HomeMy WebLinkAbout0071 CAPTAIN BAKER ROAD - Health (2) OF71 Captain Baker Roar!rstons Mills F/R
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TOWN OF BARNSTABLE
LOCATION 7/ Qom' 14 /G-t SEWAGE # 2 0o3-2gT
VILLAG ASSESSOR'S MAP& LOT/2s- 02.5-
INSTALLER'S NAME&PHONE NO. .SD3-V20-?75 cif
SEPTIC TANK CAPACITY 1690
LEACHING FACILITY: (type) 3 LS00 ���yy.��%1�S (size)
NO. OF BEDROOMS 5' /
BUILDER OR OWNERi`i�1s4z
PERMIT DATE: 4� -O i 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 lea hi g faci 'ty) Feet
Furnished by '✓�-
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No. 01)3 ' ` Fee
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THE COMMONWEALTH OF MASSACdUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIppffcation for Mizpogar *p2tem Cougtructton 3permit
Application for a Permit to Construct( )Repair(d_�'IIpgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. 91 Owner's Name,Addre s and Tel.No.
�iDrsrv,V5 Ar,//S - y
`e II
Assessor'sMap/Parcel �1fh Ca
�zs�- a 2s� y _
Installer's Name,Address,and Tel.No.fog- Z/.�d— V7.3 Designer's Name,Andress and Tel.No. Sag �MI_U17117
�/bscph tI� L3 ��os ,J y ZNe,
46 akyrz-4.4114
Type of Building:
Dwelling No.of Bedrooms :!L 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 Rep ai or Alterations(Answer when applicable) ti s 04� .b2p,9
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 issued by this Board of Health.
Signed Date
Application Approved by ` s Date 02 0
Application Disapproved for the following reasons
Permit No. ';-Uy2 �.8� Date Issued q2i,75
--,-------------------------------------
No. �()���0 !j' � \ Fee J`
THE COMMONWEALTH OF MASSACHUSETTS Entered id computer: 'Yes
PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppricati4n for Mtgpo!6a16potem Construction Permit
Application for a Permit to Construct( )Repair(z'Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No.�/ Caro 9-4i h &kww y' Owner's Name,Address and Tel.No. ,j 10- 'jq q1
rGl�rsratis r�i,i/S - .
Assessor's Ma /Parcel
p
Installer's Name,Address,and Tel.No.fn- 4/?a— V 75 6r Designer's Name,Address and Tel.No.
✓bs c Ph 491 (3A"_1_o5 ,) C' / (5,tiFry/ef I-/
Type of Building:)
Dwelling No.of Bedrooms 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 Repai or Alterations(Answer when applicable) 'r5g> Y3,,� iJJ
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 th e system-in operation until a Certifi-
cate of Compliance has been issued by this Board of Health.
Signed Date -
Application Approved by �. Date 41.2 eju
Application Disapproved for the following reasons 1
Permit No. a��� — 8 7 Date Issued 2 6 u 1
THE COMMONWEALTH OF MASSACHUSETTS
t
BARNSTABLE, MASSACHUSETTS
(fertificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (e.)-L-Fpgraded( )
Abandoned( )by JdSC /,)t &�
at Z/ /a/ � . has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.a 0 o J-Jef 7 dated G h 4 U
Installer a,, S Designer C
The issuance pf t is permit shall not be construed as a guarantee that the system �Ction s gne .
Date 3 3 Inspector
--------------------------------------
No. QUy?— A Fee U
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Xtgpo!6a1 6p6tem Construction Permit
Permission is hereby granted to Construct( )Repair( 44 t1pgrade( )Abandon )
System located at 7/ ��
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 t ' e t.
Date:_ b ).2 /f Approved by ) 12 r
i
TOWN OF BARNSTABLE
SEWAGE # 2 D03�2gT
LOCATION
VILLAGE Mel:�i,Oe5 /A/�s ASSESSOR
'/S MAP& LOT��S= 025"
INSTALLER'S NAME&PHONE NO. .54 �/2D 975� '�105��� E l�•Q;"�
SEPTIC TANK CAPACITY ,90
LEACHING FACILITY: (type) 3"fod ��"�`���^d" _(size). 3
NO.OF BEDROOMS
i BUILDER OR OWNER
PERMIT DATE:, L -: ' -D COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
Feet
an wells exist
Private Water Supply Well and Leaching Facility (If any Feet �
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
within 300 feet of leaching fac' 'ty)
Furnished by
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DATE: 5/7/02
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PROPERTY ADDRESS: 71 Captain Baker Road
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-- Marstons Mills_Mass .____
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I I COVED
On the above date Inspected the septic system at the abo a 6ddress..P .
This system consists of the following:
JUN 0 4 201
1 . 1-1000 gallon septic tank .
1-Distribution box . TOWN OFBARNSTA�LE
HEALTH DEPT. 'eF
3 . 2-500 gallon leaching chambers . ( 25 ' X 12 ' 10"
Based on my Inspection, I certify the following conditions
4 . This is a title five septic system.
5 . The leaching chambers are in hydraulic failureWas•te,-,Vats'r; is
7" below the cover . 1 . 5" -2" below the invert pipe of th& chambers .
6 . A new leaching area needs to be installed .
7 . Pumped the septic tank and the two 500 gallon leaching `ch'am-bers
at time of inspection .
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SIGNATURE:1
Name: J _p._ Macomber
Company : Joseh_P_ M_ac_om_ber_& Son , Inc , MAP
P
- - PARCEL .
Address:_ Box 66- ------------- LOT
Centerville , Ma_-02632-0066
Phone: 508_775=3338_ �� 1
r 6 03
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
A
JOSEPH P. MACOMBER & SON, INC.
Tan ks-Cesspools-Leachflelds
Pumped & Installed
Town Sewer Connectlons
P.O. Box 66 Centerville, MA 02632-0066
775.3338 775.6412
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL.AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:71 Captain Baker Road
arstons i s , ass .
Owner's Name: Linda Cody
Owner's Address: Same
Date of Inspection: 5 7 0 2
Name of Inspector: (please print)Joseph P .Macomber Jr .
Company Name: J. P .Macomber & Son Inc .
Mailing Address: Box 66
Centervillp Mass 02632
Telephone Number:508-775-33 8
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. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
,/'Fails
Inspector's Signature Date:
The system inspector shall sbzt 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
f
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 I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 71 Captain Baker Road
arstons Mills , Mass .
Owner: Linda Cody
Date of Inspection: 7
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:a
,S I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or to 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
The two 500 gallon leaching chamber are in hydraulic
failure . A new leaching area needs to be instalied .
B. System Conditionally Passes:
NQ One or more system componems 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"hot 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 sepric 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.
IND explain
4)0 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:
/C() 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:
2
Page 3 of I 1
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 71 Captain Baker Road
arstons i s , ass .
