Loading...
HomeMy WebLinkAbout0106 MOUNTWOOD ROAD - Health T06 Mountwood Road Marstons Mills F/R A = 125 017 TOWN OF BA.RNSTABLE v LOCATION ZQ6 /I IN-1 WurD go. SEWAGE # VILLAGE ASSESSOR'S MAP & LOT i Z5 n INSTALLER'S NAME&PHONE NO. CS1�t��VO i`PL SEPTIC TANK CAPACITY llq� r LEACHING FACILITY: (type) a-'50® j 4Zq C,6&ff ize) 23 x.13)(2 NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: —O_5 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 4 .. /6�` /acro T�� ,,P*,� ��O e ��®. No. U + FEE (J� Board of Health, La/a S 1 K. MA. APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair(4UpgradeO Abandon( - ❑Complete SystemVISQndividual Components Location 16(0 Owner's Name � f Map/Parcel# !2� Address 5C4&LIP, Lot# Telephone# Installer's Name Q Designer's Name e Address Address L 2 Telephone# " Telepphoone# l j Type of Building / 5 °C%C�/al � J t�c f=4 /�Ly�c/l Lot Size 7� sq.ft. Dwelling-No. of Bedrooms Garbage grinder ( ) Other-Type of Building (A No.of persons Showers ( ),Cafeteria ( ) Other Fixtures A /4 4+ Design Flow (min.required) / gpd Calculated design flow .: Design flow provided �7 2 gpd Plan: Date ` lQ� Number of sheets Z-- Revision Date Title Q fib�-/r+LAJ©_ �SfdAS Description of Soil(s)40 11 (P fZ qzl ° Z°— C ��' t► C ° Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install ove desc ' Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and t further agrees t t to pl a ern in op Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections o. FEE /�� /. us T49,11 Board of Health, 94, 4 MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair(KUpgradeO Abandon( - ❑Complete System1<Individual Components Location Owner's Name Map/Parcel# Address YVLA. Lot# Telephone# 1 Installer's Name }-G / Q ' { / Designer's Name Address �/�e 1 4st( Q�� i�.5 ! (l f Address /,Z_ We 4!� !/SS t'c1Q IC�P 3 /CJl ; Telephone# S 7 0 0 L&V4F Telep"ho'ne# 7 --5'3/ &Z4 y Type of Building A'cS t��v1 fp t �� /``i M'k,/ Lot Size 2Cl 6W F sq.ft. Dwelling-No.of Bedrooms -7 Garbage grinder ( ) Other-Type of Building N/ No.of persons Showers ( ),Cafeteria( ) Other Fixtures y A114 `J 2 Design Flow (min.re uired) 50 gpd Calculated design flow Design flow provided 7 gpd Plan: /Date � ��„� / Number of sheets �-`;, Revision Date Description of Soil(s)-b " r,, F // S Q'-1 Z '(A ,t C. /Z- "���/`O� Soil Evaluator Form No. Name of Soil Evaluator P I'L!/7C Date of Evaluation 6 40 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install Bove desc ' Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees of to pl e e tem in o a Certificate of Compliance has been issued by the Board of Health. Signed Date 3 30 t k. Inspections 1 No. 960 5—Ile, 'l.OMMONWE 14 OF MASSAC14 SETTS FEE /00 Board of Health, l Q /A MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired VUpgraded ( ),Abandoned ( ) by: �N�9yarr at 106 mouAIT 1000 PO, has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and th a�roved design plans/as-built plans relating to application N(� ,q dated Approved Design Flow � (gpd) Installer /V/��/�N Q�L Designer: 6-14 U/005 Inspector. Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No.c 5 O FEE J00 Board of Health, , h 3 f q�L MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repairk(upgrade( ) Abandon( ) an individual sewage disposal system at � (W VT� 040 as described in the application for � fYl f�. pp Disposal System Construction Permit No. dated Provided: Construction shall be completed within three years of th d�1 �. 11ocal conditio�must�be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 31311)e)5 Board of Health.__ TOWN OF BARNSTABLE LOCATION 1G6 �lC �/a 4/ i13 -SEWAGE # VILLAGE %�`� ���� ASSESSOR'S MAP & LOT STALLS ' NAME$c PHONE NO. Ll C'�r4�/✓ 01 R S SEPTIC TANK CAPACITY LEACHING FACILITY: (type). NO.OF BEDROOMS3 - BUILDER OR OWNER PERIviITDATE: —3)—�`� COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility. Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by • i i R V s /oeo� TRAM i IV �S ' � o Town of Barnstable , . Regulatory Services Thomas F.Geiier,Director MAW Public Health Division e6�P M� Thomas McKean,Director -- 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: Sewage Permit# D!r—& Assessor's Map\Parcel o.e Designer: T,,nor_ 1� � Installer: "� Address: S S� Ctt t u✓I Address: o ►�' e',fr-Lt ® Z� � On was issued a permit to install a (date) a (installer) septic system at l.O based on a design drawn by (address) ` dated j- (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box-and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Flan revision or certified as-built by designer to follow. A, e OF MgSPETER T.WENTEE(Installer's S C.) CIVIL ,o No,35109Q �Q �D 9FGtSTB�O (Designer's Signature) (Affix Designer's Stamp Here) PLEASE HE• LIHN TO BAHNSTABLE PUBLIC HEALTH DIVISION, CERTIFICATE OF COMIsI..IANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORl9 AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION, JI{YOU• Q:Health/Septic/Designer Certification Form 3-26-04 doc COMMONWEALTH OF MASSACHUSETTS a w . EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS M DEPARTMENT OF ENVIRONMENTAL PROTECTION 5 5� FAIED INSPECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION cm Property Address: 106 Mountwood Road Qn Mar stons Mills MA 02648 Owner's Name: Roger Harris ' Owner's Address: Same . Date of Inspection: February 9,2005 Job#05-25 � •�= Name of Inspector: PATRICK M.O'CONNELL �N' ' Company Name: SEPTIC INSPECTION SERVICES CO. _ rn 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 approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system ' tttkr�ii�� ����N�' �N OF Mgss.,,�% Passes `2 '•9C+�'., Conditionally Passes = TR ': Needs Further Evaluation by the Local Approving Authority _ _X_ Fails :c; Inspector's Signature: Date: 2/9/05 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: Liquid level in leaching pit currently 2" below inlet pipe and has previously been at top of structure above all effective leaching and tank also shows evidence of previous backup. ****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 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 106 Mountwood Road,Marstons Mills Owner: Roger Harris Date of Inspection: February 9,2005 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: Titl,.C Tncnontinn 17nrm AEI cionnn 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A. CERTIFICATION(continued) Property Address: 106 Mountwood Road,Marstons Mills Owner: Roger Harris Date of Inspection: February 9,2005 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: Titles i Tnmortir%"ilnrm 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 106 Mountwood Road,Marstons Mills Owner: Roger Harris Date of Inspection: February 9,2005 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 %Z day flow _X_ 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. _X_ 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 e 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. Tit].i Tnonantinn Rnrrn,<ii Ciinnn 4 Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 106 Mountwood Road,Marstons Mills Owner: Roger Harris Date of Inspection: February 9,2005 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 _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)] I Titla i Tncnortinn Rnrm </T ai,)nnn 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 106 Mountwood Road,Marstons Mills Owner: Roger Harris Date of Inspection: February 9,2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: unknown 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)): 2003—52,000 gal.2004—89,000 gal.