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HomeMy WebLinkAbout0017 CRANBERRY RIDGE ROAD - Health 17 Granberry Ridge a0 Marstons Mills F/R r A= 030 i i� No jd N L� Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �11 Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Oizpooar 6pgtem Com5tructiou i3ermit Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) ❑Complete System O Individual Components Location Address or Lot No. h� ,pe orZ Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �,' '��_r-jam�i✓ 'l'�tiGp��i.Pc��/v,E�s+�'� 43c�-✓'ip����' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building W 1' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow � ` gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank o® Tyr°' Type of S..A.S.L��'� Description of Soil Tet Z ^o rwdAn'k t- A rd d�� t�t��JU m t_ 3 % Ln4 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 is by this Board of Health. 3—.0,o-Z Signed Date Application Approved by 1T- Date Application Disapproved for the following reasons Permit No. t U a ' Date Issued 0 2 S_J7 µ o y' v �' Fee / Y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBL�.0 HEALTHY DIVISION -TOWN OF BARNSTABLE MASSACHUSETTS Y Yes Zipplication for Miopogar *potem Construction permit Application for a Permit to Construct( )Repair( )Upgrade Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. /0�74C t$( rX Owner's Name,Address and Tel.No. 4COIA.,AWj0>00' Assessor's Map/Parcel �R��~� /rL� ' ��� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. e e, o een, ' 7 7 1— 1'707 mat A11..d 47. Jtj,0tr-Vo0v Type of Building: Dwelling No.of Bedrooms -� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building f' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow6 ga llons per day. Calculated daily flow© gallons. Plan Date 3 �- -O"�' Number of sheets Revision Date Title i Size of Septic Tank .-oo"10O,O TXj"k tt Type of S..A.S.tS`/��/�'t. Description of Soil _TA 7s no l d�T� �r+ A/e a d< ` L d Mti S. 3 becI&oM, f.A 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- cace of Compliance has been issue by this Board of Health. 3..0—a-Z c,/ Signed oCes�c3 Date40, Application Approved by �• Date �"'U? Application Disapproved for the following reasons Permit No. Duo a 0N X- Date Issued_ 3-kx—a 2 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded ,�X_ ) Abandoned( )by d+-lA, at =,,, 7 b,� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.960 7-010 dated �--e-d _;1 Installer t'3"/ti L Designer .d�td/,o �•/71,��'� The issuance of this permit shall not be construed as a guarantee that the s st� will function as desi e . Date - 1 LF--r �- g Inspector y 1./A.�Lev- ,►I� EAR.] ��.1'fl�� --------------------------------------- No. ^ d Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS 7M.5poar *potem- Construction Vermit Permission is hereby granted to Construct( )Repair( )Upgrade O Abandon( ) System located at -00P/,hf cd and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this p'�mit. Date: -' � Z Approved by \ �- TOWN OF BARNSTABLE �L g LOCATION " ���•a%�'E".P�Py'°P/� SE*AGE # VILLAGE � ' �/Z-`- ASSESSOR'S MAP & LOT 30 INSTALLER'S NAME&PHONE NO. lYi� tIc ce"�® SEPTIC TANK CAPACITY. ice-®oL5'a4 LEACHING FACILITY: (type) � (size) NO.OF BEDROOMS BUILDER OR OWNER • PERMIT DATE: 3 Jb COMPLIANCE DATE: 'T— 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 / Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist v� Feet within 300 feet of leaching facility) Furnished by ��g� Qj.6c�v,r frse�sSE' - Qvt,f j�lF.c,p `� �T d✓O-foe 04,0 1044 A E' BG C '0& ' 1 • Z TOWN OF BARNSTABLE -40001, LOCATION '� 'e 'P'PyeP/Q Cr F SE*AGE # '7 g oOZ 0 90 Vf.LLA GE ���f(r1o"of -OOV/4 Z`'r ASSESSOR'S MAP & LOT 30 0 INSTALLER'S NAME&PHONE NO. �/ L lJ F'v/r 7-7 s 070.7 SEPTIC TANK CAPACITY .01?`ooOAG . LEACHING FACILITY: (type) (size) NO. OF.BEDROOMS 3 J,0k1r7 ^ BUILDER OR OWNER ���' ®/y PERMITDATE: `� o oa 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 �,cat,I�q� � Q�.