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Home My WebLink About0046 ADMIRAL'S LANE - Health 46 Admirals Lane (Osterville) A�= 118 - 133 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 46 ADMIRALS LANE Property Address EDWARD MASON Owner Owner's Name information is required for OSTERVILLE MA 02655 4/24/09 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. Important: A. General Information. When filling out \n` forms on the computer,use 1. Inspector: only the tab key to move your DANIEL JOHNSON cursor-do not Name of Inspector use the return key. DSD, INC. Company Name P.O. BOX 831 G } Company Address ` OSTERVILLE _ MA 4 01655 ; City/Town State ' Zip code,.' 508 477-9909 S1962 �r Telephone Number License Number ` s Cco �✓• -yam B. Certification I certify that I have personally inspected the sewage disposal system at this addres 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 t/ 7 4/28/09 Inspector's Signature Date The system inspeclithin shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) 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 inspection does not address how the system will perform in the future under the same or different conditions of use. TSINSP•03/08 Title 5 Official Inspection Form:Subsurface Sewage i posal Systern•Page 1 of 15 Commonwealth of Massachusetts Title 5 offic ial Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 46 ADMIRALS LANE Property Address EDWARD MASON 4/24/09 owner Owner's Name Mq 026_5 information is OSTERVILLE State . Zip Code Date of Inspection required for Cfty/Town every page. ;t B. Certification (cont.) ary: Check A,B,C,D or E/always complete all of Section D Inspection Summ q) System Passes: e not found any information which indicates that failu°e criteriain 310 CMR 15.303 or in not evalua ed areed ® 310 CMR 15.304 exist. A Y indicated below. Comments: ER AND *WATER USAGE IS LIKELY HIGH DUE TO IRRIGATION SYSTEM IS ONRSOHOMEOWNERS T THE EXISTING POOL AT THE PROPERTY O(APRIIL.695 D LAST TWO YEA WINTER IN FLORIDA FROM O g) System Conditionally Passes: tiona , ment or repair, as approved by more stem components as described in thef`thenreiplace Pass" section need to be ❑ One c m Y replaced or repaired.The system, upon completion o the Board of Health,will pass. ;ND) in the for the following statements. If"not Answer yes no or not determined (Y,N determined," please explain. ether ❑ The septic tank is metal and over 20 years old* or the septic{aonn o`N�nk failureas�mminent. structurally unsound, exhibits substantial infiltrationor exfiltra septic tank as System will pass inspection if the existingtank is replaced with a complying P approved by the Board of Health. * tank will pass inspection if it is structurally sold is available. ofleaking and if a Certificate A metal septic of Compliance indicating that the tank is less than 20 years o ND Explain: .Observation of sewage backup or break out or high static water level in the distribution box due ed i e(s) or due to a broken,settled or uneven distribution box. System will to broken or obstruct p P approval of Board of Health): pass inspection if(with broken pipe(s) are replaced y - obstruction is removed Pagers+s Title 5 pHicial Inspection Form:Subsurface Sewage Disosal SystL T51NSP-03/08 Commonwealth of Massachusetts Title 5 Official Inspection Form. r Subsurface Sewage Disposal System Form Not for Voluntary Assessments 46 ADMIRALS LANE Property Address EDWARD MASON Owner Owner's Name Information is OST_ERVILLE MA_ _026_5_5 4/24/09 required for — ------ — - ------ —` —` -- State Zip Code Date of Inspection every page. City/Town 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 not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within,a Zone 1 of a public water supply. ❑ The system has a tic tank and SAS and the SAS is within 50 feet of a private water Y septic supply well. Title 5 Official Inspection form:Subsurface Selvage Disposal System•Page 3 of 15 TSINSP•03108 Commonwealth of Massachusetts Title Official Inspection Form" Subsurface Sewage Disposal System form,-Not for Voluntary Assessments v, r• 46 