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HomeMy WebLinkAbout0230 CHUCKLES WAY - Health 230 CHUCKLES WAY MARSTONS MILLS -- - -- - A = 101 131 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 230 Chuckles Way ' Property Address , Gail Hughes Owner Owner's Name information is Marstons Mills Ma 02648 11/23/2019 required for every _.__�.....__. page. City/Town State Zip Code Date of Inspection t-.. 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 A. Inspector Informationfilling out out forms on the computer, Sean M. Jones use only the tab key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection _ use the return Company Name key. 74 trans � Companypany Address Centerville Ma 02632 M City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com, S14522 sean@smjonestitle5.com 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 11/23/2019 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 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. 15insp.doc•rev.7/26/2018 Title 5 Offbal fnspeotion form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts =, Title 5 Official Inspection Form i n Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Chuckles Way Property Address Gail Hughes Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/23/2019 page. CitylTown 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. ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 230 Chuckles Way Marstons Mills is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 4 Infiltrators in a 31'00'trench. The system was found to be in proper working condition at the time of inspection. 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.MAW 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 230 Chuckles Wad Property Address Gail Hughes Owner Owner's Name information is Marstons Mills Ma 02648 11/23/2019 required for 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.MAQ018 Title 5 official Inspection Form:Subsuftce Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts -= Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Chuckles Way Property Address Gail Hughes Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/23/2019 �. page. Cityrrown 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 t5lnsp.doc-rev.712G(2018 Title 5 Official Inspection Form.Suosurtace Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Chuckles Way Property Address Gail Hughes Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/23/2019 page. City/Town State Zip Code Date of inspection C. Inspection Summary (coat.) 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 '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® 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 6 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 15insp.doc-rev 7t2812018 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Chuckles Way Property Address Gail Hughes Owner Owners Name information is Marstons Mills Ma 02648 11/23/2019 required for every ----- _—_.. page. City/Town 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)] 15insp.doc-rev 712812018 Me 5 niirial Inspection Farm Subsurface SewaOe Disposal System•Pe$e 6 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '. 230 Chuckles Way Property Address Gail Hughes Owner owner's Name information is required for every Marstons Mills Ma 02648 11/23/2019 ---------- 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): 33090 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes Z No If yes, discharges to:Is laundry on a separate sewage system? (Include laundry,system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Da known t5insp,doc•rev,7120018 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 7 of 16 Commonwealth of Massachusetts :- Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 230 Chuckles Property Address Gail Hughes Owner Owner's Name Information is Marstons Mills Ma 02648 11/23/2019 required for every _ _...