The URL can be used to link to this page

Home My WebLink About0119 CHOPTEAGUE LANE - Health 119 Chopteague Lane, Marstons Mills A = 011 004 C� r T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Chopteague Dr -' Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is ` required for Marstons Mills Ma 02648 1-2-19 '' every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. Inspector Information c � g 3 V��' � (p forms on the computer,use Douglas A Brown only the tab key Name of Inspector to move your D.A.Brown Inc cursor-do not Company Name use the return key. P.O Box 145 Company Address. VQ Centerville Ma 02632 City/Town State Zip Code 508-420-4534 SI 4297 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails �Z 1-2-19 -Tn—spqjVors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 III c�, Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information 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: At time of inspection this system met the minimum passing requirements. There were no measurements to any components but we were able to find the distribution box( by camera)and septic tank. This report can not predict the future performance under the same or increased usage. This report is not to be used for bedroom count determination.The leaching Chambers were not opened because there were no measurements on the as-built card so the exact level of ponding could not be determined. Excavation of s.a.s is not required (see p 13#11) 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) 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. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 r Commonwealth of Massachusetts p Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner information is Owners Name required for Marstons Mills Ma 02648 1-2-19 every page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c�, Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: According to the as built card this system consists of a 1000 gallon tank and a s.a.s consisting of 2 500 gallon chambers in a 13x25x2 ft area Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2016 and 2017 average gpd was 289 gallons Also property has an irrigation system so this need to be taken into account when figuring what actually went into the septic system. Sump pump? ❑ Yes ❑ No Last date of occupancy: Nov 2018 Date t5insp.doc•rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: owner stated pumping in 2017 summer Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7r26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 I ' c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: s.a.s installed 5-21-2007 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 ft roughly feet Material of construction: ❑ cast iron ®40 PVC sch 40 into tank ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2.25 ft feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Tank is very close to back of house with the inlet cover to grade. Tank is running parallel to back of house If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon per as-built card Sludge depth: moderate heaviest at inlet Distance from top of sludge to bottom of outlet tee or baffle Scum thickness light scum build up on top of liquid Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? scour pole Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Owner stated the tank was pumped in the summer of 2017. 1 always suggest pumping at time of transfer and every 2-3 yrs there after for maintenance. Tank has pvc inlet and outlet tees. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts @ Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 4-2-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): There were no measurements to the d-box but it was viewed by camera and found to be functioning properly at time of inspection with no signs of failure or staining above outlet pipes. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): . *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: No measurements on the town as-built card Type: ❑ leaching pits number: ® leaching chambers number: 2 per as built ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 i f Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): There were no measurements on the as-built card and no actual description of the s.a.s but from the measurements it can be determined that it is 2 500 gallon chambers with 4 ft of stone in a 13x25x2 ft area. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 119 ChoFteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons'Mills Ma 02648 1-2-19 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 116 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: no g-w encountered at time of perc test feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 112017 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: owner supplied plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/201 S TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form 11.F' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 119 Chopteague Dr Property Address Bennet Edward M/Archibald Elizabeth Owner Owner's Name information is required for Marstons Mills Ma 02648 1-2-19 every page. Cityrrown State zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Assessing As-Built Cards Page 1 of 2 TOWN.OF BARNSTABLE LOCATION SEWAGE VILLAGE ASSESSOR'S MAP&PARCEL' INSTALLERS NAME&PHONE NO, I � SEPTIC TANK CAPACITY 4�>'1-1;,;J .'400 0.P.rl, LEACHING FACILITY:(type) oe:4V.. (size) NO.OF BEDROOMS OWNER PERMIT DATE: ��`�� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted GrouadwaterTable 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) J Feet FURNISHED BY (.*---I .. I ^AX o w1., / .. I http://town.bamstable.ma.us/Departments/Asse ssing/Property_V alues/HMdisplay.asp?map... 1/27/2019 Date: 9/ F /0 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: �i9 CHOPTe'; U� GNU -/19A 511NS /1'Jiees INVENTORY MAILING ADDRESS: � ' '� TOTAL AMOUNT: TELEPHONE NUMBER: 506- a ?0 — 319 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: J-0,L aey - 3/0-6, MSDS ON SITE? TYPE OF BUSINESS: i INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) i Caulk/Grout Swimming pool chlorine 1 Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (p e e list).- Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE LOCATION, /� SEWAGE 11 VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. �"j/� � '�® G ��3"" ®P®J SEPTIC TANK CAPACITYLEACHING FACILITY:FACILITY:(type) (size)JC"/�"•+% NO.OF BEDROOMS OWNER PERMIT DATE: 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 00! " Z A No. Fee M�) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: \� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS �s 0[ppYication for �Bigogal *pgtem Cougtruction Permit Application for a Permit to Construct( ) Repair Ofe'u"pgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.//( 4A'�A L Owners Name,Address,and Tel.No. Assessor's Map/Parcel 0/ p��*/ �� j�� 4. �✓� G'v Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. J Type of Building: 2 Dwelling No.of Bedrooms ✓ Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building � No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided " gpd Plan Date `—'`�"�) Number of sheets J Revision Date Title I J Size of Septic Tank ��3`/�"L� /'0�� L5U4 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Wd of Health. Signed � � "� " ate � •.• /�'of Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued �_ -.. ..r-..<.. �•'1e4 � t� •...a.. ♦.. _•..yyy M.irov` '"7`,W ., 4.r +.. s1 r 4y r.,Mfy` h..r_'I� .g,.--*t 1 I � � �Lt�r ��•' --✓ No. Fee �. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABL-E, MASSACHUSETTSe Tipprication for Dizpaal *pgtem Con.5truction pertn't Application for a Permit to Construct O Repair(Upgrade O Abandon O ❑ Complete System ❑Individual Components - Location Address or Lot No//�p L/Ip�� C ►"r Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 7/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.. Type of Building: 2 ; } Dwelling No.of Bedrooms ✓ Lot Size sq.ft.' Garbage Grinder ( ) � Other Type of Building #?4 f' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) a gpd Design flow provided ��' gPd Plan Date ��"G'>' Number of sheets '� Revision Date Title Size of Septic Tank G'eX 4717' /00`7 L5� G Type of S.A.S.,�►C/E'�+D /3 xe X.� Description of Soil i Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this PAd yof,Health. Signed Li"�' '' 1� / 1,0 Date Application Approved by ' / Ji f Ji *f ', / C Date Application Disapproved by: f i j Date 1 // for the following reasons C..' Permit No. Date Issued ——————————— ——— ———————_————' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( Upgraded ( ) Abandoned( )bye at �/ `� G�i/o��E,�4�Gsr yC� �'- ha2 been cons ructe• i accordance _ with the provisions of Title 5 and the for Disposal System Construction Permit No. i v dated r Installer Lam_ Designer ,A) #bedrooms Approved design flow 3('} gpd The issuance of this permit shall not a constr ed as a guarantee that the ystem will fun r g4 s designed. '` \ Date �-}` � � Inspe tar:M� --- No. OV6 Fee (/ HE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS x1i5poal°Q�pgtem Construction Permit Permission is hereby granted to Construct Repair ( ) Upgrade ( ) Abandon ( ) System located at Zi y G tea' �.>9�� •� y 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 �e corjpleted within three years of the date of this gdrmit Date A/ / ��/ Approved by Boa. Thomas McKean,Director 200 Main Street,Hyannis,AM 02601 Office:.508-862-4644. Fax: 508-790-6304 Installer &Designer Certification Form Date: 1 ' Designer: Installer: Address: . � L`�:� 'J'"�' ' Address• On L6 was issued a permit to install *dat (installer) P all a septic system at G ( s �I� based on a design drawn by dated �VO�O . (designer) certify that-the septic system referenced above was installed substantially- accordn to e design, which may include minor approved' es such as j..° g (41 ibution box and/or septic tank Chang 1 . relocation of the _ I cerhf-'-:that the septic system referenced above was installed with major,chance U.0 . greater dim 10 lateral relocation of the SAS or any ve.;ticaI irelocation.of any Pont of the-septi`csystem)bVt accordancewith State&Local Regulations. Plancertified as bS. by der to follow. �HOF S DAVID (Installers Signature) 8• t g . ::MASON_ y v .9 Na�1066. ti esign 's Signature) PLEASE RETURN TO jBATS 'ABLE P-IMLIC HEALTH DIMION. CERTIFICATE OF CONIPL ANCE � Q -BE IS.S BOT$:3 5 FORM AM BUIL3'CARD ARE RECEIVEDY IRE.B STABLE PUBLI. A ,. DISIOIMI. THANK YOU. Q:Health/Septic/Designe-rCertification Form v VgFt .2�ja AMM-n pt runs olio aocc�iwvuvno �-F um /17/r r. -iv Lnur (rInrc i 17%J The plans and specftations for every on-site system shall be prepared as follows: (1) Every system shall be designed by a Massachusctts Registered Brofmdonal Engineer or a i•4asavbmm RGSLdezed Sn tagian provided that such Sanitarian shall not design a syssent designed to discharge mom than 2PO gallow per day potueant to 310 CM 15.203. Any other agent of the own= MY prepare plats for tier repair of a sysoan designed to discharge not mom than than 2.=gdto>ts per day pursuant to 310 CMR 15.203 provided they are reviewed by a Massadms=Regisoerod Sates OWq*wv d by the approving authority (2) Every plan submitted for approval most be dated and bear the stamp and signature of the desigaar, (3) Every plan The a new system or plan for do ttpgtade our expaesion of an existing sysmn \ which=gairas a vague to a property-roe setback 'rnnat.alsc rtfaertQe a plan /( which bears the stamp and signatm of a--Massachusetts. Licensed Land Surveyor in accordn=with tC01-r- 112.1 g1D. (4) Every plan for a System SMU be of suitable scale(one inch 40 feet or fewer for plot plans and one inch a 1A feet or fewer for details of system components)and shall include depiction of. (a) the legal boundaries of the facility to be served; (b) the holder and location of any easmants appurtenant to or which could impact the . sWq (c) the U=fiM of theall dweffetg(s)or bua'lding(s)existing and proposed ott thefacility and identlFioation of those to be served by the systei= ^�-(d) "ffielacation of existing or propos� imparvtatts area% including driveways and parkbg areas; e location and diem mts of the SYsOM Cog ae eave Break M system,derigtt calculations.ittclading design daily sewage flow.septic tank rapacity // (requitsd and pm -n-dw.soul aoorpamt aisle$+cqxwiW. ( a d � and VV whcd=syM is design fat gm6age gam: `(� O North straw and etdong and proposed contours; �\ (h) , locatioa and log of dap obsenradon hole am including the date of test.taisdag / grade devatiM mattxd oa tm b wo. a ad flue ads of the rapreseatadve of the V- approving a dodW aad Solt evaluator. W to alit and results of percolation owes including the am of cast and the names of t 1 the rq mmmdve of the a utg audwft and soil.t valaaoou:, aqm and oaf nnmbee the Sag Evalmtor of record; '(k) ,locadon at every water supply.puldie and private, all* v*hin 4W feet-a truer paopau d symm loea&n in the=u a=if=eraser �`sFdpplfesgd Va*-puked public won fly wells. 2 `'°Mtlun 250 fat of.tdse proposed system location in due case;of tubular public / water sqpp1Y +and / 3. rovdbm Lt fat of the prod sy5aeta location in the cm of private water,location -L 111/ii of" - of t Cbtttntaetwesid4 tivus, botrierinB. 1 weNands; salt meal -'it&" or coastal beau% regulatory floodway. very mere, surface water wppEes_" itatiies to sus n water ems.eeffod vemal pond&pmraae „ wader mpprm or suetioiu=1hws, gravel packed err mbtriar ptebEc,vvaoer wells, mbsutfaoe drains.kwhlft cat&bad=cur dry wells:and dte location of'a w,t+itrogen scasinive-area ide"&&in 310 OM =15 within wbkh pordoa;,UX proposed UUM aro to nt} loeat�a of wsAer litter and otlr. ttaltnes' at tba.ftyr a) ob="d and 4used gtu=d-wacet.eleviwm in due vicinity f the systcat'r o a oaal�e pt+�of the aysteat: � ` _ (p) a Wk an the putt Cistitsg all varium to the provisions of'31O G&ism sou& mjmwd=wi&"pkn: l:a (a) the loxadmi od dvmfm of to b=cbffW&iidim so wigfeaq rich in sot*bjcct to didocafim or Iris data on thtg;onw. / (r) when dosing is-puposaL womoem desigm mW Vocillcatum of the dosing '9'011 proposed ittdading be ad ftftd oo tang chartutia aCitlr{ attd_ . touts and somilicWtom narnber.f dosiiaa cycles and 1 '. (s) whet a IR41#tIV.1 err a ooae plan ad fats the syst4tit,mlitd'ittg h F - I=fity iact g" tie tuaxt3scaotait d allot;, (n) the attar tmutibv aed lot aaaobe%if an . p,of Town of Barnstable CF tHE Tp� Regulatory Services snisras . ; Thomas F. Geiler,Director 9wA MASS. . ,•�� Public Health Division >Fp Mp2l Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 16, 2007 Mr&Mrs James House 119 Chopteague Lane Marstons Mills,MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system owned by you located at 119 Chopteague Lane, Marstons Mills,MA was last inspected February 271h,2007 by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of your septic system after further evaluation`.`Failed"under the guidelines of 1995 TITLE 5 (310 C.MR 15.00) due to the following: Liquid depth is less than 6"below invert.. You have 1 year from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. � BARNSTABLE HEALT EPARTMENT o as A. McKean,R.S., C.H.O. Agent of the Board of Health Town of Barnstable CF tNE Tp� do Regulatory Services snxxsrnst e * Thomas F. Geiler,Director 9 MASS. �1639. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 27 2007 Mr&Mrs James House 119 Chopteague Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system owned by you located at 119 Chopteague Lane, Marstons Mills, MA was last inspected February 271h,2007 by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of your septic system after further evaluation"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: �—W at time of inspection and in a pipe was 4 su merge . Liquid depth is 6" be ace► i. v You have 1 year fro e ate of the tem failure to bring the system into compliance. If there are any questions a out this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable �p THE 1p� o Regulatory Services BARNSTABLE ; Thomas F. Geiler, Director �$ MASS. ••� Public Health Division QED MA'S A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 27 2007 Mr&Mrs James House 119 Chopteague Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system owned by you located 119 Chopteague Lane, Marstons Mills, MA was last inspected February 27,by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of your septic system after further evaluation "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: e. Water level was 596" at time of inspection and inlet pipe was submerged. Liquid depth is 6"below invert. You have 1 year from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEPARTMENT Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health -\ OOMI MOI-WEALTH OF NLASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS. DEPARTMENT'OF.ENVIRo.NMENTAL -PR'OTECTIONT TITLE 5 , dl OFFICI a , . INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURI FACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: O:wner's Name: Owner's Addresl 0-1(P Date of Inspection P 1 Name of Inspecto (please print) � �, r ✓ 1,,,-4P,__ --� f-- Company Name: ° Ge{ Mailing Address: 0 �, Y c , a� r.it r Telephone Number :!Sn,�L: -9 a7 CERTIFICATION STATEMENT Oki i.certify that I have personally inspected the sewage.disposal system at this address and that the information<reportee below:is true,accurate and.complete as of the time of the inspection.The inspection was performed based ok%y, training and experience.in the proper function and maintenance of on'site sewage disposal systems. am a D.EP -approved system inspector pursuant to Section 15:340 ofTitleS(310 CMR 15.'000).`:The systern: Passes Conditionally Passes Needs Further Evaluation by the.Local Approving'Authority Inspector's Signature:. Date:. Q` The system inspector shall-submit.a copy of this inspection report to the Approvingo 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 systern 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.fhe conditions of use at that t time.,This inspection does not address'how th.e system will perform in the future under the same or different conditions of use. Title.5 Inspection Form 6/15/2000 page I I d Page 2 of I l �.,k' i OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY AS'SESSM ENT§. SUBSURFACE SEWA.GE'DISPOSAL SYSTEM INSPECTION]FORM PART A CERTIFICATION (continued) Property Address: //, Owner . Date of ection: � Inspection�Summary:, Check A,B',C,D or E/AL.WAYS complete.all of Section.D A. System Passes: I have not found any information Which.indicates.that any of the failure criteria descrioed in 3 10:CMR 15.303 or in 310 CNIR 15.304 exist.Any failure criteria.not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components.as described in the"Conditional Pass"section need to.be replaced or repaired.The system, upon completion of the replacement or repair;as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,NjND)in the for the following statements. If"not determined"please explain. The septic,tank'is.metal'and'over 2.0 years old* or.the septic tank(whether metal or net)is structurally unsound; exhibits substantial infiltration or exfftration or.tank failure is imminent:System'will pass inspection if the existing tank is replaced with-a.complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurafly sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available: . ND explain: + Observation of sewage backup or break out.or high static.water level in the distribution box due.to broken or obstructed-'pipe(s)or due to a-broken,settled or uneven distribution box. System will pass inspection if(with approval'of Board.of Health): broken pipes)are replaced obstruction is-removed distribution.,box is leveled or replaced . ND explain: The system required pumping more than:4 times a year due to broken or obstructed pipe(s).The-system will pass inspection if(with..approval:-of the Board of Health): broken pipe(s);are replaced obstruction s::remove,d ` ND explain: Paee= of l 1 OFFICIAL INSPECTION FORM -.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SE 'JAGE.pISPOSAL SYSTEM INSPECTION FORM PART'A CERTIFICATION(continued) Property Address: Owner: Date of'I pection: 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. i. 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 and1he environment. _ Cesspool or privy is within 50T feet of a surface water _ Cesspool or prfvv is within 50 feet of a bordering vegetated wetland or a salt'marsh 2. System will fail unless the Board:of Health{a;:.nd`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!I00`feet of a, surface water supply or tributary to a surface water:supply: _ The system has a septic tank and SAS and the SAS is within-aZone l of.a.public water supply. The system has`a septic tank and SAS and the SAS fs,within 50 feet of a.private.water supply weft_ _ The system.has a septic tank and SAS and the SAS is less than 100 feet.but50 feet or more from a private water supply well".Method used to determine.distance 1. "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 ofthe analysis:must be attached to this.form. 3. Other: 3 Page 4 of. I 1 O.FFIC1. AX.INSPECTION E FORl`vI-,IN OT FOR VOILUNTARY.ASSESSA/IENTS ' SUBSURFAC SEWAGE'DISPOSAI.SYSTEM-INTSPECTION.FORM PART A CERTIFICATION(continued) Property.Address: �7 Owner: Date of pection:. ; J,J007 D.. System Failure.Criteria applicable to alFsystems: You must indicate"yes" or"no."to each.of the.following for all inspections: Yes No Backup ofaewage.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 Eevel:in the distribution box above.outlet.inverCdue to an,overloaded or.clogged SAS or cesspool Liquid depth in cesspool is'less.than 6 below invert or available volume is.less.than %day flow _✓ Required pumping more than 4 times in.the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the.SAS,cesspool or privy i.s..below high.gro.und water elevation. Any.portion,o f 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 withiii: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 1.00 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 a:t:.a DEP certified laboratory, fer colifor.m.ba.cteria and:volatile organiccompounds 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:.co.py-of the analysi&must'be attachedto:this form.] `'✓ (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as.. descHbedJn310 CMR 15.303,therefo re;the system fails.The.system.owner should contact the Board of Health to determine what.will be necessary to correct the:failure. ' E. Large:Systems: To be considered a large system the system must serve a..facility-with a design flow of 10,000 gpd to.15,000 to,pd'. 