Owner: Linda Cody
Date of Inspection: 5 7 0 2
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:
A)J) Cesspool or privy is within 50 feet of a surface water
AO 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.
4Z 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.
/0The system has a septic tank and SAS and the SAS is less than 100 feet but 0 feet or more from a
private water supply well". Method used to determine distance J//, / �
"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:
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Page 4 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
PropertyAddress:71 Captain Baker Road
arstons Mills , Mass .
Owoer:Linda Cody
Date of Inspection: 5 7 02
D. System Failure Criteria applicable to all systems:
You must indicate "yes"or"no"to each of the following for all inspections:
Yes No/
_ l/ ackup 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 dism'bu ion box above outlet invert due to art overloaded or clogged SAS or
cesspool Q�-rcel ck ;2G'�J,�'i���x� 1.C" ,V �
squid depth in ossspeel is less than 6" below invert or available volume is less than 'h day flow
—
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
;Any
f times pumped
i/ ny portion of the SAS, cesspool or privy is below high ground water elevation.portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
— � water supply.
��y
y portion of a cesspool or privy is within a Zone I of a public well.
_ portion of a cesspool or privy is within 50 feet of a private water supply well.
y 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.)
(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 er
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 now 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
_ 2the system is located in a nitrogen sensitive area(interim Wellhead Protection Area— IWPA) or a mapped
Zone II of a public water supply well 4.
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.
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Page 5 of 1 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 71 Captain Baker Road
Marstons Mi11s ,Mass .
Owner: Linda Cody
Date of Inspection: 5/7/0 2
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No /
_ Pumping information was provided by the owner, occupant, or Board of Health
/Were any of the system components pumped out in the previous two weeks
_ Has the system received normal flows in the previous two week period?
k/Have large volumes of water been introduced to the system recently or as part of this inspection ?
ZWere as built plans of the system obtained and examined?(If they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out ?
Were all system components,eluding the SAS, located on site ?
_ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition
of the b ffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum ?
t7 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
�I Existing information. For example, a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) (310 CMR 15.302(3)(b))
5
Page 6 of 1 I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 71 Captain Baker Road
arstons Miiis ,Mass .
Owner: Linda Cody
Date of Inspection: 5 T7 0
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms): ✓���
Number of current residents:
Does residence have a garbage grinder(yes or no):,4e
Is laundry on a separate sewage system ( es or no): [if yes separate inspection required)
Laundry system inspected(yes or no):,A `
Seasonal use: (yes or no):4,16
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump(yes or no): Z')D M
Last date of occupancy: _ , �6WkZ4
i
COMMERCIALXgDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): -2 gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no): JLQ
Industrial waste holding tank present (yes or no): r'9
Non-sanitzry 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:/] /�G' jilftClY";
Was system pumped as part of the inspection (yes or no): —S
If yes, volume pumped,:: gallons -- How was quantity pumped determined?
Reason for pumping: en aVI scum & solids layers in the septic FanK .
Waste water was below the invert pipe o the 500 gallon
TYP� OFSYSTEM leaching chambers .
!/Septic tank, distribution box, soil absorption system
Single cesspool
If/d Overflow cesspool
Privy
Shared system(yes or no)(if yes, attach previous inspection records, if any)
22L) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be
obtained from system owner)
G�Tight tank /4 Attach a copy of the DEP approval
Other(describe):
Appr ximat�ase of all co(mppne nts, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site(yes or no):
6
,Page 7 of 1 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 71 Captain Baker Road
arstons i s , ass .
Owner: Linda Cody
Date of Inspection: 2
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: U ast iron Y 40 PVC 0 other(explain): y�
Distance from private water supply well or suction line: ,&
Comments(on condition of joints, venting, evidence of leakage, etc.):
Joints appear tight . No evidence of leakage .The system is
vented through the house vents .
SEPTIC TANK: Zlocate on site plan) 11)4V4&,)5
Depth below grade: ,
Material of construction: concretedle metal 4J� fiberglass�y,�!jolyethylene
,UD other(explain) BUG
If tank is metal list age: 1W is age confirmed by a Certificate of Compliance(yes or no):1W.1 (attach a copy of
certificate)
Dimensions: F6
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle: O
Scum thickness:_ 0
Distance from top of scum to top of outlet tee or baffle: O
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined:
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of-leakage,etc.):
Once system is repaired T.he tank should hp p»mperl every
2-3 years . The ank ; s strnrtnrally sound and spews ne
evidence of leakage .
GREASE TRAP4A.0ocate on site plan)
Depth below grade:/2//J
Material of construction 44_concrete,�AmetaWli fiberglass&Lpolyethylene,U other
(explain): ,'dIX
Dimensions: It r
Scum thickness: 4)A
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: 4)4—
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
Grease trap is not RrPspnt
7
Page 8 of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 71 Captain Baker Road
Marstons Mills ,Mass .
Owner: Linda Cody
Date of Inspection: 5/7/02
TIGHT or HOLDING TANK,r(I�(tank must be pumped at time of inspection)(locate on site plan)
Depth below glade: 41A
Material of construction: 4111 concrete4/X metal 14fiberglass/��Polyethylene fiX other(explain):
Dimensions:
Capacity: allons
Design Flow: gallons/day
Alarm present (yes or no): _4#
Alarm level: /Vq Alarm in working order(yes or no): 40
Date of last pumping: AJA
Comments (condition of alarm and float switches, etc.):
Tight or holding tanks are not present
DISTRIBUTION BOX: Zif present must be opened)(locate on site plan) i
Depth of liquid level above outlet invert: �l>
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 has one lateral There is evidence of
Gnlids rarry nvar Ale evidence of solids carry over into
the two 500 gallon leaching chambers .
PUMP CHAMBER-L�/L(locate on site plan)
Pumps in working order(yes or no): lj.i4
Alarms in working order(yes or no):W
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Pump chamber is not present
8
Page 9 of 1 I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 71 Captain Baker Road
arstons i s , ass .
Owner: 'Linda Cody
Date of Inspection:5 7 02
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, excavation not required)
2-500 gallon leaching chambers . 25 ' X12 ' 10"X2 '
If SAS not located explain why:
Located ; See Dage 10
Type
*v leaching pits, number: Q �iX i
leaching chambers, number:
/,Q leaching galleries,number:Q
,14 leaching trenches,number, length:
leaching fields, number, dimensions: Q
/' overflow cesspool, number:
innovative/altemative system Type/name of technology: /l�i �' ✓C��'�>
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, con Ilion of vegetation,
etc.):
Loamy Rand to medium sand .1he chambers are in hydraulic failure . 1x5"
nndp r inyprt pine 4riimm1ayer and -olids present alSn . Sol is arp
damp . Vegetation is normal . A new leaching area needs to be installed .
CESSPOOLSit/�vw- (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: 0
Depth-top of liquid to inlet invert: ,t14
Depth of solids layer: A14
Depth of scum laver:
Dimensions of cesspool: %4
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.):
Cesspools are not present .