__ page. City/Town 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: 'oate — Other(describe below): 3. Pumping Records: Source of information: Tank pumoed after inspection Was system pumped as part of the inspection. ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? size of tank Reason for pumping: routine maintenance t5lnsp.doo•rev.7r&2018 Title 5 official inspection Form,SUbsUfface Sewage Disposal System•Page 8 Of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 230 Chuckles Way Property Address Gail Hughes Owner Owner's Name Information Is required for every Marstons Mills Ma 02648 11/23/2019 page. CityfTown State Zip Code—'­- —Date of Inspection D. System Information (cont.) 4. Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool E] Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El 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: system installed 7/10/2000 per town records Were sewage odors detected when arriving at the site? ❑ Yes No 5. Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: El cast iron Z 40 PVC El other(explain): Distance from private water supply well or suction line- Comments(on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. t5insp.doc-rev,7/M018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form — ` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Chuckles Way Property address Gail Hughes Owner Owner's Name requir don for every Marstons Mills _ Ma 02648 11123/2019 Pge, CRy/Town _ State Zip Code Date of Inspection D. System Information (cant.) 6. Septic Tank (locate on site plan): 1.5 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons 5" Sludge depth: 3. Distance from top of sludge to bottom of outlet tee or baffle 2e Scum thickness Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was pumped after inspection and should be done again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. ftep,doe•rev,7126=16 Title 5 Official Inspection Form Subswface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Chuckles Way Property Address ----- _...,_�....__.�.,._......_.....__ Gail Hughes Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/23/2019 page. Cftyrrown State Zip Code Date of Inspection D. System Information (cons.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass Q 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 t5msp.doc•rev.7P16fl018 Title 5 Official Inspection Form,Subsurface Sewage Disposal system•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form a Not for Voluntary Assessments t 230 Chuckles Way Property Address Gad Hughes Owner Owner s Name Information is MarStons Mills Ma 02648 11/23/2019 required for every .._._.__.._ __ _____ - ---__ _...._ .__..... �e.— page Cityftown 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: -d te- Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract;required). Is copy attached? El Yes ❑ No 9. Distribution Box(if present must be opered)(locate on site plan): 01, Depth of liquid level above outlet invert --- Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was video inspected and found level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5inap.doc•rev.7012018 Title 5 Official Inspection Fort:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Chuckles Way Property Address Gail Hughes _ Owner Owners Name information is Marstons Mills Ma 02648 11/23/2019 required for every page. Cityrrown State Zip Code Date of Inspectionu 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: Type: ❑ leaching pits number: ® leaching chambers number: 4 Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5'm ,doc•rev.7r2WO18 Title 5 Official Inspatlion Form Subsurface Sewage disposal System•Page 13 of 18 Commonwealth of Massachusetts J--? Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t , 230 Chuckles Way Property Address Gail Hughes Owner Owners Name information is required for every Marstons Mills Ma 02648 11/23/2019 page. cityrrown 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.): s.a.s. consists of 4 Infiltrators in a 31'x10'trench. No signs of past overloading, no lush vegetation, soil was dry with no indication of past saturation. 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 712612018 Tine 5 Oliicol Inspector Form,Subsurface Sewage Disposal System-Pepe 14 of 18 f Commonwealth of Massachusetts ==Y60 Title 5 Official Inspection Form Subsurface Sewage Disposal System Farm•Not for Voluntary Assessments i 230 Chuckles Property Address ..ee Gail Hughes _ _._ Owner Owner's Name information is Marstons Mills Ma 02648 11/23/2019 required for every Rage City/Town State Zip Code Date of Inspection D. System Information (cost.) 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.)* t51nsp.doc•rev.7rAM18 Title 5 Official inspection Form,Subsurface Sewage❑isposat system-Pepe 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form Not for Voluntary Assessments 230 Chuckles Property Address Gail Hughes Owner Owner's Name information is Marstons Mills _ Ma 02648 11/23/2019 required ge. for every pa Gity/Tawn State Zip Code Date of Inspection D. System Information (coot.) 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 f � 1 ( 37% 36 �s t5inspAcc-rev.7126126t8 tAle 5 Ofi dal Inslivdim Forrrr Sutrsurimce Sewage nisrosal System•Pnge 18 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form -- - Subsurface Sewage Disposal System Form Not for Voluntary Assessments ` 230 Chuckles Way Property Address Gail Hughes Owner owners Name information is Marstons Mills Ma 02648 11/23/2019 required for every -- page. Cltyfrown 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 round water: 12+ p g g 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: 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: Groundwater was established by accessing town of�Bamstable groundwater contour maps. lease see Report Completeness Checklist on next page. Before filing this Inspection Report,p p p p 9 t5insp.doc-rev.7lAMI8 Title 5 Most Inspection Form:Subsurface sewage Disposal system-Page 17 of 18 � Commonwealth of Massachusetft Title 5 Official Inspection Form -. - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 230 Chuckles Way Property Address Gail Hughes Owner Owner's Name Information is Marstons Mills Ma 02648 11/23/2019 required for every _ _ ___................__._._.._ ._.. page. City/Town 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 15inap.doc•rev.dP W018 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 18 of 18 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL,AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION 0/ TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ��5 Property Address: 3 D v 4 t4c a✓' o�S /l� �Oa 6 cto`r Owner's Name: .Te S-e- c►r�e, Owner's Address: 43 O 4-( S (, v! o`er Oa b�j Date of Inspection: --cs Name of Inspector• (please rint) /� ar4 /oIS e ll -n Company Name: E;vi '_5 Mailing Address: o zkX -? �s w► dk 6 4.2— Telephone Number S CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the info tion reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Sec ' n 15340 of Title 5(310 CMR 15.000). The system: (/ passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: 2V .2 - Date: 0-6 The system inspector shall subm1t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 611512000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: G a s a w s r 4 IV4 �Od-L f<� . Owner: Date of Inspection: 0 Inspection Summary: Check A,B,C,D or E I ALWAYS complete all of Section D A. Sys 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: YB SyB. Sy tem Conditionally Passes: \ One or more system components as described in the"Conditional Pass"section need to be replaced o mP ep r repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,N-D)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title G Tnenarti nn T=nrm�ii�i�nnn 