flood boundary No Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervigul material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervi us material? Certification I certify that on _ (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. Signature Date e Z 1 a COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION yr , TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION o� Property Address: 11 Beldan Lane Centerville MA Owner's Name: Household Finance Corp. Owner's Address: Same Date of Inspection: January 4,2007 Job#07-02 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 _ CERTIFICATION STATEMENT 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 CMR 15.000). The system: _ y, �•Passes �� •' , �, _ Conditionally Passes :yG _ Needs Further Evaluation by the Local Approving Authority _ pA ILK m _X_ Fails = 'Co Inspector's Signature: Date: 1/4/07 %, The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health Ar 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. Notes and Comments: All system components have been full to top,system is in hydraulic failure. ****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. r Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 11 Beldan Lane,Centerville Owner: Household Finance Corp. Date of Inspection: January 4,2007 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. 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 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: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 11 Beldan Lane,Centerville Owner: Household Finance Corp. Date of Inspection: January 4,2007 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. _ 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 11 Beldan Lane,Centerville Owner: Household Finance Corp. Date of Inspection: January 4,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure,criteria are triggered.A copy of the analysis must be attached to this form.] _Yes_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ 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. i Page 5 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 11 Beldan Lane,Centerville Owner: Household Finance Corp. Date of Inspection: January 4,2007 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _ _X_ Pumping information was provided by the owner,occupant,or Board of Health T _X_ Were any of the system components pumped out in the previous two weeks? _ _X_ Has the system received normal flows in the previous two week period,? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X _ 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? _X _ 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: Yes no _X_ _ Existing information.For example,a plan at the Board of Health. _X_ _ 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(3)(b)] Page 6 of 11 `. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 11 Beldan Lane,Centerville- Owner: Household Finance Corp. Date of Inspection: January 4,2007 FLOW CONDITIONS RESIDENTIAL 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 or no):Unknown Is laundry on a separate sewage system(yes or no):No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):No Water meter readings,if available(last 2 years usage(gpd)): Two years total: 174,000 gal.=238 gpd. Sump pump(yes or no): No Last date of occupancy: Unknown COMMERCIALIIN DUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): - GENERAL INFORMATION Pumping Records: None Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_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:5/5/80 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 Beldan Lane,Centerville Owner: Household Finance Corp. Date of Inspection: January 4,2007 BUILDING SEWER:XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X-40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 6" Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:8.5'long x 5.2'wide—1000 gal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle:26" Scum thickness: 3" 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: 10" How were dimensions determined: STICK WITH HINGE FLAP. 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 at bottom of outlet invert,tank had been full to top. GREASE TRAP: No (locate on site plan) Depth below grade: 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 Beldan Lane,Centerville Owner: Household Finance Corp. Date of Inspection: January 4,2007 TIGHT or HOLDING TANK: No (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/day, Alarm present(yes or no): Alarm level: Alarm in working order(yes or no):_ Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" i 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.): Box had previously been full to top.box is decayed and Ieakine. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): i Page 9 of l i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 Beldan Lane,Centerville Owner: Household Finance Corp. Date of Inspection: January 4,2007 SOIL ABSORPTION SYSTEM(SAS):XX (locate on site plan,.excavation not required) If SAS not located explain why: Type _X 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.): Leaching pit had 2"of standing water at time of inspection and has staining to top of structure. CESSPOOLS: No (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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: No (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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 Beldan Lane,Centerville Owner: Household Finance Corp. Date of Inspection: January 4,2007 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. Beldan Lane Water Service w::::r. w:::::: ,:{J;:::.�::JiiiY{L;�'•% ,•:ti+tin, ?` .:..�:,.>?}%i;{.`,tn.:%i'.... :::::4:::;:::%'.{•:O;:Gi:v::•ii;::;•••••••�v::;;:..."' :.r..: x'•is::::•r:??::{¢;r,:::i:•'f„}•%}:tt%ii{%:+.• q.$'i;$:•:jiint'i;:;•i:{•:�'ryi;y•h..}%{'%'i':•�%:h:+•:%?i r::{. 32 55 59 39 47 51 Page 11 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 11 Beldan Lane$Centerville Owner: Household Finance Corp. Date of Inspection: January 4,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water Please indicate(check)all methods used to determine the high ground water elevation: _Obtained from system design plans on record-If checked,date of design plan reviewed: _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: A perc test will be performed prior to repair to determine groundwater elevation. o� I SlIx COMMONWEALTH OF MASSACHUSETTS y� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r � �0 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property 0 /r�Address: y Owner's Name:_ keU V__2L/ arm a z,riuh Owner's Address: I30y 116 s r,' `111.E 0� mar' s s. /Pw Date of Inspection: Name of Inspector:(please print)_TOLin 1901"t Company Name: 7y4 _j Mailing Address: /92 alO Mcr/ T7 ` Ors 'Telephone Number: �-g9 rQ ' �nl CERTIFICATION STATEMENT`` I certify that I have personally inspected the sewage disposal system at this address and that the info>+mation reporte&' below is true,accurate and complete as of the time of the inspection.The inspection was performed 'ased on my iL aining 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 CMR 15.000). The system Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: \��i� Date: /2'�'�� 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. Notes and,Comments s s /3 �K/l F , tvti 4 ,'..t; ca c ****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. Title 5 Inspection Form 61I 2000 page I Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT'tOR'VOL-UNTARY-ASSESSMrN'FS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 4 44i S G Dli 've A(a.v s ohs lk iL1' Owner: r O iw-1 Date of Inspection: ?!2— 06 Inspection Summary: Check A,B,C,D or E/ALWAYS completAN of S/ttk x-P 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. 