HomeMy WebLinkAbout0129 BRIDLE PATH - Health 129 Bridle,Path
Marstons Mills
- - - --- - - - - A= 149- 143 t
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owners Name
information is required for every Marstons Mills Ma 02648 2/6/2012
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. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Sean M. Jones
3
use the return
key. Name of Inspector
Capewide Enterprises
� Company Name
153 Commercial St..
Company Address
Mashpee Ma. 02649
Citylrown State Zip Code
508-477-8877 S14522
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
2/6/2012 � -
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 sja shared.systeffi''or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit ttie.
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 6- 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.
l5ins•11/70 Title 5 Official Inspection Forth: bIca Sewage isposal System•Pa e t of 17
,r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
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:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System
will pass inspection if the existing tank is replaced with a complying septic tank as approved by the
Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
H Title 5 Official Inspection Form .
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
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
l5ins 11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
El ED Liquid depth in cesspool is less than 6" below invert or available volume is less
than Y day flow
l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
129 Bridle Path
M
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year.NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
O ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ Z 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.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure..
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form.
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
every page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
® ❑ Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
s
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): 331.5 gpd
provided
(Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma' 02648 2%6/2012
every page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 4
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 Z No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
2010 = 77,000 total =211 gpd 2011= 83,000 total =227 gpd
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is"required for Marstons Mills Ma 02648 2/6/2012
every page. City/Town 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 ❑ No
If yes, volume pumped: 1000,gallons
gallons
How was quantity pumped determined? size of tank
Reason for pumping: routine maintenance, clean filter
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
GM 129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
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:
system repaired 2007.per town records
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
1.5
Depth below grade:
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
10+
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Joints ok, no leakage, vented through roof
Septic Tank(locate on site plan):
Depth below grade: 1
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: 1000 gallons
Sludge depth:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 Bridle Path
Property Address
COX, STEPHEN & NAN Y C J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
every page. City/Town 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
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
How were dimensions determined? tank was cleaned at time of
inspection
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank was cleaned as part of the inspection and should be done again every 2 years as routine
preventive maintenance. Outlet tee was intact and has a zabel filter installed that needs to be cleaned
every 6 months to prevent clogging. Tank was structurally sound and not leaking.
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
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
every page. Cityrrown 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.):
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):
Dime
nsions:
Capacity:
gallons
Design Flow: gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 129 Bridle Path
Property Address .
COX, STEPHEN & NANCY J
Owner Owner's Name -
information is required for Marstons Mills Ma 02648 2/6/2012
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
Olt
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.):
Distribution box was video inspected and found to be in good condition, water level was even with
outlet invert, no sign of past hydraulic overloading.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Lt5ins /10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
every page. CityrTown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® Teaching chambers number: 2x500 gallons
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Stone and soil surrounding leaching facility was probed in various locations and found to be dry with
no sign of past saturation.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth-top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is Marstons Mills Ma 02648 2/6/2012
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
f i
A_ ZN.S
I,/ , /y
25.5 p
i7.S ' o Z
3
L7
QD�
T3.3,:
Sys_
31.5�
4-5 : 32
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
every page. Citylrown State Zip Code Date of Inspection
D. System Information.(cont.)
Site Exam:
❑ Check Slope
Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 2 fe eett
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 007
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:
Design plan dated 5/10/2007 indicates that no groundwater was encountered at 130"and system is
designed to have a seperation of 5'+ between bottom of s.a.s. and adjusted high groundwater
elevation.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
V Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
129 Bridle Path
Property Address
COX, STEPHEN & NANCY J
Owner Owner's Name
information is required for Marstons Mills Ma 02648 2/6/2012
every page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
P I
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
TOWN OF*B,AJRNSTABLE
LOCATION Za4 /3�i0 le RL SEWAGE # 07 ' Z07-
'VILLAGE M a.r S Ewa 1-YU l I S ASSESSOR'S MAP & 10T I q `W3
INSTALLER'S NAME&PHONE NO. 4.14Ae Ertl Ee.r Clie
J f
SEPrI'IC=TANK CAPACITY !o U O } \ '
t
LEACHING'FACILITY: (type) �� mb L — 4 1 V (sine) l Z
NO.OF BEDROOMS 3
BUILDER OR OWNER tiu h ' N Q-Vnc C 0
PERMITDATE: COMPLIANCE DATE: 42
Separation Distance Between the: Y
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ` N Feet
Private Water Supply Well and Leaching Facility (If any wells exist ut
on site or within 200 feet of leaching facility) _ N Feet
Edge of Wetland and Leaching Facility(If any wetlands exist �„a
within 300 feet of leaching facility) Feet
Furnished by
!7•s
s �{ w3 a?.� a3 3�•3 .
b gay 01 tins
�; 19 ti 3s""•o� 1�10 �•S'
r
No. ��/" r Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIPPYicotiou for Digpoml *p5tem Cou.5tructiou Permit
Application for a Permit to Construct( ) Repair(01,Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components
Location Address or Lot No. IZA Ake-? ;1., HA4W),K& Owner's Name,Address,and Tel.No.
S,e.piwr. cc*,
12� ITi�i(ItQ P
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
_ Q.o,3ox �to3 Z€sy C✓2d-carry Awy.
5 08 qZ$ '-Vo i Cam•.T-cr k1 e ►A k S—og— 23'1. 6-3-7-7
r,,,, r•,p
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building 51 nSI T%44n i tti No.of Persons „j Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) J® gpd Design flow provided 3 L - gpd
Plan Date 10 �� 2pa1 Number of sheets l Revision Date
Title I-Vi BC:(Nke_
Size of Septic Tank I o O® Type of S.A.S. Q) 500 fjqc�1.. �e�cl. �Cg Cigig 5
Description of Soil _
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 Certificate of
Compliance has been issued by this Board of Health.
igned Date
Application Approved b . Date.
!ApplicatiowDisapproved by: Date
^for the'following reasons
Permit No. Date Issued
�00
—ae
_ No. / ". ,# e Fee /�V
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVA SI;ON - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for �Digpogal 6p$tem Cow5truction Permit
s Application for a Permit to Construct O Repair(v< Upgrade O Abandon O ❑ Complete System ❑Individual Components
Location Address or Lot No. 17-`1 Owner's Name,Address,and Tel.No.
15;c f i.:_- r,),A_c.y C.o7c
M qk is.C:41 t 2 P•4 V-,A _
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ` S`'r<r
X '7�3 ZLxy C!L✓L'�'7�r�y awy.
0`6 �fZ2 LIO�,c(i CP.j.T rc �t1 e � 5`019 Z3-7- 63-77 tti✓wteu✓1.+� , n,p
Type of Building:
Dwelling No;of Bedrooms Lot Size sq. ft. Garbage Grinder ( )
Other Type of Building 5 i h'0•e.�y b No.of Persons ' -57 Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ( gpd Design flow provided gpd
�! 2 QU
Plan Date HAy 10 7 Number of sheets ` Revision Date
Title 1-y-, Gr.6tv,
Size of Septic Tank ° 1000 Type of S.A.S. (Z) 5010 9,4L•
t
Description of Soil O[A,^ *'
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 Certificate of
Compliance has been issued by this Board of Health. ,
igned -j Date Z'r T 1 C �
Application Approved Date
s /T
Application Disapproved by: - Date
for the following reasons
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( �) Upgraded ( )
Abandoned( )by �A ae ,r�¢ ✓t��t �( s �e 5 l.l.�
at �'�� 3(�c�(e QA i 1 j M INS`UVL to", f�) has
sbeen
nconstructed in accordance
st (}
{� with the provisions of Title 5 and the for Disposal System Construction Permit No. Vi c• 55^ _! / dated
Installer I�A(.1 R ���- jyf'a S-eS LLQ Designer 1. C - EZ1 1��+ t '^ S
[,s,,lsc
#bedrooms 3 Approved design flow
The issuance of this permit shallltnot be construed as as guarantee that the system Date � / / � f Inspector T/,�t// G' G�I�C. -i•� c
————————————————---——————————————
No. — — —— —— ,-„--— .
