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HomeMy WebLinkAbout0012 CALVIN HAMBLIN ROAD - Health 12 Calvin IIamblin Ind:Marstons Mills A=101-027 AGAR r �I ,. /SY FKJv W /y� Co-,- i� / 9 CC•t UG h �f f I�YN • Y / TOWN OF BARNSTABLE LOCATION I Z CR/Pt n #,T.b/r. a� SEWAGE # VILLAGE /0a-1S J '-�' IIJ ASSESSOR'S MAP & LOT fQ/0 Z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY X51-00 LEACHING FACIL=: (type) t~r,4L- (size) 6 X ��Z.S" Sz4�r•� NO. OF BEDROOMS BUILDER OK OWNER 1 d� sC j(�f� PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Cross Section Bottor, or Sa ns. t. • R SAS Septic Tank• i O Stairs ' V 28. tom' Bulk T "D" Box tsa• 1 E Deck ` I a N . 9 #12 ------------ Calvin"Hamblin Road '!!! En`• Location: 12 Calvin Hamblin Road I Not To_Scale t Marstons Mills,MA. Based o�uual Obsen T„ Date: October 8,2000 .. l C o� • `S 66� 19 ,y 6� \ 0\ \ �IsT1� \vJ 0 ti v 32 , ��o ! �L /l CERTIFIED PLOT PLAW 4 AIS WcV1 CONSTRUCTION ONLY : ,_� LoTB TOP OF FOUNDATION IS � FEET ' �\s�Q �o IfJ ADOV-E LOW POINT OF ADJACENT � A 42h " D 2 'Z z 4` ` ROAD.. SCALE �0 DATE � L ' GE ETWINZERING CO lid! I CERTIFY THAT TWE C L I E W T L,53,51- Eo ZCISTERED RE 1SI TERED SHOWN ON THIS PLAW I: LDCA-TCD`. _: CIVIL I LAND ZONING J0E3 Wo. S � ON TEIE GROUND AS INDIGATED.AN CONFORt.13 TO THE ZONI L�+t"J� � EIIGIIIE,ER0 �SYRVEYOR DR. BY. � OF ©ARPdST E3 �"A� 333N0 P;4AiN ST 712 MAIN ST. CEO. E3Y �9 '^ '^ r �- So. YARMOUTH, MASS. HYANNIS, MASS.. SHEETZOF "DATE. REG.. LAWD Ground Surface �.3.. . .. J 1 WWI Foundation Septic Tank "D" Box Cross Section Bottom of SAS y 41S' R 26• SAS Septic Tank � Stairs. U 28. J T "D" Boxy 1�8 `� Bulkhead h> 1 1 4 N _ 9 Calvin Hamblin Road � II pf Location: 12 Calvin Hamblin Road Not To Scale o Marston. Mills, MA. Based on Visual Observations ' Date: October 89 2000 TOWN OF BARNSTABLE � __- LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP & LOT Ib/ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 1 ULCC�/1 t nC P1'� (size) �/?a-s C -S`�" -i CIJU aM3vll NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist -within 300 feet of leaching facility) _ _ ._.. Feet Furnished by I Ground SuAheeEL' _ to - tvs Foundation Septic Tank 'D'Box (:,Xm section BotOom of SAS Hs' R SAS Septic Tank Q sales U W B' T -o'Box 1?4 s. Bunduad —. E .... PW� , a N0 _ n aids,. .f I f I I { I I Calvin Hamblin Road .. fi.` ti'ti;' Locatiea:U Calvin Hambtla Bond Not To Seale: Marslow Mom,MA. Baxd oa Vieoal Obsays8eos October S.WOO -`{ ��R.Ry-A, I �! r r' No LIy....._.:.... Fms............... .. r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH , ApplirFation for i1spaii al Workti Tons rnrtiun Errant Application is hereby made for a Perut,to C nstruct ( )e r RepIr ( ) an Individual Sewage Disposal System at: /d� I V i� � j lYl,�L . Location Add ss or Lot No. Owner Address /J( e_.. --•-••-------•------•--•-----•------•-- ------•---------------------•---......----•-......•---•---...--•.-- ........... Installer Address d Type of Building � .� Size Lot..2.41...L.....51....b.....Sq. feet Dwelling—No. of Bedrooms...._._.�.Z............. ..._....._Expansion Attic Garbage Grinder Other—Type T e of Building ............................. No. of ersons..... ._. Showers Cafeteria dOther fixtures •-- -•-----------•----•-•.•--• ....--•----•-•-•---•-------------------------------------•----- w Design Flow........... j.....................gallons per person per day. Total daily flow____� .Q_._....................__.gallons. Septic Tank—Liquid ca acit lP..Qallons Length_ .'1". Width.y�Q~ Diameter. _ ',W ... . xDisposal Trench—No...........::....... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......I------------- Diameter....Ap.......... Depth below inlet......4t........... Total leaching area..A.A.7...sq. ft. Z Other Distribution box ()�J Dosing t `" Percolation Test Results Performed b .....1672 Mr .............. l'tig�ecvcj Date...1 Test Pit No. 1...2-......minutes per inch Depth of Test Pit../.Z........... Depth to ground water........................ fXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ ............... -- - �_ Description of So -------"-- ��,.-.0 .�SJ.I? lJ�' �+ G�f' ` x c, 2 -----------------------...............................