HomeMy WebLinkAbout0021 CAMMETT WAY - Health 21 Can-imett Way' A
1Vlarstons'MI s ` — —
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A= 099
TOWN OF BARNSTABLE
LOCATION 21 Casnnmc-14 LOA SEWAGE# ZOZI - 213
VILLAGE (n, M:11 S ASSESSOR'S MAP&PARCEL 9 4-15
INSTALLER'S NAME&PHONE NO. r EXL'atJa-1i O/1 - y77-04S3
SEPTIC TANK CAPACITY ISOO Oci l
LEACHING FACILITY:(type) SO�Q 1 L_►c. (zl (size) 13 x 2 S x 2
NO.OF BEDROOMS 3
OWNER Roy L,on rno rl
PERMIT DATE: G 9•21 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
At
Az" a9#
Bz- 3 w�y
A3• 35. REAR
83' 33. L/f
Ay. L-15 B A
O
3 �
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Y
PUBLIC HEALTH DIVISION - TAN Of BARNSTABLE, MASSACHUSETTS
21ppl Lation for Disposal *pstrm Construction Permit
Application for a Permit to Construct( ) Repair(* Upgrade( ) Abandon( ) Complete System X Individual Components
Location Address or Lot No. 7.1 CAcnTne q � � � Owner's Name,Address,and Tel.No. Nobto ( ppov r,
mckrp/Parcel Fors l�I�US
Assessor's Ma 15 21 Caf"rwlvc Fla 010kcs1ton5 /�l•lla
Parcel
Installer's Name,Address,and Tel.No.4� 4ixC0.J0.tion Designer's Name,Address,and Tel.No. IE40-IS Gh
fir" f%wkc, t3A SandW',0\ SOS-0--1-0613 ISS Gft R CIA Rd• C,\N0.%4M, SOS. 3404•08014
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 'LO t 104 S sq.ft+4 Garbage Grinder(No)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided 33O • 04 gpd
Plan Date $' •L- 70 Number of sheets ( Revision Date
. r
Title
Size of Septic Tank 1500 4n+4�nU Type of S.A.S. Q.) 500 0�0,kton (.,(CS .
Description of Soil See 00inS
Nature of Repairs or Alterations(Answer when applicable) 111t&cLAAi0 0E (23 S60 MAXon L,0S GOnrlecbnd
To ex r ki n.. (Soo ea110 n �-ank.
y i
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
ne DateOil 3L
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No.cp&19 Date Issued tL)
,1
No--, '/ Fee t V
` .= Entered in computer:
THELCOMMONWEALTH OF MASSACHUSETTS P Yes
PUBLIC HEALTH DIVISION - TOWN-617 BARNSTABLE, MASSACHUSETTS
}_. a Zipplitation for Disposal 6pstem Construction i3ermit �
ra
Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) " ❑Complete System 9 Individual Components'
Location Address or Lot No. �} �:rnyq E.4 Owner's Name,Address,and Tel.No. NAa c 4
't�mo-r 6 o-s h�'�\1 S
Assessor's Map/Parcel yq, I 21 (c-n wry Nc 1?,
Installer's Name,Address,and Tel.No. ( (� C�K(��zs; Designer's Name,Address,and Tel.No.
�'
so')(i��"„\, jo[. (IT7 0(,` 3 15S Geo 9,164.( (',ci. (..ho.Nvvkrn jf1�t j(�tl i).°Rti
Type of Building:
Dwelling No.of Bedrooms Lot Size ",O; � sq.ft. Garbage Grinder(t.3o)
Other Type of Building No.of:Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) jl} gpd Design flow providedfl . OLl gpd
.Plan Date Z ( 11 Number of sheets 1 Revision Date
Title r r
Size of Septic Tank 1 530Q �X l-j n�, Type of S.A.S.
Description of Soil (1�9
4
r .
Nature of Repairs or Alterations(Answer when applicable) ���,�t�� L> i r�A 0( 0.) �60 rwikk can 1 C'(, (.G n PV(_,b� -
• J
Date last inspected: M�
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
x t accordance with the provisions of Title 5 of the Environmental Code and not to.place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Sig ed t�l1... ~-^-,� Date`1 LCo �3 Z-,J st�,
Application Approved by Date 1
Application Disapproved by Date
for the following reasons
Permit No.t r a. Date Issued (1)1q la I
"THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired O Upgraded( )
Abandoned( )by �C,h ((NUCAi 00
at '�l (_c�mf,\e,4 has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No" ):, 1 3 dated ,,
Installer 1;-) (j � %C C vc�i c n �r1 c • Designer s '�,e
\ j
#bedrooms j Approved design flow 3'So gpd
III
The issuance of this permit/shall
/not bepconstrued/as a guarantee that the system`wilill-ffunctiontasas stg��-...ned:
Date //J f .�1 l Inspector '4.
No--_ W G',J \ Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
bisposal 6pstrin Construction 3pefmit
Permission is hereby granted to Construct.•( .) Repair( Upgrade( ) Abandon( )
System located at 2( Camme-A lr ak\
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three,years of the date of this ermit.
Date ��! / 3' ) Approved by.
Town of Barnstable
Inspectional Services
Public Health Division
Thomas McKean,Director
a ° 200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: Svne 22 Z�21 Sewage Permit# zOZI z 13 Assessor's MaplParce!
Designer: N t/l G( Installer: Rg Excp ,ga 10
Address: ( S Geotl-e Pylof Address: try
ClvyL 0243
On—461 9 IM �x(Za A;o A was issued a permit to install a
( ate (installer)
septic system at 2l Cgo weft' wQ X based on a design drawn by
(address)
00 0 A l), Cp 012'�g M owl" dated MAV Z 71 Z021
(designer)
i
V I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (Le.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system),-but- in accordance with.State&Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactoary.
I certify that the system referenced above was constructed i h the to rms of
the AA approval letteF6(if applicable) DAvtO
CQUGHAfJ(3A
(Installer's Signhu*e
No. 1 osa
FG;$TEaf.