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 4.00 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—i.WPA) or a mapped Zone II of.a public water supply well.. If you have,answered".yes;"to any question in.Section.E the system is considered a significant,threat, or answered yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat:under Section E or failed under Section D sha.11 upgrade the system in accordance with 3.10 CMR 15.304.The system owner;should contact.the appropriate regional office of the Department. Page S of I OFFICIAL IWECTION FORM—=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAOE"UTSPOSAL:SYSTEM INSPECTION FORM PART B. CHE"CKLTST Property Address: P Y Owner: Date of I ection:—= 'f 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? YHave large volumes of water been introduced to the system recently or as.part o;fthis inspection ? Were as built plans of the system obtained and examined? (1f they were not available riote as N/A) V. — Was the facility or dwelling inspected for signs of sewage back up ? ` Was the site inspected for signs of break out? Were all system components, excluding the SAS,.located on site Were the septic tank manholes uncovered; opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth"of liquid,.depth of sludgeland depth ofscum'? G . 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'deterinined'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 CIMR 15.302(3)(b)] Page 6 of 11. OFFICIAL INSPECTION FORM. NOT FOR° Qi;UNT.ARY:ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM Il'dSPEC`I ION FORM PART.C SYSTEM.INF.OR-MATION Property Addressc f a- e, /aoc.e._..- Owner: ' Date,ofl pection: "et,&4, Z ,1)0 -/ / FL�DITIONS RESIDENTIAL V Number of bedrooms.(design):.3 Number of bedrooms(actual):. DESIGN flow:based on 310:�5.203 (for example: 11.0 gpd x of bedrooms):. Number.of current r esid'ents:. _. Does residence have a garbage grinder(yes or no):. ' 0 Is laundry ono separate sewage systern( es or no): _ [if yes separate inspection required] P q l Laundry system inspected(.-yf S.or no):" Seasonal use: (yes or na):1 0 . Water meter readings if , av i1a le(last 2 years.usa�c e(�pd)):' Sump (yes L n Last dateate of of occupaa ncy:; �U,�l,Q,�,2-� C OMMERCIAL/IND USTRIALA/6 Type of.establi'shment:., ; Desiar,flow(based on 310 CMR'15.203):. gpd Basis of-design flow(seats/persons/sgft,etc*.' Grease trap present(yes:orno);_ Industrial waste holding!tank present(yes or no):— Non-sanitary waste discharged to the Title 5`system(yes or no):- Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source-of information: lky ke [/ Was system pumped as part of the.inspection(yes 6r no): (� If yes, volume pumped: gallons--How was quantity pumped determined? Reason.for pumping: TYP OF SYSTEM Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool . Privy - _Shared system(yes:or no)(if yes, attach previous inspection records,.if any) _Innovative/Alternative technology.Attach a copy of the.current operation and maintenance contract(to be obtained frorri system owner) Tight tank. _Attach a copy'of the DEP approval _.Other.(describe): Approxi to age:of all components, date installed(if known) and source of information: Were sewage odors:detected when'-arriving at the site(.yes or no) 6 i Page 7 of Y] OFFICIAL INSPE:CTION FORM—NOT FOR'VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL'1SYSTEM INSPECTT!ONFORM. PART:C SYSTEr1I.I.NFORMATION (continued) Property Address: Owner: Date of 1 ection:c (�C,Ca'� { ,CO 77 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC_other(explain): Distance-from private,vftter supply well or suction line: . ". Comments (on condition of joints, venting, evidence of leakage, etc.): SEPTIC TANK: (locate on site plan) Depth below grade: C?� Material of construction- concrete_metal_fiberglass Polyethylene —other(explain) If tank is metal list age:_ .Is aee.confi=ed by a Certificate of Compliance(yes or no).;_(attach.?copy of certificate) Dimensions: V-0 k Sludge depth:. . Distance from top of sludge to bottom of outlet tee or.baffle:. 1 Scum thickness: y Distance from top of scum to top of outlet tee or baffle:_ 3 s/ Distance from bottom of scum to bottom of outlet tee or baffle: f� How were dimensions.determined: Comments('on pumping recommen ations, inlet and outlet tee or baffle condition, structural integrity, liquid levels related to outlet invert evide ce of leakage, etc.): _ i J o /d 9©c. GREASE TRAP:locate on site plan) j Depth below grade:_ Material of construction:._concrete._metal_fiberglass_polyethylene_other ` (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from botton of scum to bottom'of outlet tee oi•baffle: Date oflast.pumping:. Comments(on'pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 , __ I Page 8 of 11 OFFICIAL.INSPECTION-FORM—NQT:FOR NO.LUNTARY::ASSESSMENTS SUBSURYA:CE SEWAGE DISPOSAL SYSTEM INSPECTION VORINI PART C.. SYSTEMINFOR-MATION(continued) Property Address: Ile, Owner:- Date of I pection: TIGHT or HOLDING TANK::/I O (tank must be pumped at time of•inspection)(locate on.site plan) Depth;below grade: Material of construction: concrete metal fberglass---polyethylene other(explain);. Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present.(yes.or no):. Alarm level: Alarm in working order(yes'or no): Date of last pumping: Comments�(condition of alarm and float switches, etc.): DISTRIBUTION BOX: V (if present must be opened)(l.ocate on site plan), Depth of liquid level above outlet invert: Comments(note if box i�s`Ievel and distribution to outlets equal,.any evidence of solids carryover;any e.vidence of leakage into or out of box, etc.): PUMP CHAMBER::/.(locate on site plan): Pumps in working.order(yes or no): r Alarms in working.order(yes or no):. Comments(note:condition of pump chamber, condition of pumps and appurtenances; etc.): f Page 9 of 11 OFFICIAL INSPECTION FORM.-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEV/-AGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOR'YIATION(continued) Property Address: Owner: Aa Date of In,Ore cti on: SOIL ABSORPTION SYSTEM (SAS): t- (locate on site plan, excavation not required) If SAS not located explain why: Typel eachingg pits,number:.L --le*aching chambers,number: :leching.galleries, number: leaching trenches, number, Iength: Ieaching fields,-number; dimensions: overflow cesspool,number: innovative/alternative system. Type/name,oftechnology: Comments (note condition of soil. signs of hydraulic.failure,level of ponding, damp soil,'condition of vegetation, et CESSPOOLS:-/VO (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth'—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of.groundwater inflow(yes or no): . Comments (note condition of soil; signs of hydraulic failure,:level of ponding, condition of vegetation, etc:): PRIVY: (locate on site plan) Materials of constriction: Dimensions: Depth of solids: Comments (note condition of soil, signs of hydraulic failure, level ofponding, condition bf vegetation, etc.): 9 Page 10 of 1 l OFFICIAE.IPiSPECTION:FORM.=NOT FOR VOLU—N 'ARY ASSESSMENTS. SUBSURFACE SEWAGE'DISPOSAL SYSTEMM-INSPECTIOiti FORM PART,C� SYSTEM INFORMATION(continued) Property Addr.ess:. Owner; Q/V /11 Date of Z ection:. C)(O-7 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the;sewage disposal system includine ties to at ieast two permanent reference landmarks or benchmarks. Locate all:wells within 100.feet.Locate.where public water supply enters the building. S , qd cp Paae i l of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART,C SYSTEM INFORMATION(continued) Property Address: Owner: 19 � Date 4 4a SITE EXAM Slope Surface water Check cellar Shallow wells 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.local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: D 11 Permit Number: �] Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site (lp 7— !Location: 1 � �,,�/ ��G�� l� Lot No. Owner: AP11,5 e Address: y�--�- Contractor: & �' Address: q5 Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. .Date / Z 50 month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OA Appropriate index well.................................. �lit� OB Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... `1® 7 s month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 213) Z determine water-level adjustment ............................................................. r . ............................. STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ............................................................................................................. � i 7 Figure 13.