HomeMy WebLinkAbout0181 MOCKINGBIRD LANE - Health 181 Mockingbird Lane
MarstOnS Mills P
A 01-3 027
TOWN OF BARNSTABLE
LOCATION SEWAGE#
ASSESSOR'S MAP & LOT "02�
INSTALLER'S NAME&PHONE NO. � 4�1 ,`jQ� �7? 177
SEPTIC TANK CAPACITY SRO
LEACHING FACILITY: (type) J' f!� �!✓ �5 (size)
NO.OF BEDROOMS
:BUILDER OR OWNER
PERMTTDATE: 10 3 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 aching Facility(If any wetlands exist
within 300 fee leaching f ty) Feet
Furnished by
Dee
Qecle i
� t
d -
6.
ocd
� eo-
TOWN OF ARNSTABLE
LOCH ILON \(&�WAGE #
VIILI, \ �S1 S � ASSESSOR'S MAP &LOT
INSTA.LER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size) �( U
NO.OF BEDROOMS
;3Ir1LDER OR OWNER
PE`UAUDATE: COMPLIANCE DATE:rd�2
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 ���'`
_
f
TOWN OF BARNSTABLE
®® rr SEWAGE #
LOCATION �/17 �®�'�i�))� � ,
VILLAGE, �— i 1!�_ASSESSO,R''S MAP & LOT
INSTALLER'S NAME&PI NO. /`'� .SQL° e17 7 Cd/77
SEPTIC TANK CAPACITY
LEACHNG FACII,ITY: (type) S!d 4,411Y (size) !2 X3�
NO.OF BEDROOMS
BUILDER OR OWNER
PERMTr DATE: 1 D 3 COMPLIANCE DATE: 3
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 aching Facility(If any wetlands exist
within 300 fee eaching f ty) Feet
Furciished,by
I
I /
Us
Dee
cd
er
r
boo 3 ��� 0 —
' No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for Mir o� Y *p6tem Construction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components
Location Address or Lot No. I!J) r4 bLKI a,°j R1 h0 L jV Owner's Name,Address and Tel.No.
�iFh�Nt� �vo�-�
Assessor's Map/Parcel / � I 1-11 U C IC rev- � `joi I/"
Installer's Name,Address,and Tel.No. 4 P� g-r j�. 7�b�')) Designer's Name,Address and Tel.lJo.,
Rb)-1 S CLCCe4o,;N- - IA,� U l{ k�k S SUCrA*"Pr
20 Q0 K I I 61 �� r.I 3aU �r,�c;r~( Kb
Type of Building:
Dwelling No.of Bedrooms Lot Size U a sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
-Nature of Re airs or Alte at' ns(Answer when applicable) !N f ` e cis 6
3 �avaGl6H l �c�► r c_ht ��� �� o J` rvOL'e
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been is ed y 's Bo o Health.
S' ned Date
Application Approved Date AV-3
Disapproved for the following reasons
Permit No. _ -5 —4/00* Date Issued 3
� o 3 -= �
?�No. <� Fee ....-.
y
THE COMMONWEALTH OF MASSACHUSETTS - Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
' 2pplication for M '5 !6 Y *pztem Construction Permit
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components -
Location Address or Lot No. I r"oc.K i o,,� 13'1 h h L w Owner's Name,Address and Tel.No.
Assessor's Map/Parcel ! 3�
[c �n;
Installer's Name,Address,and Tal.No. SQ -[! 7a f 7) Designer's Name,Address and Tel. or
90 C36 \c I I (.1 k-�-iA A 3aO v4-Cj h t) V/
Type of Building:
Dwelling No:of Bedrooms Lot Sizej U a sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow l�lw gallons per day. Calculated daily flow gallons.
Plan Date - Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Rya��r Alterations(Answer when applicable) 7l�f4A << hie t•.� n 6 )c
4 3 �A C `PAL IDS r61Mr, eA c.)i (/ U f fa
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issuedVys Bo o Health.
