The URL can be used to link to this page

Home My WebLink About0029 CEDAR TREE NECK ROAD - Health 29 C,edar, Tree ?Neck ,0 Marstons Mills A= 075 - 018 - TOWN OF BARNSTI III LOCATIOl SEWAGE # VILLAGE �Pr{L DNS tc-�� ASSESSOR'S MAP & LOT S'v Iff INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY O - P-rr 1 l�- LEACHING FACILITY: (type)2I 10b2 Loci — (size) uO O Co- vrv� NO. DROOMS UILDE R OWNER -" � C F -LDS 1� (• -Ny /3tLL"Q.*J PE ITDATE: 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 C Ll- e"��5 & �-L 1njq it -7 Do*- E f - Z,,► i I I i �f COMMONWEA�T4- OF jASSACH,, SE-S 'P*;i 7�d EXECUTIVE OFFICE OF ENVIROINI EN-rAL AFFAIRS 7asle e ' DEPARTMENT OF ENVIRONMENTAL PROTECTION / TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: -rr,.c Ne.1 5�7� 3o `` r iM O r Owner's Name: Owner's Address• 6�8 Date of Inspection: Name of Inspector• lea a print)P r`��eCe 2 eT T Company Name: rgrIG ut►ov�rlj, nb� 'ror.s Mailing Address: MAQ6`Lf1 Telephone Number: 5+ 77V`da 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: ALI Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. 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. Title 5 Inspection Form 6/15/2000 page I Page 2 of I 1 OFFICIAL INSPECTION FORM--`;NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: �Cp /J&k. �M Owner: p 95 Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have hot found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"sec' need to be replaced or repaired.The system,upon completion of the replacement or repair,as approv the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the folio g statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or th eptic tank(whether metal or not)is struct=lly unsound,exhibits substantial infiltration or exfiltration or failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank approved by the Board of Health. *A metal septic tank will pass inspection if it is stru y sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old' vailable. ND explain: Observation of sewage backup break Out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broke settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)anzeplaced obstructionisymoved distnbution box is kweled or replaced ND explain: The system,r quired pumping more than 4 times a year due to broken or obstructed pipes).The system will pass inspection if ith approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 r Page 3 of I I OFFICIAL INSPEO T ION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: N CCAr ;-ry c kAA LS n,aAi?a Owner f Date of Inspection: $Q 03 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Hea 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 ace dance with 310 CMR 15.303(i)(b)that the system is not functioning in a manner which will protect ublic health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface w r ____ Cesspool or privy is within 50 feet of a borde ' vegetated wetland or a salt marsh 2. System will fail unless the Board of He th(and Public Water Supplier,if any)determines that the system is functioning in a manner that pr tects the public health,safety and environment: — The system has a septic tank soil absorption system SAS and the SA surface w � y (SAS) S is within 100 feet of a water supply or tributary t a surface water supply. The system has a septic and SAS and the SAS is within a Zone 1 of a public water supply. — The system has a sept tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a tic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply Ii**.Method used to determine distance **This system em p s if the well water analysis,performed at a DEP certified Laboratory,for coliform bacteria and vol ile organic compounds indicates that the well is free from pollution from that facility and the presence o ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure crite " are triggered_A copy of the analysis must be attached to this form_ 3. Ot r: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.A CERTIFICATION(continued) Property Address: C � l/'t'r f�CkAWT Owner: J t a Date of Inspection: 6 M900= D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No AC Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _+A 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 or Liquid depth in cesspool is less than 6"below invert or available volume is less than'/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 SAS,cesspool or privy is below high ground water elevation. 0' Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.IThis system passes if the well water analysis, performed at a DEP certified laboratory,for coliferm bacteria and volatile organic.compomWs 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 S ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) �99 MW (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of . Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a fa ' ' with a design flow of 10,000 gpd to 15,000 Youmust indicate either"yes"or"no"to each of o owing: (The following criteria apply to large systems' addition to the criteria above) yes no the system is within 40 eet of a surface drinking water supply /th200 feet of a tributary to a surface drinking water supply — _ ocated in a nitrogen sensitive area(Interim Wellhead Protection Area—lWPA)or a mapped blic water supply well ifyouhaes"to any question in Section E the system is considered a significant threat,or answered "yes"ine the large system has failed.The owner or operator of any Iazge system considered a. significant threat under Section E or failed under Section.D shall upgrade the system in accordance with 310 CMR re t. 