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: J 414 a44-r �/G 0,1 Owner: H Date of Inspection: 3-,3 eD/b C. Further Evaluation is Required by the Board of Health: A�Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(i)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 ' Page 4 of 11 . OFFICI_AL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: t23 cvl,t c,+ z-x �✓G�_ 0oZ6 Owner: /7`-of✓� Date of Inspection: b D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No � _ _✓ ckup 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 .,dogged SAS or cesspool _/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or /cesspool v liquid depth in cesspool is less than 6"below invert or available volume is less than%Z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number If times pumped . _ fIy 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. tiny portion of a cesspool or privy is within a Zone 1 of a public well. y 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) X system is within 400 feet of a surface drinking water supply ystem is within 200 feet of a tributary to a surface drinking water supply ystem is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped e 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 sig;uficant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CNIR 15.304.The system owner should contact the appropriate regional office of the Department. Title \ rI1C-t;nn 17(1 m All vonnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1J �l�l Gl G V r�s W q�2 Owner: ', t— Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes o ZeTe ing information was provided by the owner, occupant,or Board of Health _✓ 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 ba files 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: 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 CMR 15.302(3)(b)] Titlo inch f;— Pn— All siInnn 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: R✓_G C6U `y�f („/;—) moo //// lir✓s oK1 S/ /�� 6 Sy Owner: Date of Inspection: 3-- 31— O A FLOW CONDITIONS �9 - ZC RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): -� DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents- Does Does residence have a garbage grinder(yes or no):/�v Is laundry on a separate sewage system(yes or no):/tV [if yes separate inspection required] Laundry system inspected( e or no):�� Seasonal use: (yes or no):7d Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no):�O Last date of occupancy: CU✓�rvi�— COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: O �{'- 0 �✓ '� Was system pumped as part of the inspection(yes or no): /W If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYP F 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) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date ' stalled f known)and so o information: f-- �� Were sewage odors detected when arriving at the site(yes or no) Title G lncnortinn hnrm 4/1 Vlnon 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: v C6,4'�" t" v �6� Owner: Gd Date of Inspection: BUILDING SEWER(locate on site plan) � // Depth below grade: 3 " Materials of construction:_cast iron _ 0 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:,/ (locate on site plan) Depth below grade: 30 � Material of construction: ._ ncrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) / Dimensions: X Sludge depth: �2 9 Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:AesS / 'i e-/ - Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botto,}of outlet tee or baffle: How were durensions determined: /"o/C— /Qo+S �2l/1<-c Comments(on pumping recommendations,inlet and outlet fee or baffle condition,structural integrity,liquid levels as related to outlet invert,evid nee of leakage,etc. : ii �v G S /mil Od o-, 7M GREASE TRAP-&(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7:r10 G 1,;cn 'r;n P: 411 C/7nnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEEM/INF/ORINIATION(continued) Property Address: C., vl cf , -4jt':7 Owner: ?Gi r-e— Date of Inspection: — /— 0 TIGHT or HOLDING TANK:A�__(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:0/Vt l CAL Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or ut of box,etc.): ,/ / , A �X 4eyte /y0 SOR�wl' /!