HomeMy WebLinkAbout0148 MARCHANT'S MILL WAY - Health .48 Marchant's Mill Wad
Hyannisport
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�%ay 25 2016 22:21 Jim The Inspector Man 5085349919 page 1
�■ Commonwealth of Massachusetts
Title 5 Official Inspection Form `3
6 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Cr
148 Marchant's Mill Way
I� Property Address f..
4??
Elizabeth Goulding
Owner ,
Owner's Name ,
information is
required for every Y H annisport MA 02547 5-23-16
page. City/Town State Zip Code Date of Inspection �1
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
( � t�tUlttllrtrN
on the computer, lI `��" ����t�t�N OF
use only the tab ��t�'..•••••�S'
1. Ins ector:
key to move your pr• '•.�'�G
cursor-do notuse ,lames D.Sears �: JAMES :m
key. Name return Name of InspectorX C,3, SEARS _
���------��� _Capewide Enterprises, LLC *'
.� i i Company Name 4 vRTII o
- 153 Commercial Street ���i��i�R 5 INSP�;'�
Company Address
Mashpee MA 02649
Cityrrown State Zip Code
508-477-8877 S1623
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system: �.
® Passes ❑ Conditionally Passes ❑ Fails'
❑ .Needs Further Evaluation by the Local Approving Authority
�I1.r-l1i t.ra 5-25-16
Ai spectoes Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner }
and copies sent to the buyer, if applicable, and the approving authority.
"*"This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspectlpn does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
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May 25 2016 22:21 Jim The Inspector Man 5085349919 page 2 'F
commonwealth of Massachusetts
Title 5 Official Inspection Form
6 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is
required for every Hyannisport MA 02647 5-23-16t
page. City/Town Slate Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E I 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 GMR 15.304 exist. Any failure criteria not evaluated are l'
Indicated below.
Comments:
The system is a 1000 Gal, Tank D Box and three pipe field.
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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.
41
Check the box for"yes", "no"or`not determined' (Y, N, ND)for the following statements. If"not
determined," please explain. U
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.
❑ Y ❑ N ❑ ND (Explain below):
: I
A.
15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
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May 25 2016 22:21 Jim The Inspector Man 5085349919 page 3
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a 6 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is
required for every Hyannisport MA 02647 5-23-16 .
page. City/Town State Zip Code Date of Inspection
B. Certification (cunt.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
t
B) System Conditionally.Passes (cont.):
❑ 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 ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
t
❑ 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 ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): y
•1
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
t5ins-W13 Title 5 Official Inspedion Form:Subsurface Sewage Disposal System-Page 3 of 17 e
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May 25 2016 22:21 Jim The Inspector Man 5085349919 page 4
Commonwealth of Massachusetts {
s Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
`t
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is required for every Hy annlsport MA 02647 5-23-16
page. City/Town State Zip Code Date of Inspection f
B. Certification (cost.)
2. System will fall 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. f
❑ 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 fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
x
s
i
D) System Failure Criteria Applicable to All Systems: .
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
® Backhp of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in aqwjpW is less than 5"below invert or available volume is less
than %day flow 4 Fib /V6_
15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
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May 25 2016 22:21 Jim The Inspector Man 5085349919 page 5
Commonwealth of Massachusetts
_ Title 5 .Official Inspection Form
8 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information y
ton is
required for every H annisport MA 02647 5-23-16 .—
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® 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.
w
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis '
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no".to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection °
❑ Area—IWPA)or a mapped Zone It of a public water supply well
h
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. A
t5ins•3113 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
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May 25 2016 22:22 Jim The Inspector Man 5085349919 page 6
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
148 Marchant's Mill Way ? y
Property Address
Elizabeth Goulding „{
Owner Owner's Name
information is required for every _Hyannis port p MA 02647 5-23-16
page. Cityfrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® Were as built plans of the system obtained and examined? (If they were not
El available note as NIA)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS) on the site has
been determined based on:
❑ Existing information. For example, a plan at the Board of Health. t
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
y
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
c5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
May 25 2016 22:22 Jim The Inspector Man 5085349919 page 7
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is H i3nnlS
required for every Y port MA 02647 5-23-16
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
The system is a 1000 Gal. Tank D Box and three pipe field
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ,
information in this report.) ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2014-44,000Gals
9 ( y 9 (gp ))-. 2015-77,000Gal's
Detail:
:i
E
Sump pump?
