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0355 BAXTERS NECK ROAD - Health
x ✓ b 355 BAXTERS NECK ROAD MARSTONS MILLS A= 02648 ` iv — DOS— OGb2. Commonwealth of Massachusetts D Title 5 Official Inspection Form J. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name / information is Mills s 1/ MA 02648 07/01/2020 required for every � page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 2,o on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road r� Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 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 Inspector's SI to 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 Title 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 u- 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is Marstons Mills MA 02648 07/01/2020 required for every page. CitylTown 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: ® 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: This 4 bedroom home has an H-20 -2 compartment septic tank and an H-20 D-Box feeding 3 leaching chambers with stone. At the time of the inspection the leaching was dry and no visible failure criteria was found. 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 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): ❑ 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 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 ❑ ® 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 18 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® 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. 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 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 I Commonwealth of Massachusetts �n I.? Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 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 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 ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Ii Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �r 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 plus GPD Description: Contacted the health department and no information was available at the time of inspection Number of current residents: 0 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 ® No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage town water 9 ( Y 9 (gpd))� Detail: In 2019-297,000 gallons were used and in 2018-323 000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2019 Date t5insp.6c•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form yI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 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: 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.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 f - Commonwealth of Massachusetts ,IF Title 5 Official Inspection Form ib Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 page. City/Town 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 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: 2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 27"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. town water 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 Title 5 Official Inspection Form �i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............ u � 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 page: Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-20 2 compartment tank Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 33" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? 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.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. The H-20 septic tank is under the paver driveway. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/0112020 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.�Ioc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 r Commonwealth of Massachusetts I'? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01!2020 page. CityTTown 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts i? Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 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.): * 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: a Type` ❑ leaching pits number: ® leaching chambers number: 3 ❑: leaching galleries number: ❑ leaching trenches number, length: ❑' leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insll-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 i �i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owrier Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 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.): At the time of the inspection leaching was dry and no visible failure criteria was found 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.): t5;nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form <1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 355 Baxiers Neck Road Property AJdress Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 I • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 page. Cityrrown 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 ' Front Door B A A iB 1 15' 30' Oi 2 24'6" 37'10" 0 2 3 34'3" 46`4" Paver Driveway 4 60'6" 74'6" 3 0 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t,- 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is Marstons Mills MA 02648 07/01/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Sarface water ® Check cellar ® S-iallow wells Estimated depth to high ground water: 12 plus feetfeet 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 augered a hole at a lower elevation and shot it with a transit to show 4 plus feet of seperation. 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 'ng � Commonwealth of Massachusetts • �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c � 355 Baxters Neck Road Property Address Jill and Lisa Silverman Owner Owner's Name information is required for every Marstons Mills MA 02648 07/01/2020 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 TOWN OF BARNSTABLE LOCATION l!fiz a SEWAGE # �� j VILLAGE ASSESSOR'S MAP & LO N INSTALLER'S NAME&PHONE NO. "- SEPTIC TANK CAPACITY C� LEACHING FACILITY: (ty )�SC ize) NO.OF BEDROOMS BUILDER OR OWNER PERMUDATE: COMPLIANCE DATE: Separation Distance tw the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Vy1 . �J v 0�1 TES DESIGN DATA L Water Supply ForThis Lot isMunicipal Water Single Family ge Bedroom With .Garbage Grinder 2.Location at U61it'�es Shown onThisPlan Are Approx. Daily Flow=110 x5=550 GPD At Least•72 Hours Prior to Any ExcavationForThis SepticTank.550x200%=1100 Gal Project The Contractor Shall Make The Required Use 2000Galion Septic Tank With 2Compartments. Nalifico0on to Dig Safe(1-800-322-4844) LEACHING AREA 3 The Contractor is Required to Secure Appropriate 825 GPD/0.74=1115'SF Required Permits From Town Agencies For Construct loft ! Sidewail=2(12-67')2=316 S.F. Defined byThis Plan. Bottom Area=12'3167.'= 804 SF. 4 Install Risers as Req%iredto Within leaf 1120 S.F Total Provided Finished Grade. LEACHING CHAMBER DESIGN 5.All Structures Burled Four Feet or More or Subject' All Pipes to be Schedule 40.PVC to Vehicular Traffic lobe H-20 Loading. 7-50OGo1 Leaching Chambers in 6► Septic System to be Insialledin Accordance With 12'x 67'Washed Stone Field as 310 CMR 15.00 Latest Revision And The Town of Shown. Barnstable Board of Health Regulations. 7. All Piping to be Sch.40 PVC S.Septic Tank Shall be a 20006al., 2 Compartment. The First Compartment Shall HoveoVulume of Not Less Thon II OOG 1.And The Second of Not Less . Thon550 Gal. FG.42.0 F.G. 36.0 ri 39.2 33.0 39.0 SEE NOTE 3838.8 Top EI.34.0 No.8 36.0 35.8 Sot.E1.31.0 Bedding as Per Title 5 75' 10' 10.5, 47' 32 1e Bottom of Test Hold El. 23.5,No Water DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale Finish Grade Filter -- Fabric �—"Compacted Fill a 45fai 1/8'=1/2" Pea Stone i� Leaching „ „ a Chamber 3/4 -I I/2 Double Washed OF 4-10' _l N 12'-0° Pi:1ER SULLIVAN 110.29M H CROSS SECTION OF CHAMBER CIVIL NOT TO SCALE d i SHEET 2 of 2 - KSILVERMAN a Fee 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS pplication for �Diopoml *pgtem Construction Permit n are Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No.3 H q BA x t sR N L-c v- ROAD Owner's Name,Address and Tel.No. FJ I- 3 3 u-L/S05— LD� i M�rSf�Ns Mia�s /YlA- HArry .9jLVGrM1)N Assessor's Map/Parcel ow -00 -00 e- L4 2 G-r E`r L/ Al d!7 M A P 7 S- LIftIA)iEl-D 1"A Olq410 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. q 2 S'- 3 3 q y `.lac� / ,( PCj-,Er A,j PG C -1 PwrAd E2 R D AIA 0ZG5 Type of Building: Dwelling No.of Bedrooms S_ Lot Size I os�319 sq.ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow &_50 a•-SO%a gallons per day. Calculated daily flow '� gallons. Plan Date-Ty Ly 2� /4 9 Number of sheets 7— Revision Date Wow dc Title SITE PL RAI ProPrsEP SE PT 1 G Sy steAl 3 L/9 8,4 X fIF2 NECK R.0 Size of Septic Tank 2_0a0CAL,j 2 C'49APArtMecAlfi Type of S.A.S. j;Z:x &-7 Description of Soil O-2. a� ��� Lc9,0/14 "i-Su/3So/C, 2 y v- /2a p t✓/� ED S., A D - No C-40411&�P Gti�fiE� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued bthis Bo of H lth. Signed Date 9. Application Approved by Date 7 Application Disapproved for the following reasons Permit No. Date Issued 1 r . tt ar. .:P 7:i✓e!!t' ter--- ��''., �� �' f — �i! I ,`� � <,y — " 00 : THE COMMONWEALTH OF MASSACHUSE' - —&ntered in computer: Yes F � :.2 PUBLIC HEALT-H-DIVISION OWN OF BARNSTABLE' MASSACHiUSETTS _ rf � _ZIPprication fofeMigpo.5a1 6potem Congtruction Permit Application for a Permit to Construct�Repair( )-Upgrade(, )Abandon( ) O Complete System O Individual Components Location Address or Lot No.3 4 a BAX-MPL Necle oA D Owner's Name,Address and Tel. o. La-r Z. Mgrs+ews M `s 14.4. Harry SIL116rMAiv Assessor's Map/Parcel 073 -007-o0 C-r Y I-Ag/yt' Mq P' 7 x -1' >r ^�r�Ys - L1►NNFIEG 6 M.4 O 1 G'NO Installer's Name,Address,and Tel.No. k- Designer's Name Address and Tel.No. y Z 3 3 y y PEI=r sLcuv.�H, nG t. '7 PwrKER R.0 05ter!/i41,& AIA G Type of Building: ` Dwelling No.of Bedrooms S1, Lot Size I I5;Si9 sq. ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures . t Design Flow S50 50�® gallons per day. Calculated daily flow '2 gallons. t Plan Date-TW 04 " . 19 9 Number of sheets 2-- Revision Date N 0 00 a Title S1 t1F P4,91V PAPAPS--D 5E P7!C SY S-'EM 3 N 9 8,4 X feA NEGK P-0 Size of Septic Tank 2 0470 CAL.) 2-COMAV-P-tMeA,"f Type of S.A.S.I2.X &7 L,EALh li✓�C'/IA/N(�El� Description of Soil ©"-Zy tt 4 L-!JA/" S�//350�� 2-4/ '- 120 f G'� /11EQ SAA,,D - No r_/, P ter a N thre of Repairs or Alterations(Answer when applicable) Date lasvinspected: / Agreement: t !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 operaiion until a Certifi- cate of Compliance has been issued biythis Boa, of Health. i" Signed O-- Dated Application Approved by Date 7 Application Disapproved for the following reasons Permit No. 94 S4 Date Issued f --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of QCom.p'liance THIS IS TO CERTIff, th t the On-s'te Se a a Dis . sal-System_ Cons cted fx )Repaired( )Upgraded( ) Abandoned( )by f F 't � 7 '�)0 'D►— CT/ at 3Y 9' 9, 15a WK14 IZ 0. AIAfTO Pe A 44C /YID• has been constructed inacclance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 F J�6 dated 7171f Installer Designer _ ./ The issuance of this pef. /thal/dot b construed as a guarantee that the yste will funcrjion as/esigne Date / Inspector � '��/l„//�- o vX� ,� --------------------------------=--------- 1 } No. 9 Fee 10 THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopogal *p.5tem Con6truction Permit Permission is hereb granted to Construct(5- )Repair( )Upgrade( )Abandon( ) System located at q l BAX-her 414 c(e P—Q z /' grStevols 11111-Cs, /11,4. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 's/her duty to comply with Title 5 and the following local provisions or special conditions. , Provided:Construction must com. eted within three years of the date of t ' e t. Date: Approved by - ' / /r 1 -7 MAP FEx No....qa__� 11D.0........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH V/ ...............OF...... S .................................. Appliration for Dispotial Works Tonstrurtion ramit Application is hereby made for a Permit to Construct X or Repair an Individual Sewage Disposal System at: . .... PIA ............ I . ......... ............. tion-Address 1&0 r .............. Owner Address ......... ......... Installer Address Type of Building — Size Lot..As'—Sl�....Sq* f t U r Dwelling—No. of Bedrooms.............6...........................Expansion Attic �36 Garbage Grinder P-� P4 Other—Type of Building ............................ No. of persons......................_..... Showers Cafeteria P4Other fixtures ...................................................................................................................................................... < 52 45 Design Flow..............................75- 7...gallons per person peV day. Total daily flow.....................4r . �...0101P. Septic Tank—Liquid capacitJ191,100..gallons Length.jt/.7//". Width'tp_-:?.... Diameter--—--------- :t- Disposal Trench—No..................... Width.............__..... Total Length---- ......... Total leaching area-----------_------sq. f . Seepage Pit No........... Diameter......1-41...... Depth below inlet_._........... Total leaching area...ro) ---sq. f t. Z Other Distribution box Dosin tank Vib ................ Percolation Test Result Performed nch y 4'3 _ZC*6�4t/7— Test Pit No. I :�� minutes per Depth of Test Pit---1-0......... Depth to ground watenl�jvt 0'-Cs- 14 Test Pit No. 2................minutes per inch Depth of Test Pit___................. Depth to ground water.._.............._..