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HomeMy WebLinkAbout0100 CRANBERRY LANE - Health i OQ Cranberry Lane Barnstable A= 234 - 019 1 I I TOWN OF BARNSTABLE 9/ 1 � r LOCAs'I'IOI� 'A�1�A21R��1► _ SEWAGE # VILLAGE �a�TZ�(U1\�► 'e ASSESSOR'S MAP&LOTA'I'J 0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER C`ySICA COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 ��� ___ -=.. :. � 160 Q e��.� � �J �- c �2 -��` (3Z" a3� J TOWN OF BARNSTABLE LOCATION /� �J��-y �/G'��/ I SEWAGE VILLAGE <C Uj��e ASSESSOR'S MAP&PARCEL c;04 O l f 'TSTALLERS NA)19&PHONE NO. SEPTIC TANK CAPACITY '3 00 LEACHING FACILITY:(type) C size) NO. OF BEDROOMS 7j OWNER PERMIT DATE: /6/ � 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) Fees ' FURNISHED BY At i a2 4 . :n y Ki - �J ..,...-• _�- .. .r`y".-- •..-...r--'.�.--•��1�17';�.r�.•y_�...+.... .,.,._���'..,•»--'�.s-'z,c^'1--`..-...c....-.�•.-•. ..r..,...v.�+.... '�"�.�`r_.'•---...r-�•r.+....r--/r�..,�'w-.,'G�;F.... -.�--•c-•;- No. / I ,r Fee �� v 'e 4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes r Zippli(atton for �Mpooal 6p aem Cow6truction Verna Application for a Permit to Construct( ) Repair( Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. -Mner's Name,Address,and Tel.No. Assessor'sMap/Pazcel `Q4 pk.i� Installer's Name,Address,and Tel No. Designer's Name,Address and Tel.No. /1r1��✓� 9 Type of Building: Dwelling No.of Bedrooms Z' Lot Size 174 �t�� sq.ft. Garbage Grinder ( ) Other Type of Building /2ff_5 2$2 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date — & —O 'Number of sheets Revision Date Title /4L_" I/ Y`+ Size of Septic ank Type of S.A.S. Z �u ¢ Description of Soil �jJ�2Sp �/9a/✓� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental a and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' ned Date i191o7 Application Approved b Date Application Disapproved by: _ Date for the following reasons Permit No. "� Date Issued o Owr � w. , r _ z _No. / �a , , ;3 �. Fee /� V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zlpplicatton for 30igogal 6p$tem COugtrtiction 3permit Application for a Permit to Construct( ) Repair Upgrade) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.$�Q � 'Owner's Name Address,and Tel.No. Assessor's Map/Parcel dV;Ae3 j GHQ. PA,< /y -/V. t Installer's Name,Address,and Te No. p Designer's Name Address and Tel.N �vd�.eyr%�S�.P�/ �' ✓-Z �G-Z� Cif Type of Building: ,..Dwelling No.of Bedrooms �I f' Lot Size ;7j sq.ft. Garbage.Grinder ( ) r Other Type of Building No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required),�'C gpd Design flow provided 3 q--v d gP Plan Date U U /Number of sheets Revision Date Title Size of Septic'ank / Type of S.A.S. aj--k 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 Title 5 of the Environmental.G de and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. 5 gned Date i/is�1v Application Approved b Date /b 7 t Application Disapproved by: Date for the following reasons r Permit No. ---�© � Date Issued 0 —————————— ——————--- ———————— ——————— -- - — THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY-/,,that the On-site-Sewage Disposal System Constructed ( . ) Repaired (J ) Upgraded ( ) Abandoned( )by /f O4d y f� at ocl 1 e �/j 1//L[L has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 0 dated )7. Installer a h �f`tr�, C. �����/ Designers #bedrooms Approved design flow gpd The issuance of this permit shall not be co•strued as a guarantee that the system will func 'oil-as des'g ed. Date `// �7 _ Inspector ——————————— /---- --------------------- --`—/—�— — N`q 1 Fee © l.J THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION BARNSTABLE, MASSACHUSETTS ligo!gal 6p5tem n!6truction 30ermit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at 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: Construc io\n must be completed within three years of the date of t11 his e Date I Approved by Town of Barnstable Regulatory Services Thomas F. Geiler,Director * B"NSfABLE. • 9� iM6 S. �0g Public Health Division AIFo ,ts Thomas McKean;Director 200 Main Street,Hyannis,MA 02601 Office:. 