ADMIRALS LANE Property Address - EDWARD MASON Owner Owner's Name information is required for OSTERVILLE MA 026_55----- 4/24/09 -- -- - -.. - ' — every page. CftyrTown State Zip Code Date of Inspection Y 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 s 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 overoaded 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 TI: or clogged SAS or cesspools Liquid depth in cesspool is less than 6 below invert or available volume is less ® than '/2 day flow ,Required pumping more than 41ime's in the last.year NOT due to•clogged or obstructed pipe(s). Number of times"pumped: El ® Any portion of the SAS, cesspool or privy,is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. T51NSP•03/08 z' ?ills 5 OHicial.lnspection forrii:Subsurface Sewage Disposai`System•Page 4 of 15 Commonwealth of Massachusetts Title 5 official .Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '< 46 ADMIRALS LANE --- --- — Property Address EDWARD MASON Owner Owner's Name MA 02655 4/24/09 information is OSTERVILLE — required for State Zip Code Date of Inspection every page. CityTown B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cunt.): 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 coliforn bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or les of the analysis provided that no other failure criteria are triggered.A copy and chain of custody must be attached to this form.). pd- The system is a cesspool serving a facility with a design flow of 200091 ® 10,000gpd. The system fails. I have determined that one or more of the above failure l] 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 gp d 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 El -n 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 El El Area—IWPA)or a mapped Zone II of a public water supply well stem is considered a significant threat, quest in Section E the system if you have answered yes"to any q owner or operator of or answered "yes" in Section D above the large system has failed. failed underSect on D shall upgrade any system considered a significant threat under Section E or system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page Sof 15 T51NSP•03/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 ADMIRALS LANE_ — ----- --- Property Address EDWARD MASON Owner Owner's Name MA 02655 4124/09 ate of Inspection information is OSTERVILLE - -- required for State Zip Code D every page. City/Town 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 El ® 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 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 Absorpbon'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)] Page6of15 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Commonwealth of Massachusetts 1,UTitle 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 ADMIRALS LANE Property Address EDWARD MASON Owner Owner's Name ' information is required for OSTERVILLE MA 02655 4/24/09 every page. City1rown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3-PERMIT Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 GPD (PERMIT) Number of current residents: 2 Does residence have a garbage gender? 0 Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? , . ❑ Yes ❑ 'No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 695 GPD 9 ( Y 9 (gpd)): (SEE PAGE 2) Sump pump? - ❑ Yes ® No Last date of occupancy: PRESENT 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: bate Other(describe): - T51NSP-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System .Form -Not for Voluntary Assessments` M 46 ADMIRALS LANE Property Address EDWARD MASON Owner Owner's Name information is required for OSTERVILLE MA 02655 4/24/09 - every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records:` - Source of information: TANK LAST PUMPED IN 2005 OWNER Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons . How was quantity pumped determined? Reason for pumping: y ;. Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool , 0 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 contrail (to be obtained from system owner) and a copy of latest_ inspection of the 1/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: 1979- CERTIFICATE OF COMPLIANCE (1980 CONTRACTORS AS-BUILT DRAWING) ' f Were sewage odors detected when arriving at the site? ❑ Yes•N No TSINSP•03106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form: Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 ADMIRALS LANE Property Address EDWARD MASON Owner Owner's Name information is required for OSTERVILLE MA 02655. 4/24/09 - every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2 (EST.) 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.): ACCESS TO PLUMBING LIMITED (FINISHED BASEMENT) Septic Tank(locate on site plan): Depth below grade: 18" (RISER OVER INLET COVER) 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: 81 X 5'W X 4' H (EFFECT.) - Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 16' Scum thickness 2'; Distance from top of scum to top of outlet tee or baffle 5" 13,E Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? SEPTIC MEASURING POLE T51NSP-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 ADMIRALS LANE Property Address EDWARD MASON Owner Owner's Name information is required for OSTERVILLE MA 02655 4/24/09 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.): RECOMMEND PUMPING (CONTRACTOR TO PUMP TANK ON 4/28/09 -OWNER). INLET PVC TEE IN GOOD CONDITION. OUTLET CONCRETE TEE APPEARS TO BE IN GOOD CONDITION. LIQUID LEVEL APPEARS TO BE AT OUTLET INVERT. TANK APPEARS TO BE IN GOOD CONDITION. NO SIGNS OF LEAKS(ACCESS TO OUTLET COVER PREVENTED DUE TO SHRUBINTERFERENCE) Grease Trap (locate on site plan): a 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): T51NSP•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 a a Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 ADMIRALS LANE Property Address EDWARD MASON — — Owner Owner's Name 02655 4/24/09 information is OSTERVILLE MA required for City/Town State Zip Code Date of Inspection every page. D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: -"gallons per day Alarm pres ent: en t: ❑ Yes ❑ Nb , Alarm level: Alarm in working order: ❑ Yes ElNo Date of last pumping: Date Comments(condition of alarm and float switches, etc.): .o *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 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 IN GOOD CONDITION (COVER BROKEN ON THE EDGE ONLY STILL FUNCTIONING). PIPE TO PIT#1 SLIGHTLY LOWER(< 1/8")THEN PIPE TO PIT#2. RECOMMEND INSTALLING SPEED LEVELS. 1/2" SCUM. NO SLUDGE. NO SIGNS OFLEAKS. Pump Chamber(locate on-site plan)' Yes ❑ No Pumps in working order: Alarms in working order: ❑ Yes ❑ 'No - Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 15 T51NSP•03/08 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 ADMIRALS LANE Property Address EDWARD MASON Owner Owner's Name information is OSTERVILLE _MA 02655 4/24/09 required for State Zip Code Date of Inspection every page. City/Town 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: 2- 1000 ® leaching pits number: GALLON EACH leaching chambers number: El leaching galleries number: [] leaching trenches number, length: (] leaching fields number,dimensions: El 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.): . NO SIGNS OF HYDRAULIC FAILURE OR PONDING. 2- 1000 GALLON LEACHING PITS (AS- BUILT PROVIDED BY OWNER). VEGETATION ABOVE SAS NORMAL. T51NSP•03108 t Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 12 of 15 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 ADMIRALS LANE Property Address EDWARD MASON Owner Owner's Name information is required for OSTERVILLE MA 02655 4/24/09 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 -- y .Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): T51NSP•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 ADMIRALS LANE Property Address EDWARD MASON Owner Owner's Name " Information is required for OSTERVILLE MA 02655 4/24/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. b " 3z� DC, Q g e - 45 s�rz 6o N/ETL gU - 53 g C pA fL.