HomeMy WebLinkAbout0272 PINE RIDGE ROAD - Health 77
272 Pine Ridge e Road
t-cotuit
006-065
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CbiTt 'i Of Wase4dMiseft
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5 di I n o
Suurface;age Disposal Sy stem Form-Not for Voluntary Assessments
272'Pine Ridge
property Andreas
Paul Cunningham
(WW1 . Owner's Name
'nWination-�a_ NIA 02635 4-1-2014
requftW.for evelly COtu t
per.. City/ro m State Zip Code Date of Inspection
.11195100tion results must be submitted on tEus flora. Inspection forms may not be altered in any
way.Please see completeness checklist at the end of the form.
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NEIGHBORHOOD WASTE WATER SERVICES
ay C°mparty Name
350.11 kKorREET
Company Address
W.YARMOUTH MA 02673 A�
City/ToHm state µ y+ Zip Coded
:508-775-2820 S113522 ° zz
Telephone Number License Number
A. Certllitrol`1
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.We inspection
was�rlr�tfned based on my tralningv and experience in the proper function and maintenance of on site
se, s , 1 anti a'DO, approved system inspector pursuant to Section 15.340 of
. ems.
T` e 3(310 CMR 15.000).The system;
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
4-1-2014
Inspector's 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.lWinspection does not address trove the system will perform In the future under
the same or different conditions of'use.
I1
t5W*•W 3 Title 5 Offiaal .Subsurface Sewage Disposal System•Page 1 of 17
G�'Rr+la
"n ors
Stdstt�fiae bs�sogem Form-'Not for Voluntary Assessments
272`Prne fUdge
Psi Cshrm�gtiam -
Owner ownees:Name.
'' C :MA 02635 4-1-201.4
k
�u�:w� State Zip Code Date of Inspection
page. Cttt►/ro
B. ceibifit;aton (Cont.)
inspection,Summary:Check A;B C,D or E complete all of Section D
A) Passes:
❑ I have'not found any informion which indicates'That any of the failure criteria described
S in.310 CI R .363 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The:sytern contains a.1000 Gailon septic tank and a 6x6 Concrete leaching pit.The tank was pumped
at time of inspection.The leach pit held 11"s of water and there was no signs of level higher in the
past
B) totem 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.
Check the box for"yes", "no"or"not determined"(Y, N, ND)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 tar k wiill pass inspectiori tf It 1s 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):
The sytem contains a 1000 Galion septic.tank and a 6x6 Concrete leaching pit.The tank was pumped
at time of inspection.The leach pit held 11"s of water and there was no signs of level higher in the
past.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
r
G #f?111�1 il iaiiiioft
Srhsuiifee I15 `S 'Farm=Not for VoluntaryAssessments
11 Piro
conningttar�i
Owner
a
required for every � AAA 02635 - 4-1.-2014
page. Clt mown state zip Code Date of Inspection
❑. Pu+np-Chamber 0000ptIalamis not operatio nal. system will pass with Board of Health approval if
pumliirdalarms are repaired.
.B)`g'y tin cot dWw y Palsses.(cont.):
. ❑ Observation of baclWP orbreak out or high stag water level in the distribution box due
to broke .or obstructed pipe(s)or due.to a broken, settled or uneven distribution box. System will
pans kispection (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):
Tfwsydem_contains a IM�Ifori septic tank and a 6x6 Concrete leaching pit.The tank was pumped
at-ti_me of inspection.The teach pit held 11"s of water and there was no signs of level higher in the
pasts
❑ 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):
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 CI IR
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 sal#marsh
t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 17
f ,
Comtmonwrea of. husetts
iftCc Form
`Subsuriace ftwage ftposa&jjftmIForm-Not for Voluntary Assessments
272.Pine Ridge
Property Address
Paul Cur ►ingYtam
owner ow noes Dame
infoflnatim is MA 02635 4-1-2014.
required for every Q-2tu it c State Zip Code Date of tnspection
page.