--Reproducible computation form. 15 465�ash d . lc r ayX- T Town of Barnstable P# 15,0 Department of Regulatory Services : BAJUW"tA : Public Health Division Date 69/& �7 �A t63q. �� 200 Main Street,Hyannis MA 02601 CFO NIA`l A > Date Scheduled C / Time Fee Pd. o �l Soil Suitability Assessment for Sewage MDisosalPerformed By:C�/T Witnessed By: �✓ Y1Ps - ca LOCATION& GENERAL INFORMATION y Location Address Lp,,,l Owner's Namep 7��" /lam ✓� Address III Assessor's Map/Parcel:O/'/ Engineer's Name NEW CONSTRUCTION REPAIR T 1 ��1 �-�/� �./ a ephone# � Land Use , Slopes Surface Stonesl�T' Distances from: Open Water Body ` /" t -ft Possible Wet Area ft Drinking Water Well A� ft 6 Drainage Way /v 4- ft Property Line �0 ft Other R SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n proximity to holes) D 'I�L� Parent material 1 L V V / ICY (geologic)�"�� Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater 20 , VEI OEY 44-4't. r, t DETERNIINATION FOR SEASONAL HIGH WATER TABLE ' Method Used: i Depth Observed standing in obs.hole: ___in. Depth to Soil mettles: i h, Depth to weeping from side of obs.hole: -_-- in, Groundwater Adjustment ` a 1 Index Well# Reading Date: Index Well level� _ Adl,fhetor- Adj.droundw.gttter level s PERCOLATION TEST bate z Observation [ Hole# j Time at 9" N �"�1co Depth of Perc v 0 Time at 6" (-n r- Start Pre-soak Time @ ae' �j AIf Time(V-6") End Pre-soak / Rate MinJlnch �- Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICIPERCFORM.DOC :r DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency,% ravel 0 . -�,o-., - C M� ? Stu /4 - C . 4!x Ile DEEP OBSERVATION HOLE LOG . Hole# Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consis enc %Gay-el) - L �r t DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil" Other Surface(in.) (USDA) (Munsell) _ ' 'Mottling (Structure,Stones,Boulders. Consisteric4%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consi tency. 1 , t 1 Flood Insurance Rate Map: .. Above 500 year flood boundary .No Z"Y,: Within 500 year boundary No y Within 100 year flood boundary No Yes' Depth of Naturally Occurring Pervious Material;? E Does at least four feet of naturally occurring pervious at taI exist in all arg4s observed throughout the area proposed for the soil absorption system? If not what is the depth of naturally occurring pervious material? 1^ 4 Certification I certify that on l v (date)I have passed the soil evaluiitor examination approved by the Department of Enviro enta Protection and that the above analysts was performed by me consistent with . the r uired training,expertise and experience described in 3 10 CMR 15.017. �/ s , Date c, ' nature -�-� _ Stg i -S Q:\SBPTICVERCFORM.DOC w r Ni 999 BORTOLOTTI CONSTRUCTION, INC. - Tom 45.INDUSTRY ROAD, MARSTONS MILLS, MA 02648, 508-771-9399 508-428-8926 FAX: 508-428-9399 L o to :< SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: Date Of Inspection / a spec or's Name:QWper's Name and Address: CERTIFICATION STATEMENT: I Certify that I have personally Inspected the Sewage Disposal System at this address and that the informa- tion reported below is true,accurate and complete as of the time of Inspection. The Inspectioin was perform- ed based on my Training and Experience in the Proper Function and Maintenance of On-Site Sewage Dis- posal Systems.Th system: F Passes CondItional�.,Pa es Needs/Furlier valuatthe Local Approving Authorit Failur Inspector's Signature / Date: �l5 The5ystem Inspector shall submit a copy of this Inspection Report to the Approving Authority with 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 Offie 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. INSPECTION SUMMARY: A) SYS'I'E"ASSES: I have not found any Information which i ndicates that the System violates any of the fail- ure criteria as defined in 310 CMR 15.303. Any Failure Criteria not evaluated are indi- cated below. B) SYSTEM CONDITIONALLY PASSES: One or more System Components need to be Replaced or Repaired. The System,upon completion of the Replacement or Repair,Passes Inspection. Indicate yes,nor,or not determined(Y,N,OR ND). Describe bases of determination in all instances. If"not determined",explain why not. The Septic Tank is Metal,Cracked,Structurally Unsound,shows Substantial Infiltration or exfil- tration,or Tank Failure is iimminent. The System will Pass Inspection ifExisting Septic Tank is Replaced with a conforming 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): - 1 - r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ' Broken pipe(s)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 L 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. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES 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 a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. . 2)SYSTEM WILL FAIL UNLESS THE BOARD 1.OF HE ALTH''(ANDVUBLIC WATER SUPPLIER,IF APPROPRIATE.)DETERMINES THAT THE SYSTEM'IS`FUNCTION- ING.IN A.MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: . _ The system has a septic tank and soil absorption system and'is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. < < The system has a septic tank and soil absorption system and is within 50 Feet of a private: water supply well. The system has a septic tank and soil absorption system and 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 the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined 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. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efiuent to the surface of the-,ground or surface waters due to an, , overloaded or clogged SAS or cesspool.. 4 '.Static'liquid level in the distribution box above-:outlet invert.due to.an,overloaded.or clog- ,god SAS or cesspool: . . `Liquid depth in.cesspool,is less than G"below iuvert,or available,_volumezis less than 1/2 day flow. Y, Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM 1NSPEcrION FORM PART A CER'17FICA170N (continued) 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 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. 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 SYSTEM FAILS: The following criteria apply to a large system in addition to ti►e criteria above: The design flow of a system is.1O,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the enviroiuiienl because one or more of the following conditions exist : :. The system ns withini4U6 Feet of a surface,drinking water supply`, 4 The systent'iswithin 200 Feet of a tributary to a surface'drinkingwater'supply The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone 11 of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the followinghave been done: , �Ptunping information was requested of the owner,occupant,and Board of Health. ✓None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. t***"As-built plans have been obtained and examined. Note if they are not available with'N/A. --L,:jhe facility or dwelling was inspected for signs of sewage back-up. `The system does not receive non-sanitary or industriahwaste flow. All ` tem com nents;:excludin the Soil Absorption. ._. v-1he site was inspected for signs of breakout... . . ✓ � po` g p ,System;,have been located on site. f Me septic tank manholes were uncovered,opened,and the interior of the septic tank-was in-': spected 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 or approximated by non-intrusive methods. -3- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) At; The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ✓ FLOW CONDITIONS R11'CIDENT Aia Design