PRIVYq/r�(locate on site plan)
Materials of construction: 1.14
Dimensions:
Depth of solids:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
Privy is not present .
9
P age 10 of l I
OFFI CLA.L INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Properry nddress: 71 Captain Baker Road
Marstons Mills Mass .
Owocr. Linda Cody
Date of Inspcctioo; 5/7/07
SKETCH OF SEWACE DISPOSAL SYSTEM
Provide a sketch of the )twig( disposal system including tics to el least two permanent reference landmarks or
ocncrvnuks. Locatc all wills within 100 Nct. Locate whcrc public water supply enters the building.
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sV"Q'{s'eyA IL
10
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Page I I of 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 71 Captaig Baker Road
ff—arstons Miils , Mass .
Owner: Linda Cody
Date of Inspection:5 7 02
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water OGi feet
Please indicate(check)all methods used to determine the high ground water elevation:
10 O i s on record- If checked,date of design plan reviewed:
bserved site(abutting prope observation hole within 150 feet of SAS)
�hecTed wit ocal oard of Health-explain:
Checked with local excavators, installers-attach documentation)
�nAccessed USGS database-explain:, 1f�
You must describe how you established the high ground water elevation:
Used . Gahretv & Miller Model 12/16/94 Grnt,nd water elevatiaps abovQ
sea level
Used : USGS ; nhservatinn wall r1aEa June 1999
Used ; T — —1 . Annual
ranges of groun water levels .
Leaching
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:eet
Groundwater: Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore, the vertical separation distance between the botto
of the leaching pit and the adjusted groundwater table is (�
feet.
11
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,>'.'►*1T.-n,•rs+—.•rrsrnrJn>•nlinnr�>n,TT.rr+n:-nr+'*fn�r►-n•n+rrm�lu'+s^frranrnn .Tn'1•--1-.T--'..-...-..,
1 TOWN OF Barnstable BOARD OF HEALTH
0 TryR ,SUBSUNFACR SFNAGF DISPOSAL SYSTEM IINSPECTION FORM - PART D •- CERTIFICATION I
•rn.-rr•r-�• A
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 71 Captain Baker Road Marstons Mills ,Mass '
ASSESSORS MAP , BLOCK AND PARCEL
OWNER' s NAME Linda Cody-
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P .Macomber Jr .
COMPANY NAMEJ . P . Macomber & Son Incr-e
COMPANY ADDRESS Box 66 Centerville , Mass . 02632
Strvvt Town or City state-lip
COMPANY TELEPHONE (508 ) 775 _ 3338 FAX ( 508 ) 790 - 1578
CERTIFICATION STATEMCNT
0r I certify that I have personally inspected the sewage disposal system at
this address and that the information reported is true'•, accurate , and
omplete as of the time of ' inspection , The inspection was performed and any
ecom mendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems ,
Check one :
System PASSED
The inspection lihich I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 15 , 303 , Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form ,
System FAILED*
The inspection which I have con trcted has found that the system fails to
protect the i)tiblic health and the environment in accordance with Title
5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form ,
Inspector Signature4 Dat:
ne copy of this rt.ification must be provided to the OWNER, the BUYER
( .here applioable ) and the 130ARD OF HEAL1111,
* If the inspection FAILED, the owner or*"•oparator shall upgrade
he BYete
within one year of the date of the inspection , unless allowed ortrequiredm otherwise as provided in 3.10 CPIR 16 , 305 ,
partd . doc
f
TOWN OF BARNST LE
LOCATION SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT '-®
INSTALLER'S NAME&PHONE NO. �IA�5011` :7 ZL 4?-7
SEPTIC TANK CAPACITY
LEACHING FACIIITY: (type) "ti� "vim (size)/ �NO.OF BEDROOMS4
4
BUILDER OR OWNER
PERMIT DATE: 1 `3' COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Le ching Facility Feet
Private Water Supply Well and Leaching Facility (If wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any w ands exist
within 300 feet of leaching facility) Feet
Furnished by
r
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v`
r
. No. � Fee $5 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
0[pplication for Migo!6ar *p$tem Conztrurtion Permit
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
71 Capt . Baker Rd. , Marstons Mills William Kelly
Assessor's Ma /P,tel6
Installer's/Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
m. E. Robinson Septic Service
PO Box 1089, Centerville, MA
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 Sand
Nature of Repairs or Alterations(Answer when applicable) Title-5 leach System.
D-box and 2 leach chambers .
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 issued by this Board 2PHealth. G�
Signed L.�>L1 i _/ � Datee,' <
Application Approved by Date "e-`"15 —
Application Disapproved for thYfollo9ving reasons
Permit No. — Date Issued
✓` No. 1512 .. .�' ?..�.`v Fee $50
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Rp plication for 3igpozal *pgtem (Construction Permit
Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) El Complete System El Individual Components
ocation Address or Lot No. Owner's Name,Address and Tel.No.
'�1 Capt . Baker Rd. , Marstons Mills William Kelly
Assessor's,lvla /P�r-eI
Installer's/Name,,Address,and Tel.No. Designer's Name,Address and Tel.No.
m. E. Robinson Septic Service '
PO Box 1089, Centerville, b1A `
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
Tittle
Size of Septic Tank Type of S.A.S.
Description of Soil Sand
Nature of Repairs or Alterations(Answer when applicable) Title-5 leach System.
D-box and 2 leach chambers.
1
Date last inspected:
Agreement:
Tht 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 issued by this Board o ealth.
Signed
Application Approved by Date
Application Disapproved for thYfollo4ving reasons
Permit No. Ive- 3 Date Issued
———————————————————————————————————————
THE COMMONWEALTH OF MASSACHUSETTS
Kelly BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded( )
Abandon d )b Wm, E. Robinson Septic Service 7 u
' (Capin. Baker . , Mars tons Mills
at has been,c°• tructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. datetl
InstalleNT. E. Robinson S r. Designer f% ,
The issuance of this pe shall no be construed as a guarantee that the s. e will function a'designed
Date Inspector
// — � ---------------------------- — --
No. 3�� Fe
THE COMMONWEALTH OF MASSACHUSETTS
Kelly PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
xig;pozar 6potem Con5tructton Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
System located at71 Captn. Baker Rd.. . Marstons Mills
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 this permit.
Date: 1 - 2 - Approved by
r 4
1/6/99
NOTICE: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS)
I, William E . Robinson,S,zhereby certify that the application for disposal works
construction permit signed by me dated 0/' , concerning the
property located at 71 Captain Baker Rd.. , Marstons Mills meets all of the
following criteria:
• The failed system is connected to a residential dwelling only. There are no commercial or business
uses associated with the dwelling.
" e soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch.
ere are no wetlands within 100 feet of the proposed septic system
There are no private wells within 150 feet of the proposed septic system
77 ere is no increase in flow and/or change in use proposed
re are no variances requested or needed.
