HomeMy WebLinkAbout0120 ASA MEIGS ROAD - Health 120 Asa Meigs Road
Marstons Mills
A = 031 001005 '
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delivery address below: ❑No
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KENNY TASSOULAS
33 SUNRISE LANE
EAST HAMPTON, CT 06424
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a Town of Barnstable '
Health Division
200 Main Street
Hyannis,MA 02601 -
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a KENNY TASSOULAS��
Ln 33 SUNRISE LANE
o EAST HAMPTON, CT 06424
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S
Town of Barnstable
Inspectional Services
anxcvsrAHLL
MASS.
i639• Public Health Division
`0�
0N' p 200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Thomas A.McKean,CHO
FAX: 508-790-6304
March 4, 2020
KENNY TASSOULAS
33 SUNRISE LANE
EAST HAMPTON, CT 06424
*** UPDATE***
RE: STATE ENVIRONMENTAL CODE, TITLE 5 CONDITIONAL PASS
The septic system located at 120 Asa Meigs Road, Marstons Mills, MA was inspected
again on 02/17/2020 by Chad Hathaway, certified Title V Septic Inspector for the State
of Massachusetts. This inspection was conducted after a"conditional pass" report was
already submitted to the Health Division. The results of the inspection on 02/17/2020
were a"pass." After reviewing the results with David Stanton, RS, Chief Health
Inspector and Thomas McKean, RS., CHO, Health Director along with photographs
attached to the report and verbal discussion with Chad Hathaway, it was determined the
system passes inspection and no further action is required.
Thomas McKean, 6
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mai ling\Conditionally Passes Letters\120 Asa Meigs Road Marstons Mills
UPDATE.doc
f oa1 J oo/ obs—
Commonwealth of Massachusetts
Title 5 Official Inspection Form
ja Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. Cityrrown State Zip Code Date of Inspection
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. Inspector Information LF38(0
on the computer,
use only the tab Chad hathaway
key to move your Name of Inspector
cursor-do not HPS
use the return Company Name
key.
P.O.Box
151
r� Company Address
Forestdale Ma 02644
City/Town State Zip Code
774 274 2581 12866
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
2/17/2020
Inspectors gnature Date
The system inspector sh I submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 0 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: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.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) 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:
This inspection is not a guaranteeand applies no warrantyof the described septic components in this
report including but not limited to piping structual intergrity of components and life exspectancy of
leaching and described components. This inspection is to describe conditions witnessed at time of
inspection only. Regular tank maintenance and water conservation can prolong life of septic systems
. Information on care and do's and don't's can be found at town health dept or mass.gov .. No faailure
critera was encountered during inspection
2) 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.
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 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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18
i
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owners Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ 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):
❑ 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):
3) 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.
a. 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:
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
r� p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
�. 120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for 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.
c. Other:
4) 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
t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
f
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
Required pumping more than 4 times in the last year NOT due to clogged or
q P P 9 Y 99
❑ ® 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 water supply
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 2000 gpd-
10,000 gpd.
❑ ® The system fails. 1 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.
5) 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 CA.
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
t5insp.doc•rev.7/2612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answerec"yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
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?
HasAhe 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
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 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)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
u 120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information
1. Residential 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
Description:
2003 Asbuilt card on file at BOH. and online field card
Number of current residents: seasonalpart time
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes Z No
Seasonaluse? ® Yes ❑ No
Water meter readings, if available (last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: � seasonal pagrt
time use
}
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commerciallindustrial 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
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
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 below):
3. Pumping Records:
Source of information: no record-unknown
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc-rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
4. 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 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:
tank 1983 age of house Dbox and leaching upgraded 2003 per asbuilt card
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 1.5'feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: 24'+
feet
Comments(on condition of joints, venting, evidence of leakage, etc.): D
no signs of poor venting or leaks
c,r., �9
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
l' a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
'
Depth below grade: 1
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
tank is a H10 precast tank. both covers opened PVC tees in place. tank is normal to above average
condition for age with no major decay or visable cracks or leakage. Tank does not require pumping at
this time. Recommend pumping tank in 1 year and every 2 years after with normal everyday usage
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 8'6"x5' 1000 gal
Sludge depth:
6"
Distance from top of sludge to bottom of outlet tee or baffle
24"
Scum thickness no scum
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
How were dimensions determined?
tape and 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.):
PVC tees in place. no major decay or leaks visable
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�o
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
7. 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.):
8. 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):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
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
9. 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.):
Dbox is solid with no major decay Dbox is D133 H10 woth 2 outlet pipes. no major carry overs
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cost.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
*If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
no Inspection port in leaching chambers. probed into stone bed. Probe was dry and clean
Type:
❑ leaching pits number:
® leaching chambers number: 5 Hi Cap
infultrators
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System(SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
36'x10' leaching bed with hi cap infultrators . no hydraulic failure present during inspection
12. 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.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
c Commonwealth of Massachusetts
! Title 5 Official Inspection Form
I-a Subsurface Sewage Disposal System Form Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. 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.):
t5insp.doc•rev.7/26/2618 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
u 120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. Citylrown State Zip Code Date of Inspection
D. System Information (cont.)
14. 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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t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 2/17/2020
page. City/Town State Zip Code Date of Inspection
D. System Information (cost.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 50+
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:
lot el. area of septic el. 100' low in area 50'
You must describe how you established the high ground water elevation:
town GIS mapping. bottom of leaching 4.5' below grade
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
I
Commonwealths of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Asa Miegs Road
Property Address
Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2/17/2020
required for every �
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6 (Checklist)completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
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SINE Town of Barnstable
LE.
Inspectional Services
M"K
1639. Public Health Division
1'b
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 / �6 Thomas A.McKean,CHO
FAX: 508-790-6304
CERTIFIED MAIL#7015 1730 0001 4988 1463
February 27, 2020
5�.���
KENNY TASSOULAS S /
33 SUNRISE LANE
EAST HAMPTON, CT 0642 �I
TM
ORDER TO COMPLY WIT E ENVIRONMENTAL CODE, TITLE 5 d�,
The septic system located at 120 Asa Meigs Road, Marstons Mills, MA was inspected
on 02/10/2020 by Brett Hickey, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Conditionally Passes"
under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following:
• The distribution box is rotted and the septic tank is leaking.