--...................................w U Nature of Repairs or Alterations—Answer -----------------------------------------------------------------•--•-•-----•-----••-•------_.. .........................................................-...................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT I.t;. 5 of the State Sanitary Code—The u4dersigned r r a gees not to place the system in operation until a Certificate of Compliance has bee ssue by oard i Signed..... ------ - ---- .............................. ........................... 1 Date ApplicationApproved By-------- ........................................................•------------•--.... - Date Application Disapproved for the following reasons------------------------------------------•--------••-------••---------------------••••-•-------•-•----••....... ..........................•-......----------•---.....---•-------•---...--•-••-•-------•----•---.................------------------••-----•----------•-----••-•----•--------•--•-•-----••-•-•------•••---- Date Permit No...... -I............................................. Issued.....n.....1^ --•7� ...--- Date ' No....'.��.. ..«....... FEs........ �'"' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r ..�4r,•!'�.2..............OF....... ... :-W ......................................... ApplirFa#ion for Disposal Works Tontrnr#ion rumi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage I!posal System At: k` -•---..... .. Location..Address or Lot No. Owner Address ....................................... ..........•--•-••---•------............._..--•-•••...-••••------••-•---........................_.. Installer Address F d Type of Building sSize Lot.. A,5.Y�....Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder (,16) aOther—Type of Building ............................ No. of persons....,./.................. Showers ( ) — Cafeteria ( ) Otherfixtures -----------------•.------•------•---•--------•---•------•--------------------------------------------...............------.......----...........------ w Design Flow............ .....................gallons per person per day. Total daily flow-__-.-S.-5�..........................gallons. t� ,. W Septic Tank—Ligmd ca,pac>tyf_gallons Length .:'�.:=_. Width.�_..d.S�.._ Diameter________________ Depth.`�_...::!Q_._ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____ _____________ Diameter.,., fir' ........ Depth below inlet-:_-: .......... Total leaching area__ U__ .__sq. ft. Z Other Distribution box ( i) Dosing tank aPercolation Test Results Performed by ..B(s;eA .____ =`� ;� .__.... Date_._ , ! .9_ e j........_.. Test Pit No. I... .:-......minutes per inch Depth of Test Pit.-/2------._..-- Depth to ground water........................ lZ, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... ..................... .....................--••.... .------..... ......... ....,................................... O Description of Soil.... h r �.. ...«� .. ��? .. = # w U Nature of Repairs or. Alterations—Answer whep,applic-able------—..":............................................................................. Agreement: d The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T ITLE 5 of the State Sanitary Code—The undersigned r /aees not to place the system in operation until a Certificate of Compliance has bee s e b eboard 1 Signed --- .:.... . ... --- . •------•---•---------••-. Application'Approved By..... -- --------•---•-----••---------•-••----------------------------------------------- ---------------------------------------- Date Application Disapproved for the following reasons--------------------------------------------------------•---•-------•----•-------•-----------------....._._....« ..........................................•--------•-----....--------•------...--------•---•---------•-------------.......-------------•-----•---------- td f Date Permit No.. U .....................« Issued.-.n.....1 .? r e; ..__.._...