-r i,*L 1L j U N D E`(t-. D ELK Bg - 4.4 it0OM r �( 00o GrALLonI 5 N 12 j 3S 5d PTr(- r,4-/qk p CGK I �DOO U�1 LL•�til /0b (1-�4 LLoi✓ [ EAC-�j ff IT W;z 5P/� G p- gax j�Fr20U►•►1) �%�r t3,4LL r'O°.L Ca v tiT 4 T51NSP•03/08 Title 5 Officlal Inspection Form:Subsurface Sewage Disposal Systam•Page 14 of 15 •. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments w„ 46 ADMIRALS LANE -- Property Address EDWARD MASON Owner Owner's Name information is OSTERVILLE MA 02655 4/24/09 required for — — every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar 0 Shallow wells Estimated fee depth to high round water: p 9 9 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: NO DATE ON PORTION OF PLAN REVIEWED . ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: REVIEWED DISPOSAL SYSTEM CONSTRUCTION PERMIT(COPY PROVIDED BY OWNER) ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database explain: You must describe how you established the high ground water elevation: SOIL TEST FOR THE SEPTIC DESIGN AT THE PROPERTY ON 12/15/78 BY KELLY AND KELLY FOUND NO GW(BOTTOM OF SOIL TEST AT 144" BELOW GRADE [12'1). BASED ON THE SEPTIC PLAN AND REVIEW OF SHOREY PRECST PRODUCTS LIST FOR A 1000 GALLON CIRCULAR PIT,THE BOTTOM OF BOTH PITS ARE ESTIMATED AT 8'-9'BELOW GRADE. BASED ON THE ABOVE, IT APPEARS THAT NO HIGH GW INTERFERENCE EXISTS WITHIN THE SAS. f1 Page15o 5 • Title 5 Official Inspection Form:Subsurface Sewage Disposal System P TSINSP 03/08 . - , Caring.for.~Your Septic-System: Tips:to Avoid Trouble The waste water leaving your house comes from Keeping these components functioning well is relatively simple if you follow,these tips: sinks, toilets, showers,.and,the'washing machine and dishwasher. It carries solids, grease; dirt, Do. have your tank pumped out and sys- Don't drive or park over any part of your chemicals, bacteria and viruses. It needs quite a tem inspected every three to five system! . '. bit of cleaning before*itContact your Board of Health it can-safely safely be dumped into Don't plant shrubs or trees over your sys- a pond or into the.ground water.:Your septic sys for a septic contractor Licensed in _ tem! Roots may clog and damage our town. _ Y r lines or leach field.. tem.does just that: you 1 Do keep a record of um in , ins ec- While�not all septic systems are the same, most p p p g p Don't .use your toilet as a trash can or for modern ones.(constructed since,1.978) consist of tions and repairs..lt will come-in food disposal! a septic tank;. a,distribution handy when you want to sell or rent box, and a leaching Don't dispose of cooking oil,fat and grease facility. . - - your house: in your septic system. In your septic_tank,the solids settle to the bottom Do practice water conservation. Repair (sludge) and the grease floats to the top (scum). drips and leaks. Use water-saving Don't use commercial septic system addi- showers;.toilets and.faucets.Avoid tives..At best they are harmless and The partially clarified water moves from the tank heavy use of water at any one time. a waste of money; at worst they hurt into the leaching facility-where it leaches through your system.They are not an alterna- a layer of soil before it Do use your garbage disposal sparingly. reaches the underground tive to regular maintenance, which water table. The soil and the,microbes and bacte- It puts a heavy burden on your sep- is cheaper in the long run. ria.living in it help-to purify the waste water. (Older tic system. Don't make or allow any repairs to your sys- systems, often called cesspools, do. not have a Do divert roof drains and.surface water tem without the proper permits from _ leaching facility and are considered-inadequate run-off away from your septic system. your Board of Health. treatment:) Do:,keep a map of the location of your Don't pour hazardous household chemicals system components and make sure down the drain. all household members are aware of -what is underground. Do use household chemicals such as ....... ............'lh'sp@CiiOh'{PLmp:4UtJ Rots •' bleach, disinfectants, drain and toi- let bowl cleaners in accordance with - - Tee ORNNDEGDABLES:product labels... ,/f,;fff f,f([✓✓��((�� fffff. --► grease, disposable �� f//Ff/ff