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 failum is immineaL 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 breakout or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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: 2 F'age 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART X CERTIFICATION-(continued) Property Address: 3 d ��ft� �i-iV" Owner:_1 'e lk, 4- M4.0'i�' Date of Inspect on: /2— 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 aseptic 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 frond 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 , OFFICIAL INSPECTION FORM—NOTFOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOS&-SYSTEM INSPEMON:FOR1Vl-J. PART.A CERTIFICATION(coked) Property Address: O �rI'S psi i s o Owner: Ie ll 9 o 1ZlvJ 411 Date of Inspect on: 06 D. System Failure Criteria applicable to all systems:. You must indicate`yes"or"no"to each of the following for a!1 inspections Yes No _ ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool r/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 e/ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped V Any portion of the SAS,cesspool or privy is below high ground water elevation. V 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. l Any portion of a cesspool or privy is less than 100 feet but greater than30 feet'fromzprivate water supply well with no acceptable water quality analysis.[This system passes if the avell water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] yes (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: s . To be considered a large system the system must serve a facility with a design flow of 10,000.gpd to 15,000 gPd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no 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. 4 Page 5 of 11 ' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 30y /l1 sIiG Piilillddo �n J S ' S Owner: /2C / Q �0/=M n✓1 Date of Inspec on: /2— ,7—06 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? t/_ 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? t/ _ 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? tX_ 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: Yes no _ 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(3)(b)] 5 Page 6 of I I OFFICIAL INSPECTION.FORM-NOT FOR YOLUNTAI(Y ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION , Property Address: if�lur s t tis /YI.'/Is �i� Owner: P lti m A/1ar4 /7v/zrr► h Date of inspection: J2 2 9 o6 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): H Number of bedrooms(actual): y . •y yo DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): �rVj Is laundry on a separate sewage system(yes or no):/IJv [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use: (yes or no): No Water meter readings,if available(last 2 years usage(gpd) ��'�C S 6 y �? vs' ' 3 y 7 yP�� Sump pump(yes or no): Last date of occupancy: &c c rat j ex COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gDd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or 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.Attarh•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: / }�J�r / . 2r-JS= C>G�, c©y�QlrG,v�c;� /SScrr�2 2-'tl/-GHQ by 1W11 /�cair�l Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3�y V1.f e- u4.5 Ohs Owner: A e4k*" o pia r7 Date of Inspec on: /2 g9- O6 BUILDING SEWER(locate on site plan) Depth below grade: 112'i Materials of construction:_cast iron 40 PVC_other(explain): Distance from private water supply well or ton line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: 2 0 2" Material of construction: concrete_metal_fiberglass_polyethylene ' _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: /'' et t t7K tl e)�, P.Z Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 6"at o4*e t T, Distance from top of scum to top of outlet tee or baffle: 3;" Distance from bottom of scum to bottom of outlet tee or baffle: fi" How were dimensions determined: NmaSw ri i g ra( w;L -&,T r Comments(on pumping recommendations, d outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leakage,etc.): �J 9 t J •T n k c; C+ 0 H r f9v L:Q cc" `I. /16' `t .5 yt mW eelwvArd � irw 5? 9 1 ,tr GREASE TRAP:_(locate on site plan) Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT ISM Y��.UNTARY ASSESSMENTS, SUBSURFACE SEWAGE DISPOSAL SYSTEM.INS#ECTION FORM, PAR' C } SYSTEM INFORMATION(continued) Property Address: ass Owner: kell I a /10/zsnu.1 Date of inspection: LI— Ey—o TIGHT or HOLDING TANK: (tank must be pumped at time of inipetinj(Satate an site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: ' Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): 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.): 'a d �"yBo,� i'j �pie l u n�t° �1� . b�%�.ri c �vd•� vvb w�► ceK . PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,ettc.k Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3� /�/�ot � �i>i v-? Owner: jjv Z*74,j Date of Inspection: /2 .29—06 , SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number' leaching chambers,number. 3 leaching galleries,number. leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number ianovat*ve/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): j )o p 14, Af I"1 �?vZ /S 6y�dW Gvv?r oil c:hombir, ro prfo:. r"uc �s 0' S.h�•l ire rim ,�ti r n✓4 r d- ,� is l 9 J{ 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: Matcrials of construction: Indication of groundwater inflow(yes or 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.): 0 Page 10 of 11 OFFICIAL INSPECTION FORM i4dfift VOLVWXAY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL'SYSTEM INSPECTION FORM PART:C • SYSTEM INFORIVIATION(continued) .� r Property Address: Ni ST r/iw� G S f��LS i s /,Y7� • Owner: Date of Inspe tion: 1.2 9•-e6 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. L p C p y . n 2 /•9 ' �S , 10• Page 11 of 11 ' OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE:S_EWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) • Property Address: 30'/ A_$r t c_ ?ham. Owner: i// zAa h Date of Insp tion: :2-�2 9-0 6 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked,date of design plan reviewed: /V Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-'(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 4You n 540't irlevufi h w v l v H = .