__. Date , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH , o (. .. " � « (Irr#ifiratr of Tomplionre r , That the Individual Sewage Disposal System constructed ) or Repaired by THIS IS ftTO CERTIFY, c ry t� at ... t�S -- ---- ------- -----------•----------------------------•••--------------------•--------------••--------------- has been installed in accordance with the provisions of TIT r 5 of The State Sanitary CWacCdeZc'7ibed in the ' application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................................................................. Inspector.................................................................................... � T:,`!hi ,�: �y" .hn+xhe'a.. �'L, n�. :.. i�: ,F, t" > • THE COMMONWEALTH OF'MASSACHUSETTS BOARD OF HEAL .................... .....................0 F..................................................................._......:'........ No..........., � .... FEE........................ Disposal PRY�;�� rru91�A Permission is hereby granted..................................I..........i �� ..... ....... to Construct ( or Repair ( )�a ��irj Sewag is'�& y stem atNo. . -- ----- - ----------------------------------------•-•-•- x1i as shown on the application for Disposal Works Construct�ia'�Pe`rmit No................. ----------------------------- ------ Dated------------- i /� 2 �►r . ........................ d o Health- ----•--- y -•---•------•--- --_ k j"' Boar f DATE , ��,,�>�; `-•�,..,�• ,;. Ft FORM 1255 HOBBS &-WARREN. INC._ PUBLISHERS S p� st .t'' i � ' t r r � tr .r r rA t-;••i.,` • ,,4� r J S- • , rip '. P rti,d ,t t?r'� t f i• r - I F •!5.' t d � t G ;• r, . r Dv TEST ULc s + i , n ` �f, E,KP�ill/Slb'►� • 1 L� �f cr9: , IT o c�L�rN�1 �. /I/ PTl -r z 3� _ IV 16 . we s. •v .�\ O t 0�•'�'V / o '' RBRT I -_ • ��,- � . f �y\r •-' 1 6t ''1 � KJ ^ S A\,p No.22162 n J ^csStEP r'ONAL • y t ` n LEGEND EXISTING SPOT ELEVATION OxO CERTIFIED PLOT PLAN EXISTING CONTOUR - - - 0 ; FINISHED SPOT ELEVATION ® � LoT" J + l3 , vRl/iE FINISHED CONTOUR ---- ® - IJ`'1A A�S70NS IW ILLS- IN APPROVED : BOARD OF HEALTH , ' P - DATE - AGENT SCALE :/"_ 1-0 ' DATE : / �6I7S- !EL KEDGE ENGINEERING CO. INC I CLIENT Gc 3EL I CERTIFY THAT THE PROPOSED._' EGISTERE , REGISTERED gyp® N® 77 I2, BUILD146 SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS .. ENGINEERS ,SURVEYOR DR. BY .�.--•A.•/1�� OF BARNSTABLE , MAS 3'' NC MAIN SY 712 MAIN . T. 'CH. BY:)2__p_I�- SO.-.YARMOUTH, MAS-1 HYANNIS, VASS. Z ill����° SHEET_ OF _.__.._ DAfiE i6R G. LAND SURVEYOR. , � �+,�r�of � q� � �.hrt f K3 � "i+ :�•f ...r4�9'�tw,'r f x .},r — —- .. i� Sri p_'_4 1��l'y "'+; `+ h -��0• ,r, r,� i; � .� r i t z r b' �m^i"ex t�Y* , i a; ,,;� , e • ,e tt h.x•* ` .r': � � �' r'` "�':•'` , ' - .t ✓ .i P�"� •i.i.�4 ' +_ �F/t�.IG] 'i tt f � r x �:.ti; f 7.Y � (!fv�-h... E r � r j t s..}. tr..a> 4t .t:.'� � r'��d(rY��rift il,�•}rLl Y�r1��, ()t��?� �r'�rt it rfN1;�8�j,�. �. -.t s:..� 4 r •,,t } .'r'� +i, e. 1 .YY ff,�-? i1, dd l+ +�I�t+fit r,4� _r.j. r .r• Y,ri,'.;.;d,I t;fj a l I !r�!rirflr�fx i:dl�� _/t. ,x N07"E /F E/TNER T Ale.SEP7 TANK OR ' zo FT. MIN. ;,EACH1"G PiT ARE MORE 7-NA ✓ /2"BELOW !rRADE� fI 24"O/AMETEK C�NG'RF. T� CORER ����` /O FT• MIN " 5J/ALL BE /�ROUGNT TO G/qA bE. I✓ .EXTRA - CONCRETE r :~Rvc PlP.E �yE,4VY CAI ST IRON Co!/ER S//ALL !3E USE.O COd�ERS AW IB.M PITCH /F/N ,0R/VEN/A r IpE�Q FT. C,I'E TE " a+ � 2' MNV.' CC)VER ORAoE CLEAN SANG L/QU/O LEVEL r:- z LAYER 1E� 4" CAST i ; o h IRON P/PE + /G > G/lL, e ° o� 1 •.• • • • • 1 1 a ®A' �y/ASHFD ST17NE M!!V. PjTcN D/ST, a n • • • • . • • • 1 1 ' •a� u a Rex >''T StPT/C TANK v va n 1 1 •EFFECT/VE • v bV,45HE0/5740rYE ' :::'a a v. • 1 • • • o • ,• • e 1 p n p — PRECAST SEER46E �* ; • t • G FT D/AM. Y, I Jr: INERT AT BUD/L /NG cr. _ C CSEE 710411'A*ION, ) INLET SEPTIC TANK OfJTLET SEPTIC TANK `,3 F P' o M U qRQU/VD pvATER TABLE .INLET D/STR/6UT/ON BOX FT SECT/ON �'{ OClTLETD/STR/B&rION BOX /- '' FT SEWAGE A9/SP4SA L SYSTEM INLET [EaCNING f1ITFT TA841LATIDN „ . LEA CHI/VG PIT D/M-=IVS/ON A 3 FT. D/MEN3/0N DE5/6N CR/TER/A NUMBER OF BEDROOMS � ..SDI L. LOG - • Gi+ReAGE DISPOSAL UNIT SO/.L. TEST TOTAL EST/M.47-Ep FLOW ' GAL./DAY SO/L- TEST #/ SOIL TESTydt2 c E�Fd! ,DATE O SO/ TEST' /1(G/MBER G1F �EACNlNC: PITS_ f`EL F L EY. r �' �' T./�. -3Jri� /-S I 4, •,r ACH NG R PIT ''%� S . FT. RESULTS !c//TNESSED BY S/DE�:.E / PE O O- `' � �-r�, cc PCZCOLAT/ON RATE�/ -- '� M/IV�IINCH T Fi 400TO/►1 L4CH/NG PE 7 * R P/T $Q, . ..T L7 PERCO[AT/ON RATE J � CH TOTAL LEACHING AREA ,QESERYELEAC'I/lNGAREA_ .