=193 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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: 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 _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: 8/10/83 Were sewage odors detected when arriving at the site(yes or no): No Titles C T"0nArtinn T:nr till;ionnn 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: 106 Mountwood Road,Marstons Mills Owner: Roger Harris Date of Inspection: February 9,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron X40 PVC_other(explain): Distance from private water supply well—or—suction line: 15' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 1' 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: 3" Distance from top of sludge to bottom of outlet tee or baffle: 27" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 12" 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 currently at bottom of outlet pipe observed deposits of solids on top of baffles 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.): Titla 5 Tnanantinn 17r% m,<il,gmnnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 106 Mountwood Road,Marstons Mills Owner: Roger Harris Date of Inspection: February 9,2005 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" 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.): Hi¢h stain line above bottom of outlet vine 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.): Titles i TnC11PPtinn Fnrm r,il aiinnn 8 Page 9 of 11 OFFICIAL INSPECTIO N FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) I� Property Address: 106 Mountwood Road,Marstons Mills Owner: Roger Harris Date of Inspection: February 9,2005 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.): Liquid level currently 2" below inlet nine Pit has a high stain line over top of inlet nine also observed solids buildup on top of inlet pine 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.): Title Tnonontinn 17^r F/i S/7Ml1 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 106 Mountwood Road,Marstons Mills Owner: Roger Harris Date of Inspection: February 9,2005 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. Mountwood Road Water service 57 45 24 31 44 10 Gar. #106 Titlo C 1"an-a tinn Fnrm ril,;mnnn 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 106 Mountwood Road,Marstons Mills Owner: Roger Harris Date of Inspection: February 9,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 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: 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. TIt1A 4/1 VIA0 l 11 w No..9..3_..,C.../ FEE..................`.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD F !-i A ,f H Appliration for Mipaiial Works Tonstrnrtiun rumit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at �C---------- q � 1� .......................................................A L'."C o� A s 1!/Y1 or Lot No. a e � jO Adress 7.......................•.... r .._Installer Address �� �� d Type of Building Size Lot.............�_.-____--.....Sq. feet U Dwelling No. of Bedrooms............................................Ex ansion Attic g— p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons........,-------------- Showers ( ) — Cafeteria ( ) dOther fixtures .. --.._...--•-----•--•--.....--------------••--.......... ---------- w Design Flow.................. .--•-._.s_ ._..__gallons per person pe day. Total d ily flow__._. _�._�.......................gallons. WSeptic Tank—Liquid capacityOLallons Length........ Width... j........ Diameter................ Depth................ Disposal Trench No. .................... Widt 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........................................ 14 Test Pit No. 1..... --__.minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ -- - -•---------- ------- ......--------- ------------------------- Descriptionof Soil-----,�_...__,�:............�----•- ........-•-�------. -�---••-••-•-•--••---- ................................. •••.......------••- w - 1 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 TITHE 5 of the State Sanitary Code The signe rther agrees not to place the syste in operation until a Certificate of Compliance has bee is d by and iealth. ne .