B. Cett a ion (conf.)
. 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,
safet `aind et1VR0#figent:
❑ The system Fria septic tank and.soit 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
e 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 weir*.
!Method used to determine distance:,
rr This system passes if the well water analysis, performed at a DEP certified laboratory.,for fecal
coliforrn bacteria indicates alert 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.
The sytem contains a 1000 Gallon septic tank and a 6x6 Concrete leaching pit.The tank was pumped
at time of inspection.The leach pit held 11"s of water and there was no signs of.level higher in the
past.
D) System Failure Criteria Applicable to All Systems:
You must intricate"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 '/2 day flow
Titl
t5ins•3113 e 5 Official Inspection Form:S Disposal
sewage System•Page 4 of 17
I
C�IKE10fi �i E1�`.�BS$�t�1tiS@f�S
.�' p " FQm
Form-Not for VoluntaryAssessments
Subsurface � '
272 Pine Ridge
Prop"AddmSs
Paul Curiffmaham
owner Owner's Name
infomlation;is MA 02635 4-1-2014
required for every Cotuit
P City�own State Zip Code j Date of inspection
Ce1' t 3#t (coat.)
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.
❑ 0 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 cesspoof`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.]
0 ® The system is a cesspool sensing a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system faik.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 js within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ 11 the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone.11 of a public water supply well
If you have answered'yet"to .any question in Section E the system is considered a significant threat,
or answered ayes' 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 CHAR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17
4.
C+�oter� h
9 at
ns cwTorm
S ide a d al Systm Fortn-Not for Voluntary Assessments
272 Pine Ridge
Property'Address
Paul:Cunningham
Owner . owner's-Name
informations Cotui# MA. 02635 , 4-1-2014
.required for every Zip Code Date of Inspection
page, ePt TOW state
G. �I�eck�st
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
El this inspection.
® a Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
❑ Was the site inspected for signs of break out?.
0 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.
El El approximation
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)]
D. System Information
Resiftntial Flow Conditions:
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
t5ins•3N3 Tme 5 moial by pedion Forth:SubsuAace Sewage Disposal System•Page 6 of 17
Corll � pf ftu� s
o 'onForm
g jai m Form-Not for Voluntary Assessments
272-P1ne'R>
Prolpefty-Address,
Paul Cirtgham
y Cau : MA 02635 4-1-2014
Pam; Cdylrotnm state Zip Code Date of inspection
nfoifnation
f3escriptwn: .
The sytert contains a 1000:Galion septic tank and a 6x6 Concrete leaching pit.The tank was pumped
at Ort e-.of in .The leach pit held 11"s of water and there was no signs of level higher in the
past.
2
'Number of current residents:
Does residence have:a:g b grinder'? ❑ Yes ® No
Is Wndry:on a e system?(include laundry system inspection ❑ Yes No
information in'this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ❑ No
2012 58,000
Water'meter readings, if available(last 2 years usage(gpd)): 2013 52,000
Detail:
152 gpd over the last two years --
Sump pump? ❑ Yes No
occupied
Last date of occupancy: Date
CommerciiaMdlustrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CHAR 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;
t5ins•3/13 we 5 otnoei h spechM Form:Sut Mfece&Map Disposal System'Page 7 of 17
f
�#10t1 E�` 'c�t#t3l�'f�5
s pe o
i11t4brn forth Not for Voluntary Assessments
272 Pine Ridge
Proo*j Adtdrrss
Paul Cunningham
OWw..: :. Ownees Name
iritiireratrorr+s, MA 02635 4-1-2014
required for every m
r State 7 Code Date of rnspedion
fCotIt
last dated o ccupancyluse: occupied
Date
06W(de a below):
Ttte pit eons a IM Gaffon=tank'pd and'a 6x6 Concrete leaching pILThe tank was
as; of inspection.The held 4'!"s of water and there was no signs of level
hiiglter at past.
