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HomeMy WebLinkAbout0235 CAMMETT ROAD - Health �235 Cammett Road, Marston j I_ A=078-120-001 Mills _ f L. TOWN OF BARNSTABLE LOCATION oZ 3 S Cahn mg t t- Al SEWAGE # 9-1-11 K VILLAGE Alf lfo'H S. AZ/5 ASSESSOR'S MAP& LOT */ INSTALLER'S NAME&PHONE NO. /Y4 /f17 y��-9✓�� SEPTIC TANK CAPACITY LEACHING FACIL=: (type) SO 2 /-`", �L.,,,w4 eef (size) NO.OF BEDROOMS r BUILDER OR OWNER )94,1 i Pl PERMIT DATE: "�7"`/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 43 No. l/ _ Fee z�. G4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Z(pplication for �Bigogal *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. L 07'/ ?3�,,- 04j R Owner'sName,Address and Tel.No tV1111#W *1, bMAvl&—Q q� Assessor'sMap/Parcel � 3- /QO,. ©(>( �$`Y �y,�O�S A;4)eK64is c`�—`- Installer's Name,Addgrels,and Tel.No. Designer's Name,Address and Tel.No. O — 9 a Type of Building: Dwelling No.of Bedrooms /bF Lot Size to yOr. sq. ft. Garbage Grinder( ) Other Type of Building (7010Ullia No.of Persons SiX Showers Q3 Cafeteria( ) Other Fixtures Design Flow 01 gallons per day. Calculated daily flow gallons. Plan Date /TQ Number of sheets CJy!—e Revision Date Title PIVE Size of Septic Tank 5700 Type of S.A.S. ` Description of Soil / Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by th' oard of eal Signed Zle a/_A_A__Date 3-4�``?� Application Approved by Date 7"/-0 Application Disapproved for the following reasons 6L Permit No. " Date Issued r g 7 40. Not # Fee G THE COMMONWEALTH OF MASSACHUSET S }/` rered in computer: ° Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for 3Digpoga[ *p!6tem Construction Permit Application for aj'Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. L b�/ �35 R Owner's ame,Address and Tel.No. j D$— � `QI n titJ%a/ /fl►r/1 01. ,7d9,V 1 L-14 Assessor's Map/Parcel. 0 ''$ /a D (fib( 2$'Y A- 1 RA?6 4ri S "t Installer's Name,Address,and Tell..�No. Designer's Name,Address and Tel.No. t ��o AlLTU 9 3 Ra tRvE ?4fi" -, G��EER�� /� Type of Building: r� - Dwelling No.of Bedrooms F//%F Lot Size / 21 sq. ft. Garbage Grinder( ) Other Type of Build ng o 0?1, No.of Persons S/X Showers`(-3 ) Cafeteria( ) Other Fixtures lit Design Flow .5�9_0 gallons per day.,Calculated daily flow �S�Q gallons. Plan Date 3�/�4 7 Number of sheets J"'!`-P Revision Date Title PIVE ! f Size of Septic Tank /S`DD T Type of S.A.S. } ! 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 Certifi- cate of Compliance has been issu 'by th' oard 111IJ I Signed 7 ��Gar "' Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued r ————————————————————————— ——————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,t / On�it Sewage�isposal ;em Constructed ('� )Repaired ( )Upgraded( ) Abandoned( )by _ at �3r (2#,W1n P77` ai9,D . fYI�ARS` o�tS /YIiLLs �� has been constructed in accordance with the provisions of Title 5 and the f6rjDisposal System Construction Permit No. a//A dated Installer / T! A/ Lr Designer L IC The issuance of t pe t s �allp tot a construed as a guarantee that the Sys w'll d/o d ignVA. Date I`� l Inspector / It / I U/✓` t I No. **yy Fee f ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS wigoaI'RepaiD. patent Construction Permit Permission is hereby granted to Construct( r( )Upgrade( )AbandonSystemlocatedat 3� C/�NY1�1 E7t " , Nw,4 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: Constructio; mu t g pleted within three years of the date of e it. 0 �/ b Date: 0 Approved by 0 i i $ 86'26'02-F 225.1 + P ..........�..---•--•-•- ........r........... ..