-• ...........•. ..................•-----•-•--.......... Dat Application Approved By --•••- ... -•••-•• •... -....... �r 7��a g ....... Date Application Disapprove or t e 'ollowing reasons:................................................................................................................ .......••••••••--•••-•--•---•••••-•--•-•-•••-•-••-•••-•--•-••••--•••••-•-....-••-------••-•--•-•----•••••-•-•--•-•-----.....--••----•••••-----•....••-••-----•-•-•-••••----••---•-•----•-••--•••--•-•--- Date PermitNo......................................................... Issued_-----......__.........----•._.......... ^------...-- --- Date Fi1:$............................. THE COMMONWEALTH OF MASSACHUSETTS �%ZQARDa I-I A Appliratiou for Diipniittl lVarkii Tontitrurtiun Prrutit Application is hereby made for a Permit to Construct (kloor Repair ( ) an Individual Sewage Disposal System at: -" K ' ...`...................... ........ .......................:r_.... _................................_......_.............. .. Loca o r s r Lot No. . .... -----'�,.. .............................................. r,•' j �9 lAaaress Installer r Address Type of Building Size Lot.... L. .........Sq. feet Dwelling—No. of Bedrooms......... .. .. ...............................Expansion tfic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons......... ----_---------- Showers ( ) — Cafeteria ( ) 04 Other fixt s -- ......................•--.......-•-•-------•----•••--...........---......_..---'-- W Design Flow................ allons per person pe ay. Total '1y flow...... ......................gallons. WSeptic Tank—Liquid capacit/. allons Length....... .. Width. • ....... Diameter---------------- Depth................ Disposal Trench—No. .................. Widt ----............ Total Length.......... Total leaching area... �c sq. ft. Seepage Pit No....____. ____. Diameter...._ Depth below inlet__.__ ._....._ Total leaching area �?-.--____sq. ft. z Other Distribution box,(., ) Dosing tank ( ) Percolation Test Result Performed by.......................................................................... Date........................................ ,4 Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4q Test Pit No. 2................minutes per,inch Depth of Test Pita..............._. Depth to ground water..__......_.........___,_. Description of Soil---- ». iGf _e -------------- UW ----•--------------------••------.•..... ......---------•----.._..----•----.._..-•----...--------------------------------- --- ..--.._..-------•.----------- 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 TITtZ- 5 of the State Sanitary Code The igne rther agrees not to place the syste in operation until a Certificate of Compliance has.bee is d by and ealth. f ned ^ .. .... t ApplicationApproved By------ ------ ----------------------'----------------------------------------------------------- j Date Application Disapprove or t following reasons:--'•----•-'----------------------•------..._........--••------•---•----•----•--•---••----- .............. --•----•-•------•-•-----•----'------------'--•--•--•-...---•---••-------•-------•-•---------------•-•--------•---..........----••--•-------•---•---•--•------'-•----'----------•-••----------------•--- Date Permit No......................................................... Issued................ ....................................... ...............^--- Date T COMMONWEALTH OF MASSACHUSETTS f BOARD IF F HEAAX t•- /... .....::.:.:.............OF.... ........................................................................... Trrtif iratr of Toutpliattrr THIS IS TO by T1�at e Individual wa s osal System constructed ( or Repaired ( ) --•-•-.....--- ...I U = "" ` 1 .. at---•--••--••----••....... .I ... 4-. ......... ......------'-- ..