?
- ` � Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION —BARNSTABLE, MASSACHUSETTS
=i!5poga[ ,6pgtem Congtruction Permit
Permission is hereby granted to Construct ( ) Repair (/ Upgrade ( ) Abandon ( )
System located at /2r, , rrc { 64 r d 14 w3 worts M /5
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date ofthisof e ^�
Date s 1 Z O O 1 Approvediby /n
J.P.MACOMBER a SON ! PACE 03
Town of Barnatabie`
' f R, uatpry Services
j Thomas F.aef er,Ph-War �
sl. Thomas MdCaan,Director
i goal rfl da st>e4,11yaslal g MA 6260x
If
ofaw: sog-ad2 46M i- i i08•79U304
law ,,
Datet R-I Y-07
`
{: �'finer. G: E rw\tnee.ri n - �G. I�astalter: G'anl�r «s
1 •runty^+....�o. �
Addrrmt s wt3 4 Crc+�n�v�r
uioravr�_, A3� �A�1E�
j was issued a armt�to install a s
3000 sy'`teen®t �'z 2 based Ca a deeip drawn by
' aL �
�G i✓� i1t. .Ci 1rZ '&0d May 10, 200.71 !
M1w to tho swtio ayetwn refe we d above was Wooed!substatstialt wmt�dLq to
the dms��lggnn, which may is:clude Tz Cs approval ehar� 146b:, s latew raimieu o1;th
&&btttioa box aAdor siodo tk.
_ I i;e * that the septic isyetam referenced above'wu:bntalled with mkor degas It,
9 tbaz to, iattaal rellocatinn of ft SAS or any vernnCaf reioc4on of any oompomt
of*a papule sysum)but in axccordanoe with Statc;&LoW Regulations. Plan revision or
okAed ai•built by designee io fallow. z
i
I, "'"" I ClfUFi%?ILL
9
3 O RO0
,
Baer sl a tamp ere
TEE
Q:HWfi kpddpaa*ar Cee M*6*n Form
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oPostage $
Certified Fee O,S9�
hO Return Receipt Fee (� ,Postmark ��
(Endorsement Required) Here
o �,
Restricted Delivery Fee _
.0 (Endorsement Required) /
rI Gsp
ul Total Postage&Fees -(('',�(( �s w M
Sent To Cr'45 vG� �'P �0 `.1
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city,ware,ztPtahf a rst h(/4 s hf t 4 9
:,r rr
Certified Mail Provides: (asianay)ZOOZ eunr'009c wjoj Sd
o A mailing receipt
o A unique identifier for your mailpiece
a A record of delivery kept by the Postal Service for two years
Important Reminders:
® Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®.
a Certified Mail is not available for any class of international mail.
a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
o For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is
required.
o For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
d If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT:Save this receipt and present it when making an inquiry.
Internet access to delivery information is not available on mall
addressed to APOs and FPOs.
I
■ Complete items 1,2,and 3.Also complete A. Signet
item 4 if Restricted Delivery is desired. X Ageht
■ Print your name and address on the reverse Addres ee
so that we can return the card to you, B.
Receiv d by(Pri to Na )
1. Article Addressed to: C. D t o el' ery
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address different from item 1? s
❑
i+
If YES,enter delivery address below: No
'Mr &'Nlrs'Stephen Cox
fi 29 Bridle Path
3. Service Type
Marstons Mills, M.A 02649 ❑Certified Mail ❑Express Mail
❑Registered ❑Return Receipt for Merchandise
- ❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes F
2. Article Number ?005 1160 0000 .'0191 2809
(transfer from service label)
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
pppp-
UNITED STAT- L`'
' � V r 6, ,-� • ils ° aaMssY�lej _.
` •s ai
• Sender: Please print your name, address, and ZIP+4 in this box•
PUBLIC HEALTH DIVISION
TOWN OF BARiNSTABLE
200 MAIN STREET
hYANNIS,mASSACHUSSETS 02601
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVEOwner — A111
Owner's Name
information is MARSTONS MILLS required for MA 02648 1/8/07
every page. Cityrrown State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be al Bred in any
way. �- //-3
Important:
When filling out A. General Information
W
fortes on the
computer,use 1. Inspector:
only the tab key
to move your MICHAEL DEDECKO
cursor-do not Name of Inspector
use the return
key. COMPASS REALTY DEV CORP
Company Name
P.O. BOX 2384
Company Address
MASHPEE MA 02649
Cltyrrown State Zip Code
508-221-5003
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 16.340 of
Title 5(310 CMR 15.000).The system:
❑ Passes ❑ Conditionally Passes Fails
❑ Needs Further Evaluation by the Local Approving Authority
1/8/07 l
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 sy_steni or
er
has a design flow of 10,000 gpd or greater, the inspector and the system own shall submit the>
report to the appropriate regional office of the DEP. The original should be sent too the system o�Aer_
and copies sent to the buyer, if applicable, and the approving authority. = rn
****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. ri
281OLD MEETINGHOUSE-08106 Title 5 Official Inspection Forth:Subsurface Sewage DoxsaLSXstem Page,1 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owners Name
information is required for MARSTONS MILLS MA 02648 1/8/07
every page. City/Town State Zip Code Date of Inspection
B. Certification (cunt.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
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
281 OLD MEETINGHOUSE•011106 Title 5 Official Ins
pection Form:Subsurface Sewage Disposal System•Pape 2 0l 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System,Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owner's Name
information is required for MARSTONS MILLS MA 02648 1/8/07
every page. Cityfrown 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.
281 OLD MEETINGHOUSE•08106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owner's Name
information is required for MARSTONS MILLS MA 02648 1/8/07
every page. Cityfrown State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be
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
L,J( ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
/ or clogged SAS or cesspool
❑
�_y/ Liquid depth in cesspool is less than 6"below invert or available volume is less
than %day flow
❑ Far**' 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 9
high round water elevation.
El tributary
portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
281 OLD MEETINGHOUSE•08M Tito 5 Official Inspection Forth:Subsurfeoe Sewape Disposal System-Page 4 of 15
Commonwealth of Massachusetts
ffim
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owner's Name
information is required for MARSTONS MILLS MA 02648 1/8/07
every page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
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.
❑ R 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.
❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,
or answered"yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
281 OLD MEETINGHOUSE•08/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owner's Name
information is required for MARSTONS MILLS MA 02648 1/8/07
every page. Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ Were any of the system components pumped out in the previous
P P P p two weeks?
d ❑ Has the system received normal flows in the previous two week period?