You are ordered to replace the distribution box within one (1)year from the date you
receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Thomas c Pean,+R , CHO
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mai ling\Conditionally Passes Letters\120 Asa Meigs Road Marstons Mills.doc
of THE r
Town of Barnstable
ElARNSMULE,
MASS
Inspectional Services Department
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An 'Y' marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
❑ Structurally unsound septic tank or SAS
ONE (1) YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
❑ Leaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
4c
�Ied d4ox le k 1 -e P�t, 14
O�
Repair deadline: v P c"r
Q:\SEPTIc\DEADLINES TO REPAIR FAILED SYSTEMS.doc
d31-DDI-b05y
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
- I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Road '
Property Address
Kenny Tassoulas °=
Owner Owner's Name `
information is Marstons Mills Ma 02648 2-10-20 t
required for every
page. City/Town State Zip Code Date of Inspection
C`-
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. Inspector Information 51-W Iq3�5
on the computer,
use only the tab Brett Hickey
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
374 Route 130
f Company Address
Sandwich Ma 02563
City/Town State Zip Code
(508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenan -site sewage disposal systems.After conducting this inspection I hav determined
th h em:
1 ❑ Passes _
Z ■ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
17/"
Brett Hickey ore,,.ty,re��o���,� M.��
�a1e:211M.02.if 00:3f:p045W
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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: 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.
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts ~
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Road
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) 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:
2) 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.
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.
*Nmetal 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):
Liquid level in septic tank was 7" below outlet invert showing tank is leaking. The
d-box was also in poor condition with heavy deterioration.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Y c � Commonwealth of Massachusetts
Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Road
V
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ 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):
0 distribution box is leveled or replaced ❑■ Y ❑ N ❑ ND(Explain below):
D-box was in poor structural condition.
❑ 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):
3) 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,
a. 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:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
r
Commonwealth of Massachusetts ~
�b Title 5 Official Inspection Form
w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u-
120 Asa Meigs Road
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for 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.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ a 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
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 16
cam, Commonwealth of Massachusetts
Title 5 Official Inspection Form
, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Road
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/z day flow
❑ O Required pumping more than 4 times 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.
❑ o Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ El Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ Q Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ El 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.]
❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ 0 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.
5) 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 CA.
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
t5insp.doc•rev.7/26/2018 Title 5 Offdal Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
cam, Commonwealth of Massachusetts
i? Title 5 Official Inspection Form
'= 1. Subsurface Sewag
e Disposal System Form Not for Voluntary Assessments
120 Asa Meigs Road
V�
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no" for each of the following for all inspections:
Yes No
❑ El Pumping information was provided by the owner, occupant, or Board of Health
❑ 0 Were any of the system components pumped out in the previous two weeks?
❑ ED Has the system received normal flows in the previous two week period?
Y p
❑ ❑ Have large volumes of water been introduced to the system recently or as part of
this inspection?
0 ❑ 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?
El ❑ Was the site inspected for signs of break out?
El ❑ Were all system components, excluding the SAS, located on site?
El ❑ 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?
❑ 0 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:
El ❑ 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)]
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
�v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
/
L—
120 Asa Meigs Road
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
3 3
Number of bedrooms(design): Number of bedrooms (actual):
330/GPD
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Description:
1
Number of current residents:
Does residence have a garbage grinder? ❑ Yes 0 No
Does residence have a water treatment unit? ❑ Yes 0 No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No
information in this report.)
Laundry system inspected? ❑ Yes a No
Seasonaluse? El Yes ❑ No
See below
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
2018- 37,000gallons 2019- 30,000gallons
Sump pump? ❑ Yes ❑■ No
Jan 2020
Last date of occupancy:
Date
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
_4
Commonwealth of Massachusetts
TitleOfficial 5 Inspection Form
_ iI Subsurface Sewage Disposal System Form Not for Voluntary Assessments
120 Asa Meigs Road
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/industrial Flow Conditions:
NA
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
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
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 below):
3. Pumping Records:
Source of information: Owner- date of last pump is unknown
Was system pumped as part of the inspection? ❑ Yes 9 No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
c Commonwealth of Massachusetts
+ Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Road
v
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
El 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:
SAS installed 2003 per COC
Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
2'
Depth below grade: feet
Material of construction:
❑ cast iron 9 40 PVC ❑other(explain):
Town water
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
�= . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Road
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
1'
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
1
Dimensions: 000gallons
Tank leaking
Sludge depth:
gn it
Distance from top of sludge to bottom of outlet tee or baffle
n n
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
Viewed
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 tank was leaking at the time of inspection. Liquid level 7" below invert
when viewed.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18
c Commonwealth of Massachusetts
T w _ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
............. / 120 Asa Meigs Road
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: NAfeet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
f- 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.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
NA
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Road
V�
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
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
9. Distribution Box(if present must be opened) (locate on site plan):
0"
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.):
The d-box was in poor condition at the time of inspection.
t5insp.doc•rev.7/26/2018 Tifle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
�m Title 5 Official Inspection Form
I_
5 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
- 9 P Y rY
........... � 120 Asa Meigs Road
u—
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
NA
* If pumps or alarms are not in working order, system is a conditional pass.
11. 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:
36'x10'x1'
0 leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
±= ,; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
c I
120 Asa Meigs Road
u�
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
The SAS was in working order at the time of inspection. Leaching was dry when viewed.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
NA
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.):
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
Commonwealth of Massachusetts
n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Road
u Property Address
Kenny Tassoulas
Owner Owners Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
NA
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Road
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
D, System Information (cont.)