Sig ned 1 / Date Application Approved by, Date
Application Disapproved for the following reasons
Permit No. 01� 3 Date Issued G3
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (tompliance
THIS IS TO CERTIFY, that the n-site Sewage pisposal System Constructed( )Repaired( )Upgraded( )
Abandoned( )by J9<a Iv 1 S �V C /1 t,
at I /vi G C fLCy9 I hip L'' has been construct d 'n accordance
with the provisions of Till 5 and the for Di posal System Construction Permit No.ZOOS-H 8 b dated 10�' n 7
Installer S_,_,+13 .K C !4 u o4 1 ' Designer
The issuance of thisl pe t shall not be construed as a guarantee that the system wil n ti.n as de(gried.
Date,- "7 O J Inspector ✓� fL l '
Fee
------------------------- ---
No. a .3—`ib 5 v
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
liopo.5ar bpotem Cots.5truction Permit
Permission is hereby granted to Construct( )Repair( [Jpgrade�( )Abandon( )
System located,atl / fc'k ram+ }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 this p.rtnit.
Date: /0/.3/0 3 Approved;by-=
- Commonwealth of Massachusetts
Executive Office of Enviroluuental Affairs
Dept. of Environmental Protection
One winter.Street'Boston,Ma. 02108 John Grad
D.E.P. Title V Septic Inspector
P.O. Box 2119
Teaticket, MA 02536
WILLIAM RWELD (508)564-6813
Governor
ARGEO PAUL CELLUCCI p
Lt.Governor ,
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO
PART A
CERTIFICATION 00T
Property Address: 181 MOCKING BIRD LANE MARSTON$MILLS MAP 13 PAR 2711,ddress of Owner:
Date of Inspection: 10/23/98 (If different)
Name of Inspector: JOHN GRACI JOHN MATHIESON • �F
I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) 4a,
Company Name,Address and 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:
x Passes This Inspection Is based on criteria dented In Title V
— Conditiongily Passes code 310CMR16303.My findings are ofhow the system is
— Needs ther Evaluation By the Local Approving Authority perfImplyaorming atthetimeoorguaranteefthe oftheingevitondoes
not Imply enywarranty or guarantee of the longevity of the
Fails septic system and any of Its components useful life.
Inspector's Signature: 1 Date: 10/24198
The System Inspector shall ubmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. 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.
INSPECTION SUMMARY:
Check A, B,C,or D:
A] SYSTEM PASSES:
x I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B] SYSTEM CONDITIONALLY PASSES:
_One or more system components need to be replaced or repaired. The system, upon completion
of the replacement or repair,passes inspection.
Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Cd7hpllance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or
the septic tank,whether or not metal, is cracked, structurally unsound,shows substantial infiltration or exfiltration, or tank
failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforining septic tank
as approved by the Board of Health.
(revised M7197)
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 to Telephone(617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 181 MOCKINGBIRD LANE MARSTONS MILLS MAP 13 PAR 27
Owner: JOHN MATHIESON
Date of Inspection:10r23198
_ Sew.00e backup or.breakout or hioh.static water level observed.in.the distrihotion box is due to a.broken.
or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if
(with approval of the Board of Health). Describe observations:
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
_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
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 the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
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 APPROPRIATE) DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method usedto determine distance (approximation not valid)
3)Other
D] SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
_ I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
SAS is in hydraulic failure.
(revised 04127197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 181 MOCKINGBIRD LANE MARSTONS MILLS MAP 13 PAR 27
Owner: JOHN MATHIESON
Date of Inspection:10/23199
D]SYSTEM FAILS(continued)
Yes No
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 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 0427)97)
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 181 MOCKINGBIRD LANE MARSTONS MILLS MAP 13 PAR 27
Owner: JOHN MATHIESON
Date of Inspection:10f23198
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
_c_ — Pumping information was requested of the owner, occupant,and Board of Health.
x None of the system components have been pumped for at least two weeks and the and 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.
x As built plans have been obtained and examined. Note if they are not available with N/A.
x — The facility or dwelling was inspected for signs of sewage back-up.
x — The system does not receive non-sanitary or industrial waste flow.