�vt ors` f�'ocsscz' �T ��%oE f oFck Ac �9 A EAq 8 %� A� C O DUX z TOWN OF BARNSTABLE � LOCATION A-,,e e-If-' f ,Oelp d!e" SE*AGE # s®oZ o 9© VILLAGE �� ' � ASSESSOR'S MAP & LOT $® p 0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY. - LEACHING FACILITY: (type) lL� (size) NO. OF BEDROOMS j BUILDER OR OWNER ��� ®� PERMIT DATE: 3 COMPLIANCE DATE: • Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet 1 Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by h'i r•, L ��o`�"G//�" � gE r exeakoAlD �T I/•r01�' OF'G•� - Ac A0 8 y I A E• �"ao A D&x 8-0 � x B op 6 3 0 t. t i A �3 r , { :9/V/99 DAT E PROPERTY ADDRESS: 17._Cranberry_Ridge_Road Marstons Mills , Mass . \I:— 91 ------------------------ 302Sdo I Inspected the septic stem at f e f�d%s. On the above date, p p y ��� This system consists of the following: 2 7 1999 99 N 1 . 1-6 'x8 ' block cesspools 2. 1-1000 gallon precast leaching pit . A Based on my Inspection, 1 certify the following conditions. E Z 3 . This is not a title five septic system. 4 . This is a sewage system that has been added onto .The leaching pit was added at a later date. 5. The sewage system is in proper working order at the present time . SIGNATURE: 1- Name: ber JLT-______ Company: Jose2h_P. Macomber_& Son, Inc . Address:_ Box 66—____—___—_ Centerville , Ma . 02632-0066 Phone:...508_775_3338_______ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY � I (JOSEPH P. MACOMBER & SON,. INC. Tan ks-Cess pool s-Leachf lelds Pumped & Installed Town Sewer Connectlons P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 COMMONWEALTH OF M.ASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON M.A 02108 (617) 292.6500 TRUDY C Sect ARCEO PAUL CELLUCCI DAVrD B. STR Governor CortL..;s.s SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION NopertyAd&.1: 17 Cranberry Ridge Road Nanwofown,"Harold Harriman Marstons ,Mills Mass . 02648 Adclts"of Owner: Dat, of inspection: 9/ 2 0 7 9 9 e s J o h Name of kupesctor:(Pteasa plan J p P.Macomber J r . I am a DEP oved aystam kup4ctoe ppuu��wam to Section 16.340 of Tide 6 (310 CMR 16.000) c.,p.,y Nart,e: J Y.Macomber & 5on Inc , I.ta,TNAddrau: Box 66 CPntprvi11A . MnQQ _ 02632 Telephorse Numaer: :5 C)8--i;—;3 9- CERTIFICATION STATEMENT I certify that I have personally Inspected the &*wage disposal system at tWa address and that the Information reported below is true, accurate and complete as of the Ume of"pacdon. The Inspecdon was performed based on my training and experience In the proper function and maintenance of on-site a age disposal systems. The system: _ Passes _ Conditionally Passes Needs Further E &lu&tion By the Local Approving Authority Fai Itupector's Sigruusre: Data: The System Inspector shall submit a copy of this Inspecdon report to the Approving Authority (Board of Health or DEP)within thirty 130) dsys 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 o» shall submit the report to the appropriate regional office of the Department ohfnvkonmemal Protection. The original should be sent to'MR system owner•and copies sent to the buyer, If applicable, and the approving authority. ' NOTES AND COMMENTS revised 9/2/98 Page I of II Pmts;l on R.cAWd Pap4s I �t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART A CERTIFiCATiON (contirwed) PrW.MAddrsss: 17 Cranberry Lane Marstons Mills ,Mass . Owns: Harold Harriman. Date of Irtsp.cdw:9/2 0/9 9 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which Indicates that any of the failure conditions described In 310 CMR 1-6.303 exist. Any failure "'DEEM--- criteria not evaluated are Indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: '4/16 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. Indicate yes,•no,or not determined(Y, N, or ND). Describe basis of datermJnatlon In all Instances. If 'not determined% explain why not. The septic tank Is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance (attached)Indicating that the tank was installed within twenty (20) years prior to the date of the Inspection; or the septic tank, whether or not metal,Is cracked, structurally unsound, shows substantial Infiltration or sxfiltration, or tank failure Is Imminent. The system will pass Inspection If the existing