-, Q - .. � R :, .. c.-3R�;-✓-ram- - s' �- •. � �, �. F!y,•r�� 6 ` ,Z / + ( �f_ �. ,,.r /ram �'/"/ ,l . i �_ � '+,`' -. ROBERT. P. o Sa; �• I ,� BUNIKIS �� EL DREDGEENG/NEEIVIMG CO,/NG. .1 No.2210 z y 71Z MA//Y Sr. 33 ND•MAIN4�1 1 GIST �V� © NO GROUND YYi4TL�R ENC0UNTERI�O HYANNis, MASS. SO. YARMO[/TN�MASS, SIONM- `Q GROL/NO Y>r�ATER AT ELE(/. JOB NO. '•F % �� SHEET_''OF �.� - Septi System Inspection Report ` 12 Gahm Hamblin Road 1Vlarstons'Mills,Massachusetts f 12 t , je, ' ` October 10,2000 t ; 3 REGEIi/E 1 f }= �' + 1: OCT ` p Z000 Prepared•For: TOWN OF BAR ' Y HEAt TH DE STABLE r P7; Allison Resei no 3 , ' a 12 Calvin Hamblin;Road r w Marstons"Mills,Massachusetts 02648 a 1n Gl• Providing,Innovative Solutions Ton r .Solid Waste 1 Health &=Safety . t r,• t'< ' t 'Hazardous Waste t -Monitoring Environmental � d 2 w `yy F f Materials•Management Compliance ing 5 <s+ 1 T F r ,,,•J �':+s 5. i• �•+ Phone.(508)790 8102 z M Fax:-(508) 790-7119 ` - ' "{ f 'P O-Box 1988 ,Hyannis-•MA'02601{ ,'. ,t '1 J d J 1 ' a' ♦a 1J, ' COMMONWEALTH OF MASSACHUSEM EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ' One Winter Street, Boston MA. 02108 (617)292-500 RECEIVE® ' 0 C T 2- 0 2000 TOWN OF BgRNSTggLE HEALTH DEPT. ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION PROPERTY ADDRESS: 12 Calvin Hamblin Road, NAME OF OWNER, Allison Rescigno Marstons Mills ' DATE OF INSPECTION: October 8,2000 ADDRESS OF OWNER: Same as property NAME OF INSPECTOR:(Please Print) Terry F. Bauer address I am a DEP approved system inspector pursuant to Section 15.340 of Title 6 9310 CMR 16.000) ' COMPANY NAME: Green Seel Environmental,Inc. MAILING ADDRESS: Post Office Box ISM,Hyannis,MA. 02601 TELEPHONE NUMBER: (US)79"102 ' CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system A this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and e)perierrce in the proper ' function and maintenance of orr-site sewage disposal systems. The system: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: (DATE: October 10,2000 ' The system Inspector shall submit a copy of thi4ection report to the Approving Authority(Board of Haab or DEP)within thirty(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 tha system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. ' NOTES AND COMMENTS: The septic system was found to be in good working condition on the day of inspection. The SAS portion of ' the system consists of a 6' by 6' leaching pit with 2.6 feet of stone all around. The leaching capacity of the SAS was calculated to be 487.67 gallons (424.05 gallons for the sidewall area and 63:62 gallons for the bottom area). It appears that the septic system is large enough to handle the sewage flow from a 4- bedroom house based on its calculated size. revised 9/2198 1 r ' SUBSUftfACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ' Property Address: 12 Calvin Hamblin Road,Marstons Mills Owner: Allison Rescigno ' Date of Inspection: October 8,2000 INSPECTION SUMMARY: Check A, A C, or D: ' A. SYSTEM PASSES: NIA I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CAR X 15.303. Any failure criteria not evaluated are indicated glow_ ' COMMENTS: The septic system was found to be In good working condition on the day of inspection. ' B SYSTEM CONDITIONALLY PASSES: NIA 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. ' Indicate yes,no,or not determined(Y,P!,or ND). Describe basis of determination in all instances. If"not determined",explain why not) No The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate ' of Compliance(attached)indicating that the tank was installed within twenty(20) years prior to the data of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial n on or exlittration,or tank is failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. ' Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box The system will pass inspection if(with approval of the ' Board of Health). broken pipes)one replaced obstruction is removed ' distribution box is leveled or replaced No The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ' broker