`...........? tl V 0' <9 70407 at S.F. D601 eg 008°$ a 178.L9. $ 89.44°03'W ob ® e o NOTE: ® FOR TOTAL LOT SEE PLAN 0009 460 PAGE 17. TO CAMET'T" ROAD BONE RF I cERT11`Y THAr TO THE Bar of my PROnssIONAL SETBACISB r KNOWLEDGE. INFORSIAT/ON AND BRIEF THE DWELLING FRONT - ®° SHOWN HEREON CONFORM TO THE HORIZONTAL SETBACKS SIDE I0' Off' THE ZONING BY-LAW FOR INE RF DISTRICT. REAR - 15° PROPERTY LILIES SHOWN HEREON WERE COMPILED FROM AVAILABLE PLANS OF RECORD AND DO NOT REPRESEur AN ACTUAL SURVEY '' N O �. KEISER i INDUSTRIES INC. ' KEISER INDUSTRIES 'OXFO 0WL6474' � oxmaw,IIF.tKt�o ►� PLAN APPROVED BY: 7112:f"Swam 0. FAX:M7)SH4"A rn - 2VX44' m AMHERST H COLONIAL O I 'i DAMEL3 I�' sw s�Iovs PIAJIWRS�. M"K PM I" PLA-NS rRxpAmD Pon SPEC. mn.k.ct ua m.vu rm wns wsaa► w wan.nr ww wcvutrwa L-� � � Ji1Nl+3.1997 �� �. SY•2356 VPAVWgr XWMaoWc R[VIMOR 90AIMmi III � ul T i �r QI . 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Sca .:J%40' Mercn 1989 i 1 Restricted To: 00 DEPARTMENT'OF PUBLIC SAFETY 60865 CONSTRUCTION SUPBRYISOR LICENSE i 00 - None A. Expires: ; 1G - 1 U Family Homes RestrictedYpo 00 Failure to possess a current edition of the Massachusetts State Building Code WILLI,AH H DANIELS f is cause,for revocation of this license. < i 284 SHINONS NARROWS RD " ! - E MASHTB�,,,.{� 0264.y; -„• : � ; ; 'i so fi Y$IY41AOf I.i i1 49 9' � STA f RUGM7 - =r.:L41f� Al on B8 1 PC o c iop-e .c 0 TA',9, O A I m o .35 AC-5 �. qo ; ,e.r.a•r. < LBbea 61 46 t \- .4.fw 7Apt $ ... Ab C_ �. .52AC - .I 4 4A •k Rib J tP 43 .94 AC_S . 42. .92 AC-5 _ o s = �Y \ 2 P .96 AC_5 fCr a s 17 Qy ry, C \\ �� . gee f• f 37 ` 9 w 4-16 y'I' \•° 00 .47AC ab f a9 I O r � 4` T.er, •' 9'B • e/f,'• O ..•�) `' � _•E=eti--` — 'NEw EIOLA40 NO TCaf'[L [A7YT� f�a/iT7 !s Q m 39 68 .56 4C-5 •``gip 'o ,0T' '•��� O �r3� � 1 ^^ 77 Ips 53 `J 67 AC- ..46 Es O O .St AC I (a \ ..;- L agar ne.Y/A•C. lea 8 2y AV/S 1. o a `��`P u \ REV. BY J '•' 6�•2 70,A4 b ORIGINAL ISSUE: 4•a-` O \ R/I.NI•Uf aP' SL 411111 ter`. •Qbt •• c o' sie" � O ` ~ .{ u v 78•I yb ' u a M. '301 m . •� .83AC � 9,` O 1 57 e^ -�� .41 AC YI 4g: ,> L6sac r S� I yp1/ v 0 7d •0 `80 79 100 0 lm - • 9C� a 6` a 59 7B 99 I Commonwealth of Massachusetts E Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is Marstons Mills Ma 02648 4-1.7-14 required for every page. City/Town - - - - State -Zip Code Date of Inspection- . Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. t Important:When filling out forms A. General Information _. Ion the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gilfoy use the return key. Name of Inspector - B&B Excavation, Inc: - �y Company Name 14 Teaberry Lane Alf Company Address. Forestdale ..: ::. MA 02644 City/Town State Zip Code (508)477-0653 S113640 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 PEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15000). Thesystem: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority I (WOO 4-18-14 - Inspector's Sicfiature - - Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the.system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the.approving.authority. ****This report only describes conditions at the time.of inspection and under the conditions of use at that time.This inspection does not address how the system.will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 t5ins•3/13 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 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 page. Cityrrown 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. ❑ ® 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. ❑ ® 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- 1 0,000g pd. ❑ ® 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•3113 Tide 5 Offidal 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 235 Cammett Rd 1 Property Address Troy Danials Owner Owner's Name information is required for every. Marstons Mills Ma 02648 4-17-14 page. - City/Town - State Zip Code - Date of Inspection C. Checklist .. Check if the following have been done..You must indicate"yes" or"no" as to each of the following: Yes No El ® 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 :- ® El 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. 