❑ IR/ Have large volumes of water been introduced to the system recently or as part of
this inspection?
9/ ❑ 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)]
281OLD MEETINGHOUSE•08106 Title 5 Ofiaal Inspection Form:Subsurface Sewage Disposal System•Pape 6 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
" 129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owner's Name
information is required for MARSTONS MILLS MA 02648 1/8/07
every page, Citylrown State Zip Code Date of Inspection
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): 330
Number of current residents:
Does residence have a garbage grinder? ❑ Yes 2/'No
Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes (]I/No
Laundry system inspected? ❑ Yes �o
Seasonal use? ❑ Yes 0 No
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump? ❑ Yes No
Last date of occupancy: ate
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
f 281 OLD MEETINGHOUSE•08/06 Title 5 Official tnspedlon Forth:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owner's Name
information is required for MARSTONS MILLS MA 02648 1/8/07
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of stem:
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)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes YINo
281OLD MEETINGHOUSE•08106 Title 5 Oftal Ins
pection Form:Subsurface Sewage Disposal System•Page 8 or 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owner's Name
information is required for MARSTONS MILLS MA 02648 1/8/07
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
b1 ,
Depth below grade: 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.):
Sot w r� tes UwRd- R ba&-"-4
Septic Tank(locate on site plan):
Depth below grade: feet
Z
of construction:
rete ❑ 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: ��C� q1�"
Sludge depth: 3►�
it
Distance from top of sludge to bottom of outlet tee or baffle ` I
a�
Scum thickness 62
Distance from top of scum to top of outlet tee or baffle l0 ,
ol
Distance from bottom of scum to bottom of outlet tee or baffle I q,,��
How were dimensions determined? Kfd
281 OLD MEETINGHOUSE•OBW Title 5 Official In
spection Forth:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owners Name
information is
required for MARSTONS MILLS MA 02648 1/8/07
every page. Cityrrown 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.):
T Pvwsia Ti°S (AlDrc T; 57neR711rW1.14
tl a LGVL oV Tzd- -TNR te T 1�0 S' �r1S o�
Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene [I 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):
281OLD MEETINGHOUSE•GIV06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts
lugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owner's Name
information is MARSTONS MILLS required for MA 02648 1/8/07
every page. Crty/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cunt.)
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 iIt �Y- UC canter-W LIfAt
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.):
h- x « 12A, AD CIOD, t s 6f �rl� Cyo�
bA
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
281OLD MEETINGHOUSE•08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System.pegs 11 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owner's Name
information is required for MARSTONS MILLS MA 02648 1/8/07
every page. Cityrrown 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:
L�J leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology: k
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
281OLD MEETINGHOUSE•08/OB
Title 5 Official Inspection Form:Subsurtace Sewage Disposal System•Pam 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owners Name
information is MARSTONS MILLS
required for MA 02648 1/8/07
every page. Citylrown 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.):
281OLD MEETINGHOUSE-08M Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Pop I$of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owner's Name
information is required for MARSTONS MILLS MA 02648 1/8/07
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building,
o l
Z
1 3
-33 f
PIZ.,A5-D 83,
281 OLD MEETINGHOUSE-08ft Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
Commonwealth of Massachusetts
EEL
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
129 BRIDLE PATH
Property Address
AEGOM INTERACTIVE
Owner Owners Name
informa
tion for
Is MARSTONS MILLS required for MA 02648 1/8/07
every page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
Ch ck Slope
�
Surface water
Ch k cellar
Shallow wells
Estimated depth to ground water:
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:
Cr! t �GI
You must describe how you established the high ground water elevation:
U
281 OLD MEETINGHOUSE•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 15
COMMONWEALTH OF MASSACHUSETTS
. ...ExECUTFVE OFFICE..OF-.ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART RECEIVE®
CERTIFICATION
Property Address: 129 Bridal Path 9
f- JAN O $'2QO3
e e iry ec1iv4_rno <" (�S
Owner's Name: Dennis Stewart 1 TOWN OF BARNSTABLE
�^ HEALTH:,D.Er
Owner's Address:
Date of Inspection:
�= to2.1
Name of Inspector:(please print) Wi 1 1 i am R_ . Robinson Sr. M
Company Name: , William E. Robinson Septic Service
Mailing Address: P O Box 1089 - PARCEL :
_Centerville MA
Telephone Number: ( 508). _ 775-8776 -
LOT Z
Y%r
CERTIFICATION STATEMENT
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
trainingand experience in the proper function and maintenance of on site sewage disposal systems.1 am,a.DEP
approved system inspector.pursuant to Section•15340 of Title 5(310 CMR 15.600). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
L
Inspector's Signature: �j , j �3. Date: / O y-0,3
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Healtlhlor
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 approxing
authority.
Notes and Continents
****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.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of l 1
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY`ASSESSMENTS
SUBSURFACE SEWAGt DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued):
Property Address:
Owner. enn' ^ �ewart
Date of Inspection:
Inspection Summary::Check A,B,C,D or E/ALWAYS complete all of Section D
A. Syste Passes:
rmation which indicates that any of the failure criteria described in 310 CMR
have not found any info
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
S stem gnditionally Passes:
~-�^--•�° �One or-.more�system components as described in the"Conditional Pass".section need to be replaced or
repa ed.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass:
Answ r yes,no or not determined(Y,N,ND)in the for the following statements_If"not determined"please
expla' .
e septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsoun 1,exhibits substantial infiltration or exfiltration or tank failure is imminent..System will pass inspection if the
existin tank is replaced with a complying septic tank as approved by the Board'of Health:
•A me al septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indica ng that the tank is less than 20 years old is available.
ND a plain:
Observation of sewage backup or break out or high static water level in the distribution box due to-broken or
obs cted pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
ap roval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
NDexplain:
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 rcmovcd
ND explain:
i
Page 3 of 11
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS ,
SUBSURFACE SEWAGE DISPOSAL°SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address 129 Bridal Path.
Centerville
Owner: Dennis Stewart
Date of Inspection:
C. Further Evaluation is Required by the Board of Health:
)1a
ditions exist which require further evaluation by the Board of Health in order to determine if the system protect publichealth,safety or the environment.
tem will pass unless Board of Health determines ivaccordance with 310CMR 1:5,303(1)(b).that thelem.is not functio.ning 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:feef of a bordering vegetated wetland or a salt marsh.. .
2. Sy tem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is1un�tioning 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
su face water supply or tributary to'a surface water supply.
The system has a septic tank'And SAS and the SAS is within a Zone-I 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 frorrl a
rivate 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 and volatile organic compounds indicates that the well is free from pollution from that facility 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:
3
T • ]
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FORM
FPART A
CERTIFICATION(continued)
Property Address: 1 29 $Z lda l Pa+ h p
CentPrvi
Owner: Dennis
Date of Inspection:
D. System Failure Criteria applicable to all systems:-
.inspections-
Yes . .. . . , ,; . _._ ..,
You must indicate`yes"or"no"to each of the following for all
No
Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
-- gr::
_ Discharge or ponding of effluent to the surface of the ound 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.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Anypportion 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 col bacteria.and vo
iform latile organic compounds
indicates that the well is free from pollution from that facility 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.)