pipe(s)are replaced obstruction is removed 1 revised 9/2/98 2 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ' Property Address: 12 Calvin Hamblin Road,Marstons Mills Owner. Allison Rescigno Date of Inspection: October 8,2000 ' C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: NIA Conditions e6st which require further evaluation by the Board of Health in order to determine if the system is failing to ' protect the public health,safety and 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 i ' WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 sal absorption system and the SAS is within a Zone ' 1 of a public water supply well. The system has a septic tank and sal absorption system and the SAS is within 50 feet of a private water supply well. ' The system has a septic tank and sal absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for c:oiifonn 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 and is equal to or less than 5 ppm. Method used to determine distance (appro)amation not valid). ' 2) OTHER 1 revised 9/2/98 3 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ' Property Address: 12 Calvin Hamblin Road,Marston Mills Owner. Allison Rescigno ' Date of Inspection: October 8,2000 D] SYSTEM FAILS: NIA You must indicate either"Yes"or"No"to each of the following: ' I have determined that one or more of the following falure conditions etast as descnled in 310 CMR 15.303. The basis for this determination is ideitified below. The Board of Health should be contacted to Determine what will be necessary to correct the failure Yes No ' Backup of sewage into facility or system component to an overloaded or d099�SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overioaded or dogged ' SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or dogged SAS or cesspool. Liquid depth in CeSSpOa is less that;S"below invert or available volume is less than%day flow. Required pumping more than 4 times in the last year!gT due to dogged or obstructed pipe(s) Number of tittles pumped Any portion of the Sal Absorption System,cesspool or privy is below the high groundwater elevation. ' Any portion of a cesspool or privy is within 100 feet of surface water supply or tributary to a surfaoe water supply. ' Any portion of a cesspool or privy is within a Zone I 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 thari 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be ale, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. ' E) LARGE SYSTEM FAILS: NIA You must indicate either"Yes'or"No°as to each of the following: The following criteria apply to large systerre in addition to the criteria above: ' The system serves a facility with a design flow of 10,OD0 gpd or grew(large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions erast: ' Yes No the system is within 400 feet of a surface drinkirQ wad supply ' the system is within 200 feet of a tributary to a surface drinldng water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA or mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the System in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. t , revised 9/2/98 4 II ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 12 Calvin Hamblin Road,Marston Mills Owner: Allison Rescigno Date of Inspection: October 8,2000 ' Check if the following have been done: You must indicate either"Yes"or"No°as to each of the following: Yes No Pumping infoirneion was provided by the owner,occupant,or Board of Health. Waste Water Treat nerd Runt X ' None of the system components have been pumped for at least two weeks and the system has not been receiving normal flow rates during that period. large volumes of water have not been introduced into the system X recently or as part of this inspection X As built plans have been obtained and examined. Note if they are net availabis with WA Not available. 