0 ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is:unacceptable) [310 CMR 15.302(5)] D. System Information Residential-Flow Conditions: -. Number of bedrooms (design):: . Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms) 550 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage.Disposal System•Page 6 of 17: r— - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d see below 9 ( Y 9 (gP ))� Detail: 2013- 175gpd 2012- 178gpd 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 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 °M 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1997 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appears to be in working condition. No sign of leakage Septic Tank(locate on site plan): 6" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: 5" t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 235 Cammett Rd 'M Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 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 31" Scum thickness 3 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 14" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of leakage. Tank should be pumped for maintenance. Outlet tee has a zabel filter that was cleaned during inspection. 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•3/13 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 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 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-3/13 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 wM 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 page. City/Town 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 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to be structurally sound. No sign of solid carryover or leakage. D- box does not have riser. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 l f Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4-500 gallon ❑ 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.): At time of inspection leaching appears to be in working order. No signs of hydraulic failure. Leaching dry at time of inspection. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System'form-Not for Voluntary Assessments M 235 Carnmett Rd 'Property.Address Troy Danials Owner Owners Name information is required.for every Marstons Mills Ma 02648 4-17-14 page. Cityrrown 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 Ay36-5l -Yt C� _3?, A5 � a a G i � l - G f� I - _ I 5 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 page. City/Town 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: no GW @ 13' 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: Mar-10-97 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: Plan on file at BOH Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 235 Cammett Rd Property Address Troy Danials Owner Owner's Name information is required for every Marstons Mills Ma 02648 4-17-14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed E System Information— Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 � 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 235 Cammett Road Marstons Mills, MA. 02648 v/ �t'i; r`% `- Owner's Name: Walker Realty Trust Owner's Address: Same '1 Q^ Date of Inspection: 4/06/4006 Name of Inspector: (please print) Brad J White Company Name: Windriver Enviromental Mailing Address: 107 N. Main Street Carver,MA 02330 Telephone Number: (508)-866-2576 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 training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Failso. Inspector's Signature: Date: 4/ -006 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 i ection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments System passes. Installed zabel filter in outlet ****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 