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HomeMy WebLinkAbout0128 BRIDLE PATH - Health 128 Bridle Path Marston Mills A= 149 - 138 c k eac/ y d l�/y -77 ex4'crr nn �AUN0�Y -5� iz 44 ' X L ell i LALLy LAV-`l LA(Ly i. .LLY LA LALLO Dc�/��'.�i,v� TV Liu vNO2t� yKX6�a Wb44 ,Z '�o `` )r (9 L bcr�Al ��A� i2or�s✓J . [/Ti4,,ry C,[toro4g sruq u,A1.4, ��l .Y 3G � yov�d�f`ow fv VIOL .....> ---� j AZ- Cl`� I , 1 i q ' r ---.----"_. --�- 1 .6j I r�W I IIQ 'Z q z.i 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path . Property Address Jerome Trembley Owner Owner's Name information is Marstons Mills Ma 02648 i required for [ 1 L(U 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: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Frank DeFelice J I cursor-do not Name of Inspector use the return key. The Building Inspector Company Name 53 Maki Way Company Address W.Wareham Ma. 02576 a Cityfrown State Zip Code 781-254-4825 ( V 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 16.000).The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority , 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. n D t5ins•09l08 Tide 5 Official Inspection Form:Subs dace Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Bridal Path . Property Address Jerome Trembley Owner Owner's Name information is 02648arstons Mills Ma required for M every 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 RrI 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: 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Bridal Path . Property Address Jerome Trembley Owner owner's Name information is Marstons Mills Ma 02648 t — ) —CY required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) AA� ) 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): ON ) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines-in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 128 Bridal Path . Property Address Jerome Trembley Owner Owner's Name information is Ma 02648 t arsons Millss ( required for M `` � �G every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) . 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 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. ❑ 2e 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 %day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Bridal Path . Property Address Jerome Trembley Owner Owner's Name information is Marstons Mills Ma 02648 e Q -a✓ required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ d 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. ❑ Q� Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 200' 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 2000gpd- 10,000gpd. ❑ 13/ 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. 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•09/08 Title 5 Official Inspection Form:Subsurface SewageDisposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path Property Address Jerome Trembley Owner Owners Name information is required for Marstons Mills Ma 02648 C. every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No [' ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Ed 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? [r� ❑ 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, h f liquid, depth of sludge and dimensions, depth o q depth of scum?p g ❑ 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): Number of bedrooms (actual): "3 DESIGN flow based on 310 CMR 15.203 (for example: .110 gpd x#•of bedrooms): t5ins•09/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 128 Bridal Path Property Address Jerome Trembley Owner owner's Name information is required for Marstons Mills Ma 02648 ( 1 - �, L every page. City1rown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes 20"No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes V No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes 2""'No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes 02"ONo Last date of occupancy: Date A)k 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts .14 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Bridal Path . Property Address Jerome Trembley Owner Owner's Name information is arstonsMillsa required for M Mill M 02648 every page. Cityrrown State Zip Code Date of Inspection 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 2-."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): e) �%s+ t5ins•09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path . Property Address Jerome Trembley Owner Owner's Name information is Ma 02648 arsons MillsC: c� required for M every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): e� Depth below grade: feet f Material of construction: ❑cast iron V40 PVC_ ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tanis(locate on site plan): a�t i Depth below grade: feet Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts Title 5 0 icial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path Property Address Jerome Trembley Owner Owner's Name information is required for Marstons Mills Ma 02648 every page. Cityrrown 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 r.