(Yes/No)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:
o be considered a large system the system must serve a facility with a design now of 10 000 gpd to 15,000
pd-
ou must indicate either"yes"or"no"to each of the following:
e following criteria apply to large systems in addition to the criteria above)
y s 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
I you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
" es"in Section D above the large system has failed.The owner or operator of any large system considered a
si nificant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
1 .304.The system owner should contact the appropriate regional office of the Department.
4
f
Page 5 of I I '
OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B.
CHECKLIST
Property Address: 129 Bridal Path
Centerville
Owner: Dennis Stewart
Date of Inspection: /- A/-U 3
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 H/ ealth
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?
LI/Havc large volumes of water been introduced to the system recently or as part of this inspection?_
v — Were as built plans of the system obtained and examined?(If they were not available note as NfA)
— 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:.
Yes no / .
Existing information.For example,a plan at the Board of Health.
V _ 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(3)(b)]
5
Page 6 of I
• 6
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART,C
SYSTEM INFORMATION
Property Address: 129 Bridal Path -
Centervi e
Owner: Dennis Stewart
Date of Inspection: z—I/—Q:I
FLOW CONDITIONS
RESIDENTIAL. .'
Number of bedrooms(desi
gn):gn): .f Number of bedrooms(actual): _-Z
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):,,F
Number of current residents:=�
Does residence have a garbage grmder(yes or no):/✓�
Is laundry on a separate sewage system(yes or no):�U [if yes separate inspection required]
Laundry system inspected(yes or no):jt _
Seasonal use:(yes or no):ti d
Water meter readings,if available
ble(last 2 years usage(gpd)): 2 0 0 2 6 6 0 0 0 gal s
Sumppump
es or no): 2001 67, 000 gals
Last date of occupancy: —t --6 3
.CO M RCIAIANDUSTRIAL
Type of a tablishment:
Design flo (based on 310 CMR 15.203):
Basis of d sign flow(seats/persons/sgft,etc.):
Grease tra present(yes or no):
Industrial aste holding tank present(yes or no):_
Non-sani waste discharged to the Title 5 system(yes or no)':
Water me er readings,if available:
Last date of occupancy/user
OTH (describe):
GENERAL INFORMATION
Pumping Records
Source of information: s aL_ :�h
Was system pumped as part of the inspection(yes or no):T_-
If yes,volume pumped:_gallons-=How was quantity pumped determined?
Reason for pumping:
T Y�PE.dF SYSTEM
_ eptic 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/Altemative 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,d to installed(if kno )and source of information:
V e
Were sewage odors detected when arriving at the site(yes or no): i cJ
6
Page 7 of I I
OFFICIAL INSPECTION FORM=NOT"FOR_VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM
PART C
SYSTEM INFORMATI.ON-(continued)
Property Address: 129 Bridal Path
en ervi e
Owner: Dennis Stewart `
Date of Inspection:
B DING SEWER(locate on site plan)
Depth elow grade:
Materia s of construction cast iron _40 PV.0 ._other(explain):
Distanc from private water supply well or suction line:
Comme is(on condition of joints,venting,evidence of leakage,etc.):
cate on site
SEPTIC TANK: ✓ (lo plan)P
1
Depth below grade: J
Material of construction: ✓concrete_metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Com liance es or no :—� p (y ) _.(attach a copy of
certificate) y
.......
........ ..
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: Pd
Scum thickness: O ,
Distance from top of scum to top of outlet tee or baffle: $r
Distance from bottom of scum to bottom o outlet tee or baffle �y
How were dimensions determined: /L
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of-leakage,e .):
GREAS TRAP:_(locate on site plan).
Depth bcic w grade:—
Material o construction:_concrete_metal_fiberglass_polyethylene_other.=
(explain):
Dimensio s:
Scum thic ess:
Distance om top of scum to top of outlet tee or baffle:
Distance om bottom of scum to bottom of outlet tee or baffle:
Date of I t pumping:
Comme s(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as relate to outlet invert,evidence of leakage,etc.):
7
Page 8 of I I
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION..FORM
PART C
SYSTEM-INFORMATION(continued): :
PropertyAddress• 129 Bridal_ Path
-
Owner: Denni S ewart
Date of Inspection: irk`'�
TIGH)belo
OLDING TANK: (tank must be pumped at time of inspection)(Iocate on.site plan).. .,
Depthgrade:
Materonstruction: concrete. metal fiberglass_polyethylene other(explaur):
Dimension
Capacity. allons
}-
gallons/day
Design Flo
Alarm pre ent(yes or no):
Alarm le el: Alarm in working order(yes or no):
Date o ast pumping:
Comme is(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: rifpresent must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence(if
leakage into or out of box,etc.):
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
ondition of pumps and appurtenances,etc.):
Comments(note condition of pump chamber,c
8
f
Page 9ofII
OFFICIAL INSPECTION FORM—NOT.FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 129 Bridal Path
en ervi e
Owner: Dennis ewar
Date of Inspection:,/- h'—D 3
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Ty�eaching pits,number:
leaching chambers,number: 4l
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 pondin„damp soil,condition of vegetation,
etc.):
v/'
CESSPOOLS: (cesspo I must be pumped as part of inspection)(locate on site plan)
Number and configuratio
Depth—top of liquid to' let invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cess ool:
Materials of cons ction:
Indication of gr dwater inflow(yes or no):
Comments(no condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (I cafe on site plan)
Materials of c struction:
Dimensions:
Depth of sol' s:
Comments ote condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
Page 10 of l l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSES TS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 129 Bridal Path
en
Owner: enni
Date of Inspection: —!
SKETCH OF SEWA
GE DISPO
SAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
g
D
J°GIL
f
a, V K
i
�.J
3
10
Page l I of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
129 Bridal Path
Property Address:_eeziterviiie—
Owner.
Date of Inspection: -Y
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water e) feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record i if checked,date of design plan reviewed:
O served site(abutting property/observation hole within 150 feet of SAS)
Necked with local Board of Health-explain: ra,(5
Checked with local excavators,installers-(attach documentatioh)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation: f
o moo@
11
ASSESSORS MAP NO:
�17
' No .......'_ iJ , Fps.. . .......�.�
APPROVED THE COMMONWEALTH OF MASSACHUSETTS
a 3ii
ble Conservation De a BOARD OF HEALTH
/ , TOWN OF BARNSTABLE
gned Allphrafi�3i fur Di►ipaiial �iidw C�inuitrnrtiun amit
Application is hereby made for a Permit to C'oiistruct ( ) or Repair ( ) an Individual Sewage Disposal
System 9 /xV
........../... .... -•-•-------------•---•--------•.-._...--•-•-------- •---•-•••---••------------........_._....----------•�g••••---•---------••---....----------
anon-Add".
........... ---•----•••-••-•-•-•--••---•--------••. ....... --•-y`- or �t No......//d
W r� �ddre�A�
___.___._. .._ _
Installer ' Address `
d Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms-_-_________3_____________ __ _Expansion Attic Garbage Grinder
aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
04 Other fixtures --------------------------------
---------------------- ------------------•-••--------•--
W Design Flow............................................gallons per person per day. Total daily flow..__...._.____._____.._..____.._._.__.____..gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
z Other Distribution box ( ) I Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2�................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x •---------•-------------------------------------------------------------------------•--......_---_..........................................................