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification.Form Date: Sewage Permit# w"7 __0 O tAssessor's Map\.Parcel ®4 _Designer: Tlwr-&-A6Installer: 0t1r, ( , Address: . V Address: `01S� On 04 1 was issued a permit to install a (date) (i s ller) r septic system at based on a design drawn by (address) r1e11/, 4 dated (designer) X.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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced. above was installed with major changes-(i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by signer to follow. Stripout (if required) was inspected and the soils re found sati '_ ory. t �H of kNA / '(Instal r s Signature) ' ' a`' D E Q Mt ER co .� l No. 1140 (Designers Signature) ----(Af ��� p Here) PLEASE RETURN TO BARNS ABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 03-09-06.doc t 5 Town of Barnstable P# 3, Department of Regulatory Services o.RNSTAR_A : Public Health Division MASS Hate 200 Main Street,Hyannis MA 02601 Mld j Date Scheduled O( Time %Pd. ti 1 Soil S/u�i tablt Assessmentfor Sewage Disa osal Performed By: Witnessed BY: LOCATION& GENERAL INFORMATION Location Address Owner's Name 1W741/4 � "° " "/4. Address DD (fret,lee- .�a_rhR Assessor's Map/Parcel: 2_3!4'• — 9 W ( Engineer's Name s Sr/t/t/-Q NEW CONSTRUCTION REPAIR ��6 / Telephone# (�e c�Z _ Land Useo�LSy�� d - 1 Slo es ��3/a . P (%) M- Surface Stones Distances Open Water Bady ft Possible Wet Area 'U /f- ft Drinking Water Well ' l1G�YIVk/� Y[- Drainage Way ft Property Line /2 r ft Other Z S ft Rev le 46C.O. SKETCH:(Street name,dimensions of lot,exact locations of test holes 8c pert tests,locate wetlands?n proximity to holes) TOo.i EYL- Lk -V'3 o C) - c-) 0 fi nc, -0— ` 4 Parent material(geologic) �U 7ti9�� w. epth to Bedrock 'VQ-Q' � x' Depth.to Groundwater. Standing Water in Hone:. Weeping from Pit Fate 4/14`4,t- Estimated Seasonal.High Groundwater G ZS /t/eJ 4i t?�oaf�v/o S �F DETERMIN ON FOR SEASONAL HIGH WATER TABLE Method Used: / Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side of hob/s/.hole: N in, Groundwater A justinent ft.Index Well#—A� Reading Date:� Index Well level Adj.factor Adj.Groundwater level: ( ' ,��� . PERCOLATION TEST Date ,14 Tlnta. Observation 4.3 4- Hole# Ord 1• i�-3 Time at 9" Depth of Per¢ -S¢ ., ¢ Time at 6" //:2� /!•-?( Start Pre-soak Time @ /J /!'C)6 Time(9"-611) l'�"`� 6 •�✓ End Pre-soak Rate Min./Inch Z/`� Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Xlp Original: Public Health Division Observation Hole Data To Be Completed tiri Back-----------r ***If percolation test is to be conducted within 100'of wetland,you must first notify the. -Barnstable Conselrvation 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 Other Surface(in:) (USDA) . (Munsell) Mottling (Structure,Stones,Boulders. istencL%Gravel DEEP OBSERVATION HOLE LOG Hole# 2— Depth from Soil Horizon Soil Texture Soil Color Soil' Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ns' C°'a-2s /vya 1 6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) _' Mottling (Structure,Stones,Boulders. Csistency.%Gravel) ,6 Zf ovd t�4� '✓� i9 1XA DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. l Con i e lDYR s(Z ��a v(i /2_ ht4yt C Co /v�� 7L ivsvE Flood Insurance Rate Map: / Above 500 year flood boundary No_ 'Yes ✓__/ Within 500 year boundary No= Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? ES If not,what is the depth of naturally occurring pervious material?,. . Certification I certify that on lqj,--(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 trai ' ,ex ertise n e ' ce described in 310 CMR 15.017. Date /Z. 4'J� Signature , Q:\SEPTICVERCFORM.DOC COMMONWEALTH OF MASSACHUSETTS ,rfCE EXECUTIVE OFFICE OF ENVIRONMENTAL AFF ApR o DEPARTMENT of ENVIRONMENTAL PRoTECTIo TO�h+oF 199? ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 ��Fty �Tgg�F ti WILLIAM F.WELD Governor i ARGEO PAUL CELLUCCI DAVM B. STRUHS Lt. Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address:.lom �,.,,"- _ hea.v�r�l�. Address of Owner: Date of Inspection: p /3 44 M �j �— (If different) . ��'✓p� /Z��. Name of Inspector: . _. ��_v_o ��o rt� If 7'_ p Company Name, Address and Telephone Number: Ft�'�I�wST1L Ep7 V�Cc�.•_ v�.�.:h�,�•(.:�oA 'i��y� i"1 r.Sn�s_� ty r�r i�2d.�5 C 5�=`GT y17-1 y2� 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 Conditionally Passes Needs Further Evaluation By the,Local Approving Authority F iIs Inspector's Signature: Y Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: , � I Check A, B, C, or D: r A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. 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, 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 conforming septic tank as approved by the Board of Health. (revised-11/03/95) 1 l C� Printed an Recycled Paper 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 0 j Property Address: .(�!> Owner: `= � D�ate owliispedion: B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the istribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The s stem will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year a 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 EALTH: Conditions exist which require further evaluation by t 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 HEALT 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 f a surface water Cesspool or privy is within 50 fee of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOA g OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM 15 FUNCTIONING IN .alrfN_A-NNER THAT PROTECTs THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a sep�Ctank Znk and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a sep and soil absorption system and is within a Zone I of a public water supply well. The system has a se tic tank and soil absorption system and is within 50 feet of a private water supply well. The system has aleptic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unl ss a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from poll ion from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• 3) OTHER a (revised 11/03/95) 2 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION/defined PART A CERTIFICATION (co1ntinued)I Property Address: ,(p p � .0 err y �� lA^-c f�.-v" l 1 e— Owner: P Lis r..A,- Date of Inspection: D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteriaCMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted t determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overload or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surfa waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or availa a volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT ue to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or rivy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet f a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zon I of a public well. Any portion of a cesspool or privy is within 50 eet of a private water supply well. Any portion of a cesspool or privy is less tha 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the w I has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compou ds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems n addition to the criteria above: 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 environ ent because one or more of the following conditions exist: the system is within 400 fee of a surface drinking water supply the system is within 200 @et of a tributary to a surface drinking water supply the system is located i a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply ell) The owner or operator of any such s stem shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 an 6.00. Please consult the local regional office of the Department for further information. N (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:_,(dp C_�"K•.c L y lc� w Q_ 2., Owner: 'F- G [ys i'LGr' / Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. Jk None of the system components have been pumped for at least two weeks 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. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. 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 or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: .(po Owner: y Date of Inspection: 5rz- FLOW CONDITIONS RESIDENTIAL: Design flow: '6S O gallons Number of bedrooms:_',p Number of current residents:,•Oi_ Garbage grinder(yes or no):N-i8 Laundry connected to system (yes or no):IV-S Seasonal use (yes or no): Jo Water meter readings, if available: *jy).t visip asA� Y Last date of occupancy:— tI-W— COMMERCIAUINDUSTRIAL: Type of establishment:- Design flow:_gallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: SysT"V-, SV'xi\8 be_ P om O-e.cg. k K.' System pumped as part of inspection: (yes or no) !J If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (ye r no) (if yes, attach previous inspectio records, if any) Other(explain) ' �M2& k- , o✓e Uuy �i�m1G APPROXIMATE AGE of all components, date installed (if known) and source of information: A- '?S0 Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) $ I� � J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �![�d Owner: � L[".5 Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, dept/liquid el in relation to outlet invert, structural integrity, evidence of leakage, etc.) M / GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP other(exp ain) 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 b ffle: Comments: (recommendation for pumping, condition of inlet and utlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 P SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) I Property Address: if v o Owner: Date of Inspection: �3lL�ly� TIGHT OR HOLDING TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: 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: Comments: (note if level and distribution is equal, evidence of solids /ryover, e of leakage into or out of box, etc.) PUMP CHAMBER_ /itionof (locate on site plan)Pumps in working order.(yes or no) Comments: (note condition of pump chamber, cos and appurtenances, etc.) (revised 11/03/95) 7 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: _.(oe Owner: Date of Inspection: O 3 � SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excav lion not required, but may be approximated by non-intrusive methods) x If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note con ition of soil, signs of hydraulic failure, level of ponding, condition of veg etc CESSPOOLS: (locate on site p an 1 Number and configuration: ll 1 WON Depth-top of liquid to inlet invert: 1e 11 Depth of solids layer: All Depth of scum layer: a � Dimensions of cesspool: (9 1t 1 Materials of construction: C'©Lrr uX47 -Nric—V_ Indication of groundwater: QQ inflow (cesspool must be pumped as part of inspection) r li f ' re level of ondin con ' io of a ion etc.) i • f it nsofh dau c u , Comments: (note con lion o soil, s p g, � 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.) (revised 11/03/95) 8 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C " SYSTEM INFORMATION (continued) Property dress: -C a' v �t�u c� Lj2cc_t� �y�.r�_ v�� LLe — Owner: C v S r L Date of Inspection SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' O DEPTH TO GROUNDWATER Depth to groundwater: 1 ZU feet method of determination or approximation: (�•S• U (revised 11/03/95) 9 i 3 D 1 D AT E:jj.619_ PROPERTY ADDRESS: 100_C;:ra.nberry- w1�_____ Centerville, Mass . ------------------------- 02632 � On the above date, 1 inspected the septic system at the above ,address. ; This system consists of the following: A. 2-6x8 --b-lock cesspools . I B. Age . about 30 years . Based on my inspection, I certify the following conditions: A::-Th-is not a titlefive septic system. B. No repairs are needed at this time. I - i i SIGNATURE*,c Name:_J,P -MgcgL ber_�._.