1 X The facility or dwelling was inspected for signs of sewage back-up. ' X The system does not receive non-sanitary or industrial waste flow. X The she was inspected for signs of breakout. X AD system components,including the Soil Absorption System,have been located on the site. The septic tank manholes were uncoavd,opened,and the interior of the septic tank was inspected for condition of baffies or tees,material of construction,dimensions,depth of liquid depth of sludge,depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on: X Existing information.For Example,Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, appradnatim of distance is ' unacceptable)[15.302(3)(b)1. x The facility ommer (and occupants, if different from owner) were provided with information on time proper ' X maintenance of Sub Surface Disposal Systems. 1 revised 9/2/98 5 I ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ' Property Address: 12 Calvin Hamblin Road,Marston Mills Owner: Allison Rescigno Date of Inspection: October 8,2000 ' L FLOW CONDITIONS ' RESIDENTIAL: NIA Design flow: 121.92 g.p.d./bedroom for SAS. Number of bedrooms(design) Unknown Number of bedrooms(actual): 4 Total DESIGN flow Unknown 487.67 gpd was calculated from field measuremerrts. Number of current residents: 4 Garbage grinder(yes or no): No Laundry(separate system) (yes or no): No If yes,separate inspection required Laundry system inspected(yes or no): No Seasonal use(yes or no) No Water meter readings,if available(last two(2)year usage(gpd): 1998—45K(123.29 gpd),1999—64K(147.95 gpd) Sump Pump(yes or no): No ' Last date of occupancy. Currently occupied COMMERCIALJINDUSTRIAL: NIA Type of establishment ' Design flow. (Based on 15.203) Basis of design flow Grease trap present:(yes or no): Industrial Waste Holding Tank present:(yes or no) ` ' Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy.. OTHER:(Describe) Last date of occupancy. GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped on 9/28/98. No volume recorded(from Waste Water Treatment,Facility) System pumped as part of inspechon:(yes or no) No ' If yes,volume pumped: gallons Reason for pumping TYPE OF SYSTEM X Septic taniddistribution boWsoil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) ' VA Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other ' APPROXIMATE AGE of all components,date installed(if known)and source of information: System is 21 years old according to Assessors records(house was built in 1979) Sewage odors detected when arriving at the site.(yes or no) No revised 9/2/98 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ' Property Address: 12 Calvin Hamblin Road,Marston Mills Owner: Allison Rescigno Date of Inspection: October 8,2000 ' BUILDING SEWER: (Locate on site plan) Depth below grade: a'' Material of construction cast iron X 40 PVC other(explain) Distance from private water supply well or suction line NIA Diameter 4" Comments:(condition of joints,venting,evidence of leakage,etc.) Sewer line was found to be in good condition with no leaks on the day of inspection. ' SEPTIC TANK: (Locate on site plan) ' Depth below grade: 1' Material of conshuctim X concrete _ metal Fiberglass _ Polyethylene other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance? (Yes/No) ' Dimensions: 10'x5'X4' Sludge depth: 3" ' Distance from top of sludge to bottom of outfit tee or baffle: 30" Scum thickness: None Distance from top of scum to top of outlet tee or baffle: NIA Distance from bottom of scum to bottom of outlet tee or baffle: NIA ' How dimensions were determined Direct measurement Comments: (recommendation for pumping,cord'dion of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural ' integrity,evidence of leakage,etc.) The septic tank was found to be in good working condition on the day of inspection. The inlet and outlet tees were in good condition. No signs of leakage were observed. The liquid level was at the outlet invert. The structure appeared to be sound. GREASE TRAP: NIA ' (locate on site plan) Depth below grade: Material of construction __. concrete T 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: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural ' integrity,evidence of leakage,etc.) revised 9/2/98 7 f ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ' Property Address: 12 Calvin Hamblin Road,Marston Mills Owner: Allison Rescigno Date of Inspection: October 8,2000 ' TIGHT OR HOLDING TANK: NIA (Tank must be pumped prior to,or at time,of inspection) (locate on site plan) Depth tow grade: ' Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene other(eDplain) Dimensions: CapeW. Gallons Design Floor. gallons/day Alarm present Alarm level: Alarm in waiting order Yes: No ' Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: ' (locate on site plan) Depth of liquid level above outlet invert. 