$` Vt'ti��� yhr,it.e5 G - �'s+, 2y2` Of, /qS 11 ATION p r4 'r/G AGE LLL Was. ASSESSOR'S MAP.61 LOT V 114STALLER'S NAME: PHONE NO. SfiPTiC TANK CAPB.CITYbD HING FACIi-ITY:tt9Pe� `3• .���sNC� (size) {{ I- C PUBLIC WATER lovi NO.-OF BEDItOOMS� �J .BUILDER OR OWNER Z4 DATE PER ISSUED: Z, -4-DO D -TR COMPLIANCE ISSUED: No yARI!&NCE-GRANTED:_.F - Z 23-0 - 1 Z 1 / J 1 P r 3 214 fr. yet s- RICHA q�yJAM \ *�,EP`tH OF,��f CMHEA N ^+ �'W RICHARp G "" DAMES }�1�.27 71�0 N : ONEARN O �CIST l U -00 �4 v j rGT o 5 - o j I 0 Wa. I (Z °' 0 10 ti F \j . IlQ }1 , - - LEGEND ,EXISTING SPOT ELEVATIONS O,A. �� ' EXISTING CONTOUR - - 0 FINISHED SPOT ELEVATIONS O.O FINISHED. CONTOUR o PROPOSED PLOT` PLAN` APPROVED: BOARD OF HEALTH MASS. ; DATE AGENT ,_ el T i CERTIFY THAT THE PROPOSED R ✓. O'HEARN, INC., RLS, RS BUILDING SHOWN ON THIS PLAN 1348 ROUTE 134 CONFORMS TO THE ZONING LAWS EAST DENNIS� MASS: -OF MASS DATE SCALE: / 70 , J08 N0. 8%- ii 3 / CLIENT CQ� c�rrg.y DATE REGISTERED LAND SURVEYOR DR. BY ✓F SHEETS OF _.. .r . . _ . . . �.I.-1.��..�_,`:.I.1..-'I.-1l�,1.S_.-�.-I,.,:-.,.,.1..L-�_:�,�7.I I1-._�-.,.,i.":o.���_�1�-��-:`-_:�'O-_�.�-_��__o.,.-__A�.,,�:,,�"-�-.���'_`�-�4.-1.,��.�,`.��:.%�I,-_�."i,�...,.1�:.-:.1I�,_.:I,_,7 ,. = _ - r.. .... _ - . t.' ..... .... :. .. - .. a. �y. _ _ -.�, .. ..:--__.. ,.�_.r....r,.. ..yet:. .;¢•>--..'. : , �....'-;4 _._ .. .- .. n..+t.. ... ....A..- .� - i c.- .. .. ... ..�...•..G- ,. .,a- _ ... ..- -4 �Y .:. .- ....'. ... ., _ ..'...: .. .. -:.i i .. to / -> O ►Li WORI+MA1ySItf 'AND 'MATERIALS DATE OF 0.1 T T � � ,;.: J1ERT ';-- T -;Bt�111.131.N-G.,.'. . .. _ FT S L E:S., . t .. _ ; t. r .. _ _ �. _ _ r `T, - _ w_. , M 'FO_.D E.Q;E TITLE WI TJ`tES S _u,. �. .,,.: ED HY_._' . .. ,.. . :... .�A. X3. E _,., . .. .- a .. _. - �.. > D T a QaAIN .:9f: #2U:LES �_ -,; R7 C .::..: _ __ . .,,S,, #..._. -: 4�. ..... ._. .:.: d : :l�'3.e_ .. y.: .-....'Y4 .sue+^.Y.'<,..1p...:,. ,.:..:... �- .....::... C A ,.PER. 4L '�IDN R,ATI= .: MIN./ NH :., _._ .... , -.: , ' - ,•,w 9 ,:-� = ;. ANIF3 REE11-LAfi#aN fifl SUBIRJ^AC`E - T .:.. .: ,. Q f:T.1N Ea . . 8.T .1WT ITN ... 3_ a. 1 X , E ..:2.. . _: SAI+ QE S.A:NITAi ' SE 'GE BSE lATlb _, HOLE I B —_ . - - ,.. - .o E VAT:oN t _E . .-_. . ._�.,. . -�-- . . ELEVATION - EL 1 9.7.:7 ar. _ _ _. s 9/ 2 _. _ . - _ F' T > J� I:T E .. .., -..,,. -., pr o __ ,.,. - .. ._ .. ".A _..- .:. .... ._-.. _.-. - .- ... --: .: _ .. - - .-:..... - - 1 � S r:. -.r.. -- .. .5 r - s.v a. oo _ s 4 . a. .C. c P �, . - - ✓- ._ , .: Ti.. .. ,"_ -: r . - d . . . - . _ � � I�1 _:. _ {eE�t .-. - _ � ,; x 3 .�rD .. ,: FAQ. />.. :S .:,.E:0. .SA�J� ,., „" a97iR13AGE:- DtS '(3 AL' UNIT C� Cam, TOTAL €vTIN1TE1?. Ft•01K (/i° GAL.18R;/DAY x-3 BR ) .330 GA'L:/.DAY - , : ;' FtEOUIREt3 s.EPTIc TAIa-k DAPADtT'Y. " 4'�5 G 1L. AC AL SJZE- ,4F SEFTC TANK' TO JE tN�.T�►Il. I=D -'. . �_ - . >; .. _. ' . ,,_. : L =A£kIJI AREA R£.Qil'1EME:)+ITS .. :- _ E _ _ SIDE WALL ARE AL .. . BOTTOM AREA ✓ ° GAL/S.F o ice' i` ' . o LE-ACHJN6 CARAC_LTY (:6OTTOM `SiDEWALL ).: 5-49• 7 GAL. ; 1u.L .: , Z . 2o.r REa€RVE .:LEACHING CAfACITY :GA . .. . . r - L. TOP :OF - . FOUND. . . - . ELEV.= �3,o /o '/a ,.1.4. .CONCRETE. . ' 4" "SCH.: 40 . C LEAN S AN,D COVERS PVC PIPE. .. : .: ,, . . .. M11'It. PfTCN' . . nNRR1=TE _ .. . 1;18 PER. FT : . .' . . a tZH OFF s�Z;M.IiF,� . 2.1a MIN : PITCH 3 - y� y, _ :, . FLOW :LINE y a - &. ice" WASJ�tI`DR S ONEB !! I � 0pw�►�w� � �, ��„ t - z' �,:..",�....-�I.,,��.::::�.-...�-�..'...,-.I�—.�.,I I�..;u.-:I,-..��..,I.�..,.,..:-�1.�'::_.��:.I..-��*,I I...-,I'll,'1�-.-�--..-��,�--�-:...--�,�I.,,w...,,�..�,-�IIl�:I,1.1 1��.�;.I��%.�.�.::-..:-1-..,..�-1:_.��..I-�-._.�...I..:.I"._7 1Ii I.�.-:....�.-.�:.':_-,:..,.:W.�.._..I7�p.j.,,.I�&...-I�.�II�..:..p 1�.I�I.1.-1 I:��,I.�-.,I_,I_,�...�1—I_�_;.�.,,.,-=- F. '9 Q/S7f--.... . " a z 3:14 t`I/2 . I: :, t;TE O . 4 CAST IRON 3-. ; ��. '?D I?IPE - MIN. PITCH 0-,V ;. , . - 1. WR;�ii1=fl STONE 3q .. _. _ >x: , .. .. . . - ..� D p E.R FT.. T .: :__, - 1/4 PS a;. :�.. . .- PREDT £�t1CH## . .. - : $dX a f; # aSIN UR EQtjI p .:p e: is . ,�©7' /�. /"l/ST/G '/.( 'L� . - .. ,.- _.. .. 0 . � - �irJ . . 0 b :_ __ - /d D0 GAL' �r `sr� y .r= ��� sIILA' . : v SE PT1C _. : , :.'. _ ,, . �,�r. RLS- R /.9 _ , _, TANK_ _o .o N ' q '34R R T 3 4 I3U E v .. . _ _ < . -, , _ _ _:. - ._r :. _ �_ . -�- _ A �' D w _" S ENNI ... _.. .. _- _� r... .. ..... .__ ...: ._. __...- �. .. . _ _�_._ _ ,, i�R. r:I<I.E OE - .. .,.. .. .. - : :... .: .�, ..: may. ., ;: :. , . 'NO rr�3/ �' CLIENT . WADE t #SPOSAL S1�STE A _ :. .: :; SE - :• - _ _ _ t , C E _ 4tE N0 TD .S AL �.� . _ _.._- .n T - W . - $. �v. _ _a. .a _ �_ .. ._. ." . _. .. .. _ .. ..... .'-. :.tom .. 2., _, _-. ,r. .T ..t v Jy - _ ,. ...- _ ... _- ..,. . .. .-- .___.-. .. .. .. ,, .. . .. _. - - ... ... ._ .... .. ate.... �...:.._..-.,�.. ..-._. _.. ......,.tea.. _ _ _ .. .. :._,... .:...- _. - F ` TOWN OF BARNSTABLE LOCATION SEWAGE # OM 69 VILLAGE 'MW-rDIJS MlaS ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. ,11-m 9.tE 4Z-0. O Z?i) SEPTIC TANK CAPACITY 2-060 C�I- LEACHING FACILITY:(type) 3' t AC4tlJG 1& (size) 5" NO. OF BEDROOMS_ r' PUBLIC WATER PW BUILDER OR OWNER DATE PERMIT ISSUED: 00 DATE COMPLIANCE ISSUED: Z' A`0O VARIANCE GRANTED: Yes No �' y 3 34-o z r 4-a _ 2 iq-a ° 4 '2-q No. Y— ! Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Migozar *potem Construction Permit Application for a Permit to Construct( )Repair( ).Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 0 b O 1(a ,� Owner's Name,Address and Tel.No. Assessor's Map/Parcel 304 4 Al I S T-I C. A 2i ve- Installer's Name,Address,and Tel.No. (��a ©�t Designer's Name,Address and Tel.No. q Z-d, 02-8 b �ME-S I4a-ex- Tprme- s PoU-EF4- Type of Building: Dwelling No.of Bedrooms. Lot Size r t 0 / 9q. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow !�4 I gallons per day. Calculated daily flow 17 gallons. Plan Date 2 1 i!'r, ®® Number of sheets / Revision Date l� Title Size of Septic Tank 7-600 6A-f__ Type of S.A.S. 39 901b 6Ai- r'► &�5 Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 o itle 5 of the Environ ental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Board of He 1 Signed Date 2' i�• a Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued No. gem 0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1110001" Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 3pplication for 33i�poeal Opelem Con.5truction Permit Application for aPermit to Construct,( )Repair( )Upgrade( )Abandop,� ❑) El Complete System ❑El Individual Components Location Address or Lot No. 086) 0 /41 Owner's Name,Address and Tel.No. Assessor's Map/Parcel 304 /Y) 151 ic D ki vC— Installer's Name,Address,and Tel.No. 47 0, 0 7 J/0 Designer's Name,Address and Tel.No. q�,- ��M J;-s TA-&x t� t4o LLEIL- I 136it -7i3z ft44-imrois mi" mA 136-t In- rowasrbijS Mil-Ls, mk Type of Building: t 1 Dwelling No.of Bedrooms Lot Size j, 0 q. ft. Garbage Grinder Other Type of Building No. of Persons Showers Cafeteria Other Fixtures PDesign Flow gallons per day. Calculated daily flow. gallons. lan Date 2 15', 0 0 Number of sheets Revision D'ate - Title Size of Septic Tank 7-600 6AJ ----Type of S.A.S. 3X .506 6AI- Description of Soil Nature-of'Repairs or Alterations(Answer when applicable) 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 e ntal Code and not to place the system in operation until a Certifi- ,jitle 5 of the E i ir en 1C de a, cate of Compliance has been issued W this Board of 14U He li Signed Date 2, 15 • 00 Application Approved by Date. 2- ZdV-0 .00 Application Disapproved for the following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CFATIFY, that the On-site Sewage Disposal System Constructed Repaired Upgraded an '--I A Abandoned by "4 J;Q/- has been constructed in accordance 01,� WM I)etj �_Mj, M T 1 System with the provisions of�itle 51a�nd the for DisposalSystem donsirLt'ion Permit No ated Installer i I Designer --- V t- I A. A U The issuance of this p units al not be construed as a guarantee that the sysaterm will function as d,/ igne,d. Date 7 / ,M((? Inspector jfl A 71-1) , --------------------------------------- NO.7 0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Miqoal *pe;tem Con5trupth n Permit b nd Permission is hereby granted to Construct Repair Upgrade bandon System located at 3:6 51(,- 1iS (17 c Qrtlo , 1-got"So"� IV,"//j 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 be completed within three years of the date of thi ermit. Date: —Approved by 1i6i99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIE'ICATION OF SKETCH kYD APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated .91 JS, DU concernins the property located at ST► C. -DiZl ✓E meets all of the following criteria: • The failed system is canner ed to a residential dwelling only. There are no commercial or business uses associated with the dwellins. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 fee;of the oromsed septic system • There are no private wets within 1:0 feet of the proposed septic srse n • There is no increase in flow and/or change in use proposed • There are no variances requested or ne`ded_ • The bottom of the proposed leacaina facility will not be located less than five feet above the ma..dmum adjusted undwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 2M gee;of an-i vegetated wetlands, the bottom of the proposed lerchina facility will not be located less than founeen(1+) Cet,.above the M=imum adjured groundwater table elevation. Please complete the following: q A) Too of Ground Sur:ace cif,ation(using GIS information) B) G.`N. Elevation +the MA-'(. -.igh G.W. Adjustment .__7 _ / /m 9L DT'ERENCE BETWEEN a.and 3 3Qe �0 SIGNED : 4D ATE. (Sketch pro, d plan of E stem on backj. q:`:czith foldcr.x:T r k' a 3®q M i ri �� ogre A Ae9X35 �000 A ® � ,!gw 60m, 1 to v-20®a/o z $$o eNDs 13 x 2 xZ = $2 S!U ,4_ 32.'v.2 g 2 t x 8 • t;1.�5s I o7�°e �� FuXW tDVID� �$ I i *-POO � a Soo�+ �I P _ MAP 8�® fo � C0 Aeggs N� 2000 ® m m ZOOID tea. S,T; aK ENDS 13 V. 2 x 2 = SID U- 321(2x2 '90,LyoM 32.x Tv7'�. S9G q4V FwW &ODED 1 4,41 2 ► 0�00� I TOWN OF BARNSTABLE LOCATION . 34 I IcStiG Vtzi f6 SEWAGE # VILLAGEAtONS ASSESSOR'S MAP & LOT OnD INSTALLER'S NAME & PHONE NO. fiM 426x- 4zo �fjD SEPTIC TANK CAPACITY 2-600 GQ-L i LEACHING FACILITY:(type) CgAKf, (size) 50V NO. OF BEDROOMS_ I ; PUBLIC WATER I, BUILDER OR OWNER DATE PERMIT ISSUED: 00 DATE COMPLIANCE ISSUED: 2' 2_q`op VARIANCE GRANTED: Yes No 1 o- , sfi' 5 Q-b� z o- c-Z 7 0ti �� Y3 _—._.__ _....._.__ a)'• 3�2"+- FULL DD ..,_jy;•R„ PIP, Y KNE< WAIL J - 46 Ll nae,� , o caN qAW I 6i d LiJ! 16 }3A�u y .y ]83l o O ]dYfe•3 ]8jfo ?13/o --- -- ---- 163/0 �kaT. Fcooa Ova a' dy• "+- m m � d8�/0 i 'r n I SfCONO FLOOR Pr.A A/ r� - � 7-9f 17 G5- 8" CTCS OVER © AG/ ATOP OPT. f/xE7 cis 4O-Vr, rwN F/w FD p,y O ZG) , yL_2jiT oVEQED O �14L•� LE LO(J (DitT u.+o Eel I�I— i 9 Q 1 N �� /-Iv/a o M �� I •O —� u 5{AH2w/♦y/nD£ d De.J �+W W,c �..d ED_ Mn•�R 2i�D M IJ5.0E ff I o / �t.wJ � N�w 4•/ sl. IIII \ �Ya�.+Et I —�— I I ..--7_s.:a-r--- [t�:•nc u�sz�.l t... J6 i. p.l - Wrn AaF+ IIJCJ O � aBYl� � I�A'RI ARi+�J•.(u12j I OPT/O NEtJ I • ; U, � Op � DO Doo•d l /tE Oe o .SE vD Q E DTI ^ten O O ? © �YyL�7 8 GS.3,f 3gt6� p a abks Rg*,a mBYa aFi+' ® © G o j 1• „ ,/ C .g: rt ns 3 PAM PETERS Office:(508)477-3100 Home:(508)477-6009 SEAV� EVV REAL ESTATE d� John's Pond Center,401 Rte.151,Mashpee,MA 02649 FAX 477-3334 e-mail:mappeters@aol.com r oFIME r Town of Barnstable = Department of Health, Safety, and Environmental Services sAMSTABM # ' A � Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health November 3, 1999 Ms. Pam Peters Seaview Real Estate John's Pond Center 401 Route 151 Mashpee, MA 02649 RE: Lot 18 Mistic Drive, Marstons Mills, MA Dear Ms. Peters: I am in receipt of your note requesting a letter regarding future renovations to 304 Mistic Drive, Marstons Mills. The original septic system was designed for a three (3) bedroom home (see attached documentation). Therefore, building permits can be obtained in the future to renovate the home, provided no additional bedrooms are constructed. Dens, sewing rooms, study rooms, finished attics, sleeping lofts and similar type rooms are considered "bedrooms" according to MA Department of Environmental Protection. Therefore, please ensure that any proposal to renovate this home includes complete floor plans of the interior of the existing home and the proposed renovation/addition. These plans will be reviewed by Health Divsion personnel prior to the approval of a building permit application. . Sincerely yours, iL Thomas McKean, CHO Director of Public Health peters/wp/ls � � � �2 ��e�.:.�� sy S C 2��\os�e� S�e���L, c���� ��w ��� en �.s-��\��//����5� �-o p�\c\tee/�cv�c��-�cppp���^v� b�� �ncr4� :�1L�-cc,,S'C� 56�.�.� -�ro.� ��� s�J�� ��s iS �e���-�-4 4cea.s_�� s Js cc��s�.� � E �� ��� � .moo , 0.�Z��vreSZ �.�t�I PyCOMMONWEALTH OF MASSACHUSETTS , ' EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE-WINTER STREET BOSTON MA 02108 617 292- 0 Y COXE tar9 ARGEO PAUL CELLUCCI DAVID S Governor o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC71ON FORM � PART A CERTIFICATION Property Address: Y• I Yl grsTo ns Yr1 i 11 Name of Owner r y'h r C O Ccft mR • Address of Owner: 3 p L. �y:j�'c" Dart_of Inspection; ���Name of Inspector: (Please Print) R E I D C . E L L I S I am a DEP approved system irtspectm purauant to Section 15.340 of Title 5 (310 CMR 15.000) cornpanyNarne: ELLIS BROTHFRS C.nNSIn _ MailingAddress: 23 ENTERPRISE RGA 4RM6UTH PORT , MA Telephone Number: CERTIFICATION STATEMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: k Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: `!L- 6j1/'� Date: 7 i The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority, NOTI=S AND COMMENTS �i ®�o 0 revised 9/2/98 Page Ior11 I Vim! Primed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) oAddress: 3O 11 MLb St G 6Z1)lei/-j owner:operty gr"Tkur- Ca/(orFlh Date of Inspection: INSPECTION SUMMARY: Check A, B, C, or D: -17 A. SYSTEM PASSES: / I have not found any information which indicates that any of t e failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Condi ional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the oard of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of dDtermination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or oper itor has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank wa installed within twenty (20) years prior to the date of the inspection: or the septic tank, whether or not metal, is cracked, tructurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspecti n if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution I iox. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or ro placed The system required pumping more than four 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 r - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 'Propany Address: 3 O L4 fi 16-5)" C JK n,1r5Je,, n r iy j orrncf: fj/-Vvr Date of Inspection: T Q p C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:: Conditions exist which require further evaluation by the Board of Heal h in order to determine if the system is failing to protect the public health,. safety.and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN A CORDANCE WITH 310 CIVIR 15.303 (1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PL BLIC HEALTH ARID SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. i'�Y'7 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PLII LIC WATER SUPPLIER, IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC H LTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption systo (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 soil absorption system and the SAS is within o Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _._ The system has a septic tank and soil absorption syster i and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis or coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the prusence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). OTHER revised 9/2/98 Page 3of II I' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 3 0'A Owr-,ax: 'I f.j-)4&r �n f'�• /'1 i Date of inspection: 3 �D. SYSTEM FAILS: 4 You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure c nditions exist as described in 310 CNM 15.303. The basis for this determination is identified below. The Board of Health shoulE be contacted to determine what will bo necessary to correct the failure. Yes No Backup of sewage into facility or system cornponef t due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of t ie ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outIt t invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is Tess than 6" below inveq or available volume is less than 112 day flow Required pumping more than 4 times in the last ye ; NOT due to clogged or obstructed pipe(s) Number of times pumped_. Any portion of the Soil Absorption System, cesspo I or privy is below the high groundwater elevation Any portion of a cesspool or privy is within 100 ter i of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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 frorn a private water supply well with no acceptable water quality analysis. If the well has pen analyzed to be tsccaptable,.attach copy of well water analysis lot q Y Y coliform bacteria, volatile organic compounds, amn ionia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: tgjpdrtg,.ater You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to above: The system serves a facility with a design flow of 10,000 (Large System) and the system is a significant threat to public heaiih and safety ar.d the environment because one or more of the following conditions exist: Y=s 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(Int rim Wellhead Protection Area • IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in cordance with 310 CMR 15.304(2), Please consult the local regional office of the Department for further information. revised 9/2/98 Puge4of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMA PART B CHECKLIST operty Address: Owner: (}rv.-Lf-- Car!o rei v) Date of Inspection: Check if the following have been done:You must indicate either "Yes" or "No" as to each of the following: Yes No ' Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks an&the system has-been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. yck As built plans have been obtained and examined. Note if they are not available with NIA. The facility or dwelling was inspected for signs of sewage back-up. /VO The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. JN L f(� All system components,imcluding the Soil Absorption System, have been located on the site. Y,7 The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, Plan at B.O.H. /VO Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)J 1 f The facility owner(and occupants,if different from owner) were provided with information on the proper maintanancevf ' SubSurface Disposal Systems. .revised 9/2/98 page sorn SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1 SYSTEM INFORMATION Address: 3(� �IIC D�', Ovrrser: ,1 hl� nl rS(on5 fn1��S I-YA Date of Inspection. `� �r�rp''� 3-a.5 -ci FLOW CONDITIONS RESIDENTIAL: Design flow:~ g,p.d./bedroom. Number of bedrooms(design):. `7 Number of bedrooms(actual): Total DESIGN flow_ SOD Number of current residents: l Garbage grinder(yes or no):, Laundry (separate system) (yes or no):/yp If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes g A91�. , p / ),.. �f� Water meter readings,if available (last two year's usage(gpd); C�/J y/ �Q� ®„ Sump Pump (yes or no):_ iL�b Last date of occupancy: COMMERCIAL/INDUSTRIAL: Tyoe of establishment: Design flow: QI?d ( Based on 16.203) Basis of design flow Grease trap present: (yes or no)_ Ind.istrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no). Water meter readings,if available: Last date of occupancy: A OTHER: (Describe) Last date of occupancy: GENERAL INFOR TION qkMPING RECORDS and source of information ^ /l/xwD-2,w System pumped as part of inspection: r no), (I a., If yes, volume pumped: cSt=, gallons G Reason for pumping: �� TYPE OF SYSTEM d )C. 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information; �{✓f/j�l`�j9 lG°a" t[�/9�o �' p Sewage odors detected when arriving at the site: (yes or no) " 'H.!4, revised 9/2/98 Page6ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM iNSPECI ION FORM PART C SYs i tm ieaFvrtmm I even ieb"Uiwecii PrcapertyAddress:3O14 Yp ja-lc, Dr. o+mner: ()yt,x- �orc occ�v� Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: cast iron 40 PVC other(explain) Distance from private water supply well or suction line +Z! Diameter -�1r' —��— Comments: (condition of ioints, venting, evidenceof leakage,etc.) SEPTIC TANK:_yje4 (locate on site plaA) {f Depth below grade: Matp.riAl of construction: concret metal Fiberalass Polyethylene other(expiain) If tank is metal,list age Wage confirmed by Certificate of Compliance_(Yes/No) y� I Dimensions! SG Sludge depth: / Distance from too of sludge to bottom of outlet tee or baffle:v Scum thickness:- 510 i/ Distance from top of scum to top of outlet tee or baffle; Distance from bottom of scurn to bottom of outlet tee or baffle: `7 How dimensions were determined: 0/ omments: Irecommendation for pumping, condition of iniet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) —Z GREASE TRAP: ---~---- -- ------�.