-x— — The site was inspected for signs of breakout.
x All system components, excluding the Soil Absorption System, have been located on the site.
x 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.
x The size and location of the Soil Absorption System on the site has been determined based on
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
Sub-Surface Disposal Systens.
x Existing information. Ex. Plan at B.O.H.
x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is
unacceptable)[15.302(3)(b))
(revised 04127197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 181 MOCKINGBIRD LANE MARSTONS MILLS MAP 13 PAR 27
Owner: JOHNMATHIESON
Date of Inspection:10123/99
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 440 g•p•d./bedroom for S.A.S.
Number of bedrooms: 4
Number of current residents: 2
Garbage grinder(yes or no): Yea
Laundry connected to system(yes or no): Ye:
Seasonal use(yes or no): No
Water meter readings,if available:(last two(2)year usage(gpd):
nra
Sump Pump(yes or no): No
Last date of occupancy: nla
COMMERCIAL/INDUSTRIAL:
Type of establishment: nla
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present:(yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: nra
Last date of occupancy: nra
OTHER:(Describe) rda
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
SYSTEM WAS LAST PUMPED W SEPT.BY CANCO,HAS BEEN MAINTAINED EVERY YEAR
System pumped as part of inspection: (yes or no)No
If yes,volume pumped:0 gallons
Reason for pumping: nra
TYPE OF SYSTEM
x Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) ( if yes, attach previous inspection records, if any)
I/A Technology etc.Copy of up to date contract?
Other:
APPROXIMATE AGE of all components, date installed(if known)and source Information:
SYSTEM IS 13 YEARS OLD.
Sewage odors detected when arriving at the site: (yes or no) No
(revlaed 04127197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 191 MOCKINGBIRD LANE MARSTONS MILLS MAP 13 PAR 27
Owner: JOHN MATHIESON
Date of Inspection:10123199
SEPTIC TANK: x
(locate on site plan)
Depth below grade: 15"
Material of construction:x concreate_metal_FRP_Polyethylene—other(explain)
If tank is metal, list age rda . Is age confirmed by Certificate of Compliance No (Yes/No)
Dimensions:1_e'S^H5.7"w4'10^
Sludge depth:2"
Distance from top of sludge to bottom of outlet tee or baffle: 32"
Scum thickness:0
Distance from top of scum to top of outlet tee or baffle:6"
Distance form bottom of scum to bottom of outlet tee or baffle:0
How dimensions were determined: MEASURED
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.)
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERY TWO YEARS.
GREASE TRAP:_
(locate on s•te plan)
Depth below grade: rda
Material of construction: _concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: rva
Scum thickness:rVa
Distance from top of scum to top of outlet tee or baffle:rda
Distance from bottom of scum to bottom of outlet tee or baffle: Wa
Date of last pumpingn-
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage, etc.)
rda
BUILDING SEWER:
(Locate on site plan)
Depth below grade: 22"
Material of construction:_cast iron x 40 PVC_other(explain)
Distance from private water supply well or suction Iine:TOWN
Diameter: nla
Q,mments: (conditions of joints,venting,evidence of leakage, etc.)
Irevlaed 04127197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 181 MOCKINGBIRD LANE MARSTONS MILLS MAP 13 PAR 27
Owner: JOHNMATHIESON
Date of Inspection:10/23198
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: nra
Material of construction:_concrete_metal_FRP_Polyethylene_other(explain)
Dimensions: nre
Capacity: rda gallons
Design flow: Na gallons/day
Alarm level:_nra Alarm In working order?_Yes_No
Date of previous pumping:
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
rda
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: nla
Comments:
(note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.)
rda
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)No
Alarms in working order(yes or no)_Ye:
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
rda
(revised 04127197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 181 MOCKINGBIRD LANE MARSTONS MILLS MAP 13 PAR 27
Owner: JOHN MATHIESON
Date of Inspection:10123198
SOIL ABSORPTION SYSTEM(SAS):x
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
Na
Type:
leaching pits,number: 1000 GALLON LEACH PrT
leaching chambers, number:ria
leaching galleries, number: rua
leaching trenches,number,length: rda
leaching fields,number,dimensions:rda
overflow cesspool,number:Na
Alternate system: nra Name of Technology._nra
Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
THE LEACH PUS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PR HAS V OF WATER IN IT,AND HAS NOT HAD MORE THAN 2-OF WATER.