S'4N TAAia
(Designer's Signature):I (Affix Designer's Stamp Here)
PLEASE RETURN TO BkRNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
iXtoa�epts\HEALTIASEWER connecASE0TIODesignerCertification Form Rev&14-13.DO
Noc���'�
Fee
' THE COMMONWEALTH,;OF MASSACHi7SETTS
HEAL'i'H DIVISIOIIT BARNSTABLE,1titA5SACI USE'TTS
IlDB 1'6PStPritDIYtCtiLtiDC: El2Ytt"
Permission is here�y:grantedcto Construct( j Repau
Systent toOg
ted at 21 =`Am :I} •Wat�,.
and as descnbeddxn the above Apphcafion for Disposal System Construction Pexnrt T he'applicant recognized his./her duty to comply with
J 3
Title-5 and the folloWmg log.... provisions or special conditions
Piouided Construction musf'b com eted within three years of the date of this ennit.
Date y-- Approved:.
LOCATION Z' C o nn r,n c-t� (�J A q.' SEWAGE# 'Zo Z 1 z l'3
VILLAGE; ASSESSOR'S 1vIAP&PARCEL
INSTALLER'S NAME&PHONE NO :' e "EXCaVa�i O/1 �f 7 7-oL,S3
SEPTIC TANK CAPACITY /.SOo OQ
LEACHING.FAC.LLITY:_(type) SOO,Gn.� LI c (z1 (size) x 2'S A.Z-
NO.OF BEDROOMS 3
OWNER, Ro;S L1 ofl rnon
PERMIT DATE G�9 Z l COMPLIANCE BATE
$eparation'Oistance$etweeii the:
Maximum'Adjusted Groundwater Table to the Bottom:of Leachmg Facility Feet:'
Private Water Supply Well and Leaching Facility(if any wells_e:pst on.
site Qr-wrthm 200 feet of leaching facility) Feet.
Edge of Wetland and Leaching Facility(If any wetlands exist withm
300 det of-leaching°facility) Feet
FURNISHED BY. �.
31
143 :3 5, •. i
R kAR
tj
} qy L-�5' 8 A
L° {n
�
f
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION
Date (!6 — 3 ' ^ 1 U Time: In Out
Owner. t Tenant
c
Address I?o Address oNAj 1. 04—
Complia a Remarks or
Regulation# Yes Y NO Recommendations
2. Kitchen Facilities k1Z
3. Bathroom Facilities /Pprovea:. - -
NAt l GSI . 10
4.Water Supply
5. Hot Water Facilities w
6. Heating Facilities `
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal (�
17. Temporary Housing
18. Driveway Width
19. Number of Tenants Observed � Q
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Number of Vehicles Allowed (max)
Number of:Persons Allowed (max)
Person(s) Interviewed Inspector ,Z 44
If Public Building such as Store or Hotel/Motel specify here
TOWN OF BARNSTABLE
LOCATION Ars ,Wr— 7° &124 fZ SEWAGE — ,617
VILLAGE /'L10,PSA0,47 S AX/1/ ,a ASSESSOR'S MAP & LOT*
OT d 0 4�
INSTALLER'S NAME&PHONE NO. C—ut
SEPTIC TANK CAPACITY /.Sld �6 At
LEACHING FACILITY: (type) .'� _s aO t A 2 _
NO.OF BEDROOMS l
BUILDER OR OWNER J es %�AVII
PERMITDATE: &aiZ `T&—9'G 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 leachi facility) a� Feet
Furnished by
Woo
• 4 � e.
1 8,
1
� rem
IL
No. G Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for ;Di5pogar *yztem Construction Vertu
Application for a Permit to Construct( )Repair( )Upgrade( andon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ( eat me W 144 ' Owner's Name,Address and Tel.No.
Assessor's Ma /Parc 1 Q (� D/S_
Installer's `Name,Address,and Tel.No. r Designer's Name,Address and Tel.No.
KA Qs 9, o*k4 y
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank \ Type of S.A.S.
Description of Soil -`
Nature of Repairs or Alterations(Answer when applicable) N it:K
a
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 y this oard of Health.
Signed "` Date 000 , '2v1,
Application Approved b - Date sou 31 1 V?
Application Disapproved for the following reasons
Permit No. Y 4-,- Date Issued t9 0• a1 (� �'
/ � Cry
No. Fee
+� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for Migogar *p6tem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade( andon( ) El Complete System El Individual Components
Location Address or Lot No. Al C"a M MQ w R 41- Owner's Name,Address and Tel.No.
lrvlprtrSlo e S -T,4L 4 ,Assessor's Map/,�arc O"l P Q/.5� Ciem M e 4 (7>
Installer's Name,Address,and Tel No. Designer's Name,Address and Tel.No.
C a•�.0�•o,.r 1aa.,�a�..�-�c.l'-S. C..c.e•C�-o�. }�.e v.�t�r: cS�S,
t$S �a.w gfi I�tQS �►tr,-, 04,1 o2.VHR
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Ilt
Design Flow gallons per day. Calculated daily flow gallons.
` Plan Date Number of sheets Revision Date
Title
Size of Septic Tank T e of S.A.S.
P YP
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) S-, a �� 1
1.1 ram` `�si ,� S� / •-/S�� SS 11�+ S �.w(L. ,$7J� Dcy wc-
'I tat.44_1 41 s p t
Date last inspected: R �]
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 issue - y_this Board of Health.
Signed Date 080 - a a, 19 9
Application Approved b Date Mou. 1_1 y t g 9�O
Application Disapproved for the following reasons
Permit No. — Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CER Y,that the On-site Sewage Disposal System Constructed( ')Repaired( )Upgraded
Abandoned( )by ci+-Ce.��r:
at 1 Cct rvi we. W4 S has been constructed in accordance_
with the provisions of Title 5 and the for Disposal System Construction Permit N . 1' dated •/
Installer C& w \La Designer C •-\�w �e+a�r'�N�k.s
The issuance of this permit shall no be constr
as uarantee that the y =to 11 function a dest ped. .