^_.-_ —.—� (locate on site plan) Depth below grader Material of construction:. concrete metal Fiberglass -Polyethylrother(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 battle Date of last oumpinq: Comments: lrecorrin5airuaiiOn rur purirNiiry, Jvnunrvn 07 iniei iiriiivuiiiti labs iir ucimcki, vcliui ur rryuiu raVor iii raw.i ew i7lie6iii1, revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) :;.;�:r,:. 300 4�sTLc, Dr. MRnT) o ris rfiok,mR Owner: � u`t C�rc�c�rah Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at tim of, inspection) (locate on site plan) Depth below grade:^ Material of construction:_concrete _metal _Fiberglass Polyethylene other(explain) Dimensions: Capacity: gallons Design flow: gallons day Hiarm preserti___ Comments: , (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: locate on site plan) Depth of liquid level above outlet invert: D P q /v ornments: (note if level and distribution is equal, evidefoce of s9lids carr ov r, evidence of leakage into put of box, etc.) ' PUMP CHAMBER:_ (IDcate on site plan) Pumps in working order:(Yes or No) A:arms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances; c.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'Fop"Address: 304 M�src, Dr. Mr)rsAOrs 0wnw: >ar ur Cot-&-frw\ Date of Inspection: SOIL ABSORPTION SYSTEM(SAS)- (locate on site plan, if possible; excaGation not required,location may be approximated by non-intrusive methods) If not located, explain: 9 _..... .... - ................... ..�«... {AAC.nif7rt17i TC, r111111[INC: leachtna chambers numleF.__ teaching a{Ierrbh,.nurnfaatf tearhin >[re+tches;number,lenzmjir.. leaching{ieids, number chin mttio u oveMow cesspool nurnS�ei alternative gystp Nat no:ci'T0a'hniztogy �._ _ .... ..... Comments: (note condition of,soil, signs of hydraulic fail u , level of ponding, damp soil, condition of vegetation, etc.) Iz -- — — -- CESSPOOLS: (locate on site plan) Number and configuration: Depth top of liquid to inlet invert: 4Depth of solids layer: —,Depth of scum layer:_— Dimensions of cesspool:-_ —_ Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) -- Comments: (note condition of soil. signs of hydraulic failure, level of ponding, eonditi of vegetation, etc. .PRIVY: (locate on site plan) -Materials of construction: Dimensions: Depth of solids:_ Comments: _f ataaFc f�!!a-s !ev—'! cf nai..{sl:ii6 cvfl u'i iiiil of wi!, oiy'io v ni., , ,,, ',Q„ ,,,a, c_ndi '_n of .l revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARY G SYSTEM INFORMATION(continued) Address:3b� ill S[iU D ``i1Pyf5�GnS �11``S�rn Oainer: 'AM( kv �A C'u 4w\ 1 S Date of Inspection: ry} / KETCH OF SEWAGE DIS�Iet SYSTEM: include ties to awtl.pern1h t re nce Ian marks or b�hma locate all wells within 100' (Locate where public water sZrpptfcomes into h 1 io 1� G A � X\ revised 9/2/9 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) toperty Address: )J ail SYIv 0r, mArsTan� Date of Inspection: NRCS Repoct.n8me TyFxcpl.dapth to grountlWater U-SrC Date WNhA1tR Vi%iter1 Observation Wells checked Groundwater depth: Shallow_ Moderate_ Deep SITE EXAM Slope Surface water / u Chwr_.k Cellar Shallow wells Estimated Depth to Groundwatev, Feet Please indicate all the methods used to determine High Groundwater Elevation: 71 (� Obtained from Design Plans on record 'X Observed Site(Abutting property,observation hole, basement sump etc.) �C Determined from local conditions 1 Checked with local Board of health Checked FEMA Maps Checked pumping records Char.kAd Inc-AI excavators. installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) 7 �GGvN rwLy; // ff C�C- (�/�c^'6 b GvwJ �y✓�1. ,Vd/K? �' a� �� revised 9/2/98 Page 11of11 L4 to T r0N S E W A G E PERMIT NO. V,ItLAGE INSTA LLER'S NAME i ADDRESS 0 UILDE R ON OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED S i I rI I � i o..---J.Jam......... .» FEs... ..................... THE COMMONWEAL`rH 00 MASSACHUSETTS BOAR® OF HEALTH - 2 .W..y�............OF............ �_ ....._...- . 1 Applirutiun for Eliupuuttl Morks Tomitrurtiun ranfit Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal System at: .........._./ ./.. . .! _........D c�i cv E.......--••-•-•------------- ............................................... ---•-----•-----... Location-Address r-L-At _ ............................. t /.�(1! !"hI.1- S_! .. .l�fr:lYl�1' 5....._.t� ............. Ow ` //,)1 y/�y } q, t Address `� ..,.'.z�d A+t ............................ C� .'X- �SJS.1Y_.1. !l i..J\_'t�........� r.�.E7 f P Installer Address :- d Type of Building Size Lot feet U Dwelling—No. of Bedrooms............. .....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers a YP g --------•---------•--....... p ( ) — Cafeteria ( ) Other fixtures -----------•----•--------•----•---•--- � �'T� •--�----• gallons. W Design. Flow...........ez..O.........................gallons per-pet per day. Total daily flow..._._......................._ ..........gal WSeptic Tank—Liquid capacity..&iliLgallons Length Width..4./4... Diameter................ Depth...S'r x Disposal Trench—No..................... Width..............._.... Total Length............ Total leaching area.._.................sq. ft. Seepage Pit No........./.......... Diameter....A�........_ Depth below inlet......l�__.�.._..... Total leaching area... rd ..sq. ft. Z Other Distribution box ( ) Dosing tank ( ). a Percolation Test Results Performed b P_ ................................__........._ Y s> Date y/ ............ Test Pit No. L.C.. minutes per inch Depth of Test Pit----f 4.... Depth to ground water.___......-........ Test Pit No. 2.ALZ...minutes per inch Depth of Test Pit---/ `' Depth to ground water.........__•............ ---•----•--------------------------•----••-•----.....--•-------....-•-------••-••-•--..........-----......................................................... 0 Description of Soil-3--/-•.....0.= • _.....•. cS'f1.6;5a"z ................'??�e.......��4."....----��•�.,!'�� � .......................•--•--------•---•-•-'_- =" 14 ry e,--"c�� ------------••-----•-----��- ....' C_'4:.ter �•.. UW -----•------------------------------------•--------••--•------------•-----•-•---•--•••-•-----•-------•-----•--•-------------••......---••----•--................................ ------ Nature of Repairs or Alterations—Answer when applicable.........................................................................I...................