+ d 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 Ai 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.): Ao N Grease Trap (locate on site plan): Depth below grade: feet Material of construction: fiberglasspolyethylene ❑other(explain): metal ❑ concrete ❑ ❑ 9 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•09/08 Tide 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 128 Bridal Path Property Address Jerome Trembley Owner Owner's Name information is 02648 M arsons Millsa required for M 4�— every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): ight 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): ❑ ❑ ❑ 9 ❑ ❑ 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.): 3 "_Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path . Property Address Jerome Trembley Owner Owner's Name information is arsonsMillsa required for Mt Mill M 02648 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan):' r 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.): �I 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.): NSoil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 r t Commonwealth of Massachusetts Title 5 Official Inspection Fr Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 120 Bridal Path . Property Address Jerome Trembley Owner Owner's Name information is Marstons Mills Ma 02648 required for �,-�;"~U-0.—f9�g every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Type: leaching pits number. ` (O X G ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number,length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: El 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.): A-�Ob&11 A2 .Vat IV-All esspools (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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of(Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 128 Bridal Path . Property Address Jerome.Trembley Owner Owner's Name information is Ma 02648 arsons Millsc, required for M every page. City/Town , State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation, etc.): 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•09/08 .Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 r Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 128 Bridal Path . Property Address Jerome Trembley Owner Owner's Name information isrequ Marstons Mills Ma 02648 �: L everyPa f9e. City/Town State Zip Code Date of Inspection every 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 pubic water supply enters the building. Check one of the boxes below: hand-sketch in the area below ^ -+—••inm attarhed seoarately - A a L b-t J4A' eAA i 15ins•09108 •08106 7rde 5 Official Inspection Form Subsurface Sewage Disposal System.Page 14 of 15 r r Commonwealth of Massachusetts Title 5 official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path . Property Address Jerome Trembley Owner Owner's Name information is required for Marstons Mills Ma 02648 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope [v� Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: B 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: 1 Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•09f08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Bridal Path . Property Address Jerome Trembley Owner Owner's Name information is required for Marstons Mills Ma 02648 -- U every page. City/Town 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 L Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09108 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M s 128 Path Property Address Bruce Riddick Owner Owners Name information is Marston Mills Ma. 02648 - September 25,2007 required for P every page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. l i LC Important:When fitting out A. General Information 1 forms on the � �a cam L)1. Inspector: the tab key y 4C 70 to move your Frank DeFelice r cursor-do not Name of Inspector use.the return nr key. The Building Inspector Company Name c 53 Maki Way West Wareham Ma. 0 536 Cityrrown State Zip Code 781-254-4825 S14090 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 September 25, 2007 Inspectors 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. Inspection report for Trt1eV Mosher-0a106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page f of A V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path Property Address Bruce Riddick Owner Owner's Name information is Marston Mills Ma. 02648 September 25, required for p 2007 every page. Cityrrown 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: an® I have not found y 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. Answer yes, no or not determined(Y, N, ND) in the ❑for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Inspection report for TrdeV Mosher•O&W Title 5 Offidal kispection Form:Subsaface Sere Dsposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path Property Address Bruce Riddick Owner Owner's Name information is Marston Mills Ma. 02648 September 25, required for p 2007 . every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Inspection report for TitieV Mosher•O&W Title 5 Official Uispection Form Subsurface Sewage Disposal System•Page 3 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path Property Address Bruce Riddick Owner Owner's Name information is required for Marston Mills Ma. 02648 September 25,2007 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6'below invert or available volume is less than '/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. Inspection report for TitleV Mosher•08= Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path i Property Address Bruce Riddick Owner owner's Name reps r fois Marston Mills Ma. 02648 September 25, 2007 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cons.