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Home My WebLink About0054 CALVIN HAMBLIN ROAD - Health 54 CALVIN HAMBLIN ROAD M__ARSTONS MILLS A= 101 - 032 j f f Town of Barnstable Inspectional Services Department r B""RNKAMA`"$`& ' Public Health Division 039.iOrFn�" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8197 April 2, 2021 KINSEY, ROBERT W & JUDITH E - 54 CALVIN HAMBLIN RD - MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 54 Calvin Hamblin Road, Marstons Mills, MA was inspected on 03/17/2021 by Patrick T. Sullivan, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE ARD OF HEALTH Thomas McKean, R.S., C �. Agent of the Board of Health Q:\SEPTIC\Title V Inspeciion Report Letters Mailing\Failed or Needs Further Evaluation Letters\54 Calvin Hamblin Road Marstons Mills.doc Town of Barnstable BARNSTABLL M^9 Inspectional Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Of't ice: 508-862-4644 Thomas A.McKean,CIiO I, FAX: 508-790-6304 Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x'' marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS O 1 YEAR DEADLINE CRITERIA V1131tatic liquid level in the distribution box is above the outlet im ert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems'' (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc ► or- o3a-- � Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name / information is Marstons Mills v MA 02648 March 17 2021 required for every , page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information (5 oZo1�p on the computer, use only the tab Patrick T. Sullivan key to move your Name of Inspector cursor-do not Ready Rooter Excavating use the return Company Name key. PO Box 89 Co � Company Address Forestdale MA 02644 Cityrrown State Zip Code 508-888-6055 S112843 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. 8 Passes 2. 8 Conditionally Passes 3. 8 Needs Further Evaluation by the Local Approving Authority 4. Fails March 18. 2021 Inspe or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name information is Marstons Mills MA 02648 March 17 2021 required for every , page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information whic indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 1 .304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass/Explain Check the box for"yes", "no"or" ined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over old or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infile Iltration or tank failure is imminent. System will pass inspection if the existing tank is ri a complying septic tank as approved by the Board of Health. *A metal septic tank will pass insf it is structurally sound, not leaking and if a Certificate of Compliance indicating that the ta than 20 years old is available. ❑ Y ❑ N ❑ in below): t5insp.doe•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 TOWN\ OF�BAARNSTABLE: LOCATION '- a I o I�cr��1(� `Ky SEWAGE# VILLAGE &�rs � AAA 1.LC ASSESSOR'S MAP&PARCEL /® / 3Z INSTALLER'S NAME&PHONE NO. �,� 1t�G E50Q�Y�oy>r3 SEPTIC TANK CAPACITY 3!�c J�HS, LEACHING FACILITY.(type) �7/5ab�� -10)QArosize) 12-SV2S NO.OF BEDROOMS OWNER N P� PERMIT DATE: `� COMPLIANCE DATE: 2/hi 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�, 3 �c Cc qG t62 1'6q —4 - 73o) Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name informationis required wir for for every Marstons Mills MA 02648 March 17, 2021 page. -City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage ba up or break out or high static water level in the distribution box due to broken or obstructed p' e(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with proval of Board of Health): ❑ broken pipe(s are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction " removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distributio 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 approv I of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluatio/isR quired by the Board of Health: ❑ Conditions exis require further evaluation by the Board of Health in order to determine if the system is f protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5in sp.doc-rev.7126l2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Calvin Hamblin Road v-I Property Address Robert Kinsey Owner Owner's Name information is Marstons Mills MA 02648 March 17 2021 required for every , page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil ab orption system (SAS)and the SAS is within 100 feet of a surface water supply or tributa to a surface water supply. ❑ The system has aseptic tank and SA and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and S and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank an SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply w II**. Method used to determine distan : - **This system passes if the well ter analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates able and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided hat no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doo•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I Commonwealth of Massachusetts Qk91. � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name information is Marstons Mills MA 02648 March 17 2021 required for every , page. CityfTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is /of a surface drinking water supply ❑ ❑ the system is of a tributary to a surface drinking water supply ❑ ❑ the system is trogen sensitive area (Interim Wellhead Protection Area—IWPA) one 11 of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Calvin Hamblin Road IR, Property Address Robert Kinsey Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)1310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 I Commonwealth of Massachusetts IMMOM Title 5 Official Inspection Form UIVI-1, - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 