/,y r PUMP CHAMBER:&(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Titic incnnrfinn �nrrn 411;/7nnn 8 - - Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ova Owner: Date of Inspection: Z SOIL ABSORPTION SYSTEM(SAS): ocate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: (� leaching galleries, number: leaching trenches, number,length: leaching fields,number, dimensions: J overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil, condition of vegetation, etc.): / j 0//11 5jo q 0 '��Kc�- -�-o// al'i C' LGw i r urn CESSPOOLS:N (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or—no).- Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): T;tlo S Incnartinn 7-- A/I G/7IlM 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ��'(/ �v` c��Qs �j✓�` Owner: Date of Inspection: /—� SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters thq�uilding. f I/ Titlo : Inenortinn P, 411 c/,)nnn 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ✓ v �"` �'✓ S Owner: Date of Inspection: ��— SITE EYULNI Slope Surface water Check cellar Shallow wells i Estimated depth to ground water /O feet Please indicate(check)all methods used to determine the high ground water elevation: Obtain om system design plans on record-If checked,date of design plan reviewed: Ob3eKed site(abutting property/observation hole wij�50 feet of SAS) ecked with local Board of Health-explain: / '✓4 S Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must )crib ow you establishe the high rout ater levation: / C`' Jo o�M o /n ,I-,/ �S C� e! J7 o h� a �"� /ti GC orC, a e: Talo G (nenartinn Rnrm�ii v�nnn 11 TOW rw�f OF LOCATION A T� c �1� V74 1O IN O Utiitl�iilltwi.iLOCATION CITUC IE (X� SEWAGE # V1%LAGE /�S��J i� VS ASSESSOR'S MAP& LOTrENTSTALLER'S NAME&PHONE NO. D� X d fiY1 77!}/ SEPTIC TANK. CAPACITY O6 _ LEACFUNG FACILITY: (type) V n-TOE� (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: — /7 lo loo Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of.Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet_ Edge of Wetland and Leaching Facility(If any wetlands exist within 300 fee eac ' g f lity) Feet Furnished by r r s` vb � � Iwo, < l � J � � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �✓ i Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS 0(ppfication for Migogal 6pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. 23O C*W& C� to , Owner's Name,Address and Tel.No. T7' —11 /cl VVk V-h 1, K S• flc rv,110 � ReG 1471 Trust Sohn tztfacc, Assessor's Map/Parcel . P0. 8 0* 1`l`2-y Tru S're 2 ( 0� st� 's ss, el. D / s, ner's Name,Address and Tel.No. 1 ' e Type of u ?.ti ilding: P , Sr C- C. ,f vl�a2�v. = A 1 L a Dwelling No.of Bedrooms 3 Lot Size 12, Go o sq.ft. Garbage Grinder( ) Other Type�.of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3.o gallons per day. Calculated daily flow gallons. Plan Date `1 z r Number of sheets Revision Date OU 4- Title S C,:L4= b G 1 �.v� , U t-l ref s Size of Septic Tank �' .7 Type of S.A.S. 11� Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been isV by t ' BMrd of Health. >>'� Signed Date 0 V Application Approved by Date — 2 Application Disapproved for the following reasons Permit No. 3 Date Issued 7 " f Q 1 f ,- r r--- f Fee E THE CO.N�IM�"D,NWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 4 Application for Migpool *potent Construction Vermit Application for a Permit to Construct(X)Repair( )Upgrade( )Abandon( ) O Complete System O Individual Components ^'Location Address or Lot No. ?30 C ��� (.U^ Owner's Name,Address and Tel.No. ' - o 1 `� F-/aVIA V•. Rc>r�l71 7rc.t ST 30hn C-ct�Gccr Assessor's Map/Paz i 1� S� PD• 6 Old 1 2`Zy� G?gyp' )vU,I r•[? of 31 N I stale'sss,I�V 0 sisi ner' Name,Address and Tel.No. %NC;�4k Al t►1 Type of Building: 3 / �""� Sr 6 ,4c/L o4� Dwelling No.of Bedrooms Lot Size 1 l,, G a o sq. ft. Garbage Grinder( ) Other Type of Building ! No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 6 _gallons. Plan Date r Number of sheets Revision Date' ' /1 Title i C+G ►('i-�—�1 B L h�/�-�) .A.