Fff/f F.16tYlfffff ff/ffffff - ' Inlet:sewage outlet: diapers,.plastics, etc.. enters from treated house.. wastewater goes to POISONS: distribution box' and drain field: gasoline, oil;:paint,.,: paint thinner, pesticides, antifreeze, etc: OF WE Town of Barnstable 9B^R"MASS. Board of Health i639' A P.O. Box 534� Hyannis MA 02601 ED Mp`l Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Ralph A.Murphy,M.D. Sumner Kaufman, M.S.P.H. To: MASON,BARBARA E Date Monday,March 05,2001 13218 HARBOR RIDGE BLVD PALM CITY FL 34990 RE: Underground Storage Tank at 46 ADMIRALS LANE Map Parcel: 118133 Tank NO: 01 Tag NO: 00597 Our records indicate that your underground fuel(or chemical)storage tank is over 20 years old,and has not been removed as required by section 03: subsection 2 of the Town of Barnstable Health Regulation regarding fuel and chemical storage systems. You are directed to remove this tank sixty(60)days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent 06-20-2001 e3:06PM CENT CST F I REDEPT 50879&1385 P.02 Make application to local fire uepartmenL Fire Department retains original application and issues do to as Permit., ,r' n A • �� APPLICATION and PERMIT MIT for storage lank remcvsi and transportaticri to approved tank disoesal yard it accordance with the provisions of M.G.L. Chaoter 1 45,-, Section 38A, 527 CMR 9.00, application is hereby mace by: Tank Owner Narne ip y print) -y_Ed Mason X. -_- yq- m Address 46 Admira 's Lane - _� Usterville MA 02655 } i Svasr GtY Stara Tip i Company N9rrte Advanced Environmental i Co.or lndividuai_Advanced Envirirnmental Address -J�—OHox-476 :acuth Dennis Ma 02660 Address R• d• Pox 472 S. Dennis RA 01660 I Pr;rr Anni i Si Wr� `c_er Signal Urc- (:f pty n r zerrmit) IFCI Carti�� Other , IFC1 Certified } Tank Location .46 Admiral's Lane Osterville, MA 02655 _ _(center front ysrd) "� 5!aer.�vd.vss 0 allan Substance asrStor heating_ fuei #2 _ znx Capticcty(aa!lcn�. -_-.�� . ! Tarik Dlrle:-.sicns`Gia ez r x lengr 1i 12 i v iRemarks: i iam' Firm transporting was:_ - _State Stzip_Lic - i Hazardous waste.rnar.i I i Approved tank d1.sPos.6 , d Readvill.e ma Tank yard# _008 -- i Type of inert gas . _Tank yarc address - Re.adville, MA i City or Torn Osteryilie FDID#_ 01920- Permits 1 Date of issue 9. 2001 Date of expiration June 27, 2001 � l Dig safe approval rnu rs C Sa ci Tea. Nt tuber•80U 322-<t3Sh Signature I Tine of Of;c=f nranting permit After remcval(s)send F: . 90R signed by Locei Fire Dept.to UST Regulatory t:Ornp!ic^.Cc Jr-it,One Ashburton Place, Rcom 1 31 0, Boston, VA Z- 161 S. TCTHL P.02 -133 go L 0 P110N SEWA(GE PERMIT NO. 4. 1A/ego j VILLAGE — 5 INSTALLER'S NAME i ADDRESS I� JOIN A. AALTO .BACKHOE SERVICE r West Barnstable,'Ma,-,.; 09668 BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED x 37.7 Vol r / ,ewe l I t a f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Installer Address Z Other Distribution box ( ) Dosing tank ( ) The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TI-ITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be by the board I Date ------- Date — _--'No Date _ a.. I . pf7 Fps...-.�.....Z-W .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----- .. ...........OF...... .... ./ ., -- _.d. ............................ ApplirFation for Uiipo,5 al Workii Tomuurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair (" ) an Individual Sewage Disposal System at: . Location Address or o. # f QI..... . .....k.................. i. Own r ddressy Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............................. .. _Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons---------------------------- Showers — Cafeteria 04 d Other fixtures ------------------------------------------------------ ----------------------------------------------------------------------------------•----------- W Design.Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.___---___---__-__-- Diameter.................... Depth below.inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date-------------•-------------------------- aTest 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.................... Depth to ground water........................ a -----------------• ---------------••-•----.._......----•...------•--------------------•----•-------........---••---------.....•-•---•-•-----.........-----•. Description of Soil --------------------------- x -------------------------------------- •---- . -------- -- U Nature of Repairs or Alterations—Answer when applicable.....1?' _.____Ls---- !f---► ------D!0! ----------------------------•-------------------------------------------------------•---........-•-----•----------------------------------------------------------------. .............................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i T`:L., p of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b s ed by the board eal igned------ ----•-..:...... ._ ..» ,d'"' � p - Application Approved BY + i `f . -......--�'-'��at ------- Date Application Disapproved for the following reasons------------------------------------------------------------------------------------------------•---------------- --••---•--••--------=-----•------------•-•----------------......--•--............----•------------•-•'----------••---•--•-------•-------------•----•--•---------------•------•-------•-•---•---.----- Date PermitNo.......................................................... Issued.....------------------------------••-................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH !..#...........0F.... /' t! r! e.iV................................. Trrtifiratr of Tontph anre THIS IS O CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired bY----------------- "r? 'sl,,r►-•_-_41_4.. z" ---------------------------------------------------- Installer at.. 4 ..... - ........ -25 ,t! a "A'tSl. _ �t.d?r` ........................................... has been installed in accordance with the provisions of TITIZ j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.___._..a.""_ .;v, dated-.---------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... ............................. Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....2. l ..........,OF....�f.�?., 'I-�:�'`I! a" '/4.Jj'.let�.............................. No. ' FEE Mst................... Diopooatl orko �onotra ion autit Permission is hereby granted......... .............r4A. -Z&-------------------------------------•--.........--------••-•---•-•--•-•----- to Construct ( ) or Repair ( "an Individual Sewage Disposal System atNo. ." ".. '_ > 111MI..S...........VA.->--------.---------------•----------•----•------------------•----------------•---............ Street as shown on the application for Disposal Works Constructio Permit No..................... Dated.......................................... .... -: . ............................. and of Health DATE-- .... ' -------=--------------•-• FORM 12 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE LOCATION T(o /�// L�s La-& , SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. �a kr) L� SEPTIC TANK CAPACITY /O Ud LEACHING FACILITY.(type) ®2 gi (size) IyOd NO.OF BEDROOMS OWNER PERMIT DATE: 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.facili-thy)/ Feet FURNISHED BY mg. r DE ° SE. 45 .1146 �./LrfE0.CodE2 gG" 53' 6-AR-6-E i 6"oi=62koE A 8 CPAILI'Aici f �lI-6.2, SJ� UND Ee- gl{ q4 /too^ D � (Ouo(TALL on1 SNR.,BI SePr�L r.¢Nk /Ooo &,4".M1I ' /QO U-(rA LLON' L EALN l nl G EACH/N� Pir d A SPA. G p=gox µ. t-" PA"o ti //Jfr2 o�ND �rA5/=E7-Pi/FLL PooL lo.J(LT rm.sar�+.��s..ramwe..n.m s....v.o.was.�•wo.ud�s col`3 ? L0 C A I voN �, / SEWAGE PERMIT NO. rd /�'�is litrd�ly !!aILAGE 715 IV. � 6151 IY 3 � 4ss � � �� 3 � I N S T A LLER'S NAME i ADDRESS JOHN A. AALTO .BACKHOE SERVICE West Barnstable, Mays 0266E BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED / � � -- y � ,.,.p. ��' i�� q�� ' , , � �� - , �.. � -` � ,. -yS � �� .� �. `� I P7? No .11y.:.. Fizu..%Z.`.s .�..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /C1",t ,4 _. .......