The bottom of the proposed leaching facility will not be located less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor
1- If
od when applicable]
1 S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed
(((( ing facility will not be located less than fourteen(14) feet above the maximum adjusted
groundwater table elevation,
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) l o
B) G.W. Elevation +the MAX. High G.W. Adjustment. = t�
DIFFERENCE BETWEEN A and B a' G 3
SIGNED : t� ` DATE:
[Sketch proposed plan of system on back].
q:health folder:cent
TOWN OF BARNST LE
LOCATION -2Z SEWAGE #2
VILLAGE •- s /' ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY /V-'0
LEACHING FACMITY: (type) -ts'� '01- (size)/L; ;I—
NO. OF BEDROOMS., �
BUILDER OR OWNER y
PERMTTDATE: COMPLIANCE DATE:
_q
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Le ching Facility.. Feet
Private Water Supply Well and Leaching Facility (If wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any w ands exist
within 300 feet of leaching facility) Feet
Furnished by
a
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L' • 4' v�\
C0:1iti20\`WE ALTH OF MASSACHli SETTS
j�
_ a EXECUTIVE OFFICE OF E.N'VIRONMENTAL AFFAIR,'
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON DLa 02108 (617) 292-5500
i \
TRUDY CORE
Secretarc
ARGEO PAUL CELLUCCI DAVID B. STRUHS
Governor J Conuniss:oner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Prop"Address: 71 Captain Baker Rd . , Name of Owner William Kelly
Mar s t o s �ii 1 s , MA Address of Owner: same
Date of Inspection: 7 /� Y
Name of Inspector:(Please Print) 1n11ri F . R nh inson Sr .
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
companyName:Wm. E . Robinson Septic Service
Mailing Address:P.0 . BOX 1089, f P'n t P ry i 1 l A _ MA
Telephone Number: 7 7 5_R 7 7 6
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site disposal systems. The system:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of
completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer, if applicable, and the approving authority.
NOTES AND COMMENTS
-J�'91
00
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WIVE r
.. AUG 2 ® 1999
4g Ile" Ats f
revised 9/2/98 Page IofII
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i0 Prcted on RecyC led Paper
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
"roperty Address:71 Captain Baker Rd.. , Marstons Mills, MA
Jwrw: William Kelly
Date of Inspection:
INSPECTION SUMMARY: Check B, C, or D:
A. SYSTEM PASSES:
-A- I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
@. SYSTEM CONDITIONALLY PASSES: a
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.
Indic to yes, no, or not determined(Y, N, or NO). Describe basis of determination in all instances. If "not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
a
revised 9/2/98 Page 2ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 71 Captain Baker Rd.. , Ma4stons Mills , MA
Owner: William Kell, 4-
Date of Inspection: ?
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 the
public health, safety and the environment.
11 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
r�
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
_ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface'water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for 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. Method used to determine distance (approximation not valid).
3) 0 HER
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revised 9/2/98 Page 3of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Prop"Address:71 Captain Baker F`d.. , Marstons;`Mill's , MA
Owner: William Kelly
Date of Inspection: ,� 1'X_9 3
D. SYSTEM FAILS:
You must indicate either "Yes" or "No to each of the following:
1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility.or system component due to an 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 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped_.
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
<coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E. LARGE YSTEM FAILS:
You must in icate either "Yes" or "No" to each of the following:
Th following criteria apply to large systems in addition to the criteria above:
T system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public
h Ith and safety and the environment because one or more of the following conditions exist:
Yes o
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)
The owner or perator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the D partment for further information.
revised 9/2/98 Page 4of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 71 Captain Baker Rd.. Marstons Mills , MA
Owner: William Kelly
Date of Inspection:
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
/ _ Pumping information was provided by the owner, occupant, or Board of Health.
_✓ _ None of the system components have been pumped for at least two weeks and-the system has been.receiving"trrmal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
_ As built plans have been obtained and examined. Note if they are not available with N/A.
_ The facility or dwelling was inspected for signs of sewage back-up.
_ The system does not receive non-sanitary or industrial waste flow.
The site was inspected for signs of breakout.
_ All system components, excluding the Soil Absorption System, have been located on the site.
ZZ _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles
or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_ Existing information. For example, Plan at B.O.H.
_ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is*unacceptable)
(15.302(3)(b))
_ _ The facility owner (and occupants,if differeru from owner) were provided with information on the proper maintanan"-of
Subsurface Disposal Systems.
revised 9/2/95 Page 5ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
°roperty Address: 71 Captain Baker Rd.. , Marstons Mills , MA
Owner: William Kelly ,
Date of Inspection:
FLOW CONDITIONS
RESIDENTIAL:
Design flow: �Y-f 0 g.p.d./bedroom.
Number of bedrooms(design): .?-`j Number of bedrooms (actual)3- 4-1
Total DESIGN flow 1
Number of current residents:
Garbage grinder(yes or no):A-0
Laundry(separate system) (yes or no)/, Q; If yes, separate inspection required
Laundry system inspected (yes or no)
Seasonal use (yes or no):Z—t-6
Water meter readings, if available (last two year's usage IgPd): 1998 120
, 000 gal.
Sump Pump(yes or no): lid 1997 105, 000ga
Last date of occupancy: 17-1
COMMERCIAL/INDUSTRIAL:
Typ of establishment:
Des i flow: 9pd ( Based on 15.203)
Basis f design flow
Greas trap present: (yes or no)_
Industr I Waste Holding Tank present: (yes or no)
Non-sa itary waste discharged to the Title 5 system: (yes or no)_
Water eter readings, if available:
Last d e of occupancy:
OTHE :(Describe)
Last of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no)xz";.-S
If yes, volume pumped:�66-'d gallons
Reason for pumping: ' °
TYPEPKSYSTEM
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)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components, date installed(if known)and source of information: e a --2
b �
Sewage odors detected when arriving at the site: (yes or no)
revised 9/2/98 Page 6of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
'rop"Address: 71 Captain Baker Rd.. , Marstons Mills , MA
Owner: William Kelly
Date of Inspec ion: . o7
B ILDING SEWER:
(Lo ate on site plan)
Dep below grade:_
Mat rial of construction:_cast iron_40 PVC_ other(explain)
Dist nce from private water supply well or suction line
Dia eter
Co ments: (condition of joints, venting, evidence of leakage,-etc.)