General>hdormation
Pwnpinjj'Reeords
Not provided
Source of information:
'Was systemi pumped as part of'th,e 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
El 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 IIA.system by system operatorunder contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 8 of 17
I
coanlno mism afmassachusetts
'ire ' � nsFoim
Subsurface Se 'DjispaqrW Sys WFoma-Not for Voluntary Assessments
272 fte-Ridge
Property.Address
Paul eunnftham
Owner E�lilners Name
info nation is MA 02635 4-1-2014
required for every � State Zip Code it Date of Inspection
.Page•
5. S m tnfo 'fna i01 (cont
Approximate age of all components,date installed(if known)and source of information:
27 years .
Wereserage odors detected when arriving at the site? ❑ Yes No
Builkg$ewer(locate on site plan):
30"
Depth below grade: feet
Material of construction:.
,❑cast iron 40 PVC ❑other(explain):
Distance from private water supply well or suction line: feet
Comments(omcondition of joints,venting,evidence of leakage, etc.):
The sytern contains a 1000 Gallon septic tank and a 6x6 Concrete leaching pit.The tank was pumped
at time ofinspection.The leach pit held 11"s of water and there was no signs of level higher in the
past.
Septic Tank(locate on site plan):
1.8"
Depth below grade: feet
Material of construction:
®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain)
The sytem contains a 1000 Gallon septic tank and a 6x6 Concrete leaching pit.The tank was pumped
at time of inspection. The leach pit held 11"s of water and there was no signs of level higher in the
past.
If tank is metal, list age: yeas
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes.E No
1000 Gallon
Dimensions:
Sludge depth:
t5ins•3113 Title 5 official hspedion Form:Subsurface Sewage Disposal System•Page 9 of 17
f
Co,mmOnW fth o Massachusetts
'ftt #hsctlon Form
S�ur#ace Disposal System dorm-Not for Voluntary Assessments
272 Piize Rim
Property Address., .
Paul Cunningham
owner Owner's Name
inforrnation is Cotufl MA 02635 4-1-2014
required for every page. City/Town State Zip Code Date of Inspection
D: totem,m Information (corn:)
Sept Tank(cont.)
24
Distance from top of sludge to bottom of outlet tee or baffle
6"
Scum thickness
42"
Distance from top of scum to top of outlet tee or baffle
Distant from bottom of scum to bottom of outlet tee or baffle
22"
Tape measure
How were dimensions determined?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,
liquid levels as related to outlet invert,evidence of leakage, etc.):
The sytem contains a 1000 Gallon septic tank and a 6x6 Concrete leaching pit.The tank was pumped
at time of inspection.The leach pit held 11'is of water and there was no signs of level higher in the
past
Grease Trap(locate on site plan):
Depth below grade: `feet
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene El 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 orbaffle
Date of last pumping Date
t5ins-3113 Title Official kispection Forth:Subsurface Sewage Mvosel System-Page 10 of 17
ROi iAi �of t1assadmiseft.
1ex on orm
g lace 9 �:DIISPWM system Form-Not for Voluntary Assessments
272 Pine Ridge
Propedt Address
Paul Cunoingiram
owner O+anee Name
information is MA 02635 4-1-2014
C.ota t
p eYety City/Town state Zip Code Date of Inspection
D. � r IRO#'iol1 (Cora.)
Comments(on pumping recomm- endat ns,inlet and outlet tee or baffle condition, structural integrity,
ldJevels as related to outlet invert,evidence of leakage, etc.):
Thesytem contains a 1000 Gallon septic tank and a M Concrete leaching pit.The tank was pumped
at time of insertion.The leacKpit held 11"s of water and there was no signs of level higher in the
past
TNgfitt orb Tank(tank must'be pumped at time of inspection)(locate on site plan):
Depth betow,grade:
MaWft df conshuchon:
concrye 0 metal ❑fiberglass ❑polyethylene ❑other(explain):
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
t5ins-3/13 Title 5 Offidal inspection Forth.Subsurface Sewage Disposal System-Page 11 of 17
��10 41� C111t1SE�S
' ' a forin
Sbsutfase lsposafi Syttem form-Not for voluntary Assessments
272 Pine#ti€t
PmpOrly Mdr s
PautCu11T1 t8k l
owner owrtwls:Name
tMoriat<on is . AAA 02635 4-1-2014
!+ri f�+ ' Stafie Zip Code Date of t»specfion
Pap- Ckyrrowrr
D sysIn' tit i46 (conk.)