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ Eg 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 16.304. The system owner should contact the appropriate regional office of the Department. Inspection report for Titlev Mosher-OB= Tile 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 5 of 15 I` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Bridal Path Property Address Bruce Riddick Owner owner's Name information required forts u Marston Mills Ma. 02648 September 25, 2007 every page. Cityrrown State Zip Code Date of Inspection C. Checklist I 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)] Inspection report for TiBeV Mosher+08M Title 5 Official kispection Form:Subsu face Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Bridal Path Property Address Bruce Riddick Owner Owner's Name information is Marston Mills Ma. 02648 September 25 2007 required for p every page. Cityrrown State Zip Code Date of Inspection 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 gpd 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 0 No Water meter readings, if available(last 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: March 07 Date CommerciaUlndustrial Flow Conditions: Type of Establishment: Design flow based on 310 CMR 15.203 ( ) Galbns per day(gpd) i Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes '❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): inspection report for TrdeV Mosher•0af06 Title 5 Official Inspection Forth:Subsuface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path Property Address Bruce Riddick Owner Owner's Name information required for Marston Mills Ma. 02648 September 25,2007 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: present owner 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 P� Priv y ❑ 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) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: �f 5/31f78 Were sewage odors detected when arriving at the site? ❑ Yes ® No Inspection report for TOW Mosher•013M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path Property Address Bruce Riddick Owner Owners Name information required forte Marston Mills Ma. 02648 September 25,2007 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 181" 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.): Joints structurally sound, no signs of leakage Septic Tank(locate on site plan): Depth below grade: 12"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: 400"x8'4"x5'0" Sludge depth: 411 Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 31' Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Physical measerment,Manufa. specs. Inspection report for MOW Mosher•08M Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Jr 128 Bridal Path Property Address Bruce Riddick Owner Owner's Name information is required for Marston Mills. Ma. 02648 September 25,2007 every page. Cityrrow n state Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tee in place, liquid level ok, no evidence of leakage, tank structurally sound Grease Trap(locate on.site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other{explain): Inspection report for-r"v Mosher•0t W Tithe 5 OffctW Inspection Force Suduuaface sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path Property Address Bruce Riddick Owner Owner's Name information required forte Marston Mills Ma. 02648 September 25,2007 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Off 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.): Some cant'over, D box structually sound, no sign of leakage Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Inspection report for TitleV Mosher•08f08 Title 5 Official In spection Forth:Subsurface Sewage Disposal System•Page 11 of 15 r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path Property Address Bruce Riddick Owner Owner's Name information is required for Marston Mills Ma 02648 September 25,2007 every page. Citylrown State Zip Code date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number. 1 6X6 ❑ leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No damp soil, normal soil, normal vegetation, no signs of hydraulic failure. Inspection report for Tidev Mosher•WW Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ..' 128 Bridal Path Property Address Bruce Riddick Owner Owner's Name uired fors eq Marston Mills Ma. 02648 September 25,2007 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Inspection report for TiffeV Mosher-0&06 Title 5 official In on Form:Subsurface spechi Sewage Disposal System•Page 13 of 15 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M e 128 Bridal Path Property Address Bruce Riddick Owner owner's Name information is Marston Mills Ma. 02648 September 25 2007 required for p every page. Cityrrown State Zip Code Date of Inspedion D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. L where public water supply enters the building. 