___—__ � Company:_ nc : 1 Address: ' -- Box—6 6---------•---- � � "� ---C Q.n '.ywi 11e.,_Ma-s..s---22 6 3 2 Phone:_ 508_775_3338-_-______ 9� 'THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRAN LEPMACOMBER & SON, INC. -Cesspools-LeachfIeldsmped & Installed sewer Connections Centerville, MA 02632-00665.3338 775-6412 - i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , Address of property lUU Owner ' s name Date of Inspection PART A CHECKLIST Check if the following have been done: v Pumping information was requested of the owner, occupant, and Board of Health. L/ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period . Large volumes of water have not been introduced into the � l system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility .or dwelling was inspected for signs of sewage back- 9 up. V The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. The septic tank manholes were uncovered, opened, and the interior pf 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 SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner (and occupants, if different from owner) were Provided with information on the proper maintenance of SSDS. 2G C>r-il1 r cv7 l�� L � I . E SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential 2 number of bedrooms number of current residents garbage grinder, yes or no TET laundry connected to system, yes or no seasonal use, yes or no If nonresidential , calculated flow: Water meter readings, if available: Last date of occupancy GENERAL INFORMATION Pumping r cords and source of information: V 1 ' G Q 1 1 I System pumped as part of inspection, yes or no if yes, volume pumped Reason for pumping : Type of system Septic tank/distribution box/soil absorption system Singl.e cesspool _ Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) Approximate age of all components. Date installed informat n: , if known. Source of io C_l rhlGv�G 1v Sewage odors detected when arriving at the site es o y r no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: i.)� (locate on site plan) depth below grade: material of construction: concrete metal FRP other(explain) dimensions: sludge depth distance from top of sludge to bottom of outlet tee or baffle 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. 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, recommendations for repairs, etc. ) DISTRIBUTION BOX: Klc>►UE (locate on site plan) r depth of liquid level above outlet invert Comments : (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, .recommendation for repairs, etc. ) �I ? PUMP CHAMBER: (locate on site plan) pumps in working order, yes or no Comments : (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs,etc. ) 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued �) SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: . Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number. Comments: (note condition of soil , signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,etc. ) CESSPOOLS (locate on site plan) number and configuration depth-top of liquid to inlet invert depth of solids layer EC) Ndepth of scum layer - dimensions of .cesspool ©� materials of construction Lort� 6�b, indication of groundwater inflow (cesspool must be.pumped as ��� part of inspection) N O v�D tFZ� Comments: (note condition of soil signs. of hydraulic 9 y ulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs,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, b condition of vegetation, recommendations for maintenance or repairs,etc. ) ,'--- ' 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' per , a C i r .✓/5'e DEPTH TO GROUNDWATER tic . depth to groundwater 'F-2.C)1-..t method of determination or. approximation: �� ��17 cJvYLi-ACC �L. �' 7" �J eo ,1 (O , �iLC�.vt 5 ITS (`31 Tr) 1'rn U✓l �' A-T' �,4��' h . 1 1 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. If "not determined" , explain why not) i`P)- Backup of sewage into facility? kc) Discharge or ponding of effluent to the surf ace of the ground or surface waters? K-L- Static liquid level in the distribution istribution box above outlet invert? ISO Liquid depth 1n cesspool <61� below invert or available volume< 1/2 day .flow? Required pumping 4 times or more ? -- -•.