Distribution Box(if present must be opened)(locate on site plan):
Depth..6f liquid.revel above outlot invert
Level and working properly
Comments(nee if bbk is tevel and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage-into or out of box, etc,):
The sA I con-rains a 1000 Gallon septic tank and a 6x6 Concrete leaching pit.The tank was pumped
at time of-frispection.The leach pit held I'1"s of water and there was no signs of level higher in the
Pumo`6mber:(locate on site plan):
Pumps in working order. ❑ Yes El No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.):
The sytem contains a 1000 Gallon septic tank and a 6x6 Concrete leaching pit.The tank was pumped
at time of inspection.The leach pit held 11"s of water and there was no signs of level higher in the
past.
*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:
t5ins•3113 Title 5 Official Forth:Subsurface Sewage Disposal System-Page 12 of 17
� `�
:. S€ttltsaurta�e age #
form-Not for Voluntary Assessments
.272 Rine Ridgy
Property Aftess
Paul Cunniroam
Owner Owners Name...
_ Cc�tuit MA 02635 4-1-2044
Page- CWTOwn. state Zip Code Date Inspection
D. S 3 t j't f'[tt!1t10f1 (cone.)
Type:
® leaching pits
number: 1
❑ leaching chairtbers number
leaching galleries number
leaching trenches number, length:
❑ leaching fields number,dimensions:
❑ overflow col number.
❑ innovative/altematire system
Typetname of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation;etc.):
The sytem contains a 1000 Gallon septic tank and a 6x6 Concrete leaching pitThe tank was pumped
at time of inspection.The leach pit held 11"s of water and there was no signs of level higher in the
past
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
t5ins•31 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
ComMom bstth o€ftwmchuseft
Title 5: offtie, inspeebon Form
Subsurface e DisposM.System Form-Plot for Voluntary Assessments
272 Pine Rido
Property Address
Paul Cunningham
owner owner's game
irdonn4t'On is MA 02635 4-1-2014
required for every State Zip Code Date of inspection
page. City/Tow
D.System litfiormation (cunt.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
The sytem contains a 1000 Gallon septic tank and a 6x6 Concrete leaching pit.The tank was pumped
at time of inspection. The leach pit held 91"s of water and there was no signs of level higher in the
past
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.):
t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
f -
Comm6nWi4m of Masimchuseft
oe to
ubsufface Serge pl at System Font Not for Voluntary Assessments
272 Pine Ridge
Prop"Address
Paul Cunningham
Owner Owners Name
information is MA . 02635 4-1-2014
pagrequired for every .CC4rroown State Zip Code. Date of Inspection .
page.
D. ysern lnfarrisation (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 buftng. Check one of the boxes below:
hand-sketch in the area below
dramiing attached separately
t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17
Assessing As-Built Cards Page 1 of 2
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Cominomealth..6f Massachusetts
In tion orm .
SW$S S
Form-Not for Voluntary Assessments
272 Pine R'
PFopedy Addiess
PaulCurytinghgM
Owner owners-Name
intormaf.s Cotuit MA 02635 4-1-2014
rkpgfedldr'wry. .corrown. State Zip Code Date of inspection
D tysrn'It�frrnattn (font:)
Site Exain: .
Check Slope
Suffam waiter
Check cellar
Shallow wells
12+ft
EstimaW depth to high grouted water; feet
Ptease isditate all memods 7used,to determine the high groundwater elevation:
Obtained from system design plans on record
10-7-1986
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:
No ground water encountered at 12ft according to engineered plan dated 10-7-1986
Before filing this inspection Report,please see Report Completeness Checklist on next page.
Title 5 Official Inspection Form:subsurface sewage Disposal System'Page 16 of 17
t5ins•3/13
• GO#ltlnf+0�"f��i Eft�C� . .:
eta
Fonin
Sa+i
forvn-Not for Voluntary Assessments
'272 Pine Ri.