SEPTIC TANK:_
(locate on site plan)
E �
Depth below grade:A)
d
Material of construction: concrete_metal_Fiberglass _Polyethylene_other(explain)
If tank is metal,list age_ Is.age confirmed by Certificate of Compliance_ (Yes/No)
Dimensions:
Sludge depth:_ o
Distance from top of sludge to bottom of outlet tee or-baffle:
Scum thickness: 0
Distance from top of scum to top of outlet tee or baffler
Distance from bottom of scum to bottom of outlet tee or baffler
How dimensions were determined: D ri:--A:=i 7+ w
"omments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural irate rity,
evidence of leakage, etc.) 4 }
S'
.3
GR S TRAP:
(locate o site plan)
Depth bel w grade:_
Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain)
Dimensions
Scum thick ess:
Distance fr m top of scum to top of outlet tee or baffle:
Distance fr m bottom of scum to bottom of outlet tee or baffle:
Date of las pumping:
Comment
(recomm ndation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evidenc of leakage,etc.)
revised 9/2/98 Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
i1ropertyAddress: 71 Captain Baker; Rd . , Marstons Mills , MA
Owner: William Kell
Date of Inspection:
TM N
T OR HOLDING TANK: (Tank must.be pumped prior to, or at time of, inspection)
(loca a on site plan)
Dept below grade:_
Mater al of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain)
Dime ions:
Capa ty: gallons
Desig flow: gallons/day
Alar present
Alar level: Alarm in working order: Yes_ No_
Dot of previous pumping:
C ments:
(c dition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equa, evidence of solids c rryover, evidence of leakage into or out of box, etc.) -
PUMP HAMBER:_
(locate n site plan)
Pumps n working order: (Yes or No)
Alarm in working order(Yes or No)
Com nts:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
revised 9/2/98 Page 8of11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
'rop"Address: 71 Captain Baker. Rd.. , Marstons Mills , MA
Owner: William Kelly
Date of Inspection:
SOIL ABSORPTION SYSTEM(SAS):
(locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods)
If not located, explain:
Type:
leaching pits, number:
leaching chambers, number:
leaching galleries, number:_
leaching trenches, number, length: -
leaching fields, number, dimensions:
overflow cesspool, number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic allure, level of ponding, damp soil, condition of vegetation, etc.)
'Oai i
CES POOLS:_
(locat on site plan) j
Numbe and configuration:
Depth•t p of liquid to inlet invert:
Depth o solids layer.
)epth o scum layer:
Dimensi s of cesspool:
Materials of construction:
Indicatio of groundwater.
nflow (cesspool must be pumped as part of inspection)
i
Comment
I
(note con ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
t
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PRIVY:_
(locat on site plan)
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Mate ials of construction: ,' Dimensions:
Depth f solids:
Comm ts:
(note c ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
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revised 9/2/98 Page 9of11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C .
SYSTEM INFORMATION(contirwed)
Nop"Address: 71 Captain Baker, Rd..-, Marstons Mills , MA
)weer: William Nly
Jate of Inspection: ,, ,�
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
4
4?
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revised 9/2/98 Page 10of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
rop"Address: 71 Captain Baker Rd.. , Marstons Mills , MA
Owner: William Kelly
Date of Inspection: t;Z—9
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
k
Estimated Depth to Groundwater( Feet
Please indicate all the methods used to determine High Groundwater Elevation:
``��
Obtained from Design Plans on record
,VObserved Site(Abutting property, observation hole, basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators, installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
revised 9/2/98 Page 11of11
Health Complaints
07-May-02
Time: Date: Complaint Number: 3407
Referred To: DAVID STANTON Taken By: DANIELLE ST.PETER
Complaint Type: TITLE V SEWAGE
Article X Detail:
Business Name:
Number: 71 Street: CAPTAIN BAKER
Village: MARSTONS MILLS Assessors Map Parcel:
Complaint Description: MACOMBER LEFT COVERS OFF SEPTIC
TANK
Actions Taken/Results: I SPOKE WITH MACOMBER, THEY SAID
THE HOMEOWNER TOLD THE TRUCK
DRIVER TO LEAVE THE COVER OFF THE
TANK, BECAUSE SHE WANTED THE
INSTALLER(BILL ROBINSON)TO TAKE A
LOOK AT IT. MACOMBER FAILED THE
INSPECTION BECAUSE IT WAS FULL.
MACOMBER SAID THEY DID SOME
RESEARCH WITH THE WATER
DEPARTMENT, AND THEY HAD HIGH
WATER USE AT THE HOUSE.
Investigation Date: 5/7/2002 Investigation Time: 1:30:00 PM
1
No. .............. '": " Fizz..............................
THE COMMONWEALTH OF MASSACHUSETTS
B®AR® HEAL
l ....... - � ....OF......-.. -{fin.
Appliration for Uispaaal Works Towitrnrtinn Vamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
� System at:,nr�. /�P - ....................................---- ---------------------------------------------------
Location-Address �. or Lot No.
.....1[L_4............................. ..... ................l_[__..,. ___........._._........p-_____..... .Lf.._! /S..__
Owner Address
W
Installer Address
Type of Building Size Lot_d______..____7_E..Sq. feet
aDwelling—No. of Bedrooms------3-----------------------------------Expansion Attic (Zo) Garbage Grinder (✓�)
p, Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
a Other fixtures -----------_--_------ ---- --
W Design Flow....... .__________________________gallons per person per day. Total daily flow----..... .................................gallons.
WSeptic Tank I Liquid capacity_/4ed_gallons Length................ Width................ Diameter---------------- Depth................
Disposal Trench—No_ ____________________ Width.........-........... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No._._I............. Diameter_.. _______ Depth below inlet___h.............. Total leaching area..;?_5;�(__....sq. ft.
Z Other Distribution box (1 ) Dosing tank
aPercolation Test Results Performed by. -)�i _. o'l..._. ,�� ........... Date.... .........
Test Pit No. 1................minutes per inch Depth of Test Pit_________ _______ Depth to ground water.........._.............
(% Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
R+ + r = tt---------
Description of Soil......-�--�-.---•�----- --- ---- /-� - ....------ -
x
V -----------------------••-•------------------•-------------------------------••----•-•---•-•----------------•---•-----•••--•------•-----•----------•-----------•-----------------•-•-------------•-----
W -------------------------- --------•---------------------•----------------------------•---------------------------------------------__.__.._----------------------------------------------------•-------
UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________
-----------------------------------------------•----•-----------------------------•----------------------•-•---•--•----------------•-------------------•---------._.....-------•-------•-- ------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of LiTLEI,
p of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Sign -_ ------------------•--------...._...-•----......------....------..... ... •--------••........_--
Date
Application Approved BY----- � -------_------------•- /...c.....'......
..
Date
Application Disapproved for the following reasons:_________________________ ••--•.............•---•---•--•......................-------•---.. ......-_.._.__
---•----•-•-.....•--•-------••--------------•--•-------•----•----••---•---•----------•....._-•----------.
Date
PermitNo......................................................... Issued_.....`t ....................
Date
No. .......... FEB..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® qF HE L
---------.----14^ o F.........
Appliration for Bi-gpoiml Work.5 Tomtrnrtiun Vantit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
V . . GJi A/a/rG.... ......I....w • �.1 .... ........................... .............................
J` ......_..... !• ....
Owner Address
W
Installer Address
Q Type of Building Size Lot. 0._.�.... ...Sq. feet
U Dwelling No. of Bedrooms-------. ----------------------------------Expansion Attic x Garbage Grinder '
`L4 Other—Type of Building No. of persons............................ Showers — Cafeteria
QI Other fixtures ......................................................