+ti t-y ,s l+�L-� Size of Septic Tank 5�� Type of S.A.S. I Y-EIV 6 z�5 5-17JAf Description of Soil s 69,_ -� Nature of Repairs or Alterations(Answer when applicable) f Date last inspected: r Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system ^,t in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- �"' Cate of Compliance has been isshied by t B ryd of Health. -f —- Signed Date / 10 0 cleL Application Approved by Date 7- Z Application Disapproved for the following reasons Permit No. Date Issued 7 f---------------------------------------- 1 0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal Sy t Constructed O Repaired ( )Upgraded( ) Abandoned,( y CL �✓S6 e Y CGG -U at e eAC11,1ef Vla iAAnv-5700 /� has een constructed in accordance with the provisions of Title 5 and th for Disposal System Construction Permit No. y dated — Installer C vOS>q F ltcctvc t,00Designer f) ✓1 eu F!r/1ri 00 Pe#17 t,7w The issuance of this permit.,hat �1 etc str ed.-as a guarantee that the s 1 f` i �fp�}ction as es©ned�l if (✓ � Inspector Date � 0. --------------------------------------- No., 1 r J Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Miopooar 6pgtem Construction Permit Permission is herebanted to onstrucF(x)Repair( )Upgrade( )Abandon r ( ) System located at •70 fly(C 1�//F S CK Mote 57o'l 5 M;�l� and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Tile 5 and the following local provisions or special conditions. Provided:Construction mp44e c ,mpl�eteed�within three years of the date of thi e Date: Approved by i .... _ _._..... ... .... .......... ..-____ .-.-........_.._-._�... 1 ... lo:o" to:.... ~i ~CJ 0 — tlozcf_- __ hNSiER SUIiC. r.ov 0 LOFT• -• xq .}aq >O QIOY't L �.Q DCCROOM _ ]Jto, \ 1 r.'aeec Ter«c"� Y �01 I _ o f . ...�.... e:��_ t:o" e:r I t:.:'I o:e�• f •:e•i .:v� • �:.:� [n za. ece ' 1 iSECOND FLOOR PUA I "SECTION A-A i ��r CARAC,e 1 KITCHEN 6REAKFAST 0I - �� sleviln _ ._ :,••a.co•+c.>.we v/ 1 [ I�>xawPM.IC� .e M r o O 0 � — i• -esigns — _� 1 e K at.tW. N'�.C.W>• /focal CC �,N'e.a. e,toCc I I � .apy..pnl O1/[I � o1NINC uy. ING •,� f -- tu ~� _SECTION 5-el O I i 1 i z I FIRST FLOOR PWJ O7 i A2 E - TOWN OF BARNSTABLE �d >' ; L ATION C'/'�UC�s iGS W,*bl SEWAGE # qq-4 VILLAGE i�/3/s��IS /�7 -/ ASSESSOR'S MAP & LOT . INSTALLER'S NAME&PHONE NO. c�on5 t'x C°l�r/A'fi h 7��-7 SEPTIC TANK CAPACITY J 5 - LEACHING FACILITY: (type) Lr -�/�r'i f/� : ��-S (size) 31 NO.OF BEDROOMS 3 BUILDER OR OWNER i PERMITDATE: COMPLIANCE DATE: I lo loo f Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet 1 Edge_of Wetland,and Leaching Fa 'lity(If any wetlands exist within 300 fee eac ' g f lity) Feet. 1 Furnished I' / 1E, / T.O.F. AT EL.47.0 �_� SHUBAEL 77 ACCESS COVER WITHIN 6" TO FIN. GRADE LEGEND ACCESS COVER (WATERTIGHT) a� Z-� ST INT POND WITHIN 6" TO FIN. GRADE 2 DOUBLE WASHED PEASTONE $ FEET o WATER SHUT OFF VALVE EL.46t PROPOSED LOCATION EL.43t 27. SLOPE REQUIRED OVER SYSTEM MINIMUM .75' OF COVER OVER PRECAST 43.0 MAX -46- EXISTING CONTOUR _` n4O.O RUN PIPE LEVEL Cl) FOR FIRST 2' -'4�"- PROPOSED CONTOUR W PROPOSED 1,500 3 MAX. rr_718"MIN (H-20 LOADING) X 45.9 PROPOSED SPOT GRADE GALLON SEPTIC E .39.77 Q �3 H-10 EL.40.0 +45,79 EXISTING SPOT GRADE LOCUS TANK (H- 10 ) GAS EL.39.52 BAFFLE EL ��`'� o�o Low LINE PROPOSED WATER SERVICE o �W-" APPROXIMATE LOCATION EL. 9. 