GPD Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2019= 107 GPD 2020= 167 GPD Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date t5insp.doe-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts @ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Calvin Hamblin Road'P- - Property Address Robert Kinsey Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 1 .203): Gallons per day(gpd) Basis of design flow(seats/pers ns/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit prese ❑ Yes ❑ No If yes, disch rges to: Industrial waste holdi tank present? ❑ Yes ❑ No Non-sanitary wast discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner, Pumped Spring 2020 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7126=18 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under.contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: System installed 06/01/1979. Certificate of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: n/a feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doo•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 r Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17 2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.2 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: 8.5'x 4.5'x 5' 1000 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 4"at inlet, 2"at outlet Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 18 How were dimensions determined? Dip tube and tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet pvc tee and outlet filter box in place. Liquid level 1"over outlet invert. Risers bring covers within 6"of grade. Recommend maintenance pumping every two years with full time use. Tank may be able to be utilized if found to be structurally sound. Covers need to be replaced. Filter box was forced into outlet line reducing flow<2". t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name information is Marstons Mills MA 02648 March 17 2021 required for every , page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet i Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scu to top of outlet tee or baffle Distance from botto f scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at ime of inspection) (locate on site plan): Depth below grade: Material of construction: Elconcrete Elmetal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 f Commonwealth of Massachusetts V'` Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name information is Marstons Mills MA 02648 March 17 2021 required for every , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float sw/hes, tc.): j z *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Not found 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.): One inlet, one outlet. Unable to locate d-box due to outlet filter box and overfull leach pit. t6insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sawage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name information is every Marstons Mills required for eve MA 02648 March 17, 2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(rote condition of pump cham er, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-6'x6'w/stone ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: -- t5insp.doc•rev.7/26/2D18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •r 54 Calvin Hamblin Road Property Address Robert Kinsey Owner owners Name information is required for every very Marstons Mills MA 02648 March 17, 2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System(SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Leach pit is overfull. Liquid level 2' up in riser at time of inspection. Leach field needs to be replaced with new Title 5 leach system. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, Igns hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.MW2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 I Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name information is Marstons Mills MA 02648 March 17 2021 required for every , page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs rhydraulic re, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2&M18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 li Commonwealth of Massachusetts 11 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments_ 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately I Vo_e / / > / �7 1 l a 1 , .� 33 = F � (C !/ O J t5inap.doc•rev.7/=018 Tide 5 Official Insp 'on Form:Subsurface Sewage Disposal System•Page 16 of 18 �tn,zcQ Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owner's Name information is required for every Marstons Mills MA 02648 March 17, 2021 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: >5 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: maps.massg is.state.ma.us/oliver.ph You must describe how you established the high ground water elevation: Accessed local ground water contours and topo mapping. High ground water>10' below base of leach pit. No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/28/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 L i Commonwealth of Massachusetts u p (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 54 Calvin Hamblin Road Property Address Robert Kinsey Owner Owners Name reformation is every Marstons Mills required for eve MA 02648 March 17, 2021 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doo-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 LQ CAT ION L6 13 SEWAGE PERMIT NO. off@_.�Sy eAC/IN h/ —177/ -230 VILLAGE 1' )N,eSTT"DWS IA,�k Ste_ i H S T A LLER'S NAME ADDRESS 3 U I L D E R ON OWNER UL DATE P E A M I T ISSUED DATE C 0 M P L I A N C E ISSUED a • �r Toe F K 57NW Hou5L- d �D LOCATION / SEWAG-E PER IT NO. 1. VILLAGE - 4211 d INSTA LLER'''S �i NAME i ADDRESS B U I L D E R OR OWN ER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED D Lp �b