Design Flow--------lir............................. Cy
w ggallons per person per day. Total daily flow...........................................gallons.
W Septic Tank I Liquid capacity./)?'?_gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—-No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No...... y._____-_-- Diameter___t�_4...... Depth below inlet.... ............. Total leachIngar .. .. sq. ft.
Z Other Distribution box .( I ) Dosing tank ( OR. A4i
aPercolation Test Results Performed by. _�1 F �!1•___ ! ...G'_ r__________. Date.. l ..�.. _._�_.... __-.
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-----------_............ .
LT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
D Description of Soil......` _a.� 7 ..__s ""---��_- ----- *G +�-
-----
-------------------------------------
x Pl
�.,
w
U Nature of Repairs or Alterations—Answer when applicable.____________________________•--_-_----:._.____-___------_-_____--___-____•_•___------••-----_-.
-----------------------------------••-----......•-----------------------. ...........................................................------------------------------------------------------•--•---•----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of f'1T�'1�-'•
1� 1 . E 5 of the State Sanitary Code'—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
sign: -----D..-------------
Application Approved BY y�� '. l1.. 1/ ma' s-----------------------
-•-- ------...........................
Date
Application Disapproved for the following reasons:--..........................................................-----------.......................................
..................................•----------------------•-••-----------------•----....--------•---•-----•------------------------•-•--------•-•--•-----------•--•---------------•------•-••------------
Date
Permit No.................•-
......---•--•----------------------_ Issued_--`-'- �-!��----------.._..__._...._......----
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
.................. ' OF............. :.. ..:f1-f!. .........................................
'up rdifiratr of Toutplinurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by -----------
T stall
has been installed in accordance with the provisions of T1 5 o .T e State Sanitary Cpde a d c Abed in the
application for Disposal Works Construction Permit No.__' --. .`g""
--------- ------------ da.ted ---------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME
SYSTEM'WILL FUNCTION SATISFACTORY.
DATE............... - -------- •---•-..----- ''
'. Inspector............... ..............................................
THE COMMONWEALTH OF MASSACHUSETTS
� BOARD OF HEA TH
� � O
..........oF...-......No.......... �....... FEE..� ............
Disposal sal rkn 01.1 nitrnrtion rrntit i
Permission is hereby granted-------------------- - •--_.._::.----...-•-------------------------------••---...------•------•----------..._..._..------••---•--..........
to Const4�,i.'>
� or ejif ( ) an I di ual eV ge Dispo / i�
at No..... -.... ... .1C}�$----- r...-----. ��.I. � C/ 'C��/' ,f�f' / ............
Str et
as shown on the application for Disposal Works Construction Permit o..../ IIWA�I�y
D'ated__----
.�.�..�______________
°
Board of Health
DATE--------------- 2.................................................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
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LOCATION ' SEW&C,E PERMIT UO.
�D
oC)�' s 5
IWST&LLER 5 ►J&1 AE A DRESS
BUILDERS 1.1 &VAE ADDRESS
DATE PERNAIT ISSUED - - - - - - -
DATE COMPLI &&ICE ISSUED : - - -
ACV
4,1 raze—
No..----- W`c' FEE. //)...............
THECOMMONWEALTH FHASA THL Ts
BOARD
�.
Appliration -fur 43itiplaiittl Worbi Towitrurtiou Permit
Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal
System at: d c.&X C4 4t Uy "�- Cowj dJ*,61C
� . td W--_ Si ,/ ! - ---------------------------------------cll�------------------------------ -=.-------------
Location-Ad ress or Lot N
art'.. '� Y-.-..C��...................... �i�, �� �- }G�.��4
-- ----- ---------------------
Owne Address
�Q@.' v ---------------------------------------- .....:........----------------------------•-•----
Installer_ Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms----_- Expansion Attic ( ) Garbage Grinder-------------------------------------- ( )
aOther—Type of Building ---------------------------- No. of persons.---�----------------- Showers ( ) — Cafeteria ( )
a
� Other fixtures ---•--------------------------------------------------------------------------
Design Flow............................................gallons per person per day. Total daily flow...........................................-gallons.
WSeptic Tank—Liquid capacity-/W_.gallons Length---------------- Width................ Diameter.......... ..... Depth..---__-_-.-.._
x Disposal Trench—I;. .................... Width----------------- al�j .................. Total leaching area........._......_...sq. ft.
Seepage Pit No.................... Diameter.Z.004_64%. Depthh elo , inlet_.... __.. ...... Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank ( ) �� ;I —/3` 7
Percolation Test Results Performed by------- ---------------•--•-•-------.............---•--••----------...... Date.......................... ------------
W
W Test Pit No. 1.................minutes per inch Depth of "Pest Pit.................... Depth to ground water...-------_----._.------
(� Test Pit No. 2................minutes per inch Depth of Test Pit.................._. Depth to ground water.......-.----..--__----.
------------------------------•-----.... dog_
-•--Description of Soil .` .�-------- - ---------•---•-------•------- - -----------'-5�-------- -- '
U ----------------
'=! 1 �__ -----------------------------------------------------
U Nature of Repairs or Alt rations—Answer when applicable------------------------------------------------------------------------------------------------
--------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of kealth.
Sig ed----- 2—
Date
Application Approved By--....-- ---- .......... . -,._.Z
' Date
Application Disapproved for the following reasons------------------------------------- ---------------------------------------------------------•-------------••--
............................... ..........................................•..............................................................................................................................
Date
PermitNo......................................................... Issued...................... .................................
Date
6P
NO......... a•--•••••. Flcs.../2............._
THE COMMONWEALTH OF MASSACHUSETTS
7. BOARD , F HEALTH
'f.. . .. _. ..._.............OF....... .......... ...... - -----------------
. pphratinn -for IMipmat Workii Tutudrnr#inn Vatui#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage` Disposal
System at: ,,tUr{ Clj/-7 /t crtC Y
W,aJ , r '
......------------- ...../�..
-------------------•-------..................------•--•--,--- ........................................ -------...----------------------------------------
Location.Address or Lot No
...................... .........................
Owne Address
WAG r . /1/912
-•-----•--••--------••-•---- ' - �� ................ ..................................
------------------------------------------------------
Installer Address
Q Type of Building Size Lot----------------------------Sq. feet
Dwelling—No. of Bedrooms.--_--p2------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building No. of persons 0.1 YP g ---•.............•---------- P ------..._........ Showers ( ) — Cafeteria ( )
0.' Other fixtures .........................................
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity.1�9'..gallons Length................ Width.........--..... Diameter------- ........ Depth----------------
x Disposal Trench—No- -------------------- Width........._------_�y..-Total Lepgtl--_--____.--____---. Total leaching area----.--._--_-_---.-sq. ft.