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 235 Cammett Road Marstons Mills,MA. 02648 Owner: Walker Realty Trust Date of Inspection:4/06/4006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: System passes recommend regular service 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 exfTltration 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 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: T41. G Tnan f;— 17—41i,;i,)nnn 2 Pagp 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 235 Cammett Road Marstons Mills,MA. 02648 Owner: Walker Realty Trust Date of Inspection: 4/06/4006 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. _ 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 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: T;liA G Tnc—fine P— All 1;11nnn 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 235 Cammett Road Marstons Mills,MA.02648 Owner: Walker Realty Trust Date of Inspection: 4/06/4006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow _X_ Required pumping rr_ore than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ 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 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.] _NO_(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. 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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. Titlo G Tncnartinn 17-Aii;i1nnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 235 Cammett Road Marstons Mills,MA.02648 Owner: Walker Realty Trust Date of Inspection: 4/06/4006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ 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? _X 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 _X_ Existing information.For example,a plan at the Board of Health. _X_ 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)] Titles G inenortinn Rnrn� �ii VInnA 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 235 Cammett Road Marstons Mills,MA.02648 Owner: Walker Realty Trust Date of Inspection: 4/06/4006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550gpd Number of current residents: 5 Does residence have a garbage grinder(yes or no):No Is laundry on a separate sewage 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 2 years usage(gpd)): N/A Sump pump(yes or no): NO Last date of occupancy:Current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped after Inspection Was system pumped as part of the inspection(yes or no): Yes If yes,volume pumped: 1,500_gallons--How was quantity pumped determined?Sight tube on truck Reason for pumping: check tanks structural integrity TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy No 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: System was installed in 1997 per as built plan of septic system Were sewage odors detected when arriving at the site(yes or no): NO T41. ; Inc f;n r•,.—All 6 Page 7ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 235 Cammett Road Marstons Mills,MA.'02648 Owner: Walker Realty Trust Date of Inspection: 4/06/4006 BUILDING SEWER(locate on site plan) Depth below grade: 21" Materials of construction:_cast iron X 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Building sewer is in good conditon. SEPTIC TANK: X (locate on site plan) Depth below grade: 10" Material of construction:X concrete_metal_fiberglass_polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 10'-6" x 5'-8" x 5'-8" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 31" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: Measured 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 and Outlet tees are in good condition. Liquid level is normal.No evidence of leakage in or out. GREASE TRAP:_(locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Titles G Tnc—t;n 17n—Ail;/Innn 