CESSPOOLS:
(locate on site plan)
Number and configuration: rVa
Depth-top of liquid to inlet invert: nla
Depth of solids layer: Na
Depth of scum layer: ria
Dimensions of cesspool: r0a
Materials of construction: rda
Indication of groundwater: ria
inflow(cesspool must be pumped as part of inspection)
rda
Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
rVa
PRIVY:_
(locate on site plan)
Materials Of construction: rva Dimensions: rda
Depth of solids: rda
Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
rva
(revised 04127)87)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (contlnued)
181 MOCKING BIRD LANE MARSTONS MILLS MAP 13 PAR 27
JOHN MATHIESON
10123198
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references, landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
Page ! of 10
(revised 04)2719T)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
181 MOCKING BIRD LANE MARSTONS MILLS MAP 13 PAR 27
JOHN MATHIESON
10123198
Depth of groundwater 12
Please mclicate all the methods used to determine High Groundwater Elevation:
Obtained from design plans on record.
Observation of Site(Abutting property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of Health
Check FEMA Maps
Check pumping records
Check local excavators, installers
x Use USGS Data
Describe in your own words how you established the High Groundwater Elevation.(MUST be completed)
USGS MAPS AND CHARTS
(revised04)27197) sage 10 at 10
13 a7
/LOCATION SEWAGE PERMIT NO.
442 4- gs -so)
• .,VILLAGE
I N S T A LLER'S NAME t ADDRESS
rl
R U I L D E R OR OWNER
n)
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED.
:�.q-(�
`� � !h (�
.. . `��
. ,
I THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....._....TOWN...---.....OF........BARNSTABLE
... . .........................................•----••---....--•--
Appliration for Mipaual Works Toustrurfivit "pantit
Application is hereby made for a Permit to Construct ( X) or Repair ( ) an Individual Sewage Disposal
System at:
- Mockingbird Lane,__Marstons Mills _________________________Lot 97________._____._____________
--......... .._.. ...-----• ...........
-Location-Address or-Lot
John J. Mathieson & Doris E. Mathieson P.O. Box 294, Lakeview Ter., Middleboro, MA.
- ------•--•---••---•-•-•---•-••......--•--•. ...--•-•-
a ' , Owner Address
Installer Address
Type of Building Size Lot_._._20a125 . Sq. feet
Dwelling—No. of Bedrooms...............3...........................Expansion Attic (No) Garbage Grinder (No)
Other—T e of Building __..... No. of persons............................ Showers
a YP g --------•----•-•--•-- P ( ) — Cafeteria ( )
Otherfixtures -------------------------------•---•------------•-----.....----------------•----------------------•--••-------------------..........--................
W Design Flow..................5......................gallons per person per day. Total daily flow................330............ .-__gal
Ions.
WSeptic Tank—Liquid capacity..1000_gallons Length.IT........ Width...09...... Diameter................ Depth...4-6......
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No............1........ Diameter.........$......... Depth below inlet........S.t........ Total leaching area......200.....sq. ft.
Z Other Distribution box ( x) Dosing tank ( )
aPercolation Test Results Performed by........BaXter._&.N_v.e..................................... Date.......ll-19-84_____-_____--.-.
Test Pit No. 1................minutes per inch Depth of Test Pit. .12.....__... Depth to ground water over-12!...--.
Gr4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 ............................-................................................................................................................................O Description of Soil........... Qfl,. '•-•12'_M d,_Sand_•_LightGravel.___No_water.......................
x
W
-----------------------------------------------•---------------------------------•--------........---------------------------------------------------------•------•----------------------------------•-
U Nature of Repairs or Alterations—Answer when applicable................................-_---_..-_......_.-_............................................