Date ,. `"' �r"'� Inspect
--------------
--------------
Fee
THE COMMONWEALTH OF MASSACHUSETTS
IprPUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mir, ozar * . tem Construction Permit
JQm � p
Permission is hereby granted to Construct( )Repair( )Upgrade Abandon( )
System located at C CcL m M-e.:(+ %0 4- WA S .
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of th• it. ��`!
Date: N D V g b Approved b��
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS)
i
hereby certify that the application for disposal works 4
Wy 1�9'b
construction permit signed by me dated moo,as , concerning the
1
t 'A,I-, C&-rn f,et+ 0 Pnars w n�° 1�s meets all of the
property located a �.
following criteria:
e There are no wetlands within 300 feet of the proposed septic system
• There are no private wells within 150 feet of the proposed septic system ,
t The observed groundwater table is 14 feet or greater below the bottom of the leaching facility
i.
9 There is no increase in flow and/or change in use proposed
t There are no variances requested or deeded.
SIGNED:C i4." DATE: .
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER
[Attach a sketch plan of the proposed system'.-Also if the licensed installer posesses a certified plot plan,
this plan should be submittedl.
V �
�.
.�
n'
Sid � �_ c��s�:.� �;e.SS..R�c�'`...
Q � �
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7
COMMONWEALTH OF MASSACHUSETTS
ExEt;unvE OFFICE OF ENVIRONMENTAL AFFAIRS
a DEPARTMENT OF ENVIRONMENTAL ftomCTIDN
TITLE S
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM F
PART A RECEIVED
CERTIFICATION
SEP 3 2002
Property Address: 21 CAAIMETT WAY
MARSTONS MHJ S MA.02"S TOWN OF BARNSTABLE
Owner's Name: JAMES AND CATHERINE TAYLOR HEALTH DEPT.
Owner's Address: 7 CAMMETT WAY
MARSTONS MILLS MA. 02648
.Date of Inspection: AUGUST 24,2002
Name of Inspector: Patrick M O'Connell
Company Name: Septic Inspection Services Co. MAP
Mailing Address: 189 Cammett Road PARCEL ,
Marston Mills r 02648
Telephone Numlbe.: (508)42&1779 LOT :
CERTIFICATION STATEMENT
1 certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: 8/Z8�oZ-
P� g
ci��
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.
Notes and Comments
:*"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.
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 21 CAMMETT WAY
MARSTONS MHLLS MA.02649
Owner: JAMES AND CATHERINE TAYLOR
Date of Inspection: AUGUST 24,2002
Inspection Summary: Check A,B,C.,D or E/ALWAYS complete all of Section D
A. System Passes`
_X t have not found any information which indicates that any of the failure criteria described in 310 CMR
15.36 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 grass.
Answer yes,no or not determined(`I,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 tails(whether metal or not)is structurally;
unsound,exhibits substantial infiltration or exfthration or tank failure is imminent. System wilt 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 Ceetificate of Compliance
indicating that the task 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 time 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:
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 21 CAMMETT WAY
MARSTONS MILLS MA. 02648
Owner. JAMES AND CATHERINE TAYLOR
Date of Inspection: AUGUST 24,2 02
C- Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board ofHeahh in order to determine if the system
is failing to protect public health,safety or the environment. O
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(t)(b)that the
system is not functioning in a manner which will protect publicc health,safety and the environment:
— Cesspool or prey 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 fart 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 I of a public water supply_
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well*a_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:
Page 4 of l 1
OFFICIAL,INSPECTION FORM—NOT FOR VOLITNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:21 CAMIVIETT WAY
MARSTONS MILLS MA.02649
Owner: JAMES AND CATHERINE TAYLOR
Date of Inspection: AUGUST 24,2002
D. System Failure Criteria applicable to all systems:
You must indicate°fires"or"no"to each of the following for all inspections:
Yes No
X_ Back-up 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 f6 day flow
X Required pumping more 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.
XX 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 most be attached to this form.)
_No_(YesJNo)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 ether"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.—TWPA)or a mapped
Zone II of 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 contactt the appropriate regional office of the Department.
Page 5oflt
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART R
CHECKLIST
Property Address: 21 CAMMETT WAY
MARSTONS MILLS MA.02648
Owner: JAMES AND CATHERINE TAYLOR
Date of Inspection: AUGUST 24,2002
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
scam?
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(3K6)]
Page 6 of 11
OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 21 CAMMETT ROAD
MARSTONS MILLS MA,02640
Owner: JAMES AND CATHERINE TAYLOR
Date of Inspection. AUGUST 24,2002
FLOW CONDITIONS
RESIDENTIAL.
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
Number of current residents: 0
Does residence have a garbage grinder(yes or no): NO
Is laundry on a serrate sewage system(yes or no): NO [if yes separate inspection required)
Laundry system inspected(yes or no):—
Seasonal use:(yes or no): N/A
Water meter readings,if available(last 2 years usage(gpd)): 76
Sump pump(yes or no): NO
Last date of occupancy: JUNE 2002
COMMERCIALI]NDUSTRIAL
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 reading,,,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: HAS NOT BEEN PUMPED SINCE NEW.
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
X_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)No
_InnovativelAltermtive 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:
DECEMBER 10, 1996 PERMIT #96-6ll
Were sewage odors detected when arriving at the site(yes or no): NO
I
Page 7 of 11
OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM]INFORMATION(continued)
Property Address: 21 CAMMETT WAY
MARSTONS MILLS MA.02648
Owner. JAMES AND CATHERINE TAYLOR
Date of Inspection: AUGUST 24,2002
BUILDING SEVER X (locate on site plan)
Depth below grade: 1.5'
Materials of construction:_X cast iron _40 PVC_ether(explain):
Distance from private water supply well or suction line: 24'
Comments(on condition of joints,venting,evidence of leakage,etc.):
PIPE IN GOOD CONDITION.NO EVIDENCE OF LEAKS.
SEPTIC TANK:_X (bate on site plan)
Depth below grade:8"
Material of constnx ion: 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: 150p Gal. 5'8"X10'6"
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or battle: 33"
Scum thickness: I%"
Distance from top of sewn to top of outlet tee or baffle: 11 %"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: * STICK WITH HINGE FLAP#
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.): LIQUID LEVELS SLIGHTLY BELOW OUTLET PIPE.