V/(AV I /-/I �i I -
___-- Diameter.t(iGG C�--- Depth below inlet..... .............. Total leaching area----._-.--..-._--sc ft.
� Seepage Pit No_______ _______ p g< 1.
Z Other Distribution box ( ) Dosing tank ( ) v,b /3- 7 6
a Percolation Test Results Performed bY---------- ---•----.. ..................... --------•---- -------- Date..............-------------------------
.
a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water..-.--_-_-_-----.-----
fX Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--..-.-..-_.---------.-.
Ix ......•----••---------------•-- ............z ..••--
Description of Soil.-�----------�--------- - •--.....---• !fir,---•--...-rJ:�'�------- --- --.�_.._.---- --- �7 .�j..- - •--- ---
x _
W •••-------------------------•.... . -- --- ...mot �' ------ -- -----------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable..------------------------..................
-------•-------------------•---•-•--••----------•-••-------•-------------------•--•---•-----•-----•--------••---------------------••---•------•--------•---------------•------•-•-----•--•-------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of),ealth.
t%! �ilt .
Sig ed.......,, _" ......-•---- --- a----------------
/� � Date
Application Approved BY--------1------------- -----�=-�/� �s�C.�L ----------------------- G=` . . ................ Z .
Date
Application Disapproved for the following reasons:.............................................................................................................•..
...........................-...................... -----------------------------------------------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued...................... .................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD .,OF HEALTbA
err#if irn#.e oflnt�VIittnrr l/
IS T CER" IF „ That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
by--%�.. ----- --
nstaller
at.... ..Z.--•--•- ---`---..-1.-�i�. - - V<-!^^---/C =----K/•u�i(,�t.4/'Wlt------- -J.._�n_Apd..=----- ------- --4- ---- ------
has been installed in accordance with the provisions of Ar cl I off The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. � __.____:_l.�.._...__._.. dated.--.._.'�...-. __G................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------- ..'� ............................... Inspector---�,.? .
THE COMMONWEALTH OF MASSACHUSETTS
7G BOARD 9 HEALT
..........OF......... .......
...................
No......................... FEE.I.....................
Bi-nVnli nr Tnni#rnr#inn Vrrnti#
Permission is hereby granted �- ••--.•--•-
to Cons o�-Re ar ( an Ind" idual �f ag D'spo al Syste /i v/ {
Street .2` /
as shown on the application for Disposal Works Construction Per No. _.._..__. Dated...�-.'...............................
- ------- -- -- --- - - ------ ----------------------
DATE `....7(` - ..._
//- Board of Health
/ / --- -----------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
i
CAPr: ,ate Yov�
-�5 �13- 13
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CERTIFIED PLOT PLAN
LOCATI 0N1 . ---
S C A L E D A T E e 7- -
R E P E R E N C E 8,x /,Cer S O T Z Z
rj9��v 5 TA r3 E ,�'� / 7-R K p� J� �f -s A6ar 2-7 f 724
rl -IF.
I HEREBY C E R T I FY THAT THE ft3U1 LDING
SHOWN ON THIS PLAN 1 5 L O C " T E D O N
THE GROUND AS 5 HOVVN HEREON AND �>u
T H A T I T 2�— C O N F O R kA T G T H E ',' SrAOF f,
ZONING BY - LA. wS OF THE TOWN OF
W H E N C O N 5 T R U C T E ) `4 GEORGE
�v LOW,1Q.
4 ti
BAR NSTABLt SURVEY C 0 N Sl_1L ?+ A r., r (,, INC
W E 5 T YA. RMOUTN KAA55
1�'3,3
5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS= 49,00' •- 48.80' GENERAL NOTES
TOP OF FOUNDATION= 50.50' REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM
� 4" SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE i
FINISH GRADE OVER D-BOX= 48.85 1. UNLESS OTHERWISE NOTED ALL SYSTEM COMPONENTS AND CONSTRUCTION
4 9.10' t0 48.90' 2" OF 1/8"TO 1/2" DOUBLE WASHED STONE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE
49.50' FINISH GRADE OVER TANK EL.= ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES.
FINISH GRADE @FND. EL.= -----
TOP OF SAS= 46,54� PLACE RISERS ON ALL CHAMBERS
20 MIN.ACCESS COVER 9"MIN. TO 6"OF FINISHED GRADE 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
(TYPICAL FOR 3) 36"MAX. „� I
EXISTING 4" f _ 45. 1 36"MAX. BREAKOUT EL = 46.21' OF HEALTH AND THE DESIGN ENGINEER.
-PVC PIPE
3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL
f 2" DROP MIN. PROVIDE WATERTIGHT BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. I
6 3 - 3"DROP MAX. 3 9 - JOINTS(TYP.) _
4"PVC IN FROM _ C ' O o00 O oo� 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS THAN
C 46.44' SEPTIC TANK 4 PVC OUT TO o00 0o bo ELEVATION=46.21 FOR A DISTANCE OF 15 AROUND THE PERIMETER OF THE SAS. UNLESS
14 LEACHING FACILITY T o0o =j 0 o o A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
(CONTRACTCR
46.64� � oo THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
SHALL VERIFY)
(CONTRACTOR OUTLET TEE ' 12° 2' o =1 = � 0 � � � 0 0 00 0 = = = = = o0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
SHALL VERIFY) 45.96 MIN. 45.79 0� o00 00 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
48"
CONTRACTOR TO VERIFY =1 = = = =i
EXISTING SIZE OF TANK AND 22"ZABEL FILTER 6" CRUSHED STONE � o0 0 _ 0 0 = 0 0
10.4 OVER MECHANICALLY 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED
(APPROX.)
EXISTING TEES MODEL#A1801 HIP COMPACTED BASE 4 -..-•--- 8.5' I� � 4�- L 4 g, � 41 PRIOR TO BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND
(GAS BAFFLE ON 995• (TYP) READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED
BOTTOM) 5 OUTLET DISTRIBUTION BOX - , WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH.
TO BE INSTALLED ON A LEVEL STABLE , GROUND WATER ELEV.= < 35.1 12.9'
EXISTING 1000 GALLON CONCRETE SEPTIC TANK BASE. FIRST TWO FEET OF OUTLET 43.71 � •
PIPES TO BE LAID LEVEL. 3 - 500 GAL. CHAMBERS 5'MIN. 8. ELEVATIONS BASED ON ASSUMED DATUM OF 50.0'MSL OBTAINED
LENGTH 8'6" WIDTH 4110„ DEPTH 5'71� CROSS SECTION VIEW
CHAMBER END VIEW FROM CORNER OF BULKHEAD AS SHOWN ON PLAN.
TYPICAL CHAMBER PROFILE CHAMBER DETAILS 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL NOT TO SCALE
NOT TO SCALE NOT TO SCALE THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE
AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY
DISCREPANCIES TO THE DESIGN ENGINEER.