❑ Yes ® No
Last date of occupancy: Present
Date
Commercialllndustrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CM 15.203): Gallons per day(gpd) ti
Basis of design flow(seats/persons/sq.ft.,etc.): f
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
i
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 7 of 17
May 25 2016 22:22 Jim The Inspector Man 5085349019 page 8
Commonwealth of Massachusetts
Title 5 Official Inspection Form fa
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is required for every �H annisport MA 02647 5-23-16
page. City/Town State Zip Code Date of Inspection
n
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records: b►
Source of information: 2016 :!
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
'x.
How was quantity pumped determined?
Reason for pumping:
Type of System: t
® Septic tank, distribution box, soil absorption system -t
❑ 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) and a copy of latest
F, inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
3
•i
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page B of 17
6
May 25 2016 22:22 Jim The Inspector Man 5085349919 page 9
Commonwealth of Massachusetts
Title 5 Official Inspection Form g
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
° 148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is Hyannisport MA 02647 5-23-16
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information: }.
NA
Were sewage odors detected when arriving at the site? ❑ Yes Ig No
Building Sewer(locate on site plan):
Depth below grade: 24"
feet
Material of construction:
❑ cast iron ®40 PVC ❑other(explain):
Distance from private water supply well or suction line: feet -
Comments(on condition of joints, venting, evidence of leakage, etc.):
Pipeing is 4" PVC SCH 40.
Septic Tank(locate on site plan):
Depth below grade: 14"feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑.polyethylene ❑ other(explain)
,z
If tank is metal, list age: years q
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) . ❑ Yes ❑ No
1000 Gal. Precast H-10
Dimensions: ti
Sludge depth: 1
t5lns-3113 TRIe5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
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May 25 2016 2222 Jim The Inspector Man 5085349919 page 10 j
k
Commonwealth of Massachusetts
Title 5 official Inspection Form
a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address `
Elizabeth Goulding
Owner Owner's Name
information is z
required for every Hyannisport MA 02647 5-23-16 :
page. CitylTown State Zip Code Date of Inspection
D. System Information (cons)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
29"
Scum thickness On
Distance from top of scum to top of outlet tee or baffle
8" #
Distance from bottom of scum to bottom of outlet tee or baffle
18"
How were dimensions determined? Asbuilt-Tape 'Y
Sludge Judge
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage,.etc.):
Tank at working level. Tank and covers at 14" below grade. In and outlet tee's. No sign of leak
age or over loading.
a
Grease Trap(locate on site plan):
Depth below grade: feet
hl
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
h�
a
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 t
May 25 2016 22:23 Jim l'he Inspector Man 5085349919 page 11 .
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
r` 148 Marchant's Mill Way
Property Address
f
Elizabeth Goulding
Owner Owner's Name
information is .required for every Hyannisport MA 02647 5-23-16,
page, Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction: t
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
i
Capacity:
gallons ;
Design Flow: 1
gallons per day
Alarm present: ❑ Yes ❑ No I
Alarm level: Alarm in working order: ❑ Yes ❑ Nof
,j
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
s
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
S
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
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May 25 2016 22:23 Jim The Inspector Man 5085349919 page 12
Commonwealth of Massachusetts 1
Title 5 Official Inspection Forma
it
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is 'a
required for every Hyannisport MA 02647 5-23-16 s!
page. CitylTown State Zip Code Date of Inspection
D. System Information (cant.) 'k
Distribution Box (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.):
D Box is 16"x21"-23"below grade. Box is clean and solid w/three lines out.'No sign of over
loading or solid carry over.
f
-F
f
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
4:c
Alarms in working order: ❑ Yes ❑ Now
t
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.), :.