__.. e.......r.- .� ............ ......----------- --/------------------------------------- .. .. -;t ......... ... ---------------""x Description of Soil........ ......~_ ................ ...... P/L.......... ---16----5�� i .. ..... ........................................................................................................................................................................................................ U Nature---of....Repairs----o'r*---Alterations a-'t i'o'n"s---Answer---------"''..."....when h'e"n----applicable---------------*--------------------------------------------------------------------------------------- U ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ..... --------------------------------------- Date ApplicationApproved By ------------h.. 7......................... --------------------------------- ------------------------------------- -- - ---------------------------------------- Date Application Disapproved for the following reasons: . ..................... ............................................... ---------------- - ---- ......................................... .... --- --- ---------- Permit No. Issued ..... ........ . . . .... ......... ...... ----- _ Due THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HEALTH ........... W------A---)............ OF ....... 7-------------------------------------- Trdifirate of Campliattrie THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by -------------------------------------------------------------------------------------------------------------------1.................................................................................................................................. Insialler . . ... ......................................at ............ L4.......Z #1-�5. ...I- - - ....f................ 41 . ...........Z-!:�If ..............0-t has been installed in accordance with the provisions of TITLE f he St e as described in F the application for Disposal Works Construction Permit No. ...... .. .......... .. ... .... . d d ... .......................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONS E S A GUA ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................................................................................................... Inspector ............-----------------------------__................................................... �� r 9 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF .................................. No... .................. ........................... F � 1(3 C) EE........................ ......... Permissionis hereby granted.............................................................................................................................................. to Constr2ut (X) or Repair an Individual S-wage D' p osal S stem .- -7; .........................Street ,as shown on the application for Disposal Works Construction Permit No. -- ---- ---- D e .......................................... ...................................................................................................... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS No ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..J W- 0...............OF..... uS V7��.................................... Appliration for Diipniittl Workii Tnnitrnrtinn runfit Application is hereby made for a Permit to Construct ( X or Repair ( ) an Individual Sewage Disposal system at ........ . X:� ::...1 � .. ........... .... S?Z.M "1 ..._.�-•-•---- K. Z" •-•-•----- ................ ation-Address orPot Owner Address W Installer Address _ Type of Building Size Lot--- Sq. f t Dwelling,No. of Bedrooms............................................Is— Expansion Attic C Garbage Grinder Other—t e of Building No. of persons___•________________________ Showers — Cafeteria a' Other fixtures .................................. W Design Flow..............................67�_..gallons per person .Qer day. Total dail Aow...__..............4� 2.�........ hops. WSeptic Tank—Liquid capacit ._gallons Length_ �[-_:1i__. Width.��_= ..... Diameter._.Y........... Depth� .:�..... x Disposal Trench—No..................... Width ....... Total Length................... Total leaching area......... sq. ft. Seepage Pit NO.....____s�__ Diameter..._._�7�___.__ Depth below inlet............. Total leaching area... sq. ft. z Other Distribution box ( Dosip tank (/U�'1 / f 3 `3f� ........ Date.c - -_-C Percolation Test Result Performed by. __�i!_I�� _f....... .. ................................... - --' �� a Test Pit No. I...!"_�-_minutes per inch Depth of Test Pit-__�_U.......... Depth to ground water------------------ Test �'�'�� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .` f t O Description of Soil-•-r- -.-�• --------- ....` 'U,��Q/L.-•---..... ....................................... r � 5�� � -- .. x W -------------------------------------------------------------------------------------•--------------------------...--------------------...--------•-----------------------------------••-----•--••---- f U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ..--...-' ..... .... n --------------- -------------------- ----------------- Application Approved B I e l — Dare ' Application Disapproved for the following reasons: ..............................................................................�........... ------- ................. ............................ - ^.................................................................--------------------. / Dare --------- I 1 ..-.. / .... Issued .............. ... ` Dard . ....... THE COMMONWEALTH OF MASSACHUSETTS _ BOAR OF HEALTH &60A) AIW 5 .............................................. OF .--------------`-------------- �.....�.1/�....................................... Cer#ifi ate of Tootylinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (IV� ) or Repaired ( ) by ....... .. . ...... ................................................... .. . .................................................. .. .................. .......................................................... Installer ...... °��./ .............................................. has been installed in accordance with the provisions of TITLE ofThe State Environmental Code as described in the application for Disposal Works Construction Permit No. ..: ..'... ----. ... ..f-------- dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT 4 6ONSTRR`UED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------- -- --- -- ----------------------------------- -------------------------- Inspector --------..........-- ---- --------------.....--------------------......................... ��r 9 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ........................................................•----...................... 1�C� / --/ d No._.;. ''.------ FEE........................ . �i��n��tl nrk� �.�n�trnrtilan rrutit Permissionis hereby granted------------------------------------•--.....-----...•-•----•••-•-•-•-•-•-----••-•-••-•---•---•-•-•-••......-• ..... ....... to Constr ft ( A) or Repair Z an�Individual�S".wage Disposal S eta at No.. •1C1 -! ""......... ......-�----- .A! -�`P_2. •--------- .....-��7......----•---......----�..-�......-------••---•---........ Street j /4 111 as shown on the application for Disposal Works Construction Permit No;__--,J.._,,..r--- Dated.......................................... ............................................ .......................................................... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS . � . MAP �s No................ F� .eZa... THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH Appliration for Dispoii al Works Tonotrnr#ion ramit Application is hereby made for a Permit to Construct ( K) or Repair ( ) an Individual Sewage Disposal System at ........��X �—�4<... o -MAS�O --1� "--L-�--.....-...--�T 2 ..... ..... ._......... L tion-A d s .—^� or t o. Owner Xzress W Installer Address Type of Building Size Lot-.W��..aa._Sq. feet �. Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder N05 pal Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................ _ W Design Flow....................5�................gallons per person per day. Total daily flow........8r�5..__..............._.....dal lons. WSeptic Tank—Liquid capacitygallons Length t�-..-1-I��.-. Width.( _. �.. Diameter---------------- Depth.S�_� x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......Z:........... Diameter.......1A........ Depth below inlet..-.�----------- Total leaching area..!.�>3.�..sq. ft. Z Other Distribution box (*5 Dosin tank '-' Percolation Test Results Performed by--- F1 -.' D .. .............. Date.. 3_'. ` 1 ............. aTest Pit No. 1....A -..minutes per inch Depth of Test Pit.--AO.......... Depth to ground water..l_Qr__AK.Qc. I+&%RG' fi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water..-----------.-----.---. �+ ----------------------------------------•--•----••------------------.................