0 Description of Soil..................... ---•-••••---•••-••••-•••--.._._:_..--•-•
---- -----------------------••-•--•---••___-•---------
W .......... .............................................................................................................................................................................................
UNature of Repairs or Alterations—Answer when applicable............................_.........__...._._......._____.._._....._.._.__._.___..__________..
--•••------•--••-----•••----•-------•----••-••--•-•-------------•-•----•-•-•-••••------••-•--_•-•-----•--••-••--•-_..._.........----•-•---••------••-•-•-•-••------••-••-•-••-----•---•------•-_.....__.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Comp anc has be de by the board of health.
Signed -- - ------- ... ......................................... .................................:......
• Dare
Application Approved By - tf y ............... ... ... ..... -.....----.............�-----...._-'--�- Dare
Application Disapproved for the following reasons: ................................... � ......---............................. . ....... ............----..................
. ....... ............................................................ ...................... ... ........... ... ...................................................... . ...................................
Permit No. '�
�•�'�.�.�....� �- .. Issued ���...-........1�---�.��
Dare
i THE COMMONWEALTH O�MASSACHU SETT S
-BOARD -OF HEALTH- >l
TOWN OF BARNSTABLE
.. Avv iratiort fur.:3 hipoi!u1 Wor1w Tvastrurtio`n 11amit
Application is hereby,nade for a Permltxto Gortstruct ( ) or Repair ( ) an Individual Sewage Disposal
•System at: 'f
' 4
•- � Y- -°-....... ........................................ .................................................
�DO�cation•Addre s �} fj�q ✓�L�-
...........Y..c�!.::!J__:/7A fie...�'.:::fd:.�f!( _-r.... ....._ !�c�_ 1. 1 o(f_- .......!:.rE-/E f-/1
d--- �,y (]AT-tier , _. .._. t,A ..
^ ; 1A•T�.�.�1t.f.'.L.i �� - ......................' V��Y Gl/K/14��i � � 9 ..4 C' .��L: /Sdda•�'• .............J........ ..-- v.._._...,� .� ...... ; --. ....
pq
Installer Address
d Type of Building `
^ - � Size Lot............................Sq. feet
U Dwelling— No. of Bedrooms.___.__._.__ '_____________— : -.---ENpansion Attic ( ) Garbage Grinder ( )'
Other—Type of Building ------------------ ------- No. of persons............................ Showers (, ) — Cafeteria ( )
d Other fixtures ..................
..............................'..__..-------......................-..•-••--=-•-••-•........•--•••---•-•--•••-•--................
WDesign Flow............................................gallons per person per day. Total daily flow-1-1; ...._.__....._....._.........._....gallons.
Septic Tank—Liquid capacity-_-_-�----gallons Length---------------- Width---------------- Diameter................ Depth................
Disposal Trench— No. ............. al Width......_._......_.__. Total Length.................... Total leaching area....................sq. ft. i
P. .
Seepage Pit No..................... Diamet'er.................... Depth below inlet....._.___....... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
~' Percolation Test Results Performed by-------: '-............................................................. Date........................................
Test Pit No. 1................minutes per inch Depth of.'Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depthof. Test Pit.................... Depth to ground water..._._.............._...
P.4
Description of Soil -•---------- -----------------------------------••--..------.••---
..........;� ._.. ..- - - :....� - .��_-....... 1� 1_451.1.................................
x ................................................................................................................._....----------•------••----•----••--•---•. ......--•--••--•----•--
U Nature of Repairs or Alterations—Answer when applicable.........................."_.............. ...................................................
Agreement: o
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
I,
system in operation until a Certificate of Compliance has been issued by
.Signed :_..-- �!'�.
the board of health.
1 �r�
. --- `.... f11W`_:'f...41.�.-.. -�
I \ Date
ApplicationApproved By .....-- .. ......../i ....:.... ... ... ................................ _ Ly '.. �..�;,.f.,s._.i................ Date
Application Disapproved for the following reasons: ..................
y-------------------
.-----
.-------------
.......................
.. ._..----..................
.......................................................................... .............................. .............-------------------------....................................................... ........................................
. .....
Date
Permit No. ............ ........ . .��........... - y Issued .........4.�>.--..:?:.../�...............
JDate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(11ertif rate of Tom-pltttnee
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by -----------------------------------------------------------------------------------------------_-------- ---...-----------......... .......................... .......................................................... ......
Installer
at ... .g..... ....�" .. :... ..:.... .�. -, ---------------------------------------.... - ............................ ...
has been installed in accordance with the provisions of TITLE o The State Enviro mental Code as described in
the application for Disposal Works Construction Permit No. __l :..... _ /.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NO BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........
_ _. Inspector _. -' ..... .... ......................................
_---__--._-_---_- -----_-•----_------.-__---.--_----__----- >_,_______________�__�
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
,-7-. TOWN OF BARNSTABLE A?
No •-•..........-
.......�7` FFE.:ale..=.....
Permission is hereby granted---- T_..' ...-•---•--•-------------------•--•......-••••.............•.•--
to Construct ( ) r Re air ((,�''an ndividual Sewage Disposal System
at No.... .�� d .----.. ........ .. -21-> %4� ...............................................
stm
as shown on the application for Disposal Works Construction Per it ' '�►�'
/OA `
DATE--------•--------------•---•------•-�- ----•-_---------•--_----- Board of Health
`` FORM 38308 HOBBS&WARREN.INC..PUBLISHERS
I
.LOCATICN SEWAGE PERMIT NO.
V I L L A G E
INSTA LLER'S NAME A ADDRESS
A/ —5 e,/,d r--,�1, -
���f /An
B U I L D E R OR OWN ER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED � �`�
/� � ,-
/�.e.�ci.�. � ; -�
f �
0
� `
e � ! �� i
� �
�� t
� �
I
��
�y, i
�� �
MCI I ILI
N........ .... FEE............................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR OFHEALTH
. .....................
....... . to P........OF....... ---- ----
Applir ation -for Uiiipoiial Worko Towitriartion Vrrutft
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
yst
Ad. ............................. ..........................................................
. ......j. &%.. Zw
Lqcalion-Address 7 4 or Lot No
.............................. .......
Own r Adr
............. ........ . .......................................
Insta Per& Address
Type of Building Size Lota&__20__�__Sq. feet
U I Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic Garbage Grinder Vo
PL4 Other—Type of Building sln'.VRA.... No. of persons---------3-------------- Showers Cafeteria
a4 Other fixtures ..... ---------------------------------------------------............................... --------------
3-----------------------------------------
Design Flow______ _---_-------------------gallons per person p day. Total d. ily flow------ 0/ -------------------gallons.
W (j__1
P4 Septic Tank—Liquid capacitylO.O-Q--gallons Length,..__P ....6
W ......... Width� . ....... Diameter..... ...... Depth.-_.___.._....
x Disposal Trench—No, -------------------- Width,___,--„_--__--_--_ Total Length.................... Total leaching area--------------------sq. f t.
Seepage Pit No-------I------------ Diameter____________________ Depth below inlet________-___________ Total leaching tIre,;-_2-1.4-------sq. f t.
Z Other Distribution box Dosing tank
7 1`7
Percolation Test Results Performed ...................................... Date....l...a.h
Test Pit No. 1.....tt-0--minutes per inch Depth of Test Pit-----1.4---------- Depth to -round water___.- ®_��. V
riq Test Pit No. 2................minutes per inch Depth of Test Pit..______-.._.__._... Depth to ground water-,.-.-----..--.-_--_....