t
r
If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why: '
4
i'
t5ins•3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
g
May 25 2016 22:23 Jim The Inspector Man 5085349919 page 13
Commonwealth of Massachusetts
Title 5 Official Inspection Form
A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
"< 148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is required for every Hyannisport MA 02647 5-23-16
page. City/Town State Zip Code Date of Inspection
r'
D. System Information (cont.)
Type
❑ leaching pits number:
❑ leaching chambers number:
r
❑ leaching galleries number:
❑ leaching trenches number, length:
® leaching fields number, dimensions: 1-20'x 30'x1'
❑ overflow cesspool number:
x ,
e
❑ innovative/alternative system xi
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of `}
vegetation, etc.):
Leaching is a three pipe field (20'x30'x1'). Ck D Box and camera out lines. No sign of over loading
or solid carry over. No sign of holding water.
+
f�
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert '
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
;t
t5ins•3/13 Title 5 Official Inspection Form:SubsWace Sewage Disposal System•Page 13 of 17
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May 25 2016 22:23 Jim The Inspector Man 5085349919 page 14
Commonwealth of Massachusetts
Title 5 Official Inspection Form _
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding ,
Owner Owner's Name
information is p
required for every �ann H is ort MA 02647 5-23-16
page. CityrFown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
S
a
1
Privy (locate on site plan):
4
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, a
etc.):
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Rd
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4
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t5ins-3113 Tills 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
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May 25 2016 22,23 Jim The Inspector Man 5085349919 page 15 R
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Commonwealth of Massachusetts :I
. Title 5 Official Inspection Form `{
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
`f 148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name S
information is required for every Hyannisport MA. 02647 5-23-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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151ns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
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May 25 2016 22:23 Jim The Inspector Man 5085349919 page 16 f
ii.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name =;
information is required for every Hyannisport MA 02647 5-23-16
page. Cityfrown State Zip Code Date of Inspection `
D. System Information (cont.) .
It
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
7'
Estimated depth to ground water: feet l
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record '
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers -(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Hand Auger T.H. T G.W.. Bottom of field at 3' below grade. Bottom of field at 4'+ above T.H.
Depth.
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Before filing this Inspection Report, please see Report Completeness Checklist on next page.
15ins-3/13 Title 5 Official Inspection ronn:Subsurface Sewage Disposal System-Page 16 o1 17
May 25 2016 2224 Jim The Inspector Man 5085349919 page 17
Commonwealth of Massachusetts.
Title 5 Official Inspection Form j.
' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'< 148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is required for every HY p annis ort MA 02647 5-23-16
page. Cityfrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•311 a Title 5 Official Inspection Form:Subsudam Sewage Disposal Syalem•Page 17 of 17
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �� Q
148 Marchant's Mill Way O
Property Address
Elizabeth Goulding
Owner Owner's Name
-information is H annis ort Ma. 02647 6/06/2008
required for y p
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. .,
l
Important: A. General Information
When filling out
forms on the
computer,use 1: Inspector:
only the tab key
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC
Company Name
r� P.O.Box 763
Company Address
Centerville . Ma. 02632
City/Town State Zip Code
(508)428-4028 S14454
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
informatiori reported below is true, accurate and complete as of the time of the inspection. The inspection
C= was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
o ® Passes ❑.Conditionally Passes ❑ Fails
c...s
❑ Needs Further Evaluation by the Local Approving Authority CD
9'14 6/06/2008 ::.
Insp ctor's Signat Date
The system inspector shall submit a copy of this inspection report to the Appro g Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared syxsterpr
has a design flow of 10,000 gpd or greater, the.inspector and the system owner hall suQ&t then
report to the appropriate regional office of the DEP. The original should be sent t the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only.describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
148 Marchant's Mill way•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 2
' Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is p
required for y H annis ort Ma. 02647 6/06/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
r ,
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:
The septic system is in proper working order at the present time.
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
148 Marchant's Mill way•03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 2
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
^M 148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is p required for H annis ort Ma. 02647 6/06/2008
y
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced `
ND Explain: -
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is riot 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.
148 Marchant's Mill way•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 3
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is p required for y H annis ort Ma. 02647 6/06/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
' more from a private water supply well**.