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 235 Cammett Road Marstons Mills,MA.02648 Owner: Walker Realty Trust Date of Inspection: 4/06/4006 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): distribution box is level no evidence of solids carryover and no evidence of leakage in or out PUMP CHAMBER: (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.): Titles G Tncnartinn Fnrm Oil 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 235 Cammett Road Marstons Mills,MA. 02648 Owner: Walker Realty Trust Date of Inspection: 4/06/4006 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _ leaching pits,number: _X_leaching chambers,number: 5 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.): Soil is dry.No signs of hydraulic failure.Vegetation is normal. 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 or 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.): g Y p g, g ) T;riA Tnc—fi*— P--,,,411�;iInnn 9 r • Page 10 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 235 Cammett Road Marstons Mills, MA.02648 Owner: Walker Realty Trust . Date of Inspection: 4/06/4006 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. Uj Titles C incnartinn Rnrm 411 10 PAge l l of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 235 Cammett Road Marstons Mills,MA. 02648 Owner: Walker Realty Trust Date of Inspection: 4/06/4006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 6'+ feet Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed: 1997 _X_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:No groundwater encountered at 6' per local slope off.Also taken from as built none @ 6' +, A Title V inspection is often misunderstood to suggest that we are conducting a complete inspection of your.system. A Title V inspection is limited to determining if, at the time of the inspection,the existing septic system is functioning. The State of Massachusetts has outlined specific tests that are to be performed,which will be completed during your Title V inspection. However,a Title V inspection,and the i inspection that Wind River Environmental is performing hereunder,does not evaluate if the system was installed correctly,has been engineered in accordance with state and local regulations, or whether the system will continue to function in the future. It also does not evaluate whether the system would meet the past,current,or future Board of Health or State DEP regulations. A system can pass Title V but still not meet state or local requirements or be suitable for continued use. If the customer would like a complete inspection of their system,including an evaluation as to the design and j suitability of your system,Wind River Environmental can provide a quote as to the cost of such services. As well,Wind River Environmental strongly recommends persons interested in buying a home to have a full and complete system evaluation before purchasing a new home. A new home buyer should not rely on a Title V inspection in determining if the system will function in the future,and instead should commission a complete system inspection. { I Titic S rnan t;4 Pn— 9i1;i')001) 11 TOWN OF BARNSTABLE LOCATION a 3 C.4 me f'f Rom/ SEWAGE # VILLAGE A to S A'6 ASSESSOR'S MAP& LOT 9./.`.'. INSTALLER'S NAME&PHONE NO. ITON 17 SEPTIC TANK CAPACITY /S�4t7 5 LEACHING FACILITY: (type) Snug Lva44 e 4-,,.,, er (size) `12 NO.OF BEDROOMS S' BUILDER OR OWNER Ilan ;,0/3 PERMTTDATE: " COMPLIANCE DATE: - Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist :fi- 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 Voo, ' C 13 y 3;2� 1 / 2 a€' S' 3 ;2- ' 39 ' y 3 3 S 2� 3i. ..r.., + ,. , .. ... ....... •"*.,,.:, -.,.: ,,... :«,.*, ..• ,,... -..;,...,a '•w... 1w«, av'.Reve�,•n?'.m„..::...:.......«..,:•-:"fh•::dM•w+.,,+t7..h.:.'N^;?"',"#;Mn..,:>Y,' V.K,•#,;.° N«+rx:o+,-r++r •--.. .. '- ---.. ... +.,:>s ww�T'. ^+nw.,:r'� •eM^F w..,.,q .y,;� a"Mt,i•F +ri ..v - .,.... ,,,, ...,..e,.