........--•-----•-----------------------------------•-•----------..............................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T IT11 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
ope ation til Cer 'ficate of Compliance has ben issued by th _ f health.
6 -- Si ed-� 5/'22j85..........
plicatio Approved BY r _ -:... . Gam- :::.:--- __. eyi
.•--=•-------- --- --- .
Date
Application Disapproved for the following reasons----------------------------------•----------------------------------------------------..........-----.........•-
--•-------•..................................................•--•••------•--•---------..:...••------•---•--------------•---•-----------------------------------------------------------------...._-••---
Date
PermitNo.......................................................-- Issued.......................................................
Date
No . F:ss.................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..----- . �f'�rVN......--....OF.......PAL-T Tt` B ,r
ApplirFaften for Uhip a al Works Tonitrnrtion Prrmit
}
Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal
System at:
1ljloc1dn�_"hird.T,anc, 1",Iarstons Mills I,ot 97
- .......... ............. ..............................................
,Location-Address
. Jol!n J. II�?.thiesor .� 3oris E. Plathieson P.t�. Ba : 294, Lal_ev;Fw% �er.. Pliddlehoro, AAA.
- .. ................ -------•-------------- -----•--------------- -------- -----•--- .----.. .......--
a Owner Address
. .......
Installer Address
UType of Building Size Lot..._?PtlE5...........Sq. feet
�-, Dwelling—No. of Bedrooms.:..........................................Expansion Attic ( ) Garbage Grinder ( )
a` Other—T e of Buildili
4 yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
0. Other fixtures
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per,inch Depth of Test Pit.................... Depth to ground water........................
fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Q'' ------
------------------------------------
------------------------------
........
--------------------
---
-........
........ .... --------------
----
0 Description of Soil.................................................--•---•------•--•-......-----------------------------------------------------------------•------------...------------.
x
U .--------------------------------------••----------........---------.....---------•--------------.......----------------------------------------------------------------------•------------------------
w
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
--------------------•-------...------------------------------------------------.....-------•----•----------------------------------------------•-----..........................................
Agreement: ..
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until Cer 'ficate of Compliance has been issued by the board of health.
�� Si&ed...................................................................................... --••--------------•---•-•-------
licatio A roved B — '� Date
Date
Application Disapproved for the following reasons---------------•--------------------•-------------------------•-------------•----------.._............•--.......
....................•------..............---•-----••-------....------......-----•---•--•--------.....--------------------•----•------------•-------------------------•----------•--------•-----•--------
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF
Trrtifirttte of TontpliFanrr
TI�I,F IS�TO.jCERTIFY, That the Individual Sewage Disposal System constructed ('�''}or Repaired ( )
by------------------------- -----...........-------•--------•----•-•-----•---•---------------------------------------•-------......--•----------------------•----------•--••-•-•-----------------
� (, r Installer
at
has been installed in accordance with the visions of TITLE 5 of The State Sanitary Code s described in the
application for Disposal Works Construction Permit No........ r .�`_�+.'�f- .____ dated___..'"P�.Z't
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS UE® AS A GUARANTEE THAT THE
SYSTEM WILL FLMCTION SATISFACTORY.
DATE... .........................................
Inspector.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
FEE...:-, . .......---
Disposal lRoAg Tonstrudion anti#
Permission is hereby granted........m v_-t!]L...............................
to Construct ors Rvir (� ) an Individual Sewage Disposal System
at No.... y �., IG-•-`-"��tf-I.........Lx4......i"-:cn....................
-----------------------
Street
as shown on the application for Disposal Works Construction
�Permit
\��N/y w� /��l 1.. Dated 45�"�/ -------------------
--------�"------r.,fY.Rg- yt ✓'__�'. 'a":".........................................«
n Board of Health
FORM 1255 A. M.SULKIN INC., BOSTON
E A-41J11-Y -- 3 BEO�eoorvl - -
it/O GAA-',RAGE
97
GL(L.
i
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RICHAP
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BAATER
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• . \25aL�� r���� Box 96� 97 0 •� .