14. 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
sue . '�
3 a4,sr a�x S. fr0`.
il
-
f.�F3E� ;arfia' 4`�'i, ki?.• �..ffiQ-`�€ &�t':�U+t ._..-;..:.„.....,„„,S.�F'�et.
it
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i a "V.°�'�'p Nq DctltWss
l5insp.doc•rev.7/26/2018 Tifle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�= F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Road
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
■❑ Check Slope
❑ Surface water
❑■ Check cellar
Shallow wells
No GW 4' below SAS
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
0 Obtained from system design plans on record
2-10-03
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 9
you established the high round water elevation:
Y g
A plan on file at the local Board of Health was used to determine high groundwater.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
I
Title 5 Official Inspection Form
w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
\ � 120 Asa Meigs Road
u
Property Address
Kenny Tassoulas
Owner Owner's Name
information is Marstons Mills Ma 02648 2-10-20
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
i❑ A. Inspector Information: Complete all fields in this section.
■❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
0 C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6(Checklist)completed
�■ D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
120 Asa Mei s Rd
Property Address
David Romiza and Heather Murray2
Owner Owner's Name
information is I
req u ired for every Marstons Mills V Ma. 02648 10/30/2015
Citylrown ~°page. State Zip Code Date of Inspection PQ
o,
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 A. General Information
filling out forms ��#
on the computer, /1.27
use only the tab 1. Inspector: (U
key to move your
cursor-do not Mike Bisienere
use the return Inspector
Name of Ins
key. P
Cape Septic Inspections
p
A Company Name
624 Old Barnstable Road
�I Company Address
Mashpee Ma. 02649
City/Town State Zip Code
508-280-3356 S13938
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
10/30/2015
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. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
y 120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owner's Name
information is
required for every Marstons Mills Ma. 02648 10/30/2015
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
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 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):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Mei s Rd
Property Address
David Romiza and Heather Murray
Owner Owner's Name
information is
required for every Marstons Mills, Ma. 02648 10/30/2015
page. City/TownState Zip Code Date of Inspection
B. Certification (Cont.)
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):
❑ 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.
I. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owner's Name
information is
required for every Marstons Mills Ma. 02648 10/30/2015
page. Cltylrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
*k 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:
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
❑ Z 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 cesspool is less than 6" below invert or available volume is less
than Y day flow
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
,
Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
i
120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owners Name
information is
required for every Marstons Mills Ma. 02648 10/30/2015
page. Cltyrrown 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.
❑ ® 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.]
❑ Z 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 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.
t5ins•11I10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Mei s Rd
Property Address
David Romiza and Heather Murray
Owner Owner's Name
information is
required for every Marstons Mills Ma. 02648 10/30/2015
page. Cltylrown 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
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 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)]
D. System Information
Residential 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner information is Owners Name
required for every Marstons Mills Ma. 02648 10/30/2015
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 0
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
Seasonal use?
❑ Yes ❑ No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump?
❑ Yes ® No
Last date of occupancy: 08/2015
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:
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Pj
s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
.° 120 Asa Mei s Rd
Property Address
David Romiza and Heather Murray
Owner Owner's Name
information is Marstons Mills Ma. 02648 10/30/2015
required for every City/Town State Zip Code Date of Inspection
page.
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
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):
t5ins•11/10
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
,•`ye 120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owner's Name
information is
required for every Marstons Mills Ma. 02648 10/30/2015
page. Cltyrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade:
19"
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.):
Septic Tank(locate on site plan):
Depth below grade:
1211
feet
Material of construction:
® concrete. ❑ metal ❑ fiberglass ❑ polyethylene
El 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: standard 1000 gallon
Sludge depth: < 1it
..
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 10/30/2015
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
38"
1„
Scum thickness <
Distance from top of scum to top of outlet tee or baffle
4"
Distance from bottom of scum to bottom of outlet tee or baffle
12"
How were dimensions determined? field instruments
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
I would recommend the new owner put the tank on a maint. plan based on the future use with a
local septic pumping co.The Barnstable Health Dept. has a list of local septic pumping co
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete El.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
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owner's Name
information is
required for every Marstons Mills Ma. 02648 10/30/2015
page. Cityrrown State Zip Code Date of Inspection
D. Systelrrt, 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:
❑ concrete ❑ 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
r
Commonwealth of Massachusetts
W Title 5 official Inspection Form
Subsurface Sewage Disposal System
9 p y Form Not for Voluntary Assessments
120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owner's Name
information is
required for every Marstons Mills Ma. 02648 10/30/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Sox (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.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
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:
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 10/30/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
® leaching trenches number, length: one with 5
infilltrators
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owners Name
information is
required for every Marstons Mills Ma. 02648 10/30/2015
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note conditio_ n 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.):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owners Name
information is required for every Marstons Mills Ma. 02648 10/30/2015
page. Cityrrown 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
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
TOWN OF BARNST--ABLE �.•
LOeATfC N I SEWAGE M�3-(S(p i'D
VILLAGE 1 ASSESSOR' MAP 8r L0�_,�
INSTALLER'S NAME PHONE N0.
SEPTIC TANK CAPACITY 57ASi 0- OQQ
LEACHING FACTLTIY:(type) 4LC s ZZN+ Tr4M6(size)_c6
NO.OF BEDROOMS 3
BUILDER OR WNERiC(-.(11r'.rLJLL u I l ✓G v�
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
o �,
L I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.• 120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owners Name
information
equir for
is every Marstons Mills
required for eve Ma. 02648 10/30/2015
page. Citylrown 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: 15 plus feet
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:
I aguared a hole at a lower elevation and shot elevations with a transit to show five plus feet of
se eration.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
120 Asa Meigs Rd
Property Address
David Romiza and Heather Murray
Owner Owner's Name
information is required for every Marstons Mills Ma. 02648 10/30/2015
page. Cityrrown 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
A
30'�ot-1 or- 5, A. s.