TEST PIT DATA
r
• ,� i, �- �,� � � ,*! 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
STRUCTURES SHALL BE MADE WATERTIGHT,
x � rx yjvr ,,Y INSPECTOR:
°`� �" , '� j � r :a� � �� SOIL EVALUATOR: Samuel Philos Jensen 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR7:1
" ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN
OWN
DATE: August 26.2002
SUCH DETERMINATION FROM APPROPRIATE AUTHORITYTEST PIT#: 1
.ri'xj' �,yxti* Vi 4* ii ss c�yRL3'L yµli r '
" . d 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
� - ti � ♦ � t ELEV TOP= 48.86
ti,„,•yam,I ,,ylv,,.y.p. ti7, ,Y , G+ 4 �,,�, 14 . �� ,u + ,�;f..,. *" my;, ,, -. •* _ LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH
i
ELEV WATER >13.75'BGS CASE THEY SHALL WITHSTAND H-20 LOADING.
v-s by , i !r •. , »y yrCY f � �Ir.. { } '
W E
ea
PERC RATE= <2 Min/In(Assumed) 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT DUST AND
� y' ya;rEe'���� x'vw. FINES.
vz� �' ,, ,: ti DEPTH OF PERC= N.A. d
ry• 4 L
,y, L i', yb 5" 4i y 14. WHERE REQUIRED CONTRACTOR SHALL REMOVE ALL LOAM SUBSOIL AND
MAP 126 PARCEL 052 � ��� '„, ,;• ',"'��� ;��h�iy ������, �" ,
µ a/� y � TEXTURAL CLASS: 1 UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES
Lrw
OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN
MAP 126 PARCEL 053 COARSE SAND FREE FROM CLAY, FINES OR OTHER UNSUITABLE MATERIAL IN
NJF SISSON c> '
0 48.86' - ACCORDANCE WITH 310 CMR 15.255(3).
r
x,
A Sandy Loani 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES
10YR 5/3 FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
DISTRIBUTION BOX OVE/REPLACE . ` ,� � � "
4 T� T� F� �' p�,Y thL 'i a
`�.� EXISTING SANDBOX } zy t � " , 1 s; I �i , s
G 16. PROPOSED PROJECT IS LOCATED WITHIN:
a' A x t(
MOVE/REPLACE _..,-REMOVE UNSUITABLE SOIL WITHIN 5-FT � � I§� � u 1'` B Sat 5Y 6/6 Loamy
r� H ro
PORTABLE DOG 48 84 OF SYSTEM TO DEPTH OF 7.5-FT BELOW ASSESSORS MAP 125 PARCEL 025
FENCE "
GRADE(MIN.)AND REPLACE WITH kw "
" ` • x fit* 23" 46.9' '17. OWNER OF RECORD: LYNDA ANN CODY
., CLEAN SAND(SEE NOTE 14) ADDRESS:
! , HAYES RD
* Loamy San
• O .:. C1 L 2.5Y 5/4 d HINGHAM, MA 02043
::...
NSTALL THREE 500 GAL
INFILTRATION CHAMBERS
x 48.60 p Na
Firm t
A
. .. ,. .: ,..: ,.. y ;.. { . .•; .. ..,. .` gib•;. - .$ •i PLAIy..RFFFRENCF:
AP 25 PARCEL 026 i !
/F. INr 0 ,
I:,. K.. 6
.� XISTING CHAMBERS TO 3S„
TP 1 Cp / 1p " . � z t �' _ 2.5Y "4 ., �,,
968� �V CZ ALL DIS I URBEL ARE SHALL B_ RESTORED TO ORIGINAL CONDITION.
BE PUMPED AND•FILLEC �� �. ''� A ITI
WITH CLEAN SAND
48.86 = No Grpurd;:atar or .20 PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
O r Weeping Qbservetl
• .'=' 165" 35.1' FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
LOCUS PLAN FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
:;::: 49.61 X0 B.M.
J c Corner of Bulkhead SCALE: 1"= 1000'
v Elev. = 50.00'
Assumed DESIGN DATA
LEGEND
#71 1�`; x 50 EXISTING SPOT GRADES
EXISTING 4 �'r '•• -------.._..._ 50 -------........._
EXISTING CONTOUR
BEDROOM
DWELLING %" ►� NUMBER OF BEDROOMS _4
50 PROPOSED SPOT GRADES
NUMBER OF PERSONS 4
T.O.F. =50.50' `% O DESIGN FLOW 110 GAUDAY/BEDROOM � � PROPOSED CONTOUR
EXISTING O� TOTAL DESIGN FLOW 440 GAUDAY - EITfC -- -- - - EXISTING
ELECTRICAL UTILITIES
GARAGE �' DESIGN FLOW X 200 % _ _ 880 GAL/DAY
GAS EXISTING GAS LINE
SHED p� USE EXISTING 1000-GALLON SEPTIC TANK
oNq Cb EXISTING WATER LINE
V �-LO TEST PIT LOCATION
�iC� INSTALL 3- 500 GAL. CHAMBERS
EXISTING GRAVEL DRIVE EXISTING SEP11C TANK
SIDEWALL CAPACITY
4"SOLID SCHEDULE 40 PVC PIPE
(LENGTH+WIDTH) (2) (2'HIGH) (.74 GPD/S.F.) GAUDAY
(33.5'+12.9') (2) (2') (0.74 GPD/S.F.)= 137.3 GAUDAY '
❑ DISTRIBUTION BOX
a MAP 125 PARCEL 025 °" v I 500 GAL. LEACHING CHAMBER
�o,�, G► 20,978 SF+ BOTTOM CAPACITY
9�06 CB/FND (LENGTH x WIDTH) (.74 GPD/S.F.) _ GAUDAIY
J (33.5'x12.9) (.74 GPD/S.F.) - 319.8 GAUDAY ?EV. DATE BY APP'D. DESCRIPTION
- �
cB/FND(DISTURBED) PROPOSED SEPTIC SYSTEM UPGRADE
�=47.12'
R=3 o.o o TOTALS' PREPARED FOR:
LYNDA ANN CODY
TOTAL NUMBER OF CHAMBERS: 3 Y/
LOCATED AT
TOTAL LEACHING AREA: 617.7 SQ.FT. I
TOTAL LEACHING CAPACITY: 457.1 GAL./DAY
CB/FND 71 CAPTAIN BAKER ROAD l
MARSTONS MILLS, MA 02648
SCALE: 1 INCH = 20 FT. DATE: SEPTEMBER 12, 2002
LATHOF 0 10 20 40 80 FEET
JOHN 1,
a� u.
CH
m
u URCHIU. -� PREPARED BY.
r JR
CrO
JC ENGINEERING, INC.
t N 5 ROUNDHILL BLVD.
- EAST WAREHAM, MA 02538
SITE PLAN 508.273.0377
Drawn By: SPJ Designed By: SPJ Checked By: JLC JOB No.275
SCALE: 1"=20'
-7,