__. --------------------------------------•--------------------------......---•-----..........----•--•--------------------...-----------.......------------........................._..........--. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ilTl, . 5 of the State Sanitary Code— The undersigned further rees not to place the system in OP eration until a r ifi of mom iance has been issued by the o �lof health. oL jApplication App dve rY............. --- ---- = -- -----------------------•--- ..... Date�----------- Application Disapproved for the following reasons------------------------•----•--•--...•........----------------•----------------•-----.......................... -•...........................................•----•---------.....--------............---.......--••-------•----------------------------•--------------•-----•-----------••--•--•----------•••-•-•------- Date PermitNo......................................................... Issued-....................................................... I� Date r "-No........................ F�S..3.°........_......_ THE COMMONWEALTH OP-MASSACHUSETTS "u BOARD OF HEALTH .......... 0.cU..11-------------OF............;:�,00`"1e'V-.S.I 1-: .r34..t=_.._..._.._...._......... . pphra#ion for Elispu,ittl Works Tonstrnrtion rxntit Application is hereby made for a Permit to Construct (k') or Repair ( ) an Individual Sewage Disposal System at: ............/ f!{>..:...�G.. ` ..................... ............................................... ........••••••-••••�ra f•••••.. -_-..:•�_: !!.................. ...,.... Location-Address or Lot No. ......................_.-......................................................................•• ..........-•...................................................................................... 1 Owner Address W Instal,er Address Type of Building Size Lot..... ,__Z C 2..Sq. feet Dwelling—No. of Bedrooms...............4...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures __-•-•----•-•-•--•-•---•-••-•--- d : WDesign Flow........... __________________________gallons per-per en per day. Total daily flow............................................gallons. 04 Septic Tank—Liquid capacity__ ._c.____gallons Length__"___:.__..:._ Width...?........... Diameter................ Depth.... Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......... Diameter._._/ .......... Depth below inlet___.�t____________ Total leaching area.... ` ....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by.__.__..__` .._.......:._..'J:`.!.._..__._. / a •----•-••---------------- Date.-----==?-•--••. Test Pit No. _____minutes per inch Depth of Test Pit.... Depth to ground water________ ___________ f=, Test Pit No. 2.j..Z_._minutes per inch Depth of Test Pit... Depth to ground water........................ --------------- 4............ 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 TTTL; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed........... j---------•-•............ ......... Application Approved By ��..�`�.< Z.`I'D -•--••• .... >0Dpte Application Disapproved for the following reasons-------------•_______-........................................-............... � ................. --•••--•-•••-•--•..............•-•-._..--•••••--•-••-•--•-•-••-••-•••••--•-----•--•-...----•----••--•••--•-••-•-••-••-•---••--•-••---•-••--•••--•--------------..-•-••--••------------ ................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH LC.� �TY1............OF..... ................................. Tntifiratr of Tomplianrr THIS I ERTIFY, T t the Individual Sewage Disposal System constructed ( 11/or Repaired ( ) by........... &_t,. •• •- ------•---•--••._..__.._..•-••--••----•••_-•-••• ._..•-•••-•-----••---------•--...---•---•-••.....•---••-••••-•-.._..-•-•-- ,r staller, f has been installed in accordance with the provisions of TZTJ1 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N _c /__................................ dated.................. _,,.,v;.;;, _v THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI FACTORY. DATE......................./ ..................... Inspector--- ............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ✓-,�.�' d� ............OF.... C /. rt............................. "� N ?�l. � . ... FEE.. —?-Q........... Disposal Works Tonstr inn rrmit Permission is hereby granted.....�Indivall ......' `d'-.- .......................•----�`=_ .................................. Construct `^' or Repair ( ) anSewage Disposal System at No....... -••_-•.f '--•-----.":� ''. ! ..---. .p. :-%�^ ' Street as shown on the application for Disposal Works Construction Permit No___________________ Dated.......................................... �/ B Health DATE- ............................................................. 1 FORM 1255 HOBBS & WARREN, INC., PUBLISHERS , r - y i - SOIL ES VAT i1.5' � 9.S: o `': ALL WORKMANSHLP' AND MATE�R�ALS DATE OF SOIL TEST �4�8 IBJVE:RT - .AT QUILDING F.T. � r _ .w a- 0 .�O.E. T' T1:E: 5 - �.: r . �.:..._. SHAtL • .:CE�NfE}RAA.." _. .4E 1. „e --- ' _ ,_... _,_,T-: .�:- ...,� ..�T �: SEPT.tC.:..,T�W�C ..;_� ,�.,.�,-.�..�FT, _, -a._,. _ :. � . 1NITNESSEO Y r1D �e v: - B v .. _ __. _ �,:: Fs ULES ' «,_ .._7 AI�tO ._THE - ,TOWN 0l ,PERCOLATION RATE M N./INCH r- -� _ �._., ,, r_ . .._ . . - ._:_,..9'�,=2 :_ �`�; AND R�GUTAtt�ONS . FOR 3UBS"URF'A�CE - 1 -E,T i. TRt X ._.: F T� - . PIL: : 0.S, flUT14N..._.BO, ._ BSERYAT_IO,N _. -HOLE I OBSERVATL.ON _ HOLE ._2 ', : . ., . O -. _. ,.. . ,..,.: , , tSf�OS.AI OF <:S.ANLTARY SEWAGE -ELEVATION= E EVATION.. OUfiLE --;E?1STRII 'FtON �BOX �4. o FT. _ IN .ET LE1Cii�lNti F'IT FT D _ _�.� FT - .. P s✓a.- . o Su35o_ L _ StGN _ALCUt_ATIO�VS z - .MD _ _NUM R f}F,,. BEAR. _ -3- do u�' C'L'EA-�•/. ; �.,c�.' Sf1� 0" GARBAGE •�OISPOSAL UNIT _ �. _ _, DA TOTAL ESTIMATED FLOW (/>o .GAL /BR/DAY x 3 -BR ) 3,3o GAL./ . Y I�EtUIREOr :. SEPTIC TANK CAPACITY. .,.. GAL. 495 ,. ACTUAL —SIZE =OF; SEPTIC -TA_NK-- TO BE': INSTALLED /o 0 o GAL. �. LEAC,HING. AREA RE:CUiREME,NTS` �4° �= SIDE WALL ' AREA 2.5 GAL./S.F < . . 79, z BOTTOM AREA A o SAL./S.F. / 0 1f u � LEACHING, CAPACITY. (.'BOTTOM �'"SIDEWAL,L ):. ,549. 7 .GAL. 7- . ; RESERVE LEAC+1'ING CAPACITY: - S4 9 7 _GAL. Al TOP OF FOUND. ELEV.= �.D io '�, ��, CONCRETE 4" _SCH. 40 CLEAN SAND COVERS PVC . PIPE; CONCRETE MINA ..PITCH- COMER .. T1/8 PER: FT o �N OF ��,ttH �►,�t, i •: - . 2'/o MIN. PITCH Y 1 dy, w 3 12 MAX. o�. ' iy� y� sN Z ?.'-- .LAYER /8n I/ C� C' Ti "RICHJAMES AYER OF- 1: v �� � " ~ FLOW LINE N s�snQ r,r'.._ WASHED -STONE e�•.Asa 1�911Q,ST �. 4 CAST IRON - Z 3/4- i-1/2 STE Ocr PIPE - MIN. PITCH n $q I >__ WASHED STONE 1/4 PER FT.. DIST A' T AC 1N0 i. - BOX'. BASI.N _OR- EQUIV: ' D W o . 41 . , GAL s MAS PT x� L`R S R : AR 1NC: .S E N . . ANK � - ._ . M _,. < 4 R E �I 4 - EAST 'QENNiS '14IASS.= _. -..i GRO0Wff „-DIVA CLIENT. Co n covzr9�! S DI SS SEWAGE, Y TEM s , ,:. _ -r• ,2 2 NOT... TO .SCALE, ,._ u . _• .:v< `�. „-: �: G�. __ ., , :•. .. ... . .>_ R<. _ SHE )'" J .. •—. .. `"..:., '.'