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
TOWN OF BARNSTABLE 77
LOCI:ATION SEWAGE # 03-6rra.(o
VILLAGE14,41A, (ic. 81/Y ASSESSOR�& LOT��
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY -15tc1 SS!((wS���:��►�.�
c
LEACHING FACILITY: (type) _tC (size) c�`M lD e 2C/
NO. OF BEDROOMS
BUILDER OR OWNER I CC, 'k e &
PERMITDATE: COMPLIANCE DATE:_2 &5/n3
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
IT ,��Tom/•- �� J ;= t �
�.a T
No. �� hn F,. Fee
�Jv�
6 r V
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZippIicatton for Zigpool *raem Construction Permit
Application for a Permit to Construct( )Repair()4)Upgrade( )Abandon( ) El Complete System Individual Components
Location Address or Lot No. 12D He i 5 Ow er'g Name,Address and Tel No. 1
1'�n 7 tJ, O,�&I 11,s6uh
Assessor's Map/Parcel r ;
Install Vole,Address, d Tel.No. - ° Desi ner's Name,Address and Tel.No.
YI -ASS r u I rinwI64-IL
► uxI57
6Ln �-I �Z�OI
Type of Building:
Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons —Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow >>> L f gallons.
Plan Date Number o^f'.s ets Revision Date
Title rhv
Size of Septic Tan Type of S.A.S. tr
Description of Soil , %I' 7f Qlm
f
Nature of Repairs or Alterations(Answer when applicable),
DESIGNING ENGINEER MUST _
.,1PERVWE
INSTALLATION AND CI HE ERnFv �i�G
SYSTEM WAS INSTALLED IN STRICT
Date last inspected: ACCORDANCE TO PLAN.
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu d b t is Board a lth.
Signed Date
Application Approved by Date
Application Disapprove for the following reasons
Permit No. Zya 3—0&6 Date Issued 2-It 0 o3
.` I V /} \
Fee (/
U �b.•�%4 {ems
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
` f � Yes it
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
91pplicaltion for -Migaar *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair(A)Upgrade( )Abandon( ) D Complete System Individual Components
Location Addressor Lot No. Owner' Name,Address and Tel No.
Assessor's Map/Parcel
M�rs-Fans tM�)q �. .�I G�1'��'? � �, D �I I i vc.�.►-�
Installer's Name,Addressl�,,�in`'d1Tel No. l C l Designer's Name,Address and Tel.No. '
Q Y .l�LQ�lug S��O t�`��5>f ?G .5�" l�bYlWlCln
z L-) ,
Type of Building: 2
Dwelling No.of Bedrooms 3 Lot Size sq.ft: 4", Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow ,30 gallons per day. Calculated daily flow gallons.
Plan Date a Number of s ets I Revision Date
Title �U ��GG� 1[- U G-
Size of Septic Tank IS 1 Type of S.A.S. I I I1(l"iL�D S
1 r.
Description of Soil toy f a/n
#� w Nature of Repairs or Alterations(Answer when applicable)-6, 1. (X t1
Date last inspected: '
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu` d by this Board o He lth.// �t //''
Signed ���J Date )V '7
Application Approved by Date
Application Disapprove for the following reasons
Permit No. Z 00 3—0(o Date Issued ?W 0 0.3
----------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(�)Upgraded( )
Abandoned( )by
at Asn Qio.(a .,, t�v l s f has been construc ed • accordance
with the provisions of Title 5 an ,th/re for Disposal System Construction Permit No. ZOa 3—00b dated 2 O 0 3
Installer .� (a O c� I/)Lpyr APJ Designer
The issuance of this p� it sh 31 not a construed as a guarantee that the s t� 1 function as designed '
Date Inspector ./0 V�(�.( % d �0'
711 J
---------------------------------------
No. `0p�� U�pb Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Oigogal *pgtem (Congtruction Permit
Permission is hereby gran ed to •onstruct( )Repair( )Up rade( )Abandon( ))
System located at Q. L'�l 5 C)C Cl S �S1 I S
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this pe it
Date: (�TZ�)b� Approved by
li
CARMEN E. SHAY (508)-548-0796
ENVIRONMENTAL SERVICES, INC. P.O. Box 627,East Falmouth,MA 02536
February 25, 2003
RE: Certification of Title V Septic System Installation:
Residential Property— 120 ASA MEIGS ROAD, Marston Mills, MA
Dear Sir or Madam:
On February 24, 2003, Roger Roberts, Inc. was issued a permit to install a Title V Septic System at
120 Asa Meigs Road, Marston Mills, MA. based on a design drawn by Shay Environmental Services,
dated, December 28, 2002.
XX I Certify That The Septic System Referenced Was Installed Substantially According to the Plan
I Certify That the Referenced Above Septic System Was Installed With Changes but in
Accordance With State and Local Regulations, Revisions or As-Built Plans/Sketch will Follow.
The Septic System Was Not Installed Per State and Local Regulations and Corrective Action is
Required.
If you have any questions, please do not hesitate to call the undersigned at (508)-548-0796.
Sincerely,
CARMEN E. SHA Y
ENVIRONMENTAL SERVICES, INC.
rta�� P
G
Carmen E. , R.S.Q.
President " SHAY v
No. 1181
0
r \SN�.rF?�grl_ rj
,
1
L0C^ATION SEWAGE PERMIT NO.
Lot 5 Asa Meiga Rd. 83-161
YILT.AGE
Marston Mills Barnstable
INSTA LLER'S NAME i ADDRESS
Robert B. Our Co. Inc.
Great Western Rd. No. Harwich, Mass. 02645
BUILDER OR OWNER
Barstable Holding Co. Davey Jr.
DATE PERMIT ISSUED 4/28/83
DATE COMPLIANCE ISSUED 11 �
r
F3 ask o-�- h o k S`�— �_ , . ,
. A
i�` � i
�� ,, a 3
a�� �� �
.� .. �
No... ..�.1 / FIFE .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF !-1 EAL 7.... ...fi.✓........................OF.-.-.........!aa y - .
.........................................
Appliration for Disposal Works Tomotrurtion Frrmit
Application is hereby de for a Permit to Construct epair ( ) an Individual Sewage Disposal
System at: I
oca o -Address or Lot No.