Flow: ons Number of Bedrooms: Number of Current Residents:_ Garbage Grinder: Laundry Connected To System Seasonal Use: A 7 Water.Meter Readings,ifavailable: ' Last Date of Occupancy. .CO MICR AL/iNn ST IAL., Typo of Establishment: <. Y , Deslgn Flow: gallons/day Grease Trap Present: (yes or no) Industrial'Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings,If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: 2j.4zd System Pumped as part of inspecdouz%.)u If yes,volume pumped: aallogs Reason forpumping' T1TZ5W,SYSTEM: V Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records,if a11 ny) w . . . _ Older(explain):... . APPROXIMATE.AGE of all components,date installed(if known)and_source' of,--idormatioh: " Sews odors detected when arriving at the site:I'X-K� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATIO,NN�(continucd) SEPTIC TANK: Depth below grade: Material of Constriction: ✓concrete metal FRP Other (expo). Dimisions: •S` ' ' Sludge Depth: Scum Thickness: oI Distance from top of sludge to bottom of outlet tee or baffle: je ` Distance Born bottom of scum to bottom of outlet tee or baffle: /0 " Comments:(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid 1 in lation to outlet'invert, st ural integrity,evidence of leakage,etc.) ' WY i, , GREASE TRAP: Depth Below Grade: Material of Constriction: concrete. metal FR.P Other (explain) Dimensions: --'Scuni Thickness: Distance from top of scum to top of outlet tee or baffle:_ Comments: (recommendation for pumping,condition of inlet-,and outlet-iees or baffles,-depth of liquid: level in relation to.outlet invert,structural integrity,evidence-o.f.leakage, etc.) . TIGHT OR HOLDING TANK:14—)—() Depth Below Grade: Material of Construction:___concrete_metal FRP_Otlter(explain) Dimensions: Capacity: _gallons Design Flow: gallons/day Alarm Level: _ Comments: (condition of inlet tee, condition.of alarm and float switches, etc.) , DISTRIBUTION BOX: Depth of liquid level above outlet invert: Comments: (note if el and distribut'on is equal,evidLYWce of solids carryov r,eviden of 1 age into or out of box,etc.) I A ` PUMP CHAMBER• (� Pomp Is to working order:. _ Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) - i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOEL ABSORMOk SYSTEM(SAS): (Locate on site plan,if possible;excavation not required,but may be approximated by non-Intrusive methods) If not determined to be present,explain: Type: Leaching pits,number: Leaching chambers, number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: Co ts: (note condition of soil,siggs of hydraulic f ilure leyj or pondin ondilion of vege Lion, etc.) / $ i CPSPOOLS:�v Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: _.____Materials of construction:' Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) - Comments:(note condition of soilk,signs of hydraulic failure, level of ponding,condition:of vegetation, etc.) PRWY:-V Materiels of construction: Dimensions: Depth of Solids: Comments:(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) , -6- i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. qq , 7 � t' .. w. i",./� �j , a ( rS.♦ _ .., a S r I' a co 0 DEPTH TO GROUNDWATER: / Depth to groundwater._ 36 Feet Method of Deternunation or Appro 'mation o n -7- t I t K f z ' B:OR{'f4LC� i'Tt C-ONSTRUCTtON-. I_NC. l8II88IIRY7►CL 'BET{71C3E ;DISPOSAL: BYBTEH INSPECTION PORN 1►adr4s�.,ot pxoperty // CO 'V'_- r3 �s ell Qwnar s name Oata.' of Snapection PART.,A CHECKLIST Check if the, fo,h`lowi,ng. have been' done: _ Pumpinq information, .was requested of the owner, occupant , and Board . Hea.lth: !; Nons :oi the system cippponents •have� .beenl. pumped for at least two week - and, the system;:has.`beeti` rece3ding normal'..flow rates during that .per od: Large .volumes'.or::water:. have not:;been introduced into the syst�m` recant;hy part of. this inspection. bu -lt Plana <�a t. 'oeen '''obtained `and examined . Note if they are n, availab.le;witY�; V The facility c ling was- inspected for signs of sewage back-up . ✓The site was or signs of .br.eakout_. Al`I system CO W.f;.=c s,.. excluding the SAS, have been located on the The aeptiC tai°'; Poles were unCCy,ered,.., opened, and the interior c . the septic .ta.� y in pected:. for condif.ion of- baffles or tees , aa£arial of 'constructi:on, dimensions, depth of liquid , depth of s2udge < depth The s.iZe a►nd location. of .the . SAS on: the site has been determined base on :existinq in-Lormaton- or approxiIuated by non-intrusive methods . The faciiitj• owner ' (and;.occupants, . if 'different from owner) were provided with information :on the proper maintenance of SSDS . t SUBS.URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential ._: .. number of bedrooms - I umber of current residents. ND garbage _grinderyes:.:or no g5 .laund. ry connected to< system, yes or no /✓p seasonal use, "yes or','no If -"onresidential;.,,calculated flow: Water meter readings, if available: �urrtnT Last date of occupancy GENERAL INFORMATION Pumping records and source of information: yole um a $ stem y p p d, as , part of. inspection, yes or no if.,yes., volume pumped _ /mO��ol Reason for pu�npinglj• ll o4',1C S: �� eat !�/Ot✓ LO�GJ''t'fG 7`ID [I OiJ c sehl TYPe of` system --- Septic. tank/distribution box/soil absorption system Single ..cesspool Ov.erfl i; :cesspool Pei.. Shared system .(yes or no) (if yes, attach previous inspection records, -,'if any) Other,,,;(explain) ::. PP 9all. ----__ - A roxmate:.a e: of all components. Date installed, if known . Source of information: __ Sewaqe odors detected,. when arriving at the site, yes or. no -SUBSURFACE- SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued .'SEPTI.C, TANK: A 0 V1/ (locate on site. plan) 9 depth below..,grade: /Concrete material or construction: metal FRP other(explain) dimensions: - Z:p sludge•:depth . .distance from top_.of sludge to bottom of outlet tee or baffle 2-0 Scum' tt ickness —7Pr distance from top.,of scum to top of outlet tee or baffle ` dista'nce :from : ` .bottom of scum to bottom of outlet tee or baffle _ Comments: . (recommendation. for ;pumping, - condition' of.. inlet and outlet tees or baffles , depth of.:'.1 level: in relation to outlet invert, structural integrity , evidence .of leakage, recommendations for repairs, etc. ) alM tQ�,t t`was 6 DISTRIBUTION -BOX: (locate .on .aite plan) depth of liquid level above outlet invert :Comments: (note if level'. and distribution is equal , evidence of solids carryover, evidence of leakage .into or 'out of box, ` recommendation for repairs, etc. ) �Z� 1'_�r� '_ g •vgcLGv�e O_ _ �NO��U/C C�/L O 5m l s C7?/ c� e'✓' --- PUMP CHAMBER: '.1A (locate on site plan) pumps ..in working order, yes..or no Commentsi. (note condition of pump chamber, condition of pumps and appurtenances , recommendations for maintenance or repairs, etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INNFOAXATION continued SOIL ABSORPTION SYSTEM (SAS) : V (locate; on.:site pla.n;: if possible• . excavation not required , but may be approximated., by, h6n-intrusive methods). if not determined to: be present, explain: Type leaching -.Pits-, and. number 9. i L eaehir c�,atbers and .number .leaching galleries-.and.-number _ leaching` trenches, number, length leaching .fiel`ds, .;number, dimensions overflow -cesspool, number. Comments: (note, condition. of soil, signs of .hydraulic failure, level of ponding , condition ot-'vegetationl recommendations for maintenance or repairs , etc . ) Ski� /'drlG�/�-/m h vQ/f�';/; 9/�?K�/�v D�`Y 4e'Oc!/1� S✓5 7�.