Address: .
Paut Cunaistgl am
Owner O+aws Rtame
inf imo—an is : AAA 02635 4-1-2014
required for every COtuit
page. Cityf/rov S'tafe Zip Code Date of Inspection
, e CXinpkUness Cfieckhs#
lnspeiytioft Summary: A, B, C, D,or E checked
lnspetuon Summary D(System Failure Criteria Applicable to All Systems)completed .
System Wbirmation—Estimated depth to high groundwater
!§ketc.of sewvage Disposal System either drawn on page 15 or attached in separate file
t5ins•3113 Title 5 Official Irmpection forth:Subsurface Sewage Disposal System-Page 17 of 17
Gmail- 19 Highfield, Sandwich https://mail.google.com/mail/u/0/?ui=2&ik=531804974c&view=pt&s...
Amy Clark<aclarkabcanco@gmail.com>.
......... ......... ......... .........
. 19 Highfield, Sandwich
4 messages
Sue Angus<sangus@kin ling rover,com> Sat, Mar 29, 2014 at 6:30 AM
To: info@capecodseptictank.com
< >
n M hl h bmuhlebach harvesttech.com Cc: Bethany&Stephan u ebac @
I understand from the Muhlebach's that their septic system failed. Please forward the full inspection report to.
me.
Sue Angus
Kinlin Grover Real Estate
927 Route 6A
Yarmouth Port, MA 02675
cell: 508-360-2462
fax: 508-362-8220
www.CapeCodAtltsBest.com
Blog: www.CapeCodAtltsBest.com/blog/
Amy Clark<aclark@capecodseptictank.com> Wed,Apr 2, 2014 at 1:36 PM
To: Sue Angus<sangus@kinlingrover.com>
Cc`. info@capecodseptictank.com; Bethany & Stephan Muhlebach <bmuhlebach@harvesttech.com>
Good Afternoon Sue:
I apologize for getting back to you so late. I have been out of the office sick the past two days. There is some
work that needs to be done at 19 Highfield. l have attached the small repair quote that I emailed to the
Muhlebach's.if you have any questions, please fell free to contact me.
Thank you for your patience!
Amy Clark
Neighborhood Waste Water
[Quoted text hidden]
Amy Clark
Neighborhood Waste Water Services Inc.
350 Main Street- Route 28
W Yarmouth MA 02673
Phone: 508-775-2820
Fax: 508-778-9628
l of 3 4/3/2014 2:47 PM
TOWN OF BARNSTABLE
LOCATION LOT $3- �t l DGts' /�� SEWAGE # 8�' //R s
r VILLAGE Co Ty!T ASSESSOR'S MAP & LOT
l /0 S S x—
INSTALLER'S NAME & PHONE NO. /
SEPTIC TANK CAPACITY - �U O
A /
'— LEACHING FACILITY:(type) /w (size)
NO. OF BEDROOMS 3 PRIVATE WELL O PUBLIC WATER
® BUILDER OR OWNER �rg!// 4, D T rR I D 6 E
DATE PERMIT ISSUED: 7—
DATE .+COUPLIANCE ISSUED:�
VARIANCE GRANTED: Yes No ��.
t
9a >�
1
1
O '
�„�
�'
N
Y
No. ................. = Fmi... `J. ........
_
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH �-
_-✓_- ...............OF.... Q-----------------------
pplira#iun for Disposal Works Tonutruaiun thrutit
Application is hereby made.for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal
System at:
.. oz -•--- •'•-"•-. �. .� .-....' °Q. .......-•.............•--------•••-----.........--
. ation- dress �/ or Lot No.
• 4�� ••---- ca ./-1_�!_,� .. .............. .............. -------___ ........................................
...
W Address
a - ...... ............................................. ...............................................