_....
Owner ddres
...... .............Z...... 4.4?k
Installer Address
Type of Building Size Lot....7rl���A._y ... q. feet
U Dwelling—No. of Bedrooms.... _Expansion Attic ( Garbage Grr ( )
Other—Type of BuildingL®1�,r��� No. of persons.......__!_�_�________________ Showers Cafeteria ( )
Q' Other fixtures ......................................................
Design Flow___,?Q................................gallons per person day. Total daily flow..� �_.----------------------------gallons-
WSeptic Tank Liquid capacity gallons Length__ ._"_�___ Width_.P_-C.0__._ 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 ox ( ) Dosing tank ( )
F" Percolation Test Results Performed by.......................................................................... Date........................................
Wl Test Pit No. I...,Z,_C7__minutes per inch Depth of Test Pit----/_.Z....... Depth to ground water..22vAl
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
O Description of Soil._______O - U�r r7_____ ___: kk ,?� _� ------------------
x _ ,
W •-••---•--------------------•-----------•--•---•••-----•-----------••--.................................................................................................................................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
Th Indersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the pr i ions of'ITL L 5 the State Sanitary Code— The undersigned further agrees not to pla he system in
o e t• ntil of Com fiance has been issued b he o rd of health.
P P
Signed-•• .�� O j
C iG�� Date
� �,� _
APPIi Approved By----•- ��'y�%�
Date "
A ication Disapproved for the following reasons:-------•-------------------••---------------------------------•----------------------------•---••••-••-•-....---
.....................................................-..................................................................................................................................................
Date
PermitNo.......................................................... Issue(L.......................................................
Date
No... Fw5:. .�U............
THE COMMONWEALTH OF MASSACHUSETTS
/ BOARD DOE HEAL......... . T
r
--
}, 3
s
Appliration for Biovooal Workii Tomitrnrtion ramit
Application i hereby made for a Permit to Construct ( ) o, epair ( ) an Individual Sewage Disposal
System at:
...... ...__..._.._........ ..... .... -
oca o -Address // �r'' or It//NoAl
,lJ .! _--.
.. — �`a 'P4 - ^� = i?` s18✓�7IS '
r caner ddress�
Ole .L:... ... �'�. ...............Ate!.....
............................................................
Installer Address
Type of Building Size Lot..._.` ` _t..r , __ q. feet
Dwelling—No. of Bedrooms......AR,..................................Expansion Attic ( Garbage G> r ( )
A4 Other—Type of Building `'-",. ..... No. of persons `' ________________ Showers ( /) — Cafeteria ( )
X/ora
Q' Other fixtures ....--•.......................................................................... ...............
Design Flow .0................................gallons per person per day. Total daily flow-- (...........•..:..........._gallons.�
WSeptic Tank Liquid capacityf�nl gallons Length._/._°'.�__ Width._!/-e! .. Diameter............... Depth__..'. .__�6 '
x Disposal Trench-No..................... Width......_..._..__._... Total Length__._._..... -......_ Total leaching area.............,......sq. ft.
Seepage Pit No.:..___f1__-___- Diameter.................... Depth below inlet.................... Total leaching area..Z.4 .sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY.......................................................................... Date........................................
a Test Pit No. I...:2::.O._minutes per inch Depth of Test Pit----- _�...._...Depth to ground water_.:
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x •••.......9................. .................
�;� --------------•-••----------
-D Description of Soil.........q- ..... � . ------------------------------------------------
x . .....: .
w
UNature of Repairs or Alterations—Answer when applicable....:..........................................................................................
-----------------------------------------------------------•------------•---------------.............--------------------------------------------------------------------------•••.......------•...-•---
Agreement:
The indersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the pr i ons Of�'ITIE 5 the State Sanitary Code— The undersigned further agrees not to pla a system in
ope�ti ntil of Compliance has been issued by he /oard of health.
j, Date
Appli Approved BY 3a 5,lva'
Date
A p ieation Disapproved for the following reasons------------------------------------•--------------------------•----------------•----------------------------•---
•-•-•---...---•••--•...------••-•-----•••••----••---•---•--•-••-•-•••-•-----------•--••-...--•--.......•••••--•••----•-------••••••-••-•••-••••-•••••-••---•--•--•--•---••----•-••----•---•••-•---------
Date
PermitNo......................................................... Issued.......................................................
Date
C� THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................................OF.......................................................I.............................
Trrtifiratr of Tontplittnrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Xor Repaired ( )
by.................. ...................................... ------------------•----_------.-•---------•-----_-----_---------...-----------•-•--•-----.------------
✓ Installer
at.......... ------•-- ------
e:--• ------...:- ------ - �� `� ..............................................................
has been installed in accordance with the provisions of TIT Imo. j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...... ............ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................. Inspector....................................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
No...f� 6�/ FEE.......... ...........
%Vvsal Work, �onotrnrtion rrntit
Permission is hereby granted........ - ....... } - '-........--...................................................................................
to Construct Repair ( )�a^n Individual Sew,ge Disposal System
atNo. . ... t,�n. :.r� ��--,-c....-. - � � ..............................................................
Street
as shown on the application for Disposal Works Construction Permit No------------------ Dated..........................................
B I.
DATE.................. , (J ...................................... oard of Health
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
777777
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CERTIFIED PLOT PLAN
EXISTING SPOT ELEVATION Ox0
EXISTING CONTOUR --- ® ---
FINISHED SPOT ELEVATION. [Q ] !off RoaERT
FINISHED CONTOUR 0 — f jkbo io IN
APPROVED BOARD OF HEALTH •+ . ���� Ns� , �
1°uT a O .�•.`•�A h J Y•I'�I w/ _.6 11+J M A
eEv sED 14 3
ENT 4 , 1, e ,M.-,,, l7 .1993
1 t DATE AGENT SCALE 1 4 0 DATE
3 LDREDGE ENGINEERING CO. iNp CLIENT t 1 CERTIFY THAT THE PROPOSED
t. EGISTERE REGISTERED JOB N0. 3 BUILDING SHOWN ON THIS PLAN
A CIVIL LAND CONFORMS `,TO THE ZONING LAWS
ENGINEER RYE
DR.BY OF SARNS•TABLE , . MASS
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�' �4"PE�s JrT,: SEPTIC TANK • • , r •Q • a • • • s .