TANK IS NEW,NOT LEAKING.
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 recomniendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 21 CAMMETT WAY
MARSTONS MILLS MA.02648
Owner. DAMES AND CATHERINE TAYLOR
Date of Inspection: AUGUST 24,2002
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: I"BELOW
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.): RES.HAS NOT BEEN OCCUPIED RECENTLY.LIQUID LEVEL l"BELOW
OUTLET PIPE BUT NOT BELIEVED TO BE LEAKING.
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):
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SU&SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 21 CAMMETI' WAY
MARSTONS MILLS MA.02648
Owner: JAMES AND CATHERINE TAYLOR
Date of Inspection: AUGUST 24,2002
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pit%number:_
X leaching chambers,number 2
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovativetalternative system Typetname of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
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 constnuion:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Page 10 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 21 CAMMETT WAY
MARSTONS MILLS MA.02648
Owner. GAMES AND CATHERINE TAYLOR
Date of Inspection: AUGUST 24,2002
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.
cckmat�- W04
G1ATec
21
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N2 5
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Page I I of I I
OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 21 CAMMETT WAY
MARSTONS MILLS MA.02"S
Owner: JAMES AND CATHERIIVE TAYLOR
Date of Inspection: AUGUST 24,2002
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Eshmated depth to ground water: MORE T HAN 20 FEET
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
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)
X Accessed USGS database-explain:CHECKED TOPO MAPS AND GIS CHARTS.
You must describe how you established the high ground water elevation:
COMPARED USGS CONTOURS TO GIS CHARTS. PROPERTY(ate EL.64 GW.(cx�EL.32
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SUPERIOR COURT HOUSE
J •� � ' a1� BARNSTA6LE, MASSACHUSETTS 02630
p�62- 11
A 5 ppSSccT. 3 0/
L4337
James and. Catherine Taylor 'YO�. LINI<qA...0
7 Cammett Way �`1`�
Marstons Mills, MA'02648 September 10, 1992
.)ear Mr. and Mrs. Taylor
Olt September 8, 1992 ___ _ all iisI)ectioi was held at the
address below for the detecti - of lead- Lased I)aillt . Ill
accordance with Massachusetts General Law Cha[)Ler 111 ,
Sec . 19U-199 , any lead Paiiit detected ill a residence where
a child under six years of aye resides must be removed .
Based on the iilsPectioii , the following apply !
Lice Premises are lead- free
Y lead-based paint was detec:Led , huwevr, r- , iu children
under six years of aye PresenLly reside ill Lids
dwelling
lead-based llaillt. v/;i : deLec't-0 aid it health
hazard to Lite chlldrei residing Lhet ci it
lead-based 11aiiiL was deLectod aii(I .' i it hr'il I Lit
hazard to children aLLendiiy da}•c are/I)reschuul
therein
itlsPectioll required f. or ! it lr, clf I,l ijwi I y
insPecLiun required Lou llernli L
filial insPectioi - violaLivis nuLed
have been corrected
LocaLioti of Property OwIler
F2-1 cammett 14ay James and Catherine Taylor
�-Marsfons Mills-MA 7 Cammett Way
Marstons Mills MA
Please coiLacL- Lhi s of f i c-e shuu ld y•c,ll 1 r,gii i i r, Aliy I. ur. Lher
ihfornlaLioi reyardilly this ina L Ler .
t�ut.�llc: tict�l C1•�5atllt�urian
Commonwealth of IVlassachusetts rg I 111 Lv
INSPECTOR/AGENCY CHILDHOOD LEAD POISONING METHOD USED
PREVENTION,PROGRAM
RNA 2S
305 SOUTH ST., JAMAICA PLAIN, MA
I Expiration date
INSPECTION FORM
- -- - X-RAY
Registration#A(2,3l ( 'FLUORESCENCE
Model Xl Serial I1?,4419
- ---- ------ APT
Ad�drlessl I �1µ M��I(�I I I/�IV I I I I fA
LA—LL_ CITY 1
C111L17 MM DD YV Sex
Hill,U:ne
I AST NAMF OF
. .._.----- ---..-.--. .-------.--- ---.__—.-- rFIRST NAME J
1 Ll I
Parent Guardian's Last Name Parent/Guardian's First Name
DWELL 8 OWNER 8UNITS
OWNS
2 ARE.DAV C OCC < 5SCHOOL YORN
3.OTHER Y OR N
8 2 SINGLE OF ROOMS
2.2.4 APTS INC 8 INCLUDE BATHROOMS
3.5 OR MORE BUT NOT HALLS
OWNER'S NAME: r
OWNER'S ADDRESS: I CG>
Book No. . REMARKS; In n pri u— 4v rtn44 0�(C i.,{
Page I__ (J
Date recorded
H1VICTIM 4.REPAIR 7.OTHER INSP.DATE VIOLATION
2.PAR.IIEO. 5.VACANCY o G O J V OR N
3.HIGH INC. 6.INSTITUTION �J ` C.
1--_ FLOOR
FLOOR ! I
C C
`t
A (STREET SIDE) A (STREET SIDE)
Pb MORE THAN 1.2 mg/cm 2 with x-ray fluorescence or positive with Na2S is ILLEGAL.