0 � 16" BARNSTABLE �6" CRUSHED STONE OR MECHANICAL 5' @ SIDES 3.5' @ SIDES w 3. MARSTONS MILLS P� DEPTH OF FLOW = 4' COMPACTION. (15.221 [23) 3' @ ENDS 10' 3' @ ENDS EL.38.67 EXISTING WATER GATE EXISTING HYDRANT REQUIRED TEE SIZES: H-20 14 INLET DEPTH = 10" MIN. BELOW FLOW LINE OUTLET DEPTH = 14" MIN. BELOW THE FLOW LINE 14 i go$g o� EL,37,50 ± (Ol 1 EXISTING CATCH BASIN 1 % SLOPE) LOCUS MAP 23±% SLOPE) 1 � SLOPE) ( 3/4" TO 1 1/2" DOUBLE V'ASHED� STONE ( ( FOUNDATION 17' SEPTIC TANK 8' D' BOX -2' 2' LEACHING FACILITY SCALE 1" = 1000' SEPTIC PROFILE ASSESSORS MAP 101, PARCEL 131, LOT 12 (NOT TO SCALE) FLOODZONE: C, BARNSTABLE PANEL # 15 +46.46 6,2' 5'1 ' ZONING DISTRICT: RF & GP FRONT: 30' SIDE: 15' N REAR: 15' OPEN +45.67 SPACE BENCHMARK BOTTOM OF TH 2 EL.32.40 FIRE HYDRANT S BOTTOM OF TH 1 EL,31.30 TAG BOLT 1546 +43.60\ LEV ��_ E = 41.49' � , LEVASSUMED 1. THE LOCATION OF EXISTING UNDERGROUND UTILITIES SHOWN ON THIS PLAN IS APPROXIMATE. PRIOR TO ANY EXCAVATION ON THIS SITE, THE EXCAVATING CONTRACTOR SHALL MAKE THE REQUIRED 72 HOUR NOTIFICATION TO DIG SAFE 45.6 X458 (1-888-344-7233) AND ANY OTHER UTILITIES WHICH MAY HAVE CABLE, PIPE OR EQUIPMENT IN THE CONSTRUCTION AREA FOR VERIFICATION OF LOCATIONS. 2. ALL SEPTIC WORK AND MATERIALS TO CONFORM TO 310 CMR 15.00 TITLE 5 4 6.71 AND BARNSTABLE HEALTH REGULATIONS. DECK OPEN 3. VERTICAL DATUM IS NGVD, ELEVATION ASSUMED. eA' LOT 12_ SPACE SEPTIC D7Si ,N: (GARBAGE DISPOSER IS NOT ALLOWED) 4. DESIGN LOADING FOR ALL PRECAST UNITS 4+45. 12 12,600 SF NUMPER OF BEDROOMS: 3 TO BE_AASHTO_Hl0_&-}'?^ 3 6' 45 / DESIGP, FLOW: 3 BR x 110 GZD/BR^- 330 G/D " ' ^` �- 5. THIS PLAN I� FOR PROPOSED WORK ONLY AND IS NOT TO WATER tali /b R (11 Aryl c PROPOSED � " ' L�`r BE USED FOR PROPERTY LINE STAKING. �4 49 � USE a E_.,". �� C��I; ? MAIN ---c-�" ti O X SEPTIC T�14 6. PIPE JOINTS TO BE MADE WATERTIGHT. 9a3 S 3 - BEDROOV, `h v 330 G"D (2) = 660 G/D 7• ALL SEPTIC PIPING SCH-40-4" PVC UNLESS NOTED. GATE /r 9 5' IN' 2� DWELLING � v 6 USE P;'.OPOSED 1,500 GALLON SEPTIC TANK 8. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 1 (��.3 4 ,82 3�k � TOF=EL.47.0 jr-Cl b a { 47.60 LEACHING' INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED \ k 2Z - SID'. AREA: 2 x 2' x (9.83'+31') = 163.3 SF FROM BOARD ❑F HEALTH. � 9. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT, INV OUT BOTTOt; AREA: 9.83' x 31' = 304.7 SF A_ =EL.44,0 SIDES: 163.3 SF i 45,8 + EOTTOM: 304.7 SF 39.5 9g3 , N , �X TOTAL: 468 SF 10 MZN 1 6' 2 +4 •7 0) PROPOSED CI PACITY: 468 SF x 0,74 G/D/SF = 346.3 G/D O,K. T 1 ppS P 2 CAR GARAGE _UPTIC SYSTEM DESIGN DATA s- TOS=EL.46.5 TH1 SOIL CLASS I (SANDS, LOAMY SANDS) G ;'' - Q' /{ 50.10 DEOPTH ELEV.30LAYER SOIL TYPE COLOR NOTES RATE: AT THI 2 0'-3' 42.05 / /A L❑AMY SAND 10 YR 3/4 UNS PERC. RATE < 2 MPI (I MPI DESIGN) (ASSUMED IN LAYER C) N❑ WATER OBSERVED 3 .8 �U. 9 + 3'-24' 40.30 LOAMY SAND 10 YR 4/6 UNS UNS; UNSUITABLE SOIL /I 24'-132' 31.30 C M/C SAND 2,5 Y 5/4 M: MEDIUM 45.8 /� �� - - C: COARSE � X LL S 1, `t TH2 SOIL CLAPS: AT ST N2 "h S, LOAMY SANDS)O�A +48.47 DEPTH ELEV. AYER SOIL TYPE COLOR NOTES L 0' 42.40 PERC• RATE: ASSUMED(IN PI DESIGN) 7 Jk .B tv 0'-3' 42.15 / /A LOAMY SAN 10 YR 3/4 QNS 1 1,�6 oo 3'-24' 40,40 B LOAMY SAND 10 YR 4/6 UNS NO WATER OBSERVED -P 24'-120' 32.40 C M/C SAND 2.5 Y 5/4 ENGINEER: MICHAEL S. FARIA, SE (DOWN CAPE ENGINEERING) PROPOSED -- PROPOSEDI WITNESS: HERB SCHNITZER D-BDX +44.58 SOIL ABSORPTION SYSTEM Iv PROPOSE DI LOT 10 4 NIGH CAPACITY INFIL TRATORS H-20 ExcAVAT❑R, BORTOLOTTI CONSTRUCTION 1,500 GALLON SEPTIC TANK WITH 3.5' OF STONE ALONG THE SIDES', TES' H0� LQG 3' OF STONE AT THE ENDS 12 AND 14' OF STONE BELOW, ELEC, CATV, TEL � I 0.28 CLUSTER SITE PLAN SCALE: 1 "=20' SITE PLAN OF LAND IN off. 508-362-4541 MAR S T 0 N S MILLS , MA fax 50$-362-9880 �- PREPARED FOR JOHN FALACCI down cape engineering, Inc. FOR HAMILTON HOMES OF , c LOCATED AT 230 CHUCKLES WAY CIVIL ENGINEERS ARNEH yesOAIRINE M SONS MILL A 02648 ---_ - .^ AR T" + °'�`�' N SCALE. 1 " 20' DATE: 7-21-99 .�PREVISED:BOARD OF HEALTH 3 I� ------ 2939 main st. yarmouth, ma 02675 MA �b ` 20 0 20 40 60 Feet APPROVED DATE DATE E H. ONk N '1`u+ s S.