BOX Y r.f Y 1 • • • • �•• •
• •.•s DCPTH • r • • i o WAS)/EP STONE
s e. � • • . e r • • • • o•sue PREC.45T SEEPAGE
x /D , �• , • . • • • • • • 1pi7 OR EOuiv.
IJVYP-r LrLEVAT/OHS • a — EEL='
If3. 1 x (, o .113 bID GsT D/AM.
:. 11lAVZRT.AT BU1LG/NG• (OI. S FT.
(2 FT O/ft1H- C CSA TABLILATIO-V
lNLfT SE T.
PTIC 4NI�C . (O'1. 3 FT. R 1 T CA PAc.1 r( : 4`7o [,7 D - -
:. Ol1TLET SEPT.lC TANK L41:'�F7.' _
INLET DISTRiB!/T/0N BOX-- FT. SECT/ON OF GRDUNO ITEK TitDLE
OiJTLE7-D/STRIB&-r1-0N MX too,7 F7.
!)vt Tcgvt41/vG �' AFT SWAGE O!s,4=05AL SYSTEM
p T R TASl1L.AT/DN ^
LEACHING / Nore c��
DESIGN CAI TERlA s /`:o" •Z —cAaA,E A-' 01MENS!ON /►�_FT.
(3c� r� 4 _FT.
Or Q2o�s n r�1+ 1MEN5/ON C M 1 tJ
IilU/NQER O.F DEDROOMS 3 r 17 +,r=.cz= g�-_?
Q FT sff- t.1(:::255 Ta
GitRa.4GEDJSPOSAL UNIT N osJE SOIL LOG To NSu�C:F G �Co�Nil wh \
O/L TEST .
TaTA�-.ESTJM�tTED FLO rV 33o G�►t./0.4 Y SO/L. TEST A/ SO/L M-s ws 1�ti,
XCIMBEA*GF 1.EACXI/VG PITS_ ? f`EL<"i! iO3.o r-ELFy DATE OF SO/(: TEST - 05 - 8 I
.SIDE jCACHlNG PER P/T 1`� 8 S4,L RT. LQ�AA RESULTS' N/JTNESSED BY NOS���'Q PGA
®aTTCMtE,9ChUNG PER P/T I 1 3.1 FT ®. a-''� t5 PERGOLAT/DN RATE/ L-+�SS MJN�IJNCN
TQTAL Lg4Clj/NG AREA 1-G3.9 SQ. FT. AEhCOLA7"/CN RAT£Ak2 THA*-J M/N.�INCH
RFSERVELEACHJN6 AREA 1(51L '1 547 FT
n ^e =,ri-t{ �r f ��J►�( LO`I 5 ASA M 5165 L
EL-- 97.
A��([I- o /' (V 1 A k:;.�,' f`.8 1 yt I�L.<E:
YN4 RSE
' a No.10951 ; ! t EL DREDGE'ENG/N.EER/NG CO J/YC.
t
o .GIS�E �cj �t I. 0 7/2 MAIN Sr /S✓ itl/V/S. MASS
1 + Q vj
- 'eJ cal ?ia ~ I NAI j-sq�. Q .ND Cr T0WNp YNi4TCR ENC0UNTEIe.-0 CL/ENY: 1 {o�D co. PATE
A GMO UA10 I-VATER AT ELEv _
JOB NO: 830 Z- 1 SHEET�- OR L _
=T� -
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_--gP'-�Cm—urr�ff-a ncT _.-- � � .c,cTc.�� wln..o•: olr�M/P .
. .. � � � � � �' �. .. - � dDD::'..--�6����^.::.,7+fiCPS�SMILLSyrA�t•�.:a -
.20MIZLY...E�;tDE!.L�E-.�:..
a C
MA
• _ u,wEHa.Es
L❑ JUS
ACCESS
t AM CES
4 inches tol
l)
2 8 a C
PIP Least 2 s VENT E
Sch
edule 4 5VC w Ch rao0 rFilto St. AntoneB
I
A
TION A
a
-.SEC A
P ARE .TO BE 4 SCHEDULE (
,. .. Z�'
N T ALL PIPES OE • �•�._•�1"_-•_1 �_ice•'•..-- - V Z
from <
1 min. ro M 0 LEACHING SYSTEM
VIEW ADDITION TO 'LEA H �-
t 1 tan
k
k
PROFILE IE OF
septic
�house t
o � � TE• P ^ _ h Pea t ne- ., .- SITE
xt In Foundation 3 of t/8 _i/2 Washed s o
Existing ...1 (:- t � ,
g Septic tank covers must be
p .. Q o- � 3 hool
4 1 W ed Crushed Stone SC
3 to t/2 ash ti
T.O.F. elev. 10a.DD / a TH PTIC TANK.
n. f finished rode : THE ACCESS COVERS FOR ESE `T W
, within 6 , o q / i 1 / o AD
r 2 R
_ r D Bo x 99 5
Grade over COMPONENT S Z >.