---`. •_ f l �f. has been installed in accordance with the provisions of TITLE 5 be—State Sanitary Cod as c 'bed in the application for Disposal Works Construction Permit No.._��....._f_.................. dated-...�__���� THE ISSQ! C OF THIS CERTIFICATE SHALL NOT BE CONST AS A GUARANTEE THAT THE SYSTEM WILe FACTION SATISFACTORY. DATE......J..z©..�j--•--•--------------------•------•---------....------. Inspector--- ---- ........................................................................ T,�E COMMONWEALTH OF MASSACHUSETTS BOARD HEA .......... ............OF............ �'�!1-'':� ....................................... r— No......................... FEE........................ Iw iaan rrmit Permission is her by-granted........ ... •-•-•'. ---••••..•----_---- •-•------•-•------ ---•-•-•••-•......-•---•� ....... ............•-•--- to Construct ( or R ai ( ) an I dividual Se r i al at No.---•----••••-----••-•-' - � �' Yi l f l f ' Street as shown onWtheapcat' n for Disposal .�'�'orks Construction Permit No.................... •e '0- ..oar of Health DATE-------' � FORM 1255 A. M. SULKIN, INC., BOSTON i 1 5►►.i GL.G- FA�1�►-`C - � BEOcz�oM ! , 1.10 G-�.RBAGI: �j W ti►DEtZ D� ►L�( F�0W .: 110 x 3 : -73oG.�v, 'I SEPTIG TA►jK = 33ox15�% = �956•P. R ,gyp U51= l000 GAL. o►5Po5A►- PIT U5E tt�oD C�aL. i 5%pCWALL AR_CA = 1505.E ��') •C�7^' 9 15o 6-t= X ;2--5 = 375 G.PQ 9G ,f (`� 7���£3 BOTTOM AQF-Az .. �0 6.F, �1l 50 S.t X I• o 5 O G.P•p._. . .a 'TOTA 1-- o E.S1GN ° .¢2 5 G.P D- _ _ .37 'TOTAL_ DA I L ,( FL-ov! j PE2GOLAT1o�1 RATE I"IN 2MIN or-_LI~55 � � STD �• �• N Of ! RICHAARD (r ALAN c 9-•,a . BAXTER yl,. JONES wy 91' 7 NO,24O48 i 1. • TOP FWD=tOO•O gyp. / � �G• � .•^ ' � . 9711 .• .� � s - ;; .S/LT-1 —To"ov INS. I SUI3So/L MST. p lN . SEPTIG 9�9 L JoaoINV 6uX /` 7 TANK ' GAL. 9c. c�a.✓ LEACu INV. INV. wITu SG 3 yc.s i I �QND'/ r . IWASKGD ' i 670 H es �.. C.1=RT I F I G D p L.DT P L•-A W i �o PRU t~I L.r I . ��?rt,(�. _ L o L 4-r ►o N /�j�,•�7L'yS/.S✓tf/L L s W o• 5 CP.LE SCALE , SATE P�-A N R E P S Q•E N GE• I C E wr I F Y T N AT -T 1+E �oun�A7/osl/5>{o w N NEREOIJ G0MPL45 WITO"THE S 1 of LIN o T p AND 56'ce.GK R_F.Q0IR.EMI=N•f5, C) %_4 / '`OWN Or— 5A2,al 7-A2?L 5 AN-D Z �eel L 0C_p.TED •WITNIW THE GLOoI> PL -60W�.I D AT E Ci ' c�.�fil.�� BAxTE�e NYE INC. ;I • R.EGIS'c�26V'1.Auo5u�vEYoes ! 'Tlll�j PLo.►� 15 NET' anSrp o►d AN O6TEI2.VILLE• • I>J5-1-R-uM6NT 5UZVey �_ tTVAE 6WOUtj No.T DE• 'U5ED't'o 0eTE.Ftl^1►4G ►-�T �IN1=5 APPLICA►-aT ` 0 ti 'LEGEND ROUTE 6 T 543059'12"W ti 22.64' - �! 78 PROPOSED CONTOUR 79 PROPOSED SPOT GRADE �;� � W TOP EXISTING CONTOUR �� y ® TEST PIT TOPFIELO OR t—-- EXISTING WATER MAIN o OLD srACE Ro APN 125 - 017 —OHW— EXISTING OVERHEAD WIRES a $ o 2 O 9 008±J' F BENCHMARK LOCUS (RECORD) r LOCUS MAP N.T.S. EXISTING 5.A.5. TO BE PUMPED FILLED W/5AND EXISTING SEPTIC TANK TOP OF TANK EL: 98,43± INV.(OUT) EL: 97.1 ± w GENERAL NOTES: N M 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL .0 coN BOARD OF HEALTH AND THE DESIGN ENGINEER. u) in 2 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS NO. IOG OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE I STY Z LOCAL RULES AND REGULATIONS. �. Fes. TO i 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE T.O.F. = I0O,83- DESIGN ENGINEER. 27CAR 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN GARAGE 99, ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. r 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 'N �•� �^ THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF BENCHMARK: HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. Iy 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. FYI RIGHT OUTSIDE CORNER 8. THERE ARE NO PRIVATE WELLS LOCATED WITHIN 100' OF THE S.A.S. BOTTOM STEP-EL.= 100.00 — I / I (ASSUMED DATUM) 9. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED N f EIT ON1 1 TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. DRhIEWAY 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 4 ,' PROPS A.S, I THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING +f �� CONSTRUCTION, 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF THE S.A.S. NOTE: AND REPLACE WITH CLEAN FILL AS SPECIFIED IN 310 CMR 255(3). Irrigation system 1n place-front yard. A. I- 743.01' o PETER T. N 4'56'3.1"E _-�'`�L%25' i N 056'31"E a McENTEE N PROPOSED SEPTIC SYSTEM UPGRADE MOUNTWOOD CIVIL 106 MOUNTWOOD ROAD MARSTONS MILLS, MA ✓:u �O� No. 3510�9 xS �' R %AD �, �fGIS1EftF � Prepared for: Roger Harris, 106 Mountwood Rd, Morstons Mills, MA F ECG (40' W1cle) Engineering by: Surveying by: SCALE DRAWN JOB. NO. EnglneeringWorb HOOD SURVEY GROUP 1"=20' P.T.M. 111-05 3 12 West Crossfield Road 18 Route 6A DATE CHECKED SHEET N0. Forestdale, MA 02644 Sandwich, MA 02563 (508) 477-5313 (508) 888-1090 3/18/05 P.T.M. 1 of 2 1 , tl J NOTE: TO PREVENT'BREAKOUT, THE PROPOSED TOP OF FOUNDATION ! F.G. EL: 9'9 FINISH GRADE SHALL NOT BE < EL:96.5 FOR A DISTANCE OF 15' AROUND THE EXISTING EXISTING F.G. EL: 99.7t(EXISTING) F.G. EL: 99.6f(EXISTING) PERIMETER OF THE S.A.S. MAINTAIN 2% MIN SLOPE OVER S.A.S. INSTALL RISER OVER D-BOX TO INSTALL RISER OVER CHAMBER/S T OUTLET OV R S INSTALL RISERS OVER INLET & SHOWN ON PLAN AND SET C E / TO WITHIN 6" OF FINISH GRADE WITHIN 6" OF FINISH GRADE WITHIN 6" OF FINISH GRADE b; �4 I X L =10 L 4'(MAX) "4 SCH 40 PVC s" 4" SCH 40 PVC 2" LAYER OF 1/8" TO 1/2" e tD" ®® ®® DOUBLE WASHED STONE EXISTING EXISTING 14 ® S= 1% (MIN,) 6" ® S-- 1% (MIN.) ®®®e®®® 1000 GALLON INV. ELEV.=95.17 INV. ELEV.=95.00 2' EFF. DEPTH ®®a®®a® A 3/4„_1 1/2„ ` SEPTIC TANK 4' 5.2' 4' DOUBLE WASHED EXISTING EFFECTIVE WIDTH = 13.2' STONE INSTALL INLET & OUTLET TEES INV. ELEV.=96.00 GAS BAFFLE TO BE INSTALLED ONIV INV.EL: 97.1 t OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL, OR EQUAL D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE TOP CONC. ELEV.=96.8 —BREAKOUT ELEV.=96.5 ON A MECHANICALLY COMPACTED SIX INCH CRUSHED Imam n ®®am STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). INV. ELEV.=96.00 ®®®®®®®®®®� ®am 0 m®®® SEPTIC SYSTEM PROFILE BOTTOM ELEV.=94.00 3' - 2 x 8.5, = -I 3' 5' MIN. ABOVE BOTTOM OF �FECTIVE LENGTH = 23.0' N.T.S. T.P. EXCAVATION OR G.W. NO G.W. ENCOUNTERED LEACHING SYSTEM SECTION AT OR ABOVE EL: 88.1 16" =��P��H OF Mgss 6- (3) 5" DIA.OUTLETS 9 T. 1� �.--.��2 ti DESIGN CRITERIA PETER E McENTEE o CIVIL 1 No. 351 . O SOIL LOG NUMBER OF BEDROOMS: 3 BEDROOMS R£C351'09 p 6 SOIL TYPE: CLASS I H-10 LOADING IFS �NG� • � ��" " DATE:. MARCH 7, 2005 2„ SOIL EVALUATOR: PETER T. McENTEE P.E., C.S.E. DESIGN PERCOLATION RATE: 5 MIN./IN. �- - ��ZOI —BOX INSPECTOR: NOT REQ'D-CLASS 1 SOILS DAILY FLOW: 330 G.P.D. DESIGN FLOW: 330 G.P.D N.T.S. No. 106 STY. Elev. TP Depth GARBAGE GRINDER: NO . FRM, LEACHING AREA REQUIRED: (330) = 445.9 S.F. 99.6 D" .74 T.O.F. = 100.83' FILL EXISTING SEPTIC TANK: 1000 GALLON CAPACITY ®E3®® 0 ®E3®® 2.BAR 98.9 8„ ®®®®®®®®®®® 33^ (;AP.AGF A SANDY LOAM ®®®E2®®®® a®® N Z ®kTEaE@ 2®®®®®® 10 YR 3/3 12„ USE 2-500 GALLON LEACHING CHAMBERS IN SERIES _ 98.6 102" NO u'S B SANDY LOAM SIDEWALL AREA: 2(13.2' + 23.0') X 2 = 144.8 S.F. 10 YR 5/8 BOTTOM AREA: 13.2' x 23.0' = 303..6 S.F. tkp•a pa 96.6 36" 448.4 S.F. 4" KNOCKOUT _ Z C TOTAL AREA: 20' DIA. COVER DESIGN FLOW PROVIDED: 0.74(448.4) = 331.8 G.P.D. 4' KNOCKOUT O/4' KNOCKOUT 62' I PROP, S.A.S. I N 2-SYS�ND `-" / PROPOSED SEPTIC SYSTEM - UPGRADE 4" KNOCKOUT L — — — — — - > --- 23' --- 1 106 MOUNTWOOD ROAD, MARSTONS MILLS, MA 88.1 138" Prepared for: Roger Harris, 106 Mountwood Rd, Marstons Mills, MA 500 GALLON CAPACITY, H-10 LOADING S.A.S. LAYOUT PERC RATE <2 MIN IN. "C" HORIZON Engineering by: Surveying by: SCALE DRAWN JOB. N0. CHAMBERS Engineering Works HOOD SURVEY GROUP NTS P.T.M. 11 1-05 N.T.L NO G.W. ENCOUNTERED 12 West Crossfield Road 18 Route 6A xTa DATE CHECKED SHEET NO. Forestdale, MA 02644 Sandwich, MA 02563 (508) 4-77-5313 (508) 888-1090 3/18/05 P.T.M. 2 of 2