----OF...4killl..l' --------------------------------- �[ Apphration -fur �i,4putittl urku Tomitrurtiuu rru it Application is hereby'made for a Permit to Construct (.k) or Repair ( ) an Individual Sewage Disposal System at: Locati n.Address or Lot No A&!!eLA.....XL4�(IIA .. ................. 4.. _..4/_A!,QA----411..... �.. -.4--!. ................. -� Owner Address Installer Address �r Q Type of Building Size Lot_`°4`_..*-'--'�_-_Sq. feet U Dwelling—No. of Bedrooms..3---------------------------------------Expansion Attic k%egp) Garbage Grinder (/I" P4. Other—Type of Building 4-o-1w4--------- No. of persons............................ Showers ( ) — Cafeteria ( -Ta a' Other fixtures .. . W Design Flow___ ...............................gallons per person per day. Total daily flow.-?3.G---------------------------------gallons. WSeptic Tank—Liquid capacity-------------gallons Length................ Width..........------ Diameter------- ........ Depth.--.---_-.----- x Disposal Trench—No. .................... Width../_G............ Total Length.... ------------- Total leaching area.-f-la4;r..------sq. ft. Seepage Pit No.._I............... Diameter.................... Depth below inlet________ __.._._._ Tots �e Iitlg area------------------sq. ft. z Other Distribution box Dosing tank Percolation Test Results Performed by._.^..._ . _..... ___________________ Date____l2.'�1---T�--.".. ,aa Test Pit No. 1___;�t__-minutes per inch Depth of est Pit________ _____..... Depth to ground water-----------------....... f� Test Pit No. 2................minutes per inch Depth of Test Pit................!--- Depth.to ground water__.-.--..__----.--__---- - ----- - --------- Description of Soil----0 x W -•-•--••-•--------------`---------------------------------•--------------------------------------------------------------------------------------------------------------------------------------------- UNature 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 Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of ealth. Signe .-- ••-- . `�` ate Application Approved By--!'----- ---------- ------------------------ ' - .� � • ._.. Date Application Disapproved for the following reasons------------------------`-----------------------------------------------------=-•--•-------. ••---------------•- .---•-••-•----•--•-......••--- ----------------------------------------------------------------------- //// Date . ••-••••--....... Issued_., -�7--__.Permit No------------------------------------ --�------------------• I Date :. 0:2. X- THE COMNi0NWE F�ALT 'OF MASSACHUSETTS BOARD OF . HEALTH Appliratinu -flit.IN-4-nfittt -1 rkii ( >a�t # urtilan Irrutit Application is hereby'made for a Permit to Construct L� ). or.Repair. ( ) an Individual Sewage Disposal System at • •- Locati Yin Address or Lot N Owner � Addres ---------------------------------------------------------- Installer Address Q Type of Building Size Lot/'9(A"'_.__Sq. feet U Dwelling—No. of Bedrooms.S.......................................Expansion Attic .W) Garbage Grinder (✓L aOther—Type of Building ----------- No.No. of persons________.__________________ Showers Cafeteria v"f'`` d Other fixtures ---------_---------------------- : .._.._... W Design Flow___�� __________________________'.::_gallons per person per day. Total daily flow._Z�'f::,.__"-._______"_____-__._-.."_gallons. WSeptic Tank—Liquid capacity_;.' gallons Length---------------- Width--- -------..... Diameter................. Depth-----_---_.----. x Disposal Trench--No. ___•________________ Width../&--________-" Total Length....6............. Total leaching area_ 47-4!-"_-_-_sq. ft. Seepage Pit No _______________ Diameter-------------------- Depth below inlet------- _________ Total,l citing`-area------------------sq. ft. z Other Distribution box ( ) Dosing tank Percolation Test Results f Performed by---"--.. :_- --, ✓^ � .__---------------- Date___-:_--------------------------------.. Test Pit No. 1..... =___minutes per inch Depth of Test Pit..._.____ ........ Depth to ground water_____._________________ 44 Test Pit No, 2---__------------minutes per inch Depth of Test Pit..................... Depth to ground water------------------------ O 2 f � Z�.. .. �` 7 ,'+` e y Descrtption of Soil - =`=� `� _- ._.. ,`` = x w U Nature of Repairs or Alterations—Answer.when applicable.".".................""