X AND LEACHING.COtJPO E G
e Septic Tank 99.00 \ DISTRIBUTION BOX t4EI
Grode over S P A -v ros From Elev 99.00 to t,K,00 1 ___ S S A
-�Grode over SAS or INLET AS � �
5 BELOW FINISHED d
OUT ET ' SET DEEPER THAN 6 INCHES B _ ,� r 3
ALL BE RAISED TO WITHIN 6 OF N
�.. � GRADE SHALL ',
m
f _ c FINISHED GRADE
z
.c r
is _ EQUALS _
INSTALL TUF TITE GAS BAFFLES OR �?. tins
S - 3 HOLE H-10 o N NaMb
p1ST. BOX 3' tAo:'vnum Cover _ - :..•.._ :.•. .J ,......, . .K\ ., r mA O
S=0.01 or Greater Top or SAS Eiev 96.50
• • f- EXIST. oter
10 " 8 Units a 6.25 31.25 < T -
N _ foot STEEL REINFORCED PRECAST CONCRE E / � _ i +Y_
- S_ 0.010 per ,
to 1 000 GAL. : � R 4, 1 tot0
EXIST. PIPE X � 10 , Enectrve Depth 2.5 2 STONE UNDER CHAMBERS 2.5'
N w TANK to PLAN VIEW
-FROM FOUNDATION SEPTIC 11) 30
01 H 10 nl
20
ll fl 36' 3-24' REMOVABLE COWERS
Gam Berne
1
> Lp o
;v Length
, ' GENERAL NOTES
II � Effective Le g
4) O
CONCRETE FULL FOUNOATIO If o
> cp ?
a .•.:, .; ,• - 1. Contractor is responsible for D,gsafe notification
p_ :• .,..>, . .•.. t ....,..,.- •.; .., 4 . . . and pipes. I
a�
_ - • _ -s •. and protection of all underground utilities p p
i n. f 3 4 1 1 2
II > SOIL ABSORPTION SYSTEM (SAS)6 0 / >
/ at --3 min. deoronce .. 13fILET r-. 2. The septic„tank and distribution box shall be set
> - NL > 8 min. 2 min. nlet to owtlet _
SYSTEM TEM PROFILE 4 4
S S INLET - -- -- -�----- 6 min. level on 6 of 3 4 1 1 2 stone.
compacted stone to o� - A ING)/ SHOREY PRECASTE -. --- OUTLET , / /
c > _ 2.5 CULTEC MODEL 125 CH 10 LOADING)/D
c y
0> Liquid lend
Not to Scale > 10
� �- 3. Bockfill should be clean sand or grovel with no
NT NOt to Scale t0'me ,i".
c - 1 OR EQUIVALE. } s' -T "stones over 3 in size.
C - ffective Width o ( ..
I HEIGHT I 11 ._ • - installation
NOTE. OVERALL HEIGHT OF INFILTRATOR IS 18 ,/EFFECTIVE HE GH S �� _ 4. This system is subject to inspection during , sto
v r 4-0 mm. Y
- aEnvironmental Services Inc.
Q9it9rP_s1_?eaiticIs_1_E!¢,_ b9------ a i id d to b Carmen E. Shay -
6 in.of 3 4 -1 1 2 o cm,smts. L Liquid depth
Y
/ / ff ; o I in toll this system in accordance
compacted stone
1 v 5, The contractor shall s y
•• <.$ - ., with. Title V of the Massachusetts state code, the approved pion
r and Local Regulations.
, �, _ X �_ '- -a► LEACHING FACILITY
_ SEPTIC TANK /p D BO 20 4' -10" 6. If, during installation the contractor encounters any
FOUNDATION 10 8-0
RISERS TO WITHIN 6 BELOW GRADE
soil conditions or site conditions that'ore different
NOTE. ALL COMPONENTS MUST HAVE SE S
, ENS-SECTION from those shown on the soil to or in our design
i CROSS SECI�ION 9
installation must halt & immediate notification be
Carmen E. ShayEnvironmental Services, Inc.
� I
mode to
n
OPEN SPACE USE EXISTING 11000 GALLON H-- 1 0 SEPTIC f TIC TAN K 7. No vehicle or heavy machinery shall drive over the
N 79d 18 24 E (C) ,
septic system unless noted as H-20 septic components-
NOT To SCALE 8. Install Tuf-Tite gas baffles or equols on all outlet tee ends.
Pt
151.74 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes
N 79d 22 24 E (R)
10. All solid piping, tees & fittings shall be 4" diameter
Schedule 40 NSF PVC pipes with water tight joints.
I PERCOLATION ..TEST
i r
11. SITE and Surrounding Properties W/in 200 Feet are Connected
Date of Percolation Test: `JANUARY 22, 2003 to Municipal Water:
Test Performed By. CARMEN E. '.SHAY. 'R.S., C S.E.
N A
r Results Witnessed By. /
Services -
Excavator: SHAY ENVIRONMENTAL -^
- ,1
I /
Percolation Rate. 2 min./inch
- NOTE-
/ AN
THE PROPERTY LINES ARE APPROXIMATE D
/ GENERATED "BY
/ COMPILED FROM ..THE SU
RVEY PLAN GENE E
T H
CO
s Hole Test Y NNI
NY INC.1N
F H A S
PA C ,
ENGINEERING
WG COMPANY,NG E
i / - LDR DGE E I E
-- "
_ _ N `1
S ROAD,_ � A M 1 _ 0 D
F T $ AS E G
CERTIFIED PLOT
PLAN 0 LO
_ qq ENTITLED CE �
v.
DEPTH SOILS ELE PRI 1 1983.
MARSTON MILLS, MA . DATED A L, 2,
SURVEY PLOT PLAN
_- __ o s9.10 AND IS NOT INTENDED TO BE A
t --------
------------- 108 IT SHOULD BE USED FOR NO PURPOSE .OTHER THAN
Loamy Sand
i
I THE SEPTIC SYSTEM INSTALLATION.
I to YR 3/2
/ r I
r 1 " A 98,60
/ r 0 6 I C
THERE .ARE NO WETLANDS .LOCATED WITHIN A 200 RADIUS.
i
Loomy Sand OF THE PROPERTY
r
9675,
' . I NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
NO E
/ >_ Sand DISPOSED
r �-- FROM THE EXISTING SEPTIC SYSTEM,TO BE D S
108
r 25 Y 6/6 F HEALTH SPECIFICATIONS.