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A/11-7,sE7-.9Ae ` .eEj:pv1zE�IENTS O� T//� /��GiSrS2cIJ�4rvo.SU,2tiEya,P�
TON/,v OF,t3,�lci���-,Q G AA127_/S ivoT-
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ila. 13,4SE0 Gov AN
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r
LOCUS Lakes ore0r ASSESSOR'S MAP: 13 GENERAL NOTES:
PARCEL: 27 pJ
ti 1. VERTICAL DATUM: ASSUMED
4 �a FLOOD ZONE: C Town of Barnstable #2500010015 C (8/19/85)� 0 2. MUNICIPAL WATER Is AVAILABLE.
m`o Dov7,,,,z
C o / REFERENCE: o 3. SCHEDULE 40 PVC PIPE TO BE USED' THROUGHOUT SYSTEM
co 0 /� PL. BK. 284 PG. 91 UNLESS OTHERWISE NOTED.
v °� j ti x 4. ALL PRECAST UNITS TO CONFORM TO
bit AASHTO: H-10
c 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED.
6. ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE WITH MA
PL. BK 284 PG. 91 ENVIR. CODE(TITLE V)AND LOCAL REGULATIONS.
Focus MAPrv.T.s. 7. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO
rz CONSTRUCTION.
o 0.j
a S 09054,00" E LEGEND
161.00'
co BENCHMARK SET: �- gg �- PROPOSED CONTOUR
Stone under post
0
x EL.= 101.0(Assumed) 99
PROPOSED SPOT GRADE
o x Stone Drive o o Qj
CU �' -- 40 - EXISTING CONTOUR
r\
W Water Line - ^" —30.23— EXISTING SPOT GRADE
a
TEST PIT
0 EXISTING WATER SERVICE
Above ground i
Deck / /Above ground ° C14
#181 ' / P001 00
T10FMgsso OF117
TOF=101.37 /
(Front) {: 12 / /�// // TERRY P��N ASs9
Lot 97 IEPTIC� ❑N -C❑V �* o $ ANN �. o
/ WARNER �� AMY yGN 1 20,125t S.F. C 10 . // x No.38721 ,
Q 0.46t AC. ti VON HONE
w Ma ` Existing tank o o , x o v 9 #1068�o
o o p 13 to remain Brick Q CD V-)
o 0 Parcel27 -1
o Patio sq T P
M o LO Failed Leach
W N Pit 100. 8 10b
� `� � � 100.`j2 c �/
Gar. w
v z .under l0 4S rn
o .......................
z o rNi
i� o W
> :) r)
U
DATE: HEALTH AGENT:
art ci
Drive, o cv
O o SITE AND SEWAGE PLAN
H
M 13' 11' g
I-� ��� .. �: . Shed q
M � �^ co Stockade fence
o o associates OCATION.L : 181 MOCKINGBIRD LANE
oo .: .:.: . .. _ -- Ol o
SEPT/CSYSTEMDES/GNS MARSTONS MILLS, MA
c �e �� 0 320 Cotult Road ,
I o N 09°54'00" W _ - x �50E8,MA0 5W PREPARED
RON S EXCAVATING
___ FOR: FRANK WOODS
__ --
Surveying by: SCALE:
Terry A. Warner P.L.S. 09 30 03
Co Scale. 1"=20' Horw?ch��MARoad 02645 DATE:
(5oa) 432-8309 SHEET NO.
r
Provide Riser over D-box NOTE: To prevent breakout, final grade of
Top of Foundation(Front) to within 6"of finish grade EL. 98.0 to be carried out a minimum
EL:101.37t F.G.EL:100.5 ' of 15' beyond edge of leach facility.
F.G.EL:100.7t F.G.EL:100.94t
(Existing) f Maintain Min.2%slope over leach facility F.G.EL:100.5t
Install risers w/covers over inlet
&outlet to within 6"of finish grade Install riser over one chamber
with cover minimum 12
EXISTING L=11' to finish grade.