IN PECTOR
REINSP.DATE 1.IN COMPLIANCE REINSP.DATE 1.IN COMPLIANCE REINSP.DATE 1.IN COMPLIANCE
2.WORK IN PROGRESS 2.WORK IN PROGRESS 2.WORK IN PROGRESS
F1 H 3.NO WORK T1 I I d E 3.NO WORK 3.NO WORK
REINSP..DATE t.IN COMPLIANCE REINSP.DATE 1.IN COMPLIANCE. REINSP.DATE 1.IN COMPLIANCE
2.WORK IN PROGRESS 2.WORK IN PROGRESS 2.WORK IN PROGRESS
3.NO WORK T1 I I id H 3.NO WORK 3.NO WORK
COMPLIANCE DATE
INSPECTOR -- _---
Pb = lead cov = covered
Neg = Negative scr = scraped
Pos = Positive rep = replaced
na = not accessible rev = reversed
Cam" =
UYSPE NTOR/AGENCY Commonwealth of Massachusetts
z CHILDHOOD LEAD POISONING PREVENTION PROGRAM
_ 305 South St., Jamaica Plain, MA 02130
'INSPECTION FORM
- -- — — ?DP9_ of �O --
Registrationi - -...._ _ -- - -----r 7 _,— _-._
ADDRESS OF INSPECTION API.1
1_zT_TiJcT- A1�]_mTd
ROOM # N _
SIDE SOURCEJPLoose Da B° Ma nod SIDE SOURCE Pb Loose Date° Method
Upper Walls Window Sill/Apron
Lower Walls Window Casing/Header/Stops
Chair rail Window Sash/Mullions
Baseboard Exterior Sill/Parting bead area
Door LN Window Sill/Apron
Door Casing-Jamb Window Casing/Header/Stops
Door Window Sash/Mullions
DI Door Casing-Jamb , Exterior Sill/Parting bead area
Door Exterior Side Sashes 4
Door Casing-Jamb Closet Walls
A Window Sill/Apron , Closet Door-Interior
Window Casing/Header/Stops 0.4 Closet Casing-Jamb L3, 1.1
Window Sash/Mullions ru ,
_I) Closet Baseboards Q,
Exterior Sill/Parting bead area .b Closet Shelves —
�, Window Sill/Apron -Floor
P Window Casing/Header/Stops 0,31Ceiling
Pj Window Sash/Mullions tT7 G,
g Exterior Sill/Parting bead area
Window Sill/Apron
Window Casing/Header/Stops
Window Sash/Mullions
Exterior Sill/Parting bead area ROOM # C .
Window Sill/Apron J
Window Casing/Header/Stops Upper Walls Q
Window Sash/Mullions Lower Walls 0'5
Exterior Sill/Parting bead area Chair rail
Exterior Side Sashes Baseboard b,
Closet Walls Door D G. L
Closet Door-Interior Door Casing-Jamb atG
Closet Casing-Jamb 8 Door 4v j
Closet Baseboards 0.Z. Door Casing-Jamb � G
Closet Shelves Door
Floor Door Casing-Jamb O,
Ceiling Window Sill/Apron 049
A(') Window Casing/Header/Stops ot(j
Window Sash/Mullions 0,
JL Exterior Sill/Parting bead area
Window Sill/Apron
Window Casing/.Header/Stops
ROOM # 2 Window Sash/Mullions
Exterior Sill/Parting bead area
Upper Walls (j, j Window Sill/Apron
Lower Walls (�, Window Casing/Header/Stops
Chair rail Window Sash/Mullions
A Baseboard nt ' Exterior Sill/Parting bead area
Door j — Window Sill/Apron
Door Casing-Jamb 6,Z Window Casing/Header/Stops
Door e) — Window Sash/Mullions _
Door Casing-Jamb . 1 Exterior Sill/Parting bead area
Door A. Exterior Side Sashes
Door Casing-Jamb Closet Walls
Window Sill/Apron C Closet Door-Interior
�j Window Casing/Header/Stops Closet Casing-Jamb
Window Sash/Mullions Closet Baseboards
Exterior Sill/Parting bead area - Closet Shelves
( Window Sill/Apron d,'Z Floor
Window Casing/Header/Stops ().7 Ceiling
Window Sash/Mullions 0
C I Exterior Sill/Parting bead area
Pb MORE THAN 1.2 mg/cm2 with x-ray fluorescence or positive with N82S is ILLEGAL.
REMARKS
QNS ECTOR
Inspection Da e
INSPECTOR/AGENCY Commonwealth of Massachusetts
— N CHILDHOOD LEAD POISONING PREVENTION PROGRAM
_ 305 South St., Jamaica Plain, MA 02130
"INSPECTION FORM
Pg OfRegistration/A �7i3 I _ _ .. -- - --.- ----- ._ --
ADOREtiS OF INSPECTION Ai't.
U �fTe, t TyjTYTT--f— I TT —
City
ROOM # -�
SIDE SOURCE Pb Loose na a° Method SIDE SOURCE Pb Loose ose° Mo.M.d
Upper Walls Window Sill/Apron
Lower Walls Window Casing/Header/Stops
Chair rail Window Sash/Mullions
Baseboard Q, Exterior Sill/Parting bead area
Door i Window Sill/Apron
Door Casing-Jamb t Window Casing/Header/Stops
Door Window Sash/Mullions
Pj Door Casing-Jamb ®I Exterior Sill/Parting bead area
Door-6 4-, f}(_ Exterior Side Sashes dt
Door Casing-Jamb , -Closet Walls a,
Window Sill/Apron 13 AC Closet Door-Interior t
Window Casing/Header/Stops Closet Casing-Jamb t
Window Sash/Mullions ALL-Closet`Basebowds
Exterior Sill/Parting bead area G YLd lind t`. Closet Shelves — I
Window Sill/Apron Floor
Window Casing/Header/Stops Ceiling
Window Sash/Mullions •'4o
Exterior Sill/Parting bead area v '
Window Sill/Apron
Window Casing/Header/Stops
Window Sash/Mullions
Exterior Sill/Parting bead area ROOM
Window Sill/Apron
Window Casing/Header/Stops Upper Walls
Window Sash/Mullions Lower Walls
Exterior Sill/Parting bead area Chair rail
Exterior Side Sashes OA, Baseboard
Closet Walls Door
Closet Door-Interior Door Casing-Jamb
Closet Casing-Jamb Door
Closet Baseboards Door Casing-Jamb
Closet Shelves Door
Floor Uk n D FUL4,reiDoor Casing-Jamb
Ceiling Window Sill/Apron
r�jl i-j (). 0 Window Casing/Header/Stops
Window Sash/Mullions
Exterior Sill/Parting bead area
Window Sill/Apron
Window Casing/Header/Stops
ROOM 4 Window Sash/Mullions
Exterior Sill/Parting bead area
Upper Walls (S,(j Window Sill/Apron
Lower Walls (�, Window Casing/Header/Stops
_ Chair rail Window Sash/Mullions
-baseboard Exterior Sill/Parting bead area
Cl Door Z — Window Sill/Apron
Door Casing-Jamb Q Window Casing/Header/Stops
Door4o &IpSet- Q, f Window Sash/Mullions
G Door Casing-Jamb , Exterior Sill/Parting bead area
Door p V ,Z Exterior Side Sashes
Door Casing-Jamb Ot Closet Walls
Window Sill/Apron U, Closet Door-Interior
Window Casing/Header/Stops 6t Closet Casing-Jamb
Window Sash/Mullions Closet Baseboards
Exterior Sill/Parting bead area 0t Closet Shelves
Window Sill/Apron ,3 Floor
Window Casing/Header/Stop Q,3 Ceiling
Window Sash/Mullions
Exterior Sill/Parting bead area
Pb MORE THAN 1.2 mg/cm 2 with x-ray fluorescence or,positive with Na2S is ILLEGAL.