I r ..` I OF AS BOARD 0 E
I 107
28,-46" C 9520
tIe -Coors DRY` EXISTING LEACH PIT TO BE PUMPED D &
Sand
FILLED IN PLACE
PAN l 2.5 Y 7/�
140TE: LOT #5 AS SHOWN ON THE RECORDED L
/ - HAD AN ERROR OF CLOSURE OF 0.52•. !46"-132 C, 85.t0
/ R AND (C) INDICATES RECORD AND COMPUTED � I
107 1 ( �
___ BEARINGS AND DISTANCES RESPECTIVELY
ASSESSORS MAP 031 SEC. 001 PARCEL 005
t�
, ZONING RESIDENTIAL
r _
. . NE '
Z C, FLOOD 0
r
6
P r ec
r R 2
mini./inch
r
Pe c . ate
, oObserved
AT WI
THIN N 200RADIUS N ED� _ LOC: N W TLA AR 0 E DS_. TH RE E
_ _ R it d
E
n u e A m e t e� I v N st- o d E e> .T H2 q r A S ED 0
T 5 _
/ DJLJ
lu
/ LOT /
F TH PROPERTY
ri{ _ 0 E
. T 4
_.
LO
T ,.
4Feet + _
4 4� 3
I
�Q _
s _ i �
i N .SPACE
w 0 E ..
I -
I
_ i
. ALL OUTLET PIPES FRpt THE
_- END
LEG
105� _ � aSTRisuna+ Box SHALL BE 12• ,. R
`.�� F AT LEAST 2 FIT. CONCRETE COVER ..`.. SET LEVEL OR
•. . _ f '�. `.�+ xNCC5" OUTLET
8BX0 DENOTES PROPOSED
- - -15.5 12 INLET SPOT GRADE
OUTLET
a ,
6"
S ;._... DENOTES EXISTING
104� _ SPOT GRADE
_�` 4, SCH. 40 Te r7 .
_� S
PLAN SECTION CROSS-SECTION PROPERTY LINE I
---- � HOLE DI TRIBU TION BOX - H-10 LOADING 97 - PROPOSED CONTOUR
�� 3 O S
>03_�_ O
NOT TO SCALE
_
7- - - - - - 7 EXISTING CONTOUR -
R_ BENCH MARK
.. T B Ec
02,
_ .. PROJECT
H &
P TEST LE
-z ,
DEEP ES 0
n�
I
FOUNDATION
F F D 0
P OU- T 0
_
0
.- LOCATION
_ �A C PERCOLATION TEST LO I P �, A E S CO 0
- _
E L
_ _ d t 1 I n _.As u e l o s s t n t�- 1 V 1 000 I Ca cLL� o _1 _ 0 s 0 e ELEV. ) D
_ I
_
�-
_ 100 -
--- - n. r 'Ti Min- e Title
L I. Go Do
36•- . n 0 Go a 330 1!Equivalent t o 33 D P va e t E u ( Y �r f Bedrooms: 3 / Y /
I
Number o Bed o
a FENCE
„ I
r.. r nnde No ,b G Garbage e
i 9 I{ r Title,ni r� Min. e
Leaching Capacity Pro osed 330 Gol: Do M mu , ( )
Leoc C p p / Y
_ - Tank.
, a.. AL. Septic c
r ;! 6 0 USE 500 G WATER V'd
Tank , 3 X 330 Gol. Da 6 p PRIVATE DRINKING E WELL
/ • _ • Septic o / Y
r 1
t
T L i•IOLE E5
.. _ min./inch
h
_ ,e, ;_ � �. K � SOIL ABSORPTION AREA. Using percolation rote of <2 min./ c
__ V. 99.10 r , ,_ ECE 1 . . < _
10> _ ' �. x s ft. 266.4 gallons
'. m Area, 0.74 of s ft. 360 4 Bottom g / q 9
_ -----
/ / _ . gallons REVISIONS
S,dewoll Area. 0 74 al./sq ft- x 92 sq. ft. l 68 08
/ Failed SHED
9
.• / � O Q3 � � _ 4.4 gallons
100 --- / t Provid ng 33 8 ga o s
- t r Leach Pit �� �
•
_ � _ � i N0._ DATE.. .. DEFINITION
20 O � TEC MODEL 135 HIGH CAPACITY UrJl75, HAVING A 11 EFFECTIVE DEPTH.
: Use. (5) CUL
N N THE SIDES AND 2 5 OF WASHED STONE
ExIST 1000 or. � � 1 TO BE USED WITH 4.0 OF WASHED STO E 0 ,
Septic Tank `
� ON THE ENDS AND 2 INCIHES OF STONE UNDER cc
_ (101
ko
_
_
EXI ST
ING _
3 BEDROOM - - 1 -
_ _ 0
_ 0
HOUS
E _
i #
120
` PROPOSEDF RPRE
PAREa ,
I SUBSURFACE SEWAGE DISPOSAL
POSAL S`r STEM
I � ;
OF
- 120 ASA M E(GS ROAD
r � _
r
_ 0 50
r � _
20
_ 0
- MARSTONS MILS MA
o � � HARD M . CARIGNAN I
r 8 -MR :_ RIC
r ------
r -_ t
PREPARED BY.
U : Y _
_
t _ sA
----- ---- MS . J OAN N E O SULLIVAN
OF ,,., •
o
1 ZI
r SHA Y
� CAS
a 6 0 N
1 0 ASA �J1E1GS ROAD
ENVIRONMENTAL S.ER VICE'S INC.
• � o
y 181
1 , 1
_ MA 02648
-- MARSTO NS MILLS ,L>`LS , 34 .THATCHERS LANE
_ .58 ` F
r / L 95 1
�rs-rER EAST FALMOUTH, 'MA 02536
i r , ANI RAP
-- 2 - _
_ 15i6.5
R I 5632
r TEL - 50� 420
- 4 -0796
T FAX 8 5 8 r � EL 50
r. 9
,
AS. R
0.�1 D
.lI�.�I G _ DATE:. FEBRUARY 3 2t)03
A AS'..A SCALE. 1 20 DRAWN BY CES .
PROJECT SD 389 FILENAME SD3 89PP.DW G SHEET 1 OF , 1
50 FOOT HT 0FWAY).
I
I
,