Installer
•--
ess
U Type of Building Size rLot__ b _l �''i'?_Sq. feet=
. _________________
1-4 Dwelling—No of Bedrooms ___.____.__._________Expansion Attic ( ) Garbage Grinder ,(% )
aOther—Type of Building ____________________________ No. of persons....................._...... Showers ( ) — Cafeteria ( )
Other fixtures
W Design Flow.........._.....---5 -----••------gallons per person per daa. Total daily flow..........3 3--V.................gallons.
WSeptic Tank—Liquid capacity/OQ_Qgallons Length_ .__... .... Width_/_-_62_ )iameter________________ Depth__,"'__7.
x Disposal Trench—No..................... Width_................. Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No---------.l------_. Diameter_la_'._a " Depth below inlet_.G- -Q-~. Total leaching area___.;-X.Zsq. ft.
Other Distribution box (K ) Dosing tank ( ) / ,/� J
a Percolation Test Results Performed by..F7rd�!±+-!.t.... ........... •�._.. (� Date__V_�� ...3.......p
�c !- ....._._....
Test Pit No. 1_._.. ...
_._minutes per inch Depth of Test Pit__Z y y`_'___ Depth to ground water__�jl/a -e
f� Test Pit No. 2_____________...minutes per inch Depth of Test Pit._ Y.Y.._". Depth to ground water_-_,-,e-,0 4-t--
0
Description of Soil :............••••-.............•.........-..................................
✓
U ------------------
---•------------------•---•-••-•-----------------•-------•-�L~ zyll.`'.-----------/l1�.g s.•...--.... +_ -:
W - --••-•• -_..._.
x -----------•-----•-•-----•--••••----••---•--------•••---•••--------•----•---•---•••---••----------•--•----••---•-----•--•-----•--•---•---•-••--••-----•---•--•-•••-•-------••...---•••---_..------•••••-
V Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________
--------•---------------------••---•-•------._.----•----._..._......--•--•--•-----•-•--•-----•-------•--•---•-•----•-•----••-._.-----...•-----__--•-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with J
the provisions of TLITLE4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ('
operation until a Certificate of Compliance has been i ed by the o of health.
Signed ........... ............ ----------•---•----•--....--•...._.. ... Z
D to
Application Approved BY -••-_--•--- ............. ....... ---_...._ l
---------- f
Date
Application Disapproved for the following asons_---_.......................................................
....-----•----...•-•---•...............•...----••••--•••--••-----• -----•-------- --------------------------------------------------•----•--•------=------Date----...-------
Permit No.. ....._../.. .. ................ Issued.................••-
I--' Date
y
No.__ ..__....... FEs.........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD-OF HEALTH
........................ ................O F.......................................--------------------...............................
Allp iration for Disposal Works Tontrur#ion Prranit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at•_ -j
,fi.`ocation / or Lot No.
Owner ................................. .........•------••----•-•----------.........Address-
Installer r-�-J Address
v ---Type of Building Size Lot--------- ----------------Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
`1
p-I Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
WDesign Flow-Other fixt�n'sesl......................... allons per perso _per day. Total daily flow.:..............._..�._.._.._.........galls s.,.
WSeptic Tank—Liquid capacity............gallons Length................ Width............._ Diameter________________ Depth................
x Disposal Trench—No ____________________ Width ._..........._.... Total Length......... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.......... ...._. Depth below inlet.................... Total leaching area....�...._'�.sq. ft.
Z Other Distribution box O Dosi nk ( ) l I
'-' Percolation Test Resul Performed b ....................°�"'�' �` .. <�r�; 1/� i l �
Y -----•----- -...------ -----------•----•---.._..... Date---•------}------'•---._........----�
Test Pit No. I....... .......minutes per inch Depth of Test Pit................. . Depth to ground water------_ ............__.
Test Pit No. 2................minutes per inch Depth of Test Pit.......y. ... Depth to ground water... ..................
..
x Description of Soil �y- . Tom% •�------------- ----------I--------- - f
U ..............................................---•------•---•-•------------------•---•--•-••--•---------------•.._..........._.........•••----------•-•....................................--••---------
W
V 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 TITLE 5 of the State Sanitary Code—The-undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been ' s ed by ,,th d of health.