EL.99.96t 4"SCH 40 PVC 45' L=30'(Maximum) TOP CONC.EL�8.42
6" 4"SCH 40 PVC
411 SCH 40 PVC
S=6.5%(MIN.) io @ 5=1.8%(1%MIN.) ®® o ®®
1a• s- CAS=1.7%(1%MIN.) ®®®sEaEa® . 2'EFF.DEPTH
®®®O®®®
L:98.99t EL=98.0 ®®®®®®®
Install Gas Baffle EL.=98.17 ° BOTTOM EL.�5.5
PROPOSED DBE EL.=97.5 Use 3-500 gal. Precast Chambers
EL:99.24t with double washed stone
*Contractor to verify min. 1000 gal. H-10 DISTRIBUTION BOX 9.58'
4'ends, 4'sides
(Install PVC Inlet&Outlet Tees)
septic tank. Replace with min. 1500 (33'x 13'x 2')
gal.tank if undersized or damaged. EXISTING 1000 GAL* SEPTIC SYSTEM PROFILE
Depth of tank is approximate. H-10 SEPTIC TANK EL.
BOTTOMM OF TH-1
(Verify existing elevations) N.T.S.
SOIL LOG ADDITIONAL NOTES
N,i.S.
SOIL EVALUATOR: AMY VON HONE,R.S. DESIGN C R I T E R I A
DATE: SEPTEMBER 27,2003 9:00 A.M.
PERCOLATION RATE: <2 MIN/INCH 1• Contractor to confirm soil suitability prior to installation. Contact BOH in the event of
varying soils from original soil test. Number of Bedrooms: 4 Bedrooms
2. Existing 1000 gallon septic tank to remain. Depth of tank as shown is approximate Soil Type: CLASS
TH — 1 TH — 2 Design Percolation Rate: 2 MIN./IN.
only. Contractor to confirm depth prior to construction. Contact design sanitarian and
EL. 100.92 BOH in the event that proposed elevations cannot be met. Daily Flow: 440
Design Flow: 440 G.P.D. (MIN. REQ'D)
A 3• Failed leach pit to be pumped and abandoned. Any contaminated soil within 5 feet of Garbage Grinder: NO
Sandy Loam
proposed leach facility to be removed and replaced with clean fill. Leaching Area Required: (440)/0.74 = 594.6 S.F.
10YR2/1
g^ 100.17
Septic Tank Required: 1000 GALLON (Existing to remain)
FLOOR PLAN
Sandy Loam USE 3 500 GAL. PRECAST CHAMBERS WITH WASHED STONE:
10YR5/8 N.T.S. 4'ON ENDS, 4'ON SIDES (33'X 13'X 2')
36" 97.92 Sidewall Area: 4(33'+13') = 184.0 S.F.
C1 Living Bottom Area: 33'X 13' =429.0 S.F.
Pero. Medium Coarse Sand 1st Floor Bed1 Bed2 Room/ Basement Total Area: 613.0 S.F.
2.5Y6/3 Dining
58" Design Flow Provided: 0.74(613.0 S.F.) =453.62 G.P.D.
Bed3 Bath Kitchen Family Room v H SITE AND SEWAGE PLAN
180" 85.92 i
No Groundwater Encountered s�os t 181 MOCKINGBIRD LANE
j 320CotuftRoad LOCATION: MARSTONS MILLS, MA
PERC RATE:<2 MIN/IN.("Cl"Horizon) 63
Bed4 soss33.0o4i ROWS EXCAVATING WOODS
24 Gallons In 5:47 minutes end Floor Family E PREPARED
Room Surveying by: FOR:
NOTE:Contractor to verify consistency of soils in location Terry A. Warner P.L.S. DATE: 09/30/03
of primary S.A.S. a minimum of 4' below Bath 22 Long Road
leach facility prior to installation. Harwich. MA 02645(508) 432-B309 SHEET No. of