----------------------- -------------------------.......................................................................................................
0 Description of Soil----It'......U-A-1,&...............3.a. --------------
........GAMI&I............................................................................................................................
U ................................
W
------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable------------------- --------------I.............................-------------------------
--------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------
Agreement:
The undersigned agrees to install the afored sc Individual Sewage Disposal System in accordance with
, "e 9
'nit.
the provisions of Article XI of the State Sanitary
UQ�e The undersigned further agrees not to place the system in
operation until a Certificate of C.ompliance has be iss d by the b7oaXo �h4.
Signed.............. ------------........................................................ ?
Application Approved By...... A -2—7
Date
Application Disapproved for the following-reasons:.................................................................................... ...........................
....................................................................................................................................................................................
...............
....................
f . Date
PermitNo---------7,3 ................................... Issued�..... — ........ate------------------------------------------------------
No....... .... FIB$............................
THE COMMONWEALTH OF MASSACHUSETTS
BOA F HEALTH
_.. '.. J .... OF...... .. ::. .. �`- -------------------
ti. , VVIirtttion -fur M_gpofitt1 Works Tonstrurtiuu Vrruift
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
Syst
L c ion Address or Lot No
- --- .�t_ `" l� 1't. = --..... ._�1-2. ----- r - l �4"Ar% •----1t--J_�_eU V.t--4---..
Own d r ss
W �k•
Imo.M.C. --••--------• --•-- -h� .. .r ---------------------------------
Insta le�r Address
U Type of Building Size Lo : ...Sq. feet
Dwelling—No. of Bedrooms... ..._ _.__.Expansion Attic ( ) Garbage Grinder .
a`i ___ p I.............. Showers (' ) — Cafeteria
Other—Type of Building ����� No. of persons.........
dOther Ytures ------- -------- ---------------------------------------------------------------------------------
Desi n Flow__._ �--:_:__.._.__.___ gallons per person day. Total d i1 flow.._.. �` � -.-.-----_gallons.
W g g P P P Y Y _
WSeptic Tank—Liquid capacitQQ. __gallons Length____ ______ Width. ___ .....- . Diameter-_-. . ------ Depth----------------
Disposal Trench—No_ ____________________ Width-------------------- Total Length-------------------- Total leaching area....................sq. ft.
Seepage Pit No......l------------- Diameter.................... Depth below inlet_______________:____ Total leacling are�2.44..___..sq. ft.
z Other Distribution box ( ) Dosing tan )
~" Percolation Test Results Performed by. ,: 44.Kt l_______________________________________ Date_ -
Test Pit No. 1....1_!:0---minutes per inch Depth of Test .Pit....1-4---------- Depth to ground water-- 11 ?
fZ Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water.,.:.._--_---_--___.-_-
a ----------------------- ----- -- -----_ ------------ ------
O Description of Soil . _ef" t 4s�p_J�_______..... y S'1 "� -- -------- r --- -_ 1k+1�`1~
-$ t--- •------- ------ -- ------•--- ...._. -- •----------• ----• -----------W
x ------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
U Nature of Repairs or Alterations—Answer when applicable._______________________________________________________________________________________________
---•--------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedes t d Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary de The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n iss �ed by the bo o. th.
Signed ------------------•--•- j
Application Approved BY ' /C v ; �
Date
------------------------------------------------------------------------------------
Application
..
Disapproved for the following reasons:......................................................
...............•--•-------------------------•-----------.-.-•-----•------••-•-•-•------------_..---------•-•------•----•------------------------•----------------------- ...............................
�! Date
PermitNo........Z�!I---------------------------------------- Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS "
BO - OF HEALTH
j
. .. ,+. .........oF... �...... .. :. ...........................
'M. Qrrtifirtttr of T"Jomlilittnrr
T IS TO CERTIFY, T t th ndividual Sewage Disposal System constructed ( ) or Repaired ( )
` '_:
at_.. ------- ! }!" 7�j A.
Instiller 4 �t3 �5�.�.1� ----- -i-- I-6-•--•-----•----------- ............
has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit-No----`l _________________________ dated.-../. -._ _.? _ ...............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------- ` 1 r .- ... ...........................C�`Inspector -51--- -----•---______---
THE COMMONWEALTH OF MASSACHUSETTS
BO 'OF#-ffALTH ,.
No......................... FEE....
_ �.��i��Ix�tt1 urk,� �uu�tr�trtiu$t �rrmit `
Permission is hereby granted-...TK_ t-------- * t_ 1 - ...........................................................
to Construct r or Repair—( ) an Indivi�al SewageDisposal System
..... ............................................................ ....�_y ._Q1............
Street
as shown on the application for Disposal Works Construction Permit No.10.____.._ Dated------ 1._"_�.� ?
Board of th
DATE-- -----7--7............................................--
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS .
F �
/000
cf.�W COO CF:`4L (r1 /vj � �+
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RO
BERT � r�
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h
y elf } 55�1 ..1 1 + 1 A (ENO.ZZI62 '
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ONA IV
S'
Y y.�e F'°4 is y { �.s1 r,� - f _ � .._ .._....�_ '•_ L-' .f,
4i d' I_E-G END-
Ext iT,lA10�°SPOT
ELEVATION :
Ox0 - CERTIFI_E �,
_Q �_ L-oT _ 3PLA1��,
XI9T ve CON-TCL'
PIN,ISHI�b , S-PAT ELEVATION PA?N
,FINI*H-1 ` CO-NTOUR 0 '/'k7AP
a1PP�OVE® =r•BOARD
I N I
HEALTH
B""'� f-
® bTE AGENT SCALE: 4 � ' Fx.
1 r DATE,
E' � E,MGINEERING CO CLIENT
—
THAT THE P
I CERTIFY ' f��
POSED
G13TE'RE REOtSTEJetED J08 N0. c� � BUILDIRI(3 SHORN ON THIS PLAN `
LAND. ;
Il It�R SURVEYOR DR.BY= A• ���,. CONFORMS TO THE ZONING LA�1S�. _ ��'
OF BARNSTABLE , MASS.'
MAIN ST` 712. WAIN ST. CH. BY: � '�• � .. r
`8O: "1�A►RNItt1M,, MASS. HYAItiN1S, AMASS. SHEET�` OF '. ��,U ;7
. '—' _ _ �; .