�7 ;. CESSPOOLS.;.:(hocate on site plan) number andconfiguration , depth-top, of `liquid to inlet invert -- depth of.::solids :layer depth of scum layer dimensions. of :cesspool -- materials;.of'. construction indication--:of.. groundwater inflow. (cesspool Imust be pumped as part:-of-:'.1hipection) Comments (note condition of soil signs of hydraulic failure, level of ponding , condition of :vegetation, recommendations _ for maintenance or repairs , etc . ) PRIVY: (locate on site plan) materials of construction dimensions -- depth of .solids Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition `of vegetation, recommendations for maintenance or repairs , etc . ) a SUHSURFACE.,SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART ..B,. ,SYSTEM .INFORMATION continued SKETCH OF:`SEWAGE DISPOSAL .SYSTEM: include tie.s to' at %leas,t . two permanent references landmarks or benchmarks locate all .,wells within 100 ' 99 ty" 'b4 DEPTH ',TO' GROUNDWATER Z3 depth to groundwater method .oF . determination . or approxgosew imation: O �� 0 �f P O Od teal /b t i° 1-i v.�s I -SUBSURFACE -SEWAGE - DISPOSAL SYSTEH INSPECTION FORM PART. 0 FAILURE` CRITERIA Indicate yes;_. no, .or hbt._determined (Y, N, or ND) . Describe basis of .determination. in all instances, If If not determined" , explain why not) Al Backup -of sewage into facility? Discharge or ponding of effluent to the . surface of the ground or surface waters? l Static liquid level in. the distribution box above outlet invert? NIX Liquid depth in cesspool <6" below .invert or available volume< 112 da} flow?' Required pumping. ,4 times or more in the last year? number of times pumped Septic tank is metal.? cracked? structurally unsound? substantial infiltration?substantial exfiltration? tank failure imminent? Is any portion of the SAS, cesspool or privy: below the high groundwater elevation? ,W. .within, 50 feet of a surface water? a .within : l00 feet of a surface water. supply or tributary to a surface water supply? within A. Zone I of a- public well? withiin '50 feet of :a bordering vegetated wetland or salt marsh .(Cesspools, and' pr vies 'only:, the SAs) ? .within _50. .feet of.,'. a. private water. supply well? 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 analys for :eo itorm bacteria, volatile 'organic compounds, ammonia nitrogen and nitrate-:nitro gen: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ART 'D CERTIFICATION Name of Inspector �,l Company Name 00(t 6� �i� C�r�s� � nW« -3 Company Address 0AA1ktX1-C-11 �44 (,LS V*V%+ Yg ._ Certification: Statement I certify. thaf :I. have-.:personally inspected the sewage disposal system at. this :address_ and't'liat the Information reported is true, accurate and compl-ete as- o'f rthe time of inspection. The inspection was performed and any -recommendations regarding. upgrade, maintenance and repair are consis.tent-:with my training and experience in the proper function and manitenance, of on-site sewage disposal systems. Check one: �/ I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR. 1530.3 . Any failure. criteria not evaluated are as stated in. the FAILURE CRITERIA section of this form. I have determined that the .system fails to protect public health and the environment as defined in. 310 CMR 15. 303 . The basis for this determination is provided . in . the FAILURE CRITERIA section of this form. Inspector's Signature Date Original to system .owner Copies . to: Buyer (if applicable) Approving authority lj.O C A j �� / g ,�, l / i VILLAGE INS( ` L R'S NAME i ADDR.E-,SS B U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ,� ,.�� I � s� � J THE COMMfIt*WEALI'H OF MASSACHUSETTS BOARD OF HEALTH ................. .... ..................OF..........................._....-......_..---... ..._.. ApplirFation for Disposal Works Tonstratrtinn rani# Application is hereby made for a Permit to Construct (ky"or Repair ( ) an Individual Sewage Disposal System at: - - 1.1�� •t_n:� ../ ✓�rsTay5--Ai ..............."�� ...... 3---••-•-------......... -•--...... lac 'Cation-Address o�mbot - .� a �;.*,...t.. . .. .. ddress Ad..es Installer Address Type of Building Size Lot.... ©,e__________-----Sq. feet U Dwelling—No. of Bedrooms............/.............................Expansion Attic QJ Garbage Grinder ( ) Other—Type of Buildin No. of persons ........ Showers ( Cafeteria ( ) Other fixtures .. '57 ..kg--........I- L ��.�.�V._..T p' i'. .:....._.. W Design Flow............................................gallons per person per day. Total daily flow----........................................gallons. WSeptic Tank—Liquid capacity.10 -gallons Length_.-. _---. Width---------------- Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1......0L.....minutes per inch Depth of Test Pit---- �......... Depth to ground water..t'!�_ (i Test Pit No. 2------ ,......minutes per inch Depth of Test Pit...t ........ Depth to ground 94 •--• : .._.. -- - --------------------•------------ ----------- Descrip 'gn of Soil `i e ^... _ .J__a j'-j��'___.o.. 2 �` fir. .`` !3 k45: U ------- -•- i '�........i.....`r '� ----- .- E W x ------------------------------------------------•---••------------...-----------------------------•-----------------------------------•---------••-----•-------•---------------•-......... 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 iITL!Z- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in p p he board of health. operation until a Certificate o Compliance neds bee is uedfby t_��!! ....-•-----------------------•-- ��-� - --�-.._..._ '}/w�! —- Application Approv - -_---•-------------•-----.------------•------ .� L7 t � D to Application Dis e r t e following reasons--------------------------------------------------------------------------------•----------------------....--••-- Date PermitNo......................................................... Issued.....................................................-- Date Massachusetts Water Resources Commission/Division of Water Resources 'WATER WELL COMPLETION REPORT WELL LOCAT ON M Address�,� '!�t Z-3 eh-, 'a-r" ek e ! . City/Towne kfL �1 C G.S.Quadrangle Map Owneri-+ ire �1P Q r'- 7-7 Address In WAL<USE CONSOLIDATED WELL Domestic Public ❑ Industrial❑ . Type Water-bearing Rock Other Water-bean Zones METHOD DRILLED 1) From To Rotary(type) (< Cable ❑ 2) From TO' Other 3) Fro 4 rom To CASING r D th to Bedrock Length p�v a Diameter � T �. Type l r /,t r UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface 7 Sand: fine❑ medium coarse Date measured=A Gravel: fine❑ medium❑ coarse❑ Screen: �l��T G r, GRAVEL PACK WELL Slot# E'7 leng th � from to Yes ❑ No ' reen(or 2nd screen) WATER QUALITY TESTS MADE Slot# to Chemical ElBiological De edrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To — o f � / ' A kf-�4&&ER ,orr J O Firm V` / zi Address Po ` CityPee O ZG Registration No. :� l -� p ator s signature Please pant MAY 10M-8/81.164843 - . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... ......................OF........................................................................ Appliration for Dispaiial Works Tonstrurtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..... - ....__ ...... .... ................... - ....._.. •----.......... -- ..... Location-Address or Lot No. •................•---._.--•---.....------------..---•-•----......_............-•----............• .................................................................................................. Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms......................... .Ex anion Attic� g— ••--•------------- p ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons......._.................... Showers ( ) — Cafeteria ( ) QOther fixtures ------------------------•-----------------------------.-------•-••----•----------••---------•-----••-••-•-----------------•-._...-----•...._......---- W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. CY' Septic Tank—Liquid'capacity._.____._...gallons. Length................ Width................ Diameter................ Depth................ Disposal Trench—No. =. " _ _ Vdi ° F_..... Total Length.................... Total leaching area....................sq. ft. -' Seepage Pit No.........._______ iameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) IH Percolation Test Results Performed by.......................................................................... Date........................................ 0 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (sl Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 ................-....................................................................................................................... ........ --...... ODescription of Soil-•--------------------------•----•-•----------------.._.............------------------------------------------.........------•-•-•---•••--•- x 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 TI TLE 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. ---fined --- ' . r _ _...._.._ . Application Approved—By- P" �--- - -•----------- .1 ,-' :- ---•---- Date Application Dis ve or a following reasons--------------------------------•-----------------------•----------------------------------------••-------•••••-- .........................................................'•-•----•------•........................•--•--................................................. Date PermitNo................................................... .... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tatifiratr of Toutpliattrr has I IFY, That the Individual Sewage Disposal System constructed-*( ) or Repaired ( ) •---- _-• -- -�._ .......•--•-...•-•••-•••-••••••-•-•••••••----•-•-----••••--•••.............•••--•-•......•-••-••••--•-•----•-••---••-••-•......_--•••-••.............--- by / Installer at---•••......••----------'----------....................................................................................................... - --------- ------------------------•-- has been installed in ccordance with the provisions ^Txv of The State Sanity c ie scribed in the application for Disposal Works Construction Permit No......................................... d 'ed_._.._!__________---__ •._-_--_----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. //�� /,,,� DATE.. �// -Z. ......._.... Inspector 1<-'_"----•------•---------...•-•......•---._...-••-•---••---_•---. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............�...................OF.................................. 0 No ......................... EE........................ ��on Permissi is hereby gr/ a -•....... --- ------ -----------•-•------....._...-------------------------------•--•-----------....-----•--........._...-----••----- to Construct ( /A Rep:(ir -evcrage Disposal System atNo. J- -----------------------••••----------•----- Stre------ ----------------------------------------------- __---- ..... as shown on the application for Disposal orks Constructio I o..................... Dated.......................................... Board of Health DATE.................................... ja FORM 1255 A. M. SULKIN, INC.. BOSTON - - - . r r s \' ,.j ASSESSORS MAP: Ali' TEST HOLE LOGS Q, PARCEL -�--- FLOOD ZONE Q� APR6� � SO) L EVALUATOR ; } � ' t C� -NOTES: _._..�. _�.V,�...��r..,�. ._,... � _.__ . . �..... .. .�._.��..._ ..._,.._ WITNESS � � t�,��'11 N6 REFEREE: _ +��= `'�N�� i'��.+ � ..�....��,��'��."._ � ..,_._. DATE: (o - PERCOLATION RAT �Z I , 1) The installation shall comply with Title V and Town of Barnstable Board of Health � 4`-� _ � _. .: J Regulations. I 2) The installer shall verify the location of utilities, sewer inverts and septic components prior to TH- I installation and setting base elevations. TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The fast two feet out of the l. N+� d-box to the leaching sball be level. c � � P �1 a I le 4) This plan is not to be utilized for property lure detenilination nor any other purpose other than Lb �� 6 the proposed system installation. 6 5) All septic components must meet Title V specifications, 2 t f) Parking shall not be constructed over H10 � t septic components. ' 7) The property is bounded.by property corners and property lines. LOCATION MAP � _ �a - 8) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and + # installation based on the plan shall be deemed approval of the design flow b the owner. y 9) The existing leaching or cesspools shall be pumped and filled with material per Title V /� Z4 4 Zi ��; abandonment procedures. Those within the proposed SAS shall be removed along with J }U contaminated soil and replaced with clean washed sand per Title V specs. e I i 10) System components to be 10 feet from water line. Sewer lilies crossing the water line shall be May 1 sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. �' 1 11) If a garbage grinder exists it is to be e I l b WOO, 6) ND t( �,� g g g removed and is the responsibility of the owner to ensure such. l �1 12) The installer is to take caution in excavation around the gas line if applicable. SEPTIC SYSTEMDESIGN . 13) Marsto Mplls Water Company was contacted to verify the existence of public water at the abuttingproperties. A0 . � FLOW ESTIMATE 1 { cJ BEDROOMS AT 110 GAL/DAY/BEDROOM - GAL/DAY I SEPTIC TANK l�;l 1 '3�OGAL/DAY x 2 DAYS - GAL rr� t7l? ' I',i y curl USE 1 GALLON SEPTIC TANK ' Y`. '�£. = / /✓✓✓ SOIL ABSORPTION SYSTEM L� SIDE AREA: I +( _ (r U' BOTTOM AREA: l 0 7 Z?� -( p SEPTIC SYSTEM . S ECT I O NJT � h _ Kr r r 1 I J '� r✓ �j �Dra�uNA P� X�� fW tl a .1 X, �c�� ✓✓✓""""`rrr� a'►�1�1. _— is l "l 141 Ei� L LIM— M z BOX GAL J GAL � 6 t C / SEPT I C T K J I, '� ��'—f y'"T�QV1 _ F ¢ r�T N a DV Ili ` MAS SITE AND SEWAGE PLAN ' LOCATION : art 2 PREPARED FOR : �>�—'° T1C. N SCALE: l W DAV I D B MASON �j DATE: 0 z DBC ENVIRONMEN AL DESIGNS V Z EAST SANDWICH . MA W DATE HEALTH AGENT z ( 508 ) 833- 2177 --_ - ,- - -- -- - -- - S011 LOG N 0. 1 NO. 2 s,�7,vo y .gy 75 SITE PLAN . 4 TOP OF FOUNDATION EL.: 6 e t * 7 • ° .-�_r i 9 . D•, ..t ._. _tom i ° • IN,EI. l f. IN.EL. e °. -- -. -- ----- r�- --,�T� - ;� _ ' 2" COVER 1/8 3/8~ WASHED STONE , ♦o IN.El. 4 r7�111" -- —I N.E I. � �� I N. E L.9 �3 ? ° o' / " `' i` 12 4 li UID LEVEL D/B W/ 6 SUMP3/4 - 1 1/2 WASHED STONE Ejvcc�urv � f3 13 1 o C •L C � oc of n � _ o 14 •Y �o 6"EFF.' DEPTH ".� � � � " 15 cl o ° • c a •e ° • D �) C v fJ ♦ c b ° • a PERC TEST. RESULTS PRECAST SEPTIC TANK WITH PERC RATE ' ' r PRECAST LEACHING PITS �� ° 4 9° NO.: 1_ SIZE : �� .�. x �s,, hicy WHITNESSED BY: CAST IN -PLACE INLET AND EL OUTLET T 'S PER TITLE �L - .Bs ��.�sT.�4� BOARD OF HEALTH s SIZE : io cDo �,lqz_1 one �-- D IA . I�L 0 9. D ATE: y L_r__z ,Q -, ` a z y�� (B _Z_ >< -51' k//®� X s' "oEc-�) r— g' D I A . I 7 Z o, S PROFILE OF PROPOSED SEWAGE SYSTEM SYSTEM DESIGNED BY THE TOWN OF 1Fr�iy�si�._� REGULATIONS ANO `., `, 3Z ` STATE TITLE V FOR SUBSURFACE DISPOSAL OF SEWAGE SCALE : 1/4"—I' 0 "" y N . B . 1. ALL PIPES SHALL BE SCHEDULE 40 P.V.C. SEWER PIPE lk -_ 2. ALL PIPES SHALL BE SLOPED 1/4 PER FOOT EXCEPT FOR THE FIRST 2 FEET OUT OF THE D / B WHICH SHALL BE LEVEL 3. DESIGN FLOW 3 BEDROOMS AT 110 GALDAY PER BR. GAL/DAY SEPTIC TANK SIZE X ems= -� ' " GAL.. USE /000 GAL. W/��;;- GARBAGE DISPOSAL 51100 LEACHING SYSTEM: USE %� , ,�.z � fy7 � �-,��c,��w� ,�� EFFECTIVE AREA : SIDE 0- x8 xz_s BOTTOM =� s Ge�<< ��. , t Vic=S,�i�vlf ; TOTAL TOTAL REQ 'D FLOW 33c: X -33cD ocu7- � r W/-_ . GARBAGE DISPOSAL , -- RESERVE FLOW �e� -- _ -- — GAL/DAY_ - _ _ i -. - - -- ---- ,� O T J. 2 . ,n REFS R E N C E PLANS O� �,�",r�"'U S /�G. A.N BC�Of-C 2 72 �'��,_.�" 9Z I Z•�_. ,��.� I S 93' is5" t LoT APPROVED BY : cz BOARD 0f1� HEALTH DATE : : PROPERTY OWNER : ' -- = t SITE AND SEWAGE PLAN F 0 R o ,��' BEDROOM SINGLE FAMILY DWELLING OBF J r D A T E . 1-71 24500 �r .� DOYLE ASSOCIATES FALMOUTH MASS .