� 9 in the last year.. number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? �(T Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? . within 50 feet of a surface water? ►y� within 100 'feet of a surface water supply,or tributary to a surface water supply? within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? t within • 50 feet of a rivate water ater supply well . 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 Qrganic compounds, ammonia nitrogen and nitrate nitrogen. s SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART D CERTIFICATION Inspector : Peter Sullivan PE Location : 100 Cranberry Lane Centerville Date :June2,1995 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. Please note the summary of recommendations as presented in this form. Lastly please note 310CMR:15.302 Criteria for Inspection(1) "The inspection is not designed to provide information to demonstrate that the system will adequately serve the use to be placed upon it by the new owner. " truly yo 4etAe�rulan PE Distribution: Original to system owner OF Buyer KTFR1G Board of Heath SULLIVAN � No. 29733 STANDARD NO TES TOP OF Raise covers to within 6" of 1) THIS PLAN IS FOR THE INSTALLATION OF A SEPTIC SYSTEM. FOUNDATION finish ,grade install risers as needed EL 77 2) ALL INSTALLATION PROCEDURES AND MATERIALS SHALL CONFORM TO 310 CMR 15 000, THE STATE ENVIRONMENTAL CODE, 60. �--,. TITLE 5 AND THE TOWN OF _�� Barnsta ble Gr = 60. 0 �"'''�- GROUND SURFACE AL__59_. 7-- ' ____�_ SUBSURFACE DISPOSAL REGULATIONS. 4 Ban 3) NO DETERMINATION HAS BEEN MADE AS TO "COMPLIANCE OF A VAILABLE.PROPERTY INFORMATION WITH RECORDED DEEDS Stainless Steel Proposed OR ZONING REGULATIONS. Connector Top 58. 6' D Di8-Box ( +'QAU 57 55 4) TOWN WATER DOES SERVICE THIS PROPERTY so ---_____ TOP EL 2794 5) THERE ARE NO EXISTING WELLS WITHIN 200' OF THE PROPOSED SOIL ABSORPTION SYSTEM., 2",MIN-3'MAX MIN 2' LAYER DOUBLE WASHED INVERT EL 1/8'-00i/e' STONE 6) ALL COVERS OF SYSTEM" COMPONENTS SHALL 8E BROUGHT TO WITHIN 6" OF FINISHED GRADE 1p24 •'•' 1 " :; •; — .� _ _.._ _ _ — ..— �.. � .� _4 EFFECTIVE 7) ALL SYSTEM COMPONENTS SHALL` REMAIN ACCESSIBLE' FOR INSPECTION. NO STRUCTURE'S SHALL BE LOCATED DIRECTLY i INSTALL "''"' — — — ..••. SIDEWALL UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS, WHICH ,TfOULD INTERFERE WITH THE PERFORMANCE, ACCESS, INSPECTION PUMPING OR REPAIR. GAS L BAFFLE W Two 500 Gal Cane 3/4'- 1 1/2' DOUBLE 8' NO DRIVEWAY, PARKING OR 'TURNING AREA, OR 'OTHER IMPERVIOUS AREA SHALL..BE LOCATED ABOVE A SOIL ABSORPTION W Bot 53.0 W b � WASHED STONE ) 6 STONE BASEchambers w/4' stone all around „ � � � � � � " � �, � " '�' � 54.B0 BOT7i0M EL SYSTEM, EXCEPT WHEN VENTING HAS BEEN PROVIDED. � �, (4 -1�0 x 8-6 x 2-8) Q, Proposed (H-10) r.; 9) SEPTIC TANKS; GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6" STONE BASE 1,500 Gal .Septic Tank � S = 0 06 �S' = 0.01....I �I �I 10 OU7LETTO URE DISTRITBUTION LINESABILITY AND SETTLING. S = 0. 02 (Typical) � �--__ 1 ) S ALL REMAIN LEVEL FOR A MINIMUM OF THE FIRST TWO FEET OF THEIR LENGTH. 18' I I 478 11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' F._..,. EL BOTTOM OF TEST HOLE J2 2s' No Ground Water OF DRIVEWAYS OR PARKING OR TURNING AREAS, IN. WHICH CASE H 20 COMPONENTS SHALL BE USED 12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DIAMETER OF 4 AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC. 13) THE DEPTH OF THE TOP OF ALL SYSTEM ''COMPONNENTS SHALL NOT EXCEED 36 UNLESS VENTING HAS BEEN PROVIDED. 14) IN THE AREAS OF EXCAVATION, EXISTING GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS. 15) IF SOILS ARE ENCOUNTERED DURING THE EXCA VA'TION OF THE SOIL ABSORPTION SYSTEM, THAT DIFFER NOTABLY FROM THE DEEP OBSERVATION HOLE LOG, CONTACT THE ENGINEER BEFORE PROCEEDING. 16) CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES 17) EXISTING PLUMBING TO BE MODIFIED TO MEET PROPOSED OUTLET ELEVATION & LOCATION 18) EXISTING CESSPOOL TO BE PUMPED AND REMOVED PER TITLE 5 N/F- Fnd Commonwealth Electric Map R34 Parcel 50 .DEEP OBSERVATION .DEEP OBSERVATION syoa - ..