_--_-__-______-__."".____.".:____-"'.-"-""..._......_...___.".-".--.___--. ------------------ --------------------------------------------- ----•-•-----------------------------------•--------------------___---------------•----_._-----•-------•-----•-•-•----------------••-------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of bealth. Signe < -- --- -- -� 011— .-_ _� Application Approved B .- - .... ------ Date Application Disapproved for the following reasons:-------=----------�_/._._.__.._._.._._:_._......_______._..._....__-______.._..__._D -...__________ I -----------------•-------------"--------------------•--------------------------------•----------=---..--.__-______-------------------------------------------------------------------------------------- A Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF yEALTH ....Z.....:............OF....... . .....it.�.✓............................................................. Trr#ifirttte of f0111utphaurr THISJIS TO CER IFY1 That the Individual Sewage Disposal System constructed ( �'or Repaired ( ) I • __ by - i41 + f ' •------• -•----------- / / /� Installer "r �d '�1 � l ./ ,f.1 L e i° f °'.� , f -_ has been installed in accordance with the provisions QArticle T)of the State Sanitary Codes des Abed in the application for Disposal-Works Construction Permit __:-________--______-___. dated____ _____________ --•--------•--------••----•- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS UED AS A GUARANTEE THAT THE SYSTEM WILL FUNCT)ON SATISFACTORY. DATE - -- ---••-----•-• Inspector- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �f No FEE................ tt1 ur (n thin motif Permission is hereby grantied........ . ..... to Construct or Repai an 'ndivi al w ge Dis Sys �,r �f� P f _'_'... Street as shown on the application for Disposal Works Construction. Permit L �t e fq th Board of Hea - .. DATE............. -- -----= -------- -------- .... . FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS t. Z �S i r N OAL: . / oi _1 1 Inc 1 . VA Q flit v, � 4dy7�� 4: 1 T�O of Z07 - _ �P►f t oo)( ® f po 3 ors t3�e� oc, Ass�H�D 7��'lLry ' /1/oT'-t7tVfYl'l CERTII=IED PLOT PLAN T LOCATION �.STE�z yic G MA s S , SCALE . !. Sa ' DATA-Dc e_ /8 o ` EDWARD E. 10ELLEY PLAN EFI3�C€ L' �/C. . .�?-..` ... . M-AMAQUID, MASS. 0263 �d 1 SIICIW v o.v ,q Plg.. CE, FlG�y� T 6\ a E. EDWARD G ��. \� •�j o KELLEY �7 . . . . . . . . . . `J 2;10;l •F, a I CERTIFY THAT THE ... .... . , SHOWN ON.THIS PLAN IS LOCAT F GPOUND AS SHOWN HEREON AND IH44,, R S TO THE . SETBACK RE9UiRF EgN�''S - H TOWN OF 1?1 . . . W HE CONSTRUCTED. S/GVi 1/iIQ L✓niUA LRNE DATE . . . . . . .. . PETITIONER: RE3ISTERED LAND SURVEYOR 4.- y :. ¢E. .i o ' TOP OF FOUNDATION e CONCRETE COVER .CONCRETE COVERS. e 4"CAST IRON 12"MAX. 12"MAX. T3'/4 OR 4ORANGEBURG(OR EQUIV.)MIN. PIPE- MIN. LEACH /4"PER. PITCH 1/4PER.FT PITINVERT ' Q`•o EL '44:�7 INVERT INVERT e .Disw INVERT SEPTIC TANK 369 BOX EL:!-3,: ' >=.. GAL. INVERT ~a EL:'`i3•86 43S INVERT V` ww �:� .0 � :w DI PROR LE OF GROUND WATER TABLE SEWAGE.- DISPOSAIL==_ SYSTEM- NO :-- .SCALE F NO R L Y`1 I'm A R Y SOIL LOG - WITNESSED BY : DATE": �9,,,G BOARD OF HEALTH TEST HOLE 1 TEST HOLE 2 7 , �; / ' Z.G�`�!/ ENGINEER ELEV. .?`.�G . . ELEV. . . . . . woolXdt�1 DESIGN - DATA NUMBER OF BEDROOMS TOTAL: ESTIMATED FLOW .33o GALLONS/DAY BOTTOM LEACHING AREA �8.S . . SO.FT./PIT SIDE LEACHING AREA : .�&8c`�o SQ.FT./ PIT Corte,r Sv a Aj GARBAGE DISPOSAL !19^!E. .(50016 AREA INCREASE) TOTAL LEACHING AREA . SQ.FT /41 rr PERCOLATION RATE 494:S. « .Z. . MIN/INCH LEACIING AREA PER PERCOLATION RATE .-1.3.7.0... SQ.FT. .!.'�o.WATER ENCOUNTERED NUMBER OF LEACHING PITS �.Pr?rw! 7??4 F6z7 APPROVED . .. . . . . . . . . . . BOARD OF HEALTH 0! _-57 AIE oi✓ 6eZ -SrD s, — /.5:G Tdnr,S o TlfO',N fA*'E: EL•L y CO. STD�E" P_-Z T, r7GINEERS-SURVEYORS DATE. . . : . . . . . . 346 LONG POND DRIVE AGENT OR INSPECTOR /r' n.n 6- r; rEY SO'ITH y&RIMOUTH,MASS. //{.t 0 02664• 47 �� -0, i. E g sr s K l CY .24260 ✓� cn PETITIONER