3� all 3 4 r , I i �a0 I ` Inspection report farMftV Mmher 0&W Title 5 Official Inspection Form:Subst&"Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Bridal Path Property Address Bruce Riddick Owner Owner's Name informarequired forte Marston Mills Ma. 02648 September 25, 2007 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to ground water. 14' 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 you how o y established the high ground water elevation: Checked surrounding property i Inspection report for TitleV Mosher•08M Title 5 Official Inspection Form:Surface Sewage Disposal System-Page 15 of 15 Town of Barnstable OF IME 1p� Regulatory Services rsrAs Thomas F. Geiler, Director cbMAP `0�' Public Health .Division ATfD�.(A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. / TOWN OF BARNSTABLE i LOCATION La�j'/,� RIA—t ZZ-- Any SEWAGE# VILLAGE 9LKL9 -S ASSESSOR'S MAP&PARCEL/ INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility Feet FURNISHED BY &�00 46 � Q ,FR�7n lT LOCATION I SEWAGE PERMIT NO. T /o�t VILLAGE f�Z9/YSTurS � a 6f INSTALLER'S NAME & ADDRESS B U I'L DE R OR OWNER -� '0/.z DATE PERMIT ISSUED DATE COMPLIANCE ISSUED J-3l 7S — —. �. - --_ s i . � ,� 77 d� THE COMMONWEALTH OF MASSACHUSETTS BOARD Fw,.E 'LTH n? - t38 ...OF........ ................ ......................... Appliration for %ipoaa1 Works Tontitrnrtinn Prrmit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: .....,t..a..7` / ......, .:€'� � r ---------------- -/.l. ....... ...fi Location-Address or Lot No. P _.. .14 ✓� 1��...f94,..t t............Y.. D r ---------•.................Address InE.taller Address UT e of Building Size Lot............................Sq. feet Dwelling—No. of Bed-ooms...t_ ..........Expansion Attic �ByQ Garbage Grinder (/V)� ..N.A._ti.__.�E_..... No. of persons............................ Showers — Cafeteria p., Other—Type of Building ( ) ( ) a' Other fixtures ............................................................ W Design Flow..................6:7.�--_--......�gallons per person per day. Total daily flow...... .1(�.: ..................gallons. WSeptic Tank-t Liquid capacity/J.1'._gallons Length................ Width................ Diameter________--_-_- Depth................ x Disposal Trench—No..................... Width..._.....�_-........ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......-.________.. iameter.... .X_._f.. Depth below inlet.................... Total leaching area..................sgAt. Z Other Distribution box (v) Dosing tank Percolation Test Results Performed by...-'__ _ t_!' ......11,=_e.................. Date_.ID.�_` aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................... Gx Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water. ... ......_......_... j`� --------------- Description of Soil-- v - 1 ... �� J 1� W UNature of Repairs or Alterations—Answer when applicable............................................................................................... 4 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT1 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance om liance has Mn issued b ithn bo of hea . P P Y �� r . gne �7 Date Application Approved BY............ ....... •-- ... .. .--... ............... ' 2=Y.,- Date Application Disapproved for the following reasons:--.............................................................................................................. ---------------------------------------------------••................................................................................................................................................... Date Permit No......................................t.........--•..... Issued.. "-`31 c No........>t C THE COMMONWEALTH OF MASSACHUSETTS r BOARD F 1-1EALTH Allp irafion for Disposal Works Tnnitrnrtiun rnmit Application is hereby made for..a Permit to Construct (y �-) or Repair ( ) an Individual Sewage Disposal System at: Locatio Address or o M/}'yis.r+'•!{�y y,�I8p p- ��/..Af.�T q...... 1 .......]4 - )))..rr�.yyy #e�A.{ii�ys sO . - • -Wd__ �}4pns i •w Installer Address d T e of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms:_,. ._ .....................Expansion Attic Garbage Grinder �V )0 'L �ther—T e of BuilAin A No. of persons......................... Showers P.1 YP g -- -�- '-�------ P --- ( ) — Cafeteria ( ) P4.• Other fixtures ---------_------_------------------------ W Design Flow................. """ _ _ gallons per person per day. Total daily flow......Jr-70-e........._..........gallons. W q p ci y/ g Y Length Width Diameter Depth Septic Tank Li uId ca aclt - allons ,Y x Disposal Trench—No..................... Width:•.__..__ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------I----------- iameter... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ( ) Percolation Test Results z 1.Performed by.-w--.: dbt4 �- Ale -----•------ Date- '3� ��---•--• Test Pit No. 1........}-------minutes per inch epth of Test Pit .................. Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth. of Test Pit.................... Depth to ground water.. _,_....._......