...: r'r.T .. ..- ...:. s .: <• -by-....: _ r - _ yf - s. .r• ': Tom.- .[ .... 1 . "..y.- , .. .. _.. _. ..... ... ., , -. .'x':..;^ _ , ;- r t .r, O C rn tow �1 O �. zz d o _i. Z.m D -U N m N f G'�� i'u : E 'E.�'L/E i 'fiQ O�O�► '��' :. � C � m p mmzz 270 , �xa= s / f in _ < 'vvc� c� - - \ ., Via. --1 = -� n cn n N r u % pFo Z Sa3 rn O --I z .o z G� O O. � --� m D m Z v i O ® G.9G S-!F,�?ric rI = mNa Z m OOOp _ \ \ \ \ a D.m-1 C) o I Z cn m (A cn _ _ _ _ _ -� 1 _ /// c�� ya r � Zf*i �� \ � /off,, = � \ `� 0 • � \ � � � _ OD CO Z CO cn / 0 1 Mo zC: ,; \ = rr- n �"m m rn m D wci i N 1� D "D. s�.�i �' � �-;,c,-,4•C G'2 ti pFs s,v. ! � o N. - O `(/� r\ ♦�1 �"' fi'Giy,yi:�/ ESSE.c./'T, �.S�GL . �V�/��� V/ D ZJ COT✓ tic" ..LcirT - Go THE SR/�/E. %J QC�,� � •. �: /�7 r�:r . ✓�/ �E /mac 7�/c'it"�.;'i[,' 1 j 4" PVC vent Pipe o o _Z\ F.F. EL 76.92 T with Screened Opening � -j- � / �F, S T 36 MIDDLE Finish Grade EI. 75.5t MIDDLE Finish Grade E1. 74't POND POND 6" 6" » 118., to 1/2,. Washed Stone Cs} 3" Thick 6 I PATH . u RISER .. F�-� 12.83 -►( Existing 20 Dta, 20 Dta. .. Finish Grade El. 73't- 75t To Remain RISER H A M B LI N 34" o p. . 24" llll/llllif 1{1lIJJII/lJllll/llllllllJllll/lll / e„ 11111111111111111 I 1 POND Illl I l/f1l llilllilflfllll 48' 48" 58 - RISER LOCUS 8.5 T Min. 6 70.0 .. Sump NV EL 10 Min. 14 Min.. INV EL � INV EL INV EL 69.67 Number of Trenches 1 INV EL °' ° d A o 0 o A a o EI. 6717' u��--- _ 0 9elow Flow Line/ 69.87 '6" Stone - 71.34 71.09 Number of Chambers 3 69.17' -48" 48 -. n p OLD 3/4 1 1/2 JYashed Stone Liquid Level 48 �i '� { ► - ALMOUTH 4 HOLE DISTRIBUTION BOX PROPOSED LEACH TRENCH END VIEW N. T.S. 33.5 Install Three 500 'Gallon Units OR RD n! with Four Feet of Stone at Sides-and Ends. EXISTING 2000 GALLON SEPTIC TANK TO REMAIN PROPOSED LEACH TRENCH � LovE«'s .J (�� cry o - Bottom of Dee Observation Hole El 6 .0' L,O C' ��p 2 AA CHECK AND UPGRADE TANK CONDITIONS AS FOLLOWS. �-7 2j G High Ground Water.. <EIeV 44" (Hamb)in Pond) 40 PVC and shall extend a Tees shall be constructed of Schedule o 6" above the flow line of the septic tank and be on L_ � G �_ r� o minimum f P ' t under the _ the centerline of the septic tank located directly and 35 EXISTING CONTOUR clean out manhole. w'•-: EXISTING WATER.LINE shall be no less than 2" nor more than 3" The inlet pipe elevation �`'�°--o_ EXISTING FENCE .above the invert elevation of, the outlet pipe. / Septic `tank shall have a minimum cover of 9 / „ Two 20 manholes with readily removable impermeable covers / o able material shall be provided with access ports. f d ur p The outlet tee shall bee uz ed with as baffle. R' PP � 1 , / S84° / -- 20 00 E / /� � _ 270 t 64 62 60 58 56 4 � 5 52 50 48 46 44 % J / 42 _ - - - - - - - - - BM: 72 - 1 TOP CB FND. l F / / 66 / Np EL V. 7 .01 E 3 Y , DATUM. GISt\\ VENT 70 Z 74 8 _ tv � I I s .� T�1 XIS TING 9 A ' E T Q ® o 46 � O PAVED DRIVE F 9 68 38 '�' t 11 G\ p PRECAST REINFORCED CONCRETE DISTRIBUTION BOX New � / o Install on a leF•el base j Minimum wall thickness 2 . . �? -DECK ! / t s dimension f ✓ _ , u inside dime Minimum / -s r` co $ a 4 other and a t ,� -------� 184 � Outlet Inverts shall be equal to each oth r q Q ,�- I 44 � W - 2 minimum below znle t invert •,., R , z -� �. � P2 from the distribution .box shall all have � The distribution .Imes fr � � 1 .o button box to IStrl �.. , b flooding the d e ual inverts as determined y g qEx IST G ti t �_ O . L 0 C I t_ H o line invert after all lines have � �, the height of the distribution � � AREA gTp w 20 B f ABA NDONED Q 1 D in lace. o been sealed , N E � durable and Invert adjustments shall be made b filling with V J y g � 01 to the line or nondefarma ble material permanently fastened P yo _ -`� of equal elevation. / o reconstructingthe lines- until all Inverts are q w / 76 / o / o / REFERENCE PLAN. 203-53' 137' 4 / EXISTING / O c� . `200o GALLON REFERENCE DEED. 12784 2 / \ 75 0 0 1 1 R TANK <v 66 PRECAST T N p , / TO REMAIN Q z ASSESSORS D A TA. DEC • / K MAP:80 PARCEL 16 Design Data:�' LOT 18 I I _ ,, » Four Bedrooms = 4 X 110 gpd _ 440 gpd Required:Flow. / FEMA DATA. ZONE C 43,570tS.F. PANEL 250001 0015` C No Garbage Disposal Allowed / g P x MAP REV- AUG 19, 1985 / 66 0 Use. Chamber Trench 33.51 x 12.83 W x 2 Eff/Depth 7 Ke a 8 nnei a- 44 Area / 50 a = 185 sf 78 / . 33.5 + 33.;5 f 1�?83 t 12 B3 x 2 D / /- 7 ZONING DISTRICT. RF L J 72 70 64 68 3 5 12.83 = 429 sf 74 �- i 0 / 46 - OVERLAY DISTRICT. GP & RP OD x / 6 / OD Flow --� 62 // 56 614 x 0. 74 454 GPD Total Design F / 58 � 48 LOCUS ADDRESS. ° 54 S 1 80 40 >, 76 � // 304 MISTIC DRIVE, MARSTONS MILLS - 00 .E w 52 / 1 _ 1 3- C 0o t � GENERAL CONSTRUCTION NOTES _ C 1. All the workmanshipand materials shall conform to D.E.P Title 5 the Town of Barnstable rules. and regulations" for the subsurface and _ P# 11609 disposal of sewage.e. P g accessible t over tank tees shall.. be access Health Agent: Dave Stanton 2. At least. one access par g » - SEPTIC UPS remaining access arts Test Date. 01 31 07 UPGRADE PLAN w Within 6 of finish. grade, with any g• P v brought to within 6 of finish"grade. Soil Evaluator- S. Doyle Prepared For.• b°' g P i ar system shall be capable of High .Ground Water <Elev. 44 Hamblin .Pond 3. All components of the san t y y P g ( ) - in unless the are under or within 10 ft withstanding H 10 loading JT �p A�,4 4 MIS TIC` D �.. - shall be used under or within 10 of drives or parking. H 20 loading' P g t drives or parkingunless noted Plastic equals may be In e of all recast units. TH #1 EL. 73.0 TH #1 EL. 76.0 used In lieu P � L �SiE?HEN �, � Mills,Ma.1�St01IS ilMassachusetts shall call di safe and verify the location PERC <2 MIN/INCH PERC <2 MIN/INCH � o ,1. ^ � 4. The excavator/contractorg Y excavation, and shall be responsible for o" o" :�,,-:9 r of all site utilities prior to any e.xca P ,� Scale: 1" matters relating to electric easements. A A ® 20 Date: February 1 0 all ma g SL 10YR 3 2 SL 10YR 3/2 » / a or ti�•� y 2 07 id a t a min. 0. 02 slope. C 5. Sewerpipes".shall be 4 Schedule 40 PVC laGRAPHIC GALE � � •"v 8 a � � ��� a Prepared' By,- 6. be used to bring covers to grade shall P Any masonry units u g � zo o ,o zo 40 80 Stephen J. Doyle and Associates Y in lace. B Ls �oYR 5/s B Ls 1oYR 5/8 � mortared p 42 Canterbur Lane, E. ,Falmouth MA 0 7. Finish grade shall have a minimum slope ,of 0. 02 ft per foot. EL. 70.0 36 EL. 73.0 36 Y 2536 g Telephone: 508,,/540-2534 s shall be responsible to check all grade 8. The exca va for/contractor p v� c� o an disoe ancies PERC 60 ( 1N FEET ) a�,Sii or�j Jt�-Z and elevations and to contact Doyle 'Associates f y p , C MED. To � MED. To FINE FINE 1 inch = 20 ft. �4 CHRISTI O� prior t0 construction. SAND SAND NE G ,� � F I E to contact 2.5Y 6 6 2.5Y 6/6 o A RN NY 9. The exca vator contractor` shall be responsible / inspections.Doyle Associates 24 hours error to any requiredp No. 426 0; .y 132" 132" �FG ¢�O NO WATER ENCOUNTERED NO WATER ENCOUNTERED rSTE EL. 62.0' EL. 65.0' S01TAR1a� 7V0. DA TE 2 j 07 DESCRIPTION BY