- M,.-. -•... s... `9m -, r. r+?q ..aJs-.. Y _. '�..,^;,.+s .,. ,.,.. ,. ... r": .._ ... ...,. .. .... .:,.• 1. ,. a: .._, : ....-. .- .: .. _ ,. _ . ... .. .. .. ,. ...- .. .+,..c.. , Vie!-„+#„_ p , US B W1 THIN ACCESS COVERS.MUST E H - MUM. S l TER I A MINIMUM. INVERT ELEVATIONS : DE 1 GN R ., GENERAL:. ,NO TES.:.. ... , . .; 6 -0F FINISH GRADE , w. _ - 3• MAX 1 MUM COVER INVERT AT BUILDING: DESIGN 2 T 1 THIS PLAN 1 S FOR THE DESIGN AND CONSTRUCTION BE LEVEL MIN 2- OF PEASTONE INVERT 'IN SEPTIC TANK: 98.3 BEDROOMS AT110_G,P.D. PER OF THE SEWAGE DISPOSAL' SYSTEM ONL Y. BEDROOM EQUALS ��G.P. D, OUTSEP SEPTIC TANK- `4' PVC INVERT T 96. 25 I :f 3/4' 1 1/2' DIA. 2. ALL CONSTRUCTION METHODS AND MATERIALS AND scHEDULE 40 : INVERT 1N DLST. BOX: 97. 62 ' WASHED STONE c HE SEPTIC C SYSTEM sHALt` e 2• NO GARBAGE GRINDER MA I NTEMAN E OF T 1• r�s . 97. 45 CONFORM:TO MASS. D.E.P. TITLE '5 AND LOCAL 98 5 eAFFLE 7 _. � INVERT OUT 'D I ST BOX: BOARD OF HEALTH REGULATIONS. 4-500 GAL LEACHING CHAMBERS INVERT IN LEACH CHAMBER: 97, 0 - ,� OUTLET p, _ O W/4 STONE AROUND. 12.8 X 42 X 2 SEPTIC TANK REQUIRED: a Io MIN. D B x BOTTOM OF LEACH CHAMBER: 95. 0 1500 GAL 5,S�G. P. D. X 200x I l 00 GAL . 3, ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER SEPTIC 'TANK 6' CRUSHED STONE BASE . ADJUSTED GROUND "WATER: N/A AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER SEPTIC TANK PROVIDED: 1500 GAL . THAN 3 1N DEPTH SHALL BE CAPABLE OF ITH OBSERVED GROUND WATER: N/A STANDING H-20 WHEEL LOADS. PROFILE : NOT TO SCALE BOTTOM OF TEST HOLE +�1 : 87. 2 SOIL ABSORPTION SYSTEM REQUIRED: .4. ALL SEWER PIPE SHALL BE�$CHEDULE 40 OR DESIGN PERC RATE - 5 MIN/INCH APPROVED 'EQUAL. - SOIL TEXTURAL CLASS - I �. M. S.E. CORNER CB/DH EFFLUENT LOADING RATE -_0. 74 ` GPD/SF S. BEFORECONSTRUCT/ON CALL 'DIG-SAFE'. EL. - 99.64 f 550 GPD / 0. 74 GPD/SF -_Z44-S.F. 1-800-322-4844 AND THE.LOCAL WATER DEPT. 00.2 - " FOR'LOCATION`OF UNDERGROUND UTILITIES. � S 86.26'02'E 225. IS oo.t OV 4-500 GA ACHI G AMBERS ; R D 6. VERTICAL.`DATUM IS: ASSUMED , ,�"\ ��\ W/4' STONE AROUND, A-757 S.F. 7, FOR BENCH MARKS SET. SEE SITE PLAN. 8, NO DETERMINATION HAS _BEEN MADE AS TO � o `^ LOT I COMPLIANCE WITH .DEED RESTRICTIONS OR ZONING � � ��� � 1 SOIL TEST P I T DATA REGULATIONS. 17 SHALL REMAIN THE CL IENTS r �� - ' ` \\ 70. 407t S.F. to 9 RESPONSIBILITY -TO OBTAIN ALL-PERMITS. SPECIAL a, a•t? ._ _ _ _- 9e a\� INDICATES _� INDICATES ' PERMITS. VARIANCES ETC. FOR THIS PROJECT. , PERCOLATION = OBSERVED 1 _ \ e2•: 3 TEST = GROUNDWATER P* 8150 = TPA I TP• 2 GRND EL, 100.2 GRND EL. J00.5 G. W.EL N/A G.W.EL. N/A I' � E - TOPSOIL TOPSOIL R i. o, i1 '' i /�� SUBSOIL SUBSOIL J - v IN I I N o ii 9 Q ,� ,�• -' - 2.5• 98.0 :r �x I , ► - - t_ Isoo aa�� 97.2 oo. oo:a 3 I _:, � _.._..__. _.- --- •'� _ _ T.o I ._,_ ._ H.- / �R m i. �� SEPTJ'C"7ANK -}1 i Q• t t 9 / ♦/ 21 MED I UM MED I UM 60 . t 1 / t / / SAND SAND 4r Fps -eox 4,y 47. � I �\ � i � ! �� 4-300 GAL LEACHING CHURERS W14' STONE y ' Y • .. co .............. .�... v / Q RESERY • 4 S 89'41 '31 E 13 67.2 12.5' 86.0 DATE: NOVEMBER 12. 1993 TP #2 TEST BY: STEPHEN HAAS WITNESSED BY: JERRY DUNNING Az PER RATE: f2 MIN/INCH 178 9' 89'44'03'W 8. S.W. CORNER CB/DH EL. - 100.84 ?< j` / - SE-P T / G S -YS TE- �l LEES / 01V r , TOWN WA TER �� RN.�J TA SL.. AE , (",4RSTOMS MILLS ) �� FRiTF 4 RED F'Ot4 rn Vv, K E- R f EA L T Y T R U S T of � ► � Q • 1 1 W / L L / ,4 M M . D.4 /V / E"L S Tf? US TEE r OF t �ST'EPIiEN E ; / .. .3 0 MARCH . I O / 9 9 7 i Z`!11"lTTt{�3 : N �4s� ENG I N,E'.�•.R I NG' I1V C A �, L'14 GL . S'UR L'Y I N 0 u o � x, �s �9 2 3 R O L! f 6'�4 Ycz r m o l t�p7 � 5 � �, 36'2 -- 132 7 -- 3 � 32 533 C. 5 CHECK: CFW DRN`: SAH d. 0 15, 30; 6o JOB ND. 93 363 FIELD.RVB/CFW CAL AH =,. •fit... ,.. .. -... ,. .. ..5. :...::. .,. ... .f" , w: nt r ,V I