Signed-. ...............
( ? �>>
;. to
r,. ' App,ication Approved BY ('l/} -1 _ --I•r...........................y
Date
Application Disapproved for the followingjeasons:--------------------------------•-••----.........._..•...--•---------------------------•-----Date
........----•-----•••--•-.-•••••••-••-----•---. ..._.._..... ------•••--'--------------••---•-•--------•-•--•-----•••--------•-----•-------......--- ......-•--••-••-
Date
�"
PermitNo.............f.........I..-`-^'-------•-•---•--•••-................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF..........I..........................................................................
Trrtifiratr of Tomplinurr
THIS_IS TO-CERTIFY; That-the Individual Sewage Disposal System constructed (A or Repaired ( )
Imo.e "�. _f r..
by.................. • ........ ---- ..----......-------------- ----- --,-------•- .•. = -------------•----------•--------•-----•---------
at I�V . � 1 C
nstailer
}
has been installed in accordance with the provisions of TIM ,�if he State Sanitary � de dc�cribed in the
application for Disposal Works Construction Permit No............................................................................. dated__..___7_7. �__vv_._..___.._.....__.____.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTIO SATISFACTORY.
DATE...............IV_
........_..�. ..�/S.1.---•------••-••---••••.. Inspector....A......................•----•------------------•--....-------•------•---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
(� .......................................... ........................................................................----•........
No. .......... -l.� FEE.---.--:
Disposal Vorkii T-Fonstrnr##ion unfit
Permissi n is hereby granted.___...-'........ '..............:...�-!:'........ _
t ...�.......
to Construct ) ff 1epai ) an ivI ua Se silos em
; � �, iMd G
atNo.. = ....- .............................
Street �' 1 �\ 1 1— 7_�/
as shown on the application for Disposal Works Construction Permit INo..................�_ ated..•........_.II._...W._.....................
' 2/ �C� Board of Health
(aE!�DATE------. -•-•--------------•---------•...�........---•-••-••••••--
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
— — — —
_ - -oil
i
S YS TEM PROFILE
NOT TO SCALE
TOP FDN. FINISH GRADE FINISH GRADE OVER
EL . a. oe. , FINISH GRADE OVER DIST. BOX - FINISH GRADE OVER
%o.'•s SEPTIC TANK f>-? LEACHING PI T
r . ,
0
VARIES /
0 ° ° :o ?' •'o:.q° qQ�. .o"' a r'.o.r , . :o:.a:a. ';v .:• ° o: 'r of 3" OF 1/B" 1/2" 12- MAX
. .• o;:d o•.'.:t • . . .o•: -o: o • .•: o. :A.. ..e:. ..a:. e•s... a o PRECAST CONC. OR
o
o.. ASHED PEAS TONE
:e ;: BRICK 6 MORTAR
TO 12" BELOW GRADE
- - 3 OUTLET PIPE LEVEL
FOR 2FT. MIN.
0.
O 'Q e
EED/
:'p
•"0:.':! '°i..• .,w' O O b "e..e.p6: C, 'O p e 0 4,
q . -: °.p 6:. p ''�.7 G:y� �.�-:°4�'C� o o. •p .• :o d: . . :D. O p D
C. I. OR PVC TEES
BSMT. FLR. i � 0 GALLON
° o `)IS TRIBUTION BOX
° e INSTALL ON LEVEL BASE u 6 '
PRECA S T CONCRETE 3�4 To 1-1/2 4; PRECAST p I
°..'.o. :a o % WASHED
is. H— /0 REINFORCED o CRUSHED I a
CONCRETE
o.p.o, o.ao..e."'e:o:::a:o.°'.o"®;a:•'o'.:a.o p'.e:.. :.�°:•d..'a. 'e:o.'o, STONE y
.0:;e'.'O. °..o.p p.o:JD•.a..O.o:.;°;•o,•,0.0;•.o.a 0•:O•d:.- .;0.',. D;. o•o.:p: ; df o
H— /0 REINF. br
6 � o �°° 0 I
a
SEPTIC TANK
;_•� ._.