----..... -------------•--•-----••----.... . .... O Description of Soil....... .._ ... -oRM_ �..L-------.2 L�---��--LFi4►V--M6D... - x W ••------•••-----...•••••...-•------•----••--•-••--•----------------••-•------•--•-•--•-----•----•----•-•-----•------------••------•---•-••--•---- ...................................................... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ----------------------------------------------------------------------------------------•----.......----•---•----------------•------------------------------........................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed .. ... ........... . ... .... .. ... ... ................................................. .................................. Dare Application Approved By, - i :... ' �r�� Date Application Disapproved for the following reasons: ................... -.....-.-.....-------------------------------------...-...------------------------------- ............................................ ...................................... .-------..................--.............-- .......------........----- ----.---- --- ... ........................................ 3 �®t � Date Permit No. ......3_1 9.9...................................... Issued ......... 9 ------........... -- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - 1% ---------------- OF .-.�f .t r` c;.......................................... 1lertifirate of Tumpliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....... .. ............................ ............................. ........ ........................................ . . ............................................. ..... -- ---- . ............... ( Installer �n at ... )C ..../V�- .... 0 * -.. ...��ate .t..2- 1 �.....1�'.44 -5------ has been installed in accordance with the provisions of TITLE 5pof Environmental Code as described in the application for Disposal Works Construction Permit No. -----.✓..1.'_59................. 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......... ��.tl.���.V3aL ....................... y®® .�� No. ...... FEE...` .......... Disposal Work.5 TwOnstrurtion famit Permissionis hereby granted.............................................................................................................................................. to Construct or Re 'r ( ) an Individual Sewage Disposal �tem at No..--•---......-- ...k—m �! .�" 1 �2... l LLS Street p as shown on the application for Disposal Works Construction Permit No.-Jl..�Q..... Dated..` .4..°- ............ -----------------•--•--.......-------------------------------------------•••-----......---......._---.._ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 1. No.................... Fps.. .............. THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH _ tS�." NA.. ............OF... As2(1,kS A6L Appliraffou for Rapasal Works Tonstrnr#inn Prrutit Application is hereby made for a Permit to Construct ( X� or Repair ( ) an Individual Sewage Disposal Syst13em &x i c—,t c 1 o A-.Q 2`�:�J .. Lotio -A ss . . .........• ---- ----------------•-- --•• --...... . Owner ......-- Address W 1.4 ...................................................................r..__._._____._...___._......._ ._...._.._.._....__.......____._..___..._..._._.....__.___._.____________'___._.__.............._. Installer Address d Type of Building Size Lot---S_1----._;)...............Sq. feet U Dwelling—No. of Bedrooms............ ...........................Expansion Attic (` Garbage Grinder 01E�5 '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ............................ . _ W Design Flow.............................................gallons per person per day. Total daily ffiow..._.... ....�..........___...........gallons. 9 Septic Tank—Liquid capacity!;: gallons Length.! Diameter__'" ------- Depth_ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No-------Z----------- Diameter-------+.f�-------- Depth below inlet....:a_.......... Total leaching area..53.-�..sq. ft. Z Other Distribution box (Ye6 Dosing,.tank (1 9 s s _ Percolation Test Results Performed by-- ........................----�._�_�...-----------�=----_--------- Date------:---------.-.------------.--__---- aTest Pit No. 1..... _ ._.minutes per inch Depth of Test Pit---- ).......... Depth to ground water_ ........=:'..t 1� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Frj .__-----............................. .........................................r______.