REMARKS
NS ECTOR
Inspection
o
v
'INSPECTOR/AGENCY Commonwealth of Massachusetts
—� CHILDHOOD LEAD POISONING PREVENTION PROGRAM
305 South St., Jamaica Plain, MA 02130
*INSPECTION FORM
�t� �" P9 Of —
Registration /AI C/
AOVRISS OF INSPECTION
=yy
City
KITCHEN '_1_A_T14 1 _. _
Comp Comp Comp Comp
SIDE—Lopt;p
SOURCE Pb Loose Date Method SIDE SOURCE _ Pb Loose Date Method
er Walls G.zUltper Wallser WallsLower Wallsir rail Chair rail --
AD- Baseboard Cl Q --- Baseboard —
Door IG -- Door p �tm,
i� Door Casing-Jamb O Door Casing-Jamb
Door Door
Door Casing-Jamb Door Casing-Jamb
Door C Window Sill/Apron
Door Casing-Jamb C Window Casing/Header/Stops
Door Window Sash/Mullions --
Door Casing-Jamb Exterior Sill/Parting bead area -�
Door Exterior Side Sashes
Door Casing-Jamb Upper Cabinets
Door Upper Cabinets Walls
Door Casing Jamb Upper Cabinets Shelves
Window Sill/Apron _ Q I —_— Lower Cabinets
Window Casing,Header/Stops - 0, — Lower Cabinets Walls -
- Window Sash/Mullions _ _ �,Z - --— — — —_ Lower Cabinets Shelves -
- 0 Exterior Sill/Parting bead area -1 — L — _ -_ — Shelves ---
Window Sill/Apron -- Drawers —
Window Casing;Header/Stops Floor
Window Sash/Mullions Ceiling
Exterior Sill/Farling bead area
Window Sill/Apron
Window Casing;Header/Stops
r Window Sash/Mullions
Exterior Sill/Parting bead area
Exterior Side Sashes 4- BATHROOM
Upper Cabinets G t
j Upper Cabinets Wall — Upper Walls
Upper Cabinets Shelves — Lower Walls - (;
�p,[, Lower Cabinets Q t Chair rail
L Lower Cabinets Walls Baseboard
gC Lower Cabinets Shelves — Door
Shelves ADoor Casing-Jamb at --
Drawers Door _—__—
Closet Walls Door Casing-Jamb
- Closet Door Interior--_---- _ _ - _ - -- -- Window Sill/Apron _
Closet Casing-Jamb — -- Window Casing/Header/Stops t
Closet Baseboards 'D Window Sash/Mullions
Closet Shelves Exterior Sill/Parting bead area r' UW
Floor — f� Exterior Side Sashes
Ceiling CP,W AUpper Cabinets
C. Lower Cabinets
C Lower Cabinets Shelves
Shelves
Closet Walls
Closet Door Interior
Closet Casing-Jamb
Closet Baseboards
Closet Shelves
Floor —
Ceiling cove
t
Pb MORE THAN 1.2 mg/cm 2 with x-ray fluorescence or positive with Na2S is ILLEGAL.
REMARKS `'
14 l
IN PECTOR
he:pection Date
,
INSPECTOR/AGENCY Commonwealth of Massachusetts
-- �R CHILDHOOD LEAD POISONING PREVENTION PROGRAM
305 South St., Jamaica Plain, MA 02130
"INSPECTION FORM
Ypg �of�
Registration #A I?,3 q. -- -- —
APT
ADDRESS OF INSPECTION
City
HALL I HALL
Comp Comp Comp Comp
SIDE SOURCE Pb Loose Date Method SIDE SOURCE Pb Loose Date Metho,t
Upper Walls g,(j Upper Walls
Lower Walls — Lower Walls a,b _
Chair rail Chair rail —_
r Ac Baseboard G,3 Baseboard
r —
Door Door U t
_A Door Casing-Jamb-ID vn 6-Z- Door Casing Jamb
Door U 1�g--Jam►rl Z Door D (jS or
f-j Door Casing-Jamb o' C� Door Casing Jamb 6
1
Door ) - 1 0. Door
Door Casing-Jamb 0'Z ej Door Casing-Jamb
Door Door
Door Casing-Jamb Door Casing-Jamb —
Window Sill/Apron Window Sill/Apron —
Window Casing/Header/Stops Window Casing/Header/Stops
Window Sash/Mullions Window Sash/Mullions
Exterior Sill/Parting bead area Exterior Sill/Parting bead area
Exterior Side Sash Exterior Side Sash
' Closet Walls C Closet Walls btO
Closet Door-Interior _ e. Closet Door-Interior_ O,Z
Closet Casing-Jamb G Closet Casing-Jamb
Closet Baseboards —
Closet Shelves Closet Shelves
'--- Floor — Floor - A _
CeilingCPW Ceiling
I--
STAIRCASE STAIRCASE
_._ Upper Walls --- — Upper Walls
Lower Walls Lower Walls
Wall Casing Wall Casing
Chair rail Chair rail
Treads Treads
Risers Risers
-------
--... _..__ ._.. _.._........ _
Railinq Cap Railing Cap
Handrails Handrails _
Balusters Balusters_—
Newel Posts
Stringer Stringer
Baseboards Baseboards
Window Sill/Apron Window Sill/Apron
Window Casing/Header/Stops Window Casing/Header/Stops
Window Sash/Mullions Window Sash/Mullions
Exterior Sill/Parting bead area Exterior Sill/Parting bead area
Exterior Side Sash Exterior Side Sash
Door Door
Door Casing-Jamb Door Casing-Jamb
Door Door
Door Casing-Jamb Door Casing-Jamb
Ceiling Ceiling
Pb MORE THAN 1.2 mg/cm2 with x-ray fluorescence or positive with Na2S is ILLEGAL.