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B [C/H�EOCKLIST Property Address: Aw1/t'tP N�-�C IW cr - Owner- yr Date of Inspection: 4 3q OS— Check if the following have been done.You must indicate`yes"or"no"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? _ Have large volumes of water been introduced to the system recently or as part of this inspection? Y _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) — Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of thebaffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? K — 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 — 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 CNM 15.302(3)(b)] 5 r Page 6 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 7rVf mt 'C!s Owner: f Date of Inspection: oS- FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_�K Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents:0 Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):W [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use:(yes or no):- Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):!y Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 31Q CMR t5.203): apd Basis of design flow(seats/persons/sq c.): Grease trap present(yes-or no): Industrial waste holding tank p ent(yes or no):— Non-sanitary waste dischar� to the Title 5 system(yes or no):— Water meter readings,i ailable: Last date of occup n /use: OTHER(desc a}: GENERAL INFORMATION Pumping Records Source of information: To Was system pumped as part of the inspecti (yes or no):jog If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Y Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool —Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components to ins led(if known)and source of information: to Were sewage odors detected when arriving at the site(yes or no):/'UO 6 Page 7 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: r y/`* /JCGk Owner: Date of Inspection: BUILDING SEWER(locate on site plan) . Depth below grade:-,� Materials of construction: cast iron X 40 PVC`other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (J (locate on site plan) N II Depth below grade: 09 Material of construction: 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: /5 X Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: o�f Or Scum thickness:_._ Distance from top of scum to top of outlet tee or baffle: 7 Distance from bottom of scum to bottom of outlet tee or aiRe /V How were dimensions determined:_ , 'r//z Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,Iiquid levels as related_W outlet in a evidence of le aka e,etc.): 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 outlet tee or baffle: Distance from bottom of scum ttom of outlet tee or baffle: Date of last pumping: Comments(on pumping commendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet inv evidence of leakage,etc.): 7 Page g of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: c� act (r+C�lt/ Owner: a Date of Inspection: p TIGHT or HOLDING TANK: (tank must be pum at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete m fiberglass_polyethylene other(explain): Dimensions: Capacity: Zno): Design Flow: Ions/day Alarm present(yeAlarm level: der(yes or no): Date of last pumpiComments(condititches,etc.): DISTRIBUTION BOX: iC (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: &t0t,% 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.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no):. Alarms in worldng order(yes or no): Comments(note condition of p chamber,condition of pumps and appurtenances,etc.): �� - 8 Page 9 of I I OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSUAFACI SE*ACE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: on CeAr rer " r Owner Ni _ Date of Inspection: 6 cW o SOIL ABSORPTION SYSTEM(SAS):JK(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: v9 leaching chambers,number. leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): re t a6f d'a 0 trod b ef- 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 laver: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater, ow(yes or no): Comments(note conditto of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note con di on of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 3 PART C SYSTEM INFORMATION(continued) Property Address: 6 eA t,. !r. Cck-W . � Owner: r cc Date of Inspection: Q 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_ �7 in f I p�� 5 3a iR 11 Page H of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addr o� �I d �a Owner: ,:s* _ Date of Inspection: 00 SITE EXAM Slope pe S. Surface water lia Check cellar Y0 Shallow wells /U8 Estimated depth to ground water_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 Iocal excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high gro d w ter elevation: $- -4c 14 9he— u o .20 li N 7g•45'20 E 46• w D .296.46 BUILD SG STOZg DEwNG I. •� 11 DECK POOL NOT ALLOWED / WITHIN 20' OF LEACHING PITS D-OBOX ISEPTIC TA K APPROXIMATE CHAIN_U EXISTING SEPTIC NK ONCE LOCATION OF SYSTEM 1 \ A . CONSERVATION. Q SF �� : EASEME 4T ACRES (SCALED FROM REC 9 q 0 ORD PLA1) OCA CK LINE -- 1• S 7g'0T1��• 516.38 CBS TO CB _ 5 9-07 Z 2- 5 - LOT 4 — MICHAEL N. COULTER, ET UX. G7 JENMU NOTES : THE INTENT OF THIS PLAN IS TO DETAIL IXISTING SITE CONDITIONS AT THIS SITE 5•) A TITLE SEARCH HAS AOT BEEN PERFORMED FOR'THIS SITE IF DE LOCUS IS COMPRISED OF : NECESSARY A TITLE SEARCH SHALL BE PERFORMED BY OTHERS. BARNSTABLE ASSESSORS MAP 75 PARCEL 018 6.) THE PROPERTY LINE INFORMATION SHOWN IS BASED ON CURRENT Al DEED BOOK 21700 PAGE 281 INFORMATION CONSISTING OF PLANS AND DEEDS. LOT 3 AT PLAN BOOK Z67 PAGE 10 THE EXISTING FEATURES SHOWN HEREON WERE 0 STAINED FROM AN OWNER/APPLICANT.: VLADIMIR AND ANASTASIA L TRAININ SURVEY PERFORMED BY BAXTER NYE ENGINEERING do SURVEWNG ON 9 THURSTON ROAD .. NEWTON, MA 02464 7•) FLOOD ZONE C, COMMUNITY PANEL NUMBER 250001 0018 D. PROJECT LOCATION: 29 CEDAR TREE NECK ROAD 8•) ENWRONMENTAL INFORMATION• MARSTONS MILLS, MA 02648 •SITE IS NOT WITHIN AN A.C.E C (AREA OF CRITICAL ENVIRONMENTAL ZONING INFORMATION 'SITE IS WITHIN AN AREA OF ESTIMATED HABITAT OF RARE WILDLIFE PI OCTOBER 1, 2006 'ESTIMATED HAB17ATS OF RARE WILDLIFE' FOR USE ZONING DISTRICT : RF WETLANDS PROTECTION ACT REGULATIONS (310 CMR 10).'