Method used to determine distance:
` **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes". or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El ® 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). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
148 Marchant's Mill way-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 4
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is p required for �H annis ort Ma. 02647 6/06/2008
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
The system is a cesspool serving a facility with a design flow of 2000gpd-
❑ ® 10,000gpd.
❑ E The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes;' or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a,surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
148 Marchanl's Mill way•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 5
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is ann H is ort Ma. 02647 .6/06/2008
required for y p
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes"'or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant; or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
El ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ® Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage backup?
® ❑ Was the site inspected for signs of break out?
• ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner) provided with
® ❑ information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria.related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
148 Marchant's Mill way•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 6
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is p
required for y H annis ort Ma. 02647 6/06/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (actual): 5
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
Number of current residents: unknown
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?,[if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2006:170,000
9 ( Y 9 (gpd)): 2007:62,000
Sump pump? _ ❑ Yes ® No
Last date of occupancy: 6/06/2008
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons'per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ 'Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No.
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
{
148 Marchant's Mill way•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 7
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is required for Hy p annis ort Ma. 02647 6/06/2008.
every page. City/Town State Zip Code . Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes ® No
148 Merchant's Mill way•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 8
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is required for H annis ort Ma. 02647 6/06/2008
y p
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
14"
r Depth below grade: feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
0'+
Comments (on condition of joints,venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.System vented through the house vents.
Septic Tank (locate on site plan):
14"
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
---------------------------------------------------------------------------------------------- ---------------------------
Dimensions: 1000 gallon
4„
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle
28"
Scum thickness
3"
6"
Distance from top of scum to top of outlet tee or baffle
9"
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined? Measured
148 Marchant's Mill way•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 9
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is required for Hy p annis ort Ma. 02647 6/06/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pump septic tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank
appears to be structurally sound.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth,below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
148 Marchant's Mill way•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 10
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
C4M ,0 148 Marchant's Mill Way '
Property Address
Elizabeth Goulding
Owner Owner's Name
information is required for Hy p annis ort Ma. 02647 6/06/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.)
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert No
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any,
evidence of leakage into or out of box, etc.):
Box is Ievel.Box has 3 outlet laterals with equal distribution.No evidence of solids carryover.No
evidence of leakage into or out of box.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
148 Marchant's Mill way-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 11
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is p
required for H annis ort Ma. 02647 6/06/2008
y
every page. City/Town State Zip Code Date of Inspection
D. System Information.(cont.).
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
❑ leaching chambers `number:
❑ leaching galleries number:
❑ leaching trenches number, length:
® Teaching fields number, dimensions: 20'x30'x1'
❑ 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.):
Sandy dry soil.No signs of hydraulic failure.No ponding or damp soil.
148 Merchant's Mill way•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 12
i
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is p
required for y H annis ort Ma. 02647 6/06/2008
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools (cesspool must be pumped as part of inspection) (locate on.site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
148 Merchant's Mill way-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 13
Map Page 1 of 2
Town of Barnstable Geographic Information System
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http;Hwww.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=266026&&mapp... 6/7/2008
-Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
148 Marchant's Mill Way
Property Address
Elizabeth Goulding
Owner Owner's Name
information is required for Hy p annis ort Ma. 02647 6/06/2008
every page. City/Town State. Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: Bottom of field T
feet
Please indicate all methods used,to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of
groundwater elevations.
I
148 Marchant's Mill way-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15
Town of Barnstable
�01.1HE, ti
o� Regulatory Services
anxt,sras>>r Thomas F. Geiler, Director
9� b 9. ��� Public Health Division
ArFO MA'I A
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS
DISCLAIMER
This septic system inspection report was completed by a private inspector who is certified by
the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original or copy of the report;
this Division does not warranty the functionality of the septic system in the future nor does
this Division agree with any technical observations and interpretations contained within this
report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual number of
bedrooms approved at a particular property would be listed on the "Disposal Works
Construction.Permit
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
QASEPTIC\Disclaimer Private Septic Inspections.DOC