� HOLE LOG HOLE LOG DESIGN DA TA Test Hole #1 Test Hole #2 - .. (EL = 60.0 f) (EL = 59,e f) Number of Bedrooms:` 2 7 '1?hy TA xoMzon Texture egolr �i )o Hogz'on TSx°ture Color Garage Grinder; NO Lot (USDA) (M,�neeli) USDA) Mansell) Design Flow: 3 BR , . �30 17, 770E Sq. Ft. (110 (al/SR/Day x Number of SR) 4 - 1 48.0 C Cgcrse Sandy ' .. a itiB.O LOAA ' SAND' _2!�1+ "4k"„ 5," ` Gravel Tank.Uc 1,500 / 18" — 144" 47.8 C COARSE SAND corm/e (Minimum - Design Flow a 200%) (gal 5% Gravel Leaching Area; �0 / Sidewall - (s5:0+ lees) x 2 x 2 = 151.3 SF 6$ LEA / Deep Obs Hole Date: 12-4-06 Deep Obs Hole Date; 12Jb4/08 Bottom; + 25,0' 12. + 20.8 r5'F ...._._a t x _._.__p t? ..,....,, .8 SP PROPOSED LEACHING FACILITY soil Evaluator: ED STONE Boil Evaluator: ED STONE Leaching Area Design Capacity: 4 72.1 SF 66 Two 500 Gal Cone Chambers with witnessed By: D. DE'SMARAIS witnessed By: D. DASMARAIS 4' Stone all around Total Dim's = 25' X 12'-10" Pere Rate: 2 Min/In 0 54" Pere Itate: (Sidewall Area + Bottom Area) x LTAR x a 74 8 (4=-YO" X �'-6" 2 .9` soil survey Description: CARDER soil Survey Description; CARVER GPD Provided 349 GPD X 60 .--�'' Geologic Material: GLACIAL 0u ASS J14MAINS Geologic Material: GLACIAL 00WASN MOMAINa Depth to standing Water: NA Depth to Standing water. NA 19 Depth to weeping Water: NA Depth Weeping 349 330 D th to wee in Water. NA ---- — ---- —_-- g �� .; ,,+: ;j; ., 9 Depth to Mottling(Color): NA Depth to Mottliag(Color): D Provided GPD q 0; p DTX �"""�--- ,.� Est Seasonal High Gw; NA Eat seasonal High GW; N� GP Pro P Required = Reserve d�8 'fix 0 Aft Proposed USGS Observation well: NA vsGs Observation Well: NA Pump. Sand Fill 12 ti 0 DTX D_Box � Co °xi�et Measurement NA Cpsof Last Measurement NA and Crush Cesspools DTX,�4 ACE 0 NIF Proposed Chaplic .0 O 1,500 Ga I Map 254 Parcel 20 , 6 y Q s—Tank Slte & Se tic .Plan C ' o e1 45.4'._.."`�` Rep air Upgra d e Assum d , + 1 gowPef DEEP OBSERVATION DEEP OBSERVATION 60.00 19.4 � Car O 0 HOLE LOG zoned.• RF-1 & 100 Cranberry Lane NIF PIN00 COr. � m.ar• ayes Port HOLE LOG GP, Zone II I bg in Open Space Bldg J100 Test Hole #3 Test Hole #4 Centerville, MA Map 66 Parcel 9 2 Bdr (EL = 60.4 f) (EL = ao.l f) TOF 60. 77 D 1188v soil g�ii gg" t1 D 1 v Boil soil ii Scale.' 1"=20' DATE.' 1108107 / �ipn M Horizon Texture Cbolor �ipn� Cf1) Horizon Te oilr� eovolr 20.9' I (USDA) Munseil) (vSDa) (Mumseu) REV. 0' - 8" 59.7 A LOAMY SAND 10YR3/2 41.e,;,--'� Bth Kit Deed Refezence 800E - 20" 58.6 B LOAMY SAND 1oYR5/6 0 - 12" 59.1 B LOAMY SAND - 1orR5/6 Bk. 10718 ,'Pg. 50 Prepared For.' {�0 �Le Bed bb 20 — 144" 48.4 C COARSE SAND f0YR7/6 12" — 144" 48.1 C COARSE SAN IOYR7.6 --� _---- A MI t ch ell G. Ba rros 336' Bed Liv Plan Reference 100 Cranberry Lane a Pl. Bk. 1�,2 Pg 51 Centerville, MA 0,?632 gitlx Deep Obs Hole Date: 12/04/06 Deep Obs Hole Date: 12104106 ° Floor Plan Soil Evaluator: ED 'STONE Soil Evaluator: ED STONE' Fema Map Ref. Prepared By." b5 85'06;�0" j� (�� N.T.S, witnessed Hy: D. DESNARAIS witnessed Sy: D. DESMARAIS �v -`` _ 97000 Q Pere,Rate: 2 min/in 0 44" Pere Rate: 250001--5(.� Inc.Soil Survey Description: CARVER Soil Survey Description: CARVER EAS Survey, I Geologic Material: GLACIAL OUTIIASS AN AWNS Geologic Material: OLACIAL WMASM MOMUINS Depth to Standing Water: NA Depth to Standing water, NA Zone l,./� 8; 09185 141 Rte 6A P.O Box 1729 HyaTretll Depth to weeping Water! NA Depth to weeping water: NA Sand ideb, MA 02563 \ Depth to Mottling(Color): NA Depth to Mottling(Color): NA \\ Est Seasonal High Gr. NA Bet seasonal High Gw NA (508,) 888-3819 USGs Observation Well: NA psGs Observation well: NA ASSESSORS MAP ,234 LOT 1 Fax 888-2498 �Ry ] /J Date'of Last Measurement: NA Date of Last Measurement: hrA -L.! Comments: Comments: DW No, SM Cape Now ( N Ev MEYER STONS GRAPHIC SCALE CrCranberry., �No. 1140o q o.28980 20 0 10 20 40 so Lane l GISTS c�P� S4'N►TAMP� ( IN FEET ) Locus1 c Huc insinch 20= ft. Huck ins Neck Rd I