REMARKS
IN PECTOR -
Inspection e
o 161114
1INSPECTOR/AGENCY Commonwealth of Massachusetts
CHILDHOOD LEAD POISONING PREVENTION PROGRAM
305 South St., Jamaica Plain, MA 02130
"INSPECTION FORM
G of
,/Registration A Q,-3 J _ - _. —. _-- -__.-- pg
.\I,OM S5 01 INSIY Cl IUN API.
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City
EXTERIOR —fX 4_
Comp Comp Comp Comp
SIDE SOURCE Pb Loose Date Method SIDE SOURCE Pb Loose Date Method
iding & 6 t Z ,5 Siding
-DripboaTd Dripboard
�kiri Skirt
Coinerboards Cornerbo8rds
J Door -ha 5 3,3 � Door-� m 3
A Door Casing/Jamb ,( L G' Door Casing/Jamb ,fj
Threshold + L. Threshold —
Door _� 3 — Door
Door Casing/Jamb (j� Door Casing/Jamb _
Threshold ^— Threshold
A. Window Sill 4 It Z 3,0 1 Window Sill A
A Window Casing 15.(' L p Window Casing
Window Sash/Mullions + L Window Sash/Mullion _
— Window Sill — — — C Window Sill +
A Window Casing Window Casing ,
Window Sash/Mullion Window Sash/Mullions —I" L.
A Window Sill �}QI (�,'� Window Sill + L
Window Casing +v VM o.Z Window Casing ,
Window Sash/Mullionl _ — Window Sash/Mullioni L
D Window Sill rj,'Z Window Sill
p Window_Casing ,Z Window Casing
Window Sash/Mullion Window Sash/Mullions
Upper Trim Upper Trim
Cellar `.".'indow Units v Cellar Window Units
Cellar Window Units Cellar Window Units
Cellar Window Units Cellar Window Units
_ Cellar Window Units Cellar Window Units
Bulkhead Bulkhead
Fences_____ _ Fences
Foundation _ _ Foundation
Pb MORE THAN 1.2 mg/cm 2 with x-ray fluorescence or positive with Na2S is ILLEGAL.
REMARKS kr- _h l.c,mU,- _A L D ,
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Inspection Date
T7_1
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old Falmouth
EXISTING LEACHING CHAMBERS MAY BE REUSED41, Rya
Ml�j� �a-4
WITH NEW STONE IF IN SOUND STRUCTURAL CONDITION.
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IF ABANDONED IN PLACE, CHAMBERS ARE TO BE PUMPED ° • :. N camMett'Laoe
WATER LINE
AND FILLED' WITH SAND PER BARNSTABLE REGS. ��
WATER GATE �90-`.� a�q.t a t." •
GAS LINE a ; aO D
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PONENTS Raad ko
SMARSTONS MILLS MA'
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XISTING
LEACH PIT/
CESSPOOL •
• •
DISTRIBUTION BOX[I •
TEST PIT
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rl 90.33 ft `' FN
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P Lo3L�D)ROOM THIS IS A.
p��2p I / Q �g
} 8LAB FN®� O vl%LSL�� QNO 44 MINIMAL �®16.®1►�
b 44 rop ®� ���M / GRADING
4 PROPOSED PLAN
sq.0,9 I USE COLOR PLAN ONLY
-- - FOR INSTALLATION
.PROPOSED SOIL FULL DETAIL IS BEST
VIEWED IN
ABSORPTION l /S ft ----- FULL COLOR
SYSTEM
-SEE DETAIL /
ON BACK
67 / o
29
TIM
O
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/ GARB
1 G R
EXISTING SOIL = OT
O 0 / A OWED
ABSORPTION Sart7WI _67
L Oo Il' 2
AREA = 20345 sf+-
66 LAND COURT PLAN 29500-A
ASSR MAP 99 PCL 15
130^00 \
Y' L A #r\\S
SCALE: I in = 20 f t 66
�pBIF G/S pq O
0, 20 40 '
_ ELEVATION
o to — 20 - 69.08
PRINT ON 11 x 17 in T op OF FOUNDPt���
PAPER FOR PROPER SCALE
OF OF MAs,
DAVID yGs o DAVID yGs
COUGHANOWR � COUG ANOWR�, o SEWAGE DISPOSAL
No. 1093 No. 461 SYSTEM PLAN
c -TO SERVE EXISTING DWELLING
�FNRER�o So,�PPRA�P ROBERT LIPPMAN
$R,GREG� EDNTON
DW
21 CAMMETT WAY
THIS PLAN IS INTENDED SOLELY FOR INSTALLATION OF THE SEPTIC SYSTEM v M A R S T O N S MILLS, MA
* DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING 155 Geo By Rd 5 PROPERTY ADDRESS
PLACEMENT OF ADDITIONS, SHEDS. FENCES OR SWIMMING POOLS. OWNER Chothom, MA 02633
SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. DOVIdCOuOHotm011.Com DATE: MAY 27. 2021
508 364-0894 PG.UZ JOB+ ETE-4568 R51 N
I
I t
SOoIL TEST LOo DESIGN CALC LA40OaG
SOIL EVALUATOR: DAVID D. COUGHANOWR. ASE #461 DESIGN FLOW: 3 BEDROOMS X 110 GPD = 330 GPD
WITNESSED BY: DONALD DESMARAIS, HEALTH DEPT.
SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS
TEST PIT 1 PNEOCAT 6N n - 2RMIN/NCCHrINECED USE EXSTING 1500 GALLON SETIC TAN IF IN
SOILS SOUNDI STRUCTURAL CONDITION• IF NOTKINSTALL
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER NEW 1500 GALLON SEPTIC TANK.
67.00 INCHES HORIZON TEXTURE (MUNSELL) MOTTLES DISTRIBUTION BOX, INSTALL UNIT DEPICTED BELOW.
0-10 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE SOIL ABSORBTION SYSTEM:
64.33 10-32 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE
32-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE
56.00 SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES
PER INCH = 0.74 GALLONS PER DAY PER SQUARE FOOT.
TEST PIT 2 NO GROUNDWATER ENCOUNTERED THE 24 ft x 12.5 ft x 2 ft LEACHING GALLERY
- 2 MIN/INCH IN C SOILS DEPICTED BELOW CAN LEACH:
ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER
66.80 INCHES HORIZON TEXTURE (MUNSELL) MOTTLES BOTTOM AREA = (24 x 12.5) = 300 sq. ft.
0-10 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE SIDEWALL AREA = (24+24+12.5+12.5)x2 =146 sq. ft.
64.30 10-30 Bw LOAMY SAND 10 YR 5/6 NONE FRIABLE TOTAL AREA = 446 sq. ft.
55.80 30-132 C MEDIUM SAND 10 YR 5/4 NONE LOOSE FLOW CAPACITY = 0.74 x 446 = 330.04 gal/day
_ INSTALL A 24 ft x 12.5 ft x 2 ft GALLERY AS CONFIGURED
BELOW. FLOW CAPACITY = 330.04 gal/day WHICH EXCEEDS
THE 330 gal/dog REQUIRED FOR A THREE BEDROOM DESIGN.
. 150 GALLON SEPVC TAN#M ,:
DIMENSIONS & DETAIL
.USE EXISTING TANK IF. STRUCTURALLY SOUND.- � �p
PUMP & INSPECT TANK REPLACE WITH A NEW ���� ��OIT�T �QOuV
AT TIME OF REPAIR 1500 GALLON TANK SYSTEM• CONSTRUCTION DETAIL
I in IF CRACKED, ROTTED USE SHOREY PRECAST 500 GALLON LEACHING DRYWELL
TAPER OR OTHERWISE
g,. COMPROMISED. DRYWELL
UNIT 24.0 ft
5 ft- wf w
(M r All
8 In
NOT _ �w
TO
10
ft_6 in SCALE STONE 3.5 ft 8.5 ft 8.5 ft 5 3.5 ft
INLET OUTLET 500 GALLON DRYWELL
COVER COVER DIMENSIONS & DETAIL INSTALL ONE INSPECTION
-F + r� RISER TO WITHIN THREE
3 IN DROP USE INCHES OF FINAL GRADE
-► /l FLOW LINE & INDICATE LOCATION
-► H-10 .. ON AS-BUILT
FROM 10 in = 14 TO UNIT
BUILDING
1 D-BOX
48 in �p 33
LIQUID GAS � i ,p$yD0
in
LEVEL BAFFLE DIDrp�O`
I
Dpp-
(a
b !n STONE BASE 102 in
SEPARATION
LESSWEEN THANINLET &LIQUID OUTLET
CROSS SECTION VIEW
CROSS SECTION VIEW I FABRIC OVER S NSTALL AN APPROVED ONE GEOTEXTILE-\
.:��. sue.
2B 3/4 in TO ® 24 EFFin a' 3/4 in TO
Da� u u U�v v ��Ou v �OX USE SHO20y /n zl/2 in GRAVEL DEPTH Ti
►-)/2 in GRAVELa
z11 � :
DIMENSIONS PIPES EXITING D=BOX TO RUN LEVEL 46 in 58 in 46 in
AND DETAIL FOR 2 FEET BEFORE.PITCHING DOWN.
150 in
12 in
C MIN
FROM = —�
N TANK TO
SAS INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE
O _.,P,.N NGT STARTING WORK.
ii7o0o� c��6oC� —ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM
\� b in STONE BASE ��� REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC
CODE (310 CMR 15).
21 jn 7,� CROSS SECTION VIEW INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND
UTILITIES BEFORE EXCAVATING FOR SYSTEM.
Q —ECO—TECH RAPID RESPONSE RECOMMENDS THE INSTALLATION
' OF LOW FLOW FIXTURES & APPLIANCES, AND PERIODIC
PUMPING OF THE SEPTIC TANK.
—SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR' LOADING.
DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM.
TOP OF FOUNDATION RAISE COVERS TO WITHIN ALL PIPE TO BE 4 in SCH. 40 PVC
EL = 69.08 +- 6 in OF FINAL GRADE AND TO PITCH AT 1/8 in/ft MIN
i ii � 7 j j 67.25
D=BOAIIIIII 3.
.,, MAX
E=TWG USE H-23' 64.95
EXISTING 1500 GALLON � °000a°ooaoo°
°o°00000°0 PRECAST 00000go°�o
SE(,��� TA
Q nll� 65.25 �00000000aoo DRYWELL �o�o°°oo 000a
Ir (/V��J 64:33 °oo° ooaoo°c J°°oo°o Qo°o
in EXISTING REFER TO DETAIL BOX STONE SOL A°- BSORPT ON +
64.50 BASE 64.20 ,-
b In STONE BASE IF NEw ['� -REFER TO
EXISTING ����
18 ft 5-12 ft DETAIL BOX O
6.2.20 NO GROUNDWATER VBELOW
MOTTLING OBSERVED _ 55.80
SEWAGE DISPOSAL SYSTEM P(Wl 21 CAMMETT WAY MARSTONS MILLS, MA MAY 27. 2021 ETE-4568 PG 2/2