7
INSTALL ON LEVEL BASE NOTE.' EXCA VA TE TO ELEV.�V ` FOR
" LOWER TO REMOVE ALL IMPERVIOUS
- MA TERIAL BENEA TH THE L EA CHING AREA I
_ REPL A CE EXCA VA TED MA TERIA L WI TH
CLEAN. LAY SAND
�!' z EFFEC TI VE DIAME TER
{f J °• - LEACHING PIT
t GENERAL NOTES
1. ALL ELEVATIONS SHOWN ARE BASED ON • °,, ° ; .r : INSTALL ON LEVEL BASE
,... �•
2. ALL PIPES IN THE S YS TEM MUS T BE CA S T IRON
OR SCHEDULE 40 ^"`" ^^r+r'-^e • . '� 's' +. " ra �
3. THE BOARD OF H-AL TH MUST BE NOTIFIED
CAST ONCRETE
4 E cL�ACHrN PrT WHEN CONS TRUC TIDN IS COMPLETE PRIOR J' { r
PER COL TID RA TE
' TO BA CKFI L L ING C N
_.,` ... . ..-- „�� ., _._ ,• � _, 4 MIN. /IN.
x. ANY CHANGES IN THIS PLAN MUST BE APPROVED
BY THE BOARD OF HEALTH AND CAPE 6 ISLANDS WI TNESSED B Y.'
SURVEYING CO., INC. -
' - =•__ - 5. MATERIALS AND INSTALLATION SHALL BE IN
BRO. OF� /• ,, � _._-,. -`. �Oki
COMPLIANCE WI TH THE S TA TE SA NITAR DA TE. HEAL TH DESIGN DA TA
� � ` •-.., ' ``�, �•...- �- RUES ANDTLE REIaULATIONSAND LOCAL APPLICABLE
� 7 i O
i000 CALLOW 1 o'_"_ _ __ NUMBER OF BEDPOOMS
ti
? `
_ , t`1 PRECAST Cl , . 6. NORTH ARROW IS FROM RECORD PLANS AND
' } <. $EPTrrr ,TANK ` ``, ,� ;� IS NOT TO BE USED FOR SOLAR PURPOSES '" ¢'` GARBAGE DISPOSAL SAL .
i °,o `\e 7: FL OOD HAZARD ZONE f �"" µ�"""" DA IL Y FLOW - '
'_...... �%z .F 6 ` B. WA TER SUPPL Y �' :��>r rJ :;
� ��� � � SEPTIC TANK REO 'D � GAL .
_._-w..� - _ _._ � e
_ ED ,
_ , ,,,, ,,a. , � • °� �• SEPTIC TANK PRO VID GAL .
_. °., .J� ,�,,• z LEACHING REOUIRED
GPD.
! P
SIDEWALL AREA `' S. F.
t / s S. F. X G/S.1F. _ GPO
BOTTOM AREA S. F.
LEGEND S. F. X G/S. F. _ 'V GPO
` r LEACHING PROVIDED a = 'y GPD
�
PROPOSED EL EVA TIDN
o -- —-- EXISTING CONTOURMIL r
x
S OBSERVA TIDN PIT µ ,.
0 DISTRIBUTION BOX
PROPOSED SEWAGE DISPOSAL S YS TEM
t fj O LEACHING PIT PREPARED FOR
2 v v.r-
t—
'--- -- _ [� SEPTIC TANK g DA VID DOT TRIDGE
1117-1, - , lRp) RESERVE a LOT 83 PINE RIDGE ROA D
CO TUI T — BA RNS TA BL E — MASS.
PIPE INVERT ELEVATION
PLOT PLAN r^ CAPE 6 ISLANDS SURVEYING, INC.
SCALE AS NOTED
SCALE: ? "_ �a �; �.�" ��� z�z �`� P. 0. BOX 334
PLAN NO. TEA TICKET, MASS.
MAP SEC PeL LOT HSE '� h