DATE REG. LAND SURVEYOR
' w r
S71
EPTIC r,4 AI I<' OR
LEAC"/.VG .P/T ON/ \` j
At
1.0
>� S/,IALL ®� /9QOUGNT TO'eo/�i4OE.�fiN EXTRA ..6>
- t- - •"^ . � 4•'PVL' Imo//'E
c.O NCRC'TE -dIIN. P/TCN r/E.4 v ! CAST
0 D.D / -.
a,. COVERS _/ ° 0 /F!NR/.VE1�VR y
�fo•At/H. CO/VCR�T"E
----f- C,/¢AoE CUVER CLEAN S'ANO '
_ • . L/�}u/D LEVEL' � • ' � r
r W' CAST
IRON P/PE OF
GAL. D o r • ' • .. • • r r a �a
-'! %"Pere rar. SE)PT/C TANK > B X o o A 1 • � �• o WASHED STi�NE
o • o • • e r n
C - O • 1 ® a •. 0 • • r e A e
• s o vD o 1 e o`cFFECT%VE ° ` . e s '3�4 - I �2.,
' . e a ° ' • • DEPTH ° • 1 r E o WAStIED STONE
0
: .o... - v oe • • • • aeon ,00 ,
p P/PECAST SEE.PAGE-
y va a �lr • • e e • e • o e•p
0 0 5`Jr r • o s s • r e e o P/7OR EQU/V
5: w: /Nl/ERT EL E✓AT/DN s
INVERT AT ff09& JING q .✓ ---- --
C�gEE TRBULATION
INLET SEI "/�' b4/VK
OUTLET SEPl NK JS.3 FT.FT ---
/N4E.Y D/STR>iftTIT/ON BOX FT. GROUNo HINTER TABLE
OUTLET„DI S.TlZ/09T/UN BOX 9415 SECT/O/V O F
//t/LE'T:$EEPAC7. f�/T 9 3_a FT S'E1�1A4 GE O®eS'f�OS�i I— .S b�.STEiM T/4 e��Lf4T/ON
LEACHING P/T
DES/GX• CRITERIAscALE /�- O.• p//y/.+cNs/a/v $ FT.
NUMBER OF ®EOROOMS
GAP®AGE D/SPO.SAL UN/T SOIL LOG
TOTAL EST/MATED FLOW_j O_GA4.1OAY SOIL TEST 009�/ SO/L TESTyd�2
NUMBER OF SEER46E PITS_ _'1 r^FLEK `�7 n /�^-ELEY. ,DATE OF SOIL TEST S6l�, 7 i�`! F
S/OE LPAC•H/IVG PER P/T _Z�—SQ, =;r a� P. /�"Wl`( /S
RESULTS M//TNESSED BY �•
BOTTOM L-rgCN/A/G PE)? P/T ��C S4• Fr 4 -4FMC0LA77/0N RATE,'/ ( � 0 M//V,1INCH
T07A' L LEACH//YG AREA ? e'r SQ. FT. AERCoLA7-1-oNRA7•E1k2
.BESERI/ELE.4CHlNG,gRE�_� SQ►. FT. Z SuijS �L.
o --ROBERT \y /tij Ci- 'S T'C� ✓S /�!� 1 L S
P.
No.22162 O N
��� s T E�`� _ ._ra',eh tip F EL®RZDoSE ENGI)V,=Zd?/!VG CO,l NG.
a` _ 7/0 MA/iY S7
-GISTS
ALE 7 HYAN/V/S /"1A55 . 50. YARMOVTH MASS,
• `- ® ND GROUND iNi4TE/� LSNCOUNTL�•REa � �
C1 G�DUN:o, LvATE�P AT- EL F(/ ✓OB ND. 77..0_. ab SHEET Z-OF -
FINISHED GRADE OVER TANK EL. = 102,9± PROVIDE PRECAST CONCRETE FINISH GRADE OVER D-BOX= 103.0''}'
EXTENSION RISER WITH CONCRETE SLOPE @ 2/o FINISH GRADE OVER CHAMBERS= 102.8'-- 103.2', G E(�E RAL NOTE S
ELEV= 103.4±
TOP OF FOUNDATION COVER TO WITHIN 6"OF FINISH GRADE CONCRETE RISER AND COVER u MIN. OVER SYSTEM 3/4"TO 1-1/2"DOUBLE WASHED STONE TO 1. UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION
OVER INLET AND OUTLET COVERS. TO WITHIN 6"OF GRADE 4"SCHEDULE 40 PVC MIN SLOPE 1% ACCESS BOX WITH COVER TO GRADE CROWN OF PIPE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
FINISH GRADE VARIES 5" DIA. OUTLET(S) (SEE NOTE#21)
@ FND. EL.=
;2"OF 1/8"TO 1/2"DOUBLE WASHED STONE CODE AND ANY APPLICABLE LOCAL RULES.
20"MIN.ACCESS COVER ,
IF 1 PLACE RISERS ON ALL 2• ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
TOP OF SAS = 100.58' CHAMBERS WITH
DESIGN ENGINEER.
(TYPICAL FOR 3) PROPOSED 4" 9"MIN. INLET PIPES TO 6"OF 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
EXISTING 4" PVC SEWER PIPE 99.75' 36"MAX. � FINISHED GRADE
SEWER PIPE r--EXISTING 4" BREAKOUT EL = 100.25 SYSTEM UNLESS OTHERWISE NOTED.
j SEINER PIPE PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
2"DROP MIN 3" 9" I - JOINTS(TYP.) o ELEVATION = 100.25' FOR A DISTANCE OF IV AROUND THE PERIMETER OF THE SAS. UNLESS A
10" " { , S4"PVC IN EPT C TANKOM 4"PVC OUT TO O � 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
14 \-*l QQ,ij - o o THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
O LEACHING FACILITY o0 00 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
"
op
CONTRACTOR " CONTRACTOR SHALL OUTLET TEE 100.17, MIN. 100.00, 2' oo 0 0 0 `' o0 6• THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
SHALL VERIFY SIZE 48 VERIFY CONDITION OF � � 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
AND CONDITION OF EXISTING TEES 22"ZABEL FILTER 6"CRUSHED STONE o 0 0 000 oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION.SYSTEM IS
EXISTING SEPTIC AND REPLACE AS MODEL#A1801-4x22 OVER MECHANICALLY I o - NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
TANK NECESSARY COMPACTED BASE
AND DESIGN ENGINEER.
8.5' TYP
5 OUTLET DISTRIBUTION BOX 4 0 ( ) 4.0 3.55 4 9 3.55 g ELEVATIONS BASED ON ASSUMED DATUM OF 103.87'ESTABLISHED ON A
TO BE INSTALLED ON A LEVEL STABLE 25.0 < 92.07' ) NAIL SET IN TREE AS SHOWN ON PLAN.
BASE. FIRST TWO FEET OF OUTLET 97.75' GROUND WATER ELEV.= 12' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
EXISTING 1000 GALLON CONCRETE SEPTIC TANK - PIPES TO BE LAID LEVEL. CHAMBER END VIEW THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
CROSS SECTION VIEW 2 - 500 GAL. CHAMBERS 5'MIN. 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
DISTRIBUTION
TYPICAL CHAMBER PROFILE CHAMBER DETAILS TO THE DESIGN ENGINEER.
SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
NOT TO SCALE "CONTRACTOR TO VERIFY NOT TO SCALE NOT TO SCALE STRUCTURES SHALL BE MADE WATERTIGHT.
x 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION ZONE �pµ z TEST PIT `DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
` �k � APPROPRIATE AUTHORITY.
x. Donna Miorandi 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
INSPECTOR: TRAVELED WAYS IN WHICH CASE
K EVALUATOR: Michael Pimentel, E.I.T.
LOCATED UNDER PAVEMENT, DRIVES OR
THEY SHALL WITHSTAND H-20 LOADING.
DATE: May 10,2007
SWING-TIESrI(
13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
a a' TEST PIT#: 1
DESCRIPTION PC1 PC2
ELEV TOP
14 ABLE
r• E = « 102.9' WHERE REQUIRED, SHALL REMOVE ALL LOAM,SUBSOIL AND UNSUITABLE
C • + MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
LEACHING CORNER(1) 13.2' 19.9' r ` �;,,< • �' ELEV WATER= <92.07' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
u ... • .
FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
LEACHING CORNER(2) 24.3' 27.7'
.;� � ! r• r , r PERC RATE_ <2 Min/In
CB/DH(fnd) LEACHING CORNER(3) 30.2' 47.6' mqqqq 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
^- z r DEPTH OF PERC= 34"-52" SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
MAP 149 LEACHING CORNER(4) 22.1' 43.6' M N k { �U`z TEXTURAL CLASS: 1 16• PROPOSED PROJECT IS LOCATED WITHIN:
- :
DISTRIBUTION BOX 5 10.4' 27.1' 'f/' l r ASSESSOR'S MAP 149 PARCEL 143
MAP 125 LOT 144 ( ) O r Y,
ar a
Z / �� r �� + " OWNER OF RECORD: STEPHEN COX&NANCY COX
LOT 17 Qr ` 7 x'� t �`t 0" 102.90'
a '� Fill ADDRESS: 129 BRIDLE PATH
+►
v Y ' 4"A Loamy Sand 102.5T MARSTON MILLS, MA 02648
_ Y. r '�
J x a . ,Iv9VA Y x F� =; 7" 10 Yr 3/3 102.32' FEMA FLOOD ZONE C
�� fi p Loamy Sand COMMUNITY PANEL# 2500010015C
r '4 B
10 Yr 5/6
17. DEED REFERENCE:
34" 100.07' LAND COURT CERTIFICATE NO. 169051
x l� x
0 1� Pere
r + �, �` 1:> - 98.5T LAN REFERENCE:
PROPOSED 2-500 GALLON r , E - } k -
18.
L7 � � � �� � x: 52 LAND COURT PLAN NO. 38325-B
LEACHING CHAMBERS
MAP 149 �, .
ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. -
PROPOSED ` ,
LOT 143 19
,.fix �
DISTRIBUTION BOX � � ' "�'�- '�'�<;' ` �'
�� 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
28,201 SFt f n�
: „< ;i r = � Medium Sand FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
��. `� � . ` � ' C 2.5Y 6/6 FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
3) ' I (Loose) 21. A 4"PERFORATED SCH.40, PVC PIPE SHALL BE PLACED IIN A VERTICAL POSITION TO A
a i LOCUS PLAN DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3"OF FINISH GRADE. A
•�Q' TP 1 4) REMOVABLE THREADED CAP SHALL BE PLACED ON THE'TOP TO ALLOW FOR INSPECTIONS.
102.9' /
CB/DISK(fnd) ��O .
Benchmark '' O . 2 SCALE: 1"= 1000'
Nail in Tree 02. 130" 92.07'
Elev. = 103.8T ' 'O
No Mottling, Standing or Weeping Observed LEGEND
\ Assumed
2 :,
� ••••� �•':• � - 50 - - EXISTING CONTOUR
how 103-- - 5 �2 DESIGN DATA �+
MAP 125 (1 /-BULKHEAD +/ / TEST PIT' DATA 50 PROPOSED CONTOUR
LOT 6-02 � C1 /�- ^0�1. f
/'�- INSPECTOR: Donna Miorandi ELEC EXISTING UNDERGROUND ELECTRIC
LP o � NUMBER OF BEDROOMS 3 , TELE EXISTING UNDERGROUND TELEPHONE
G`� \ C ' DESIGN FLOW 110 GAUDAY/BEDROOM EVALUATOR: Michael Pimentel, E.I.T.
#129 }/ E�CC ��� TOTAL DESIGN FLOW 330 GAUDAY DATE: May 10, 2007 C EXISTING UNDERGROUND CABLE
EXISTING S.A.S.✓' C2 EXISTING 3 CHI NEY C
CB/DISK(fnd) BEDROOM o = 660 TEST PIT#: 2
s / \\ E - CB/DhH(fnd / DESIGN FLOW X 200 /o - GAUDAY W W EXISTING WATERLINE
EXISTING LEACHING PIT ,��� DWELLING �eC o C / ELEV TOP
TOF = 103.4± \� � USE EXISTING 1000 GALLON SEPTIC TANK ELEV WATER= <92.07 X-X-X-X-X-
TO BE PUMPED AND 0 7 Ede EXISTING FENCELINE
FILLED WITH SAND 103 C
/ SHE t 103 j PERC RATE_
TEST PIT LOCATION
DEPTH OF PERC=
ETING INSTALL 2 - 500 GALLON CHAMBERS TEXTURAL CLASS: 1
LP EXISTING LEACHING PIT
DISTRIB TION BOX /-� o
�} EXISTING �� o�rO�oo SIDEWALL CAPACITY CJ C} EXISTING 1000 GALLON SEPTIC TANK
EXISTING SEPTIC TANK '-bRTVEW �� ��. / (LENGTH + WIDTH) (2 SIDES) (2'HIGH) (0.74 GPD/S.F.) = GAUDAY 0" 102.90'
2 - -'� '` PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
Fill
/ (25'+ 12')(2) (2') (0.74 GPD/S.F.) = 109.5 GAUDAY 4 Loamy Sand 102.57
TO BE UTILIZED AS PART �-1 `�' /�� !Y-
OF THIS DESIGN - ' �- /�' \ "A 10 Yr 3/3 p PROPOSED DISTRIBUTION BOX
}�'��, � BOTTOM CAPACITY 7 102.32
��• ���. / / (LENGTH x WIDTH) (0.74 GPD/S.F.) = GAUDAY B Loamy Sand L,J PROPOSED 500 GAL. LEACHING CHAMBER
(25'x 12') (0.74 GPD/S.F.) = 222.0 GAUDAY 10 Yr 5/6
34" 100,07'
�Q �OJ TOTALS: Perk g8 57 REV. DATE BY APP'D. DESCRIPTION
MAP 149 / O4 t�s TOTAL NUMBER OF CHAMBERS 2 52 t PROPOSED SEPTIC SYSTEM UPGRADE
TOTAL LEACHING AREA 448.0 SQ.FT.
PREPARED FOR:
LOT 142 �-� ` TOTAL LEACHING CAPACITY 331.5 GALJDAY STEPHEN & NANCY COX
Medium Sand LOCATED AT
C 2.5Y 6/6
��- (Loose)
/ 129 BRIDLE PATH
MARSTON MILLS, MA 02648
/ l�,�� 130" g2.0T SCALE: 1 INCH = 20 FT. DATE: MAY 10,2007
No Mottling, Standing or Weeping Observed Of
o 10 20 ao 8o FEET
�Q PREPARED BY-
0 RESERVED FOR BOARD OF HEALTH USE G �� JC ENGINEERING, INC.
JOHN L. �'
o CHURCHILL
�o� NOTE: CML
BERRY HIGHWAY
1. MAGNETIC MARKING TAPE SHALL BE
No- 4,�, 2854 CRANBERRY
� EAST WAR'EHAM MA 02538
SITE PLAN PLACED ALONG THE TOP EDGE OF EACH '
SEPTIC SYSTEM COMPONENT. 508.273.0377
SCALE: 1"=20'
Drawn By: JRM Designed By:MCP Checked By: MCP JOB No.1188