___. �+ t = -. O Descripxion of_.Soil... A_ � , ♦ -_- W •---_--t ---••--------------- ---------------------•----....._-..----------•------•-----•------------ -••-----------•---------•--• --------,-----------••-••----••-------•--.. 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 Sanit Code—The undersigned further agrees not to_place the system in z" operation.until a Certificate of Compliance h s b ss ed by e boa f h h. .' ' Sign `= D--------- -------------------- ----------------- Date - Application Approved By........... c._ ............. / � Date Application Disapproved for the ollowing reasons----- --------------------------- •--•-----------------•--•-•-------•-•----••-----••--•---.....------•-••••••-- y --...Date-•---•-•----- PermitNo....................................... - =- ........ Issued-........................................................ Date { THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEAL H JI� ... ... .............................. Trrtifiratr of Tv mptianrr IS IS 'TO CE fTj17FY hat the�dividual Sewage Disposal System constructed �or Repaired ( ) by ; .......... ...... ....... •.................•....._ C. -• s of Insta ha been installed in accordance with the provision TI r o T e State Sanitary ode as described in the application for Disposal.,Works Construction Permit No." . ................ dated �_" `.'Q1! `..77_____________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTgM WILL FUNCTION SATISFACTORY. ................ Inspector.............................................. ...................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ........OF...... ................: FEE ................ No.... i �t��t1aM� �rk� n � 1UE11� rrntt�t � > Gl�r�-. �.�t r Permission is hereby granted:_________ ______ ___ .__..._. .................. to Cons ct (� o a� ( a nnddiv'�al. wage Di nn 2 ,. �.L.:-..... _..... � at No. _ ..' 1 ,y r� Street �/�� �{/�, as shown on the application for Disposal Works Construction Per. it No ___:. _._._.__ ated..:.__...(:/-__•------------.♦-__---_____---- V E - '� ' Board of Health DATE ------....=-•---------•------•--•--•..........•-- FORM 1255 HOSES & WARREN. INC.. PUBLISHERS - .t J r '(' Lo Leo on k bra } , a / j ROBERT o P' BUNIKIS Na 22162ac qi p vz l I A Oct "15TE v 1 / G} ,�`1Fy 4 tY I / t 2 ' r r.:}.�• ^ a }_ 1 /( 1• _ - `$' �I , ; Ai' } + e✓ . .../ �bY i\ `mot �: ` A rLEGEND ` ' *IS TIN0 SPOT ELEVATION OAO CERTIFIED PLOT PLAN EXISTING CONTOUR— 0 FIN-iSMED'. SPOT ELEVATION �. J- � PFiNiSbi0 CONTOUR 0 - -- - - -- IN APP ,QVED .1 BOARD OF HEALTHTAS\ ' + + `1 +l -DlA—Tt—AGENT SCALE: � �� �� DATE4c�'A� 197 DREDGE ENGINEERING CO. ON , CLIENT `�'' �e _.._.._..._. _ .---- _ -- ��_._-�.__ I CERTIFY THAT THE PROPOSED j EGISTI RE REGISTERED ,• , JOB td0.7 70 9 G_ BUILDING SHOWN ON THIS PLAN »ti fi CPVIL'' LAND -CONFORMS TO THE ZONING LAWS '` tEINEEiS SURVEYOR DR-BY _n _. OF BARNST 9LE , MASS. 33t,Wb. RAAIPI ST 712 MAIN ST. CH. BY •>01YARMOUTH; UAASS. HYANNIS, ,-MASS,. SHEET OF 2-_ DATE REG. LAND SURVEYOR . l� . /Y07E :''/F: E/TNER TN:E SFf�T/G TANJ� .D�Q ---ai G _.P/T .ARE MORE THA A✓ /d? 8,40 /®.fsT M/N - -- ii•P R®,Ez `fa "O/AM COVi,—SaR R SJ�A L 8.E .9'"Zig SN T To 4/TA l;,.E A J1!;E>t'7"R-A r YCONCR@TER 4NPVC P/PF NEAYY CAST /RO/Y_ GOVER Sf�ALL L3E US,-1� ` GDI�EI�S YB0PER.,=r. �l.Vq-we9Y r _n G .4oE Co VEfz CLEAN SANG - - - L/Q[//D LEVEL _��... -.�• .. ' . _ �� e 4.. C.vST - - z"LAYERr t /JSON P/PE t IO 0 `J Cr y o M/N. P/Tc/0 GAL. _r ° o e i • • . • • r e v �Qo � D/ST. WASHED 5701YE S'EPT/C TA/V/C o b • � o • • s n d.4 BO X p ? i i.•I s r A • • s n e p C b .' „ •EFFECT/VE ` c ° • e pEPTH • ° e • ° v o WA5RjFP STONE . :`. o•;.; •~ T- .F _ � o � e � s s e • • e � boo , _ _ _ . e�+ a • . e o • • • • pe y — PREASTSEEPAGE_. //VI�iL�l�r �LEYs�T/®NS o e op o o ® o e 0 a Q u P/7 OR EQU/V. /NYERT AT El/LD/NG ?.L' FT. /NLET SE'F'T/C TANK 9 (..-S FT. _ L 0�- FT. O/.4/r_1. _ C SEE gBULATJON> OUTLET SEPTIC TANK 9 6.3 FT• /NLEr 49157R/4507101v BOX 96-6 FT. - SECT/b/v O J= GROUND WATER TABLE y 0UrLE7-10/STR/BUT/Old 60X q S•`t FT f //1/LETSEEPAGE O/T _� C FT. .SEJVAGE ®/6'.4P05A L Sd�.STEM T��l✓L.AT/®/V L EAC.A///1/6 �/T DES/GN CR/TEft/�l JcCALE %� _ / O" v/MENS/ON — F'T. _ - DIMJ=-Ns/aa t-- FT. NYJMBER OF BEDROOMS 3 r D/HENS/®N C FT Mir• GARBAGEO/SPOSAL liy/T_ . SOIL LO& 707AI- EST/MA7r,--O F1-0H/_3 3 0.4L./DAY -SOIL TEST ,#/ SO/L TE.ST'02 S®/•C. 7:65T /4(UM8ER P/TS_ f � ._ E OF SO/L TES 7'[ 9 , 7f .D rr - RESULTS iV/TNESSE� BY T ,T�. SQ BOTTOM L rFrgCN/A/G,PE1= P/T /�' 8 PtRCOLA'7'/ON_RRT0 Ai/ _2._0_ /.?/N /NC!'1 TOTAL LEACH//YG AREA -G; /� SQ. FT. P1EJeC0LA710N RATE#2 .eESERYELEAC'H/NGAREA_ SQ. FT. 2 "S u3v�f R�i2l�E �c s �o ROBERT o euNlKls el-DRZ®CrE FNCr A'AUplAfG eo e,vc. p No.22162 O a G/S TE 7/2 MA//Y ST.. Opo a<'' CC . B4,l 33 oVO,MA/N S'7.` �f"rs'ONAL \` ND`rROIJN(� Y3�iaTEFt �NCOU/VTEREO HYANNI3 M.955. SO. YA RAl OU 7,Y,MASS_ GM04JA/O- kV-4TE'R eA7 ELEV — JOB No. 770� SHEET OF Yz V JAX : - - � 4 _ V r A L4.7 r OA s 9 i_ 5 - i 9 t� 'tivo x 01t 0 y P�ioT�[,T or `TO CE1-L SNP• DNS . A M 1' Fcpp S. �o , v l"J SIQ )L- -- r VWT • M71 l J 1 36 - Y OwAmalli t . 1 t • p7 y c v ' r 1 � r t " i { t . ' j r • �: t , { s J r l 1 F