__._�____-------------------------------._._________..._.___..__-- UL- o Description of Soil ` :,r -----•-- ----------•--------------------------------- . ------------ ------.... ... x U W ................... ......-..........................................................................................-------------------------------------------•-••---------------•-•---..........---- VNature of Repairs or Alterations—Answer when applicable............................................................................................... ..------•--•---------------------------•--------------------------•-----------------------------•--------•-----------------------------------------------------------------------------••-----..._-•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed . --------------------------------------------------------------- -------- ....................................... _;4 ��"' Dare CV Application Approved By .....s '� to - ........................... .........------. --'�..... � Date Application Disapproved for the following reasons- -------------------------------------- .............. .--- ---- -- --------.......---........---.........---...---...........................------..--. ..... . --- ........................................ Dace Permit No. 9 �! 9�..................................... Issued ........32a � ....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s ' 1C�.. OF t� ...--- ----------------------------------------- (11.er#ifira a of TO'itpXialtre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Y) or Repaired ( ) - t . ......--by Insmller at ...... .A K l� �.:'L�.--. 0�.,� ..� ....'._� ------------------------ ------....----- . has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. -----.J.A--... L ................. 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 ... -? .13 ...............OF.......7. :� Sly. C. r -------------------------------------------------------- ,o No......................... FEE..1 d...---•-••. Elisposal Workii 0-ynnstr ion amit Permission is hereby granted---- ---• -•--•-----------•- ................•---•------•-:.................---------------•-------.............. to Construct ( �) or Rep r ( ) an Individual Sewage Drsp sal System "'� � -cam� atNo---------------------------- - s 1 _`f ..................... ---- Street as shown on the application for Disposal Works Construction Permit No�.!�99..... Dated.3'_Z�. L�.�._..__._.... ----------------- •--------------- ------------------------------------------------------- --•......... ... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 4 SITE :PLAN PROPOSED :SEPTIC SYSTEM AT z t 349 BAXTER NECK ROAD MARSTONS MILLS, MA SL FOR c - HARRY SILVERMAN a ' z •` ��. ?SCALE: I"�0'- _519ATE: DULY 27, 1998 . SULLIVAN .ENGINEERING INC. _ DSTERVILLE, MA t :. N OF InSULLIVAN CIVIC. - . 1 _ . y F no 1T- i YMN -vo 46 jr, 3g RY; 1 00 eR 1VOTE : ALL FrAt. OW NGVD ;DRTW✓► 1M.e MAP -75 pA cE� o z PLAN VIEW 3t ?o, �` `�'1 tz) Scale: 1"= 50' ° J a: ELS%4. 3-5.5 p6RC0LATI0N 'r'EST LOAM CLAS5 1 MgTER%AL AIR SUBSOIL. DEPTH'- LAU" 24 LESS TNAP1 2IJ►IN/ INCH * Ha PERK TEST NO WATER ENCOtANTED ; MEDIUM MATE: Os/z'l/e8 C. SANS No. P-6877 A n < 120 WITNESS:�.DUN1d1NC. NO GROUND WATER •TEST BY: P. SULLIVAN SHEET I of 2 a r ' C EGG. Q r 4,Q(> f ce �Ej 4-leL Ir; h� I� i . r q .?".) .I 11/�.t_� L".f `_p- _ 34,9Gl. t, � n I 1 t o�.M d 5u B=oI f r� 6Ai_ Trill 3��1 I'T�1���A� QpJSL'� Flee GY3 rnC.t, l P1 1 O�o �i Qom" Derr �o ! Ir '� ; I1�Island I1 � ,` p a a • ,< � '� `� �� Z� �•----� ,�a, � ,,,, i-.a �c�'t' Z � • . f i st'M•rys Yf •��;� I�I�nd �, Pond �1r,\rxl_ 1�.1s1y�_``� .7'{��")Crr_�M5 O �� " Isabella r ra n Q1' �>aIi f i 'T'A_ ,! ;� X11O * :�O r , • . �kISTr l tr �oDP �'a�tM�(7 r"�4�KSc i Ji '' �� ,,.+ 8�:. .: t�'TtG� •1t` ': X�10 +2�pq's = 1100 Pubh, / • t o rP r / ' LC t..l jl �- � � P IZ'..a�,�,/ �; {• , '�r � �'- 4"L SC- t- : 1= :aza •r�_5���.gZ- a �� to ALL P A G f f '"' ^ F.1• i nJ\,Y �C�C1�0..F.IT.nM � �rt' i5mc,4 , - O Ct.E A;,J c5► 6AILD fi 'P i'' �0�.� �' O#' �t ..;-� ; �T-ct..t� � I�e�: ���1 w r"r ,. ... I r•�-•,,. � " � d ------------------- 'F. TGCeT1F T�A7 7-f VZO FCC ----0 t W.5C-. a 1,.A , '' F.x+STUN Fr `i_ . . r 5 � ' _ --. � '`�� y-{E2Eb1.� !AMPL`(S wr�1-} T�•E Si��F�Lrf,� .- `� AoA► .T (.r 1 �`' ' ' � A�:t' \ 5 T Bay C_K.. R G?�.l 12 E M S 1 •S OF T1 L�. `T��/t� p'F 'i2lr p-t"A5-r- ► l5L.Fs 15, 1Ao-r �S J -r n 4: ,44 / y 71 r 0 Y E t,6 LA A-A-V s - �� i 'r*� �^� �!.^ J,�/� ,� �„f F� r..•1 r,E- r_ �� �; .� � /• .�.@_�"��-°�'� 1 �� �../5��' ��.[ 1�..L.�,:r �� �i r :zr Zcc)