0" ' Comments: (note if 6W and distribution is equal,evidence of solids carryover,evidence of page into or out of box,etc.,) The distribution box was observed to be level on the day of Inspection. No solids carryover was observed. No leakage was observed. PUMP CHAMBER: NIA (locate on site plan) ' Pumps in working order(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) I revised 9/2/98 8 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ' Property Address: 12 Calvin Hamblin Road,Marston Mills Owner. Allison Rescigno Date of Inspection: October 8,2000 rSOIL ABSORPTION SYSTEM(SAS): (locate on site plan,d possible;excavation not required,but may be appro)amded by non-intrusive methods) If not located,explain: Type: Leaching pits,number. 1(with 2.5 feet of stone all around) Leaching chambers,number: ' leaching galleries,number. Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number, ' Altematiue system: Name of Technology. Comments: ' (note condition of soil,signs of hydraulic failure,level of ponding,damp sal,edition of vegetation,etc.) No signs of hydraulic failure were observed on the day of inspection. No effluent was observed to be ponding. No lush_ vegetation was observed and the soil near the surface was dry. CESSPOOLS: NIA (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(cesspool must be pumped as part of inspection) Comments:: (note condition of sail,signs of hydraulic failure,,level of ponding,condition et vegetation,etc.) 1 ' PRIVY: NIA (locate on site plan) Materials of construction: Dimensions: Depth of solids: r (note condition of sal,signs of hydraulic failure,level of ponding,condition d vegetation,etc.) 1 r 1 revised 9/2/98 9 1 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ' Property.Address: 12 Calvin Hamblin Road, Marston Mills Owner: Allison Rescigno Date of Inspection: October 8,2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 1W(locate where public water supply canes into house) I ' Please see the attached septic system sketch 1 revised 9/2/98 10 ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ' Property Address: 12 Calvin Hamblin Road,Marston Mills Owner: Allison Rescigno Date of Inspection: October 8,2000 ' NRCS Report name Soil Survey of Barnstable County Soil Type Merrimac Series I ' Typical depth to groundwater >6 feet USGS Date web site visited October 10,2000 Observation Wells checked SDW-253(Zone B) ' Ground water depth: Shallow Moderate Deep X SITE EXAM Slope: Flat Surface water. None on site ' Check Cellar: No signs of infiltrating groundwater into basement Shallow wells: No wells in site area. Estimated Depth to Groundwater 42 Feet(from the ground surface). I ' Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump,etc.) Determined from local conditions X Checked with local Board of Health II Checked FEMA Maps ' Checked pumping records Checked kcal excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) The seasonal high groundwater elevation was determined using the USGS and Cape Cod Commission ' method. Groundwater was estimated to be at elevation 40(above Mean Sea Level-MSL)from the Town of Barnstable Groundwater Contour&Road Index Map(June 1992). ' The site is located in Zone B of indicator well SDW-253. The June 1992 adjustment(from archive Cape Cod Commission information) for that indicator well was 7 feet upward. This resulted in a seasonal high groundwater elevation of 47 feet above MSL. ' The surface elevation at the SAS area of the site was estimated to be 82 feet above MSL(from the Town of Barnstable Assessors Map as prepared by the Barnstable GIS Unit, 1996). The bottom of the SAS was measured to be approximately 10.5 feet below the surface. When the adjusted groundwater elevation (47 MSL) is subtracted from the SAS bottom elevation (82- 10.5 = 71.5 MSL)the separation was found to be ' approximately 24.5 feet. revised 9/2/98 11 1