septic tank Is replaced with a complying septic tank as approved by the Board of Health. Eve- Sewage backup or breakout or high static water level observed In the distribution box Is due to broken or obstructed pips(s) or due to a broken, settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of Health). broken plpe(s) are replaced obstruction Is removed distribution box Is levelled or replaced - The system required pum*g-more than-fourtfines a•yeardue to broken or obstructed pipe(s). The rystam wNtvv r-- Inspection If(with approval of the Board of Health): broken pips(s) are*replaced obstruction Is removed revised 9/2/98 Page 2of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM 1NSPEC•Tn. �J PART A CERTIFICATION (cortdrnwd) Propertyaddraaa; 17 Cranberry Ridge Road Marstons Mills ,Mass . Ownw- Harold Harriman D.t'of Inapoceion: 9/V 9 9 C. ''FURTHER EVALUATION LS REQUIRED BY THE BOARD OF HEALTH: Nv ConcUdons exist which require further evaluation by-the Board of Health In order to determine If the system Is falling to protect th public health, safety and the environment. i) SYSTEk1 WILL PASS UNLESS BOARD OF HEALTH DIFTER.MINES IN ACCORDANCE WITH 310 CI.IR 16.303(1)(b)THAT THE SY IS NOT FUNCTIO.NINO IN A WARNER WWCH WUj p.R0IF,CT THE PUBUC HEALTH.AND SAFETY AND THE D1ZIEOKJ.t - QD Cesspool'or privy Is within 60 fast of surface water .4� Cesspool or privy Is wlWn 60 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FALL UNLESS THE BOARD OF HEALTH(AND PUBUC WATER SUPPLIER,IF ANY)DETERI.t1NES THAT THE SYST FUNCTIONING W A MANNER THAT PROTECTS THE PUBUC HEALTH AND SAFM AND THE ENVLRONMENT: The system has a septic tank and soil absorption system(SAS) and the SAS Is within 100 feet of a surface water supp tributary to a surface water supply. The system has a septic tank and toll absorption system and the SAS Is within a Zone I of a pubUc water supply well. The system has a septic tank and toll absorption system and the SAS Is within 60 feet of a private water supply weu. The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 feet or mots trom a private water supply well,unless a wall water►n&lysis for coUform bacteria and volatile organic compounds indicates u well is free from pollution from that facility and the presence of iLmmonla nitrogen and Nuats nitrogen Is equal to or Is than 6 ppm. Method used to determine distance • AIA- (approxJmadon not valid).- 3) OTHER � 1 revised 9/2/98 Page 3of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Pr.pertyAddreti.17 Cranberry Ridge Road Marstons Mills ,Mass . Owner: Harold Harriman Date of Inspection:9/r 9 D. SYSTEM FAILS: GG��// You must Indicate either"Yea" or"No" to each of the following: 41_ I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is Identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No /r Backup of•towage irttofeciiityor-estem componertt•due Ko an overloaded orcbgged•SAS•or•casspod. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the istribution box~bove outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool Is less than 6" below Invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(3). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy Is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is-+within a Zone 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 60 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 organlo-compounds, ammonia nitrogen and nitrate nitrogen. - E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system•la•wiWn 200 teetof�tsi ►Lary-toasucfaoedrinkiwg+w+ier+uppiy•••• - _ . . .__... ... _ ._ Y the system Is located in a nitrogen sensitive area(Interim Wellhead Protection Area:IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:l7 Cranberry Ridge Road Marstons Mills ,Mass . Owner: Harold Harriman. Date of Inspection: 99 Check if the following have been done:You must indicate either"Yes" or"No" as to each of the following: Yes No Pumping information was provided by the owner,occupant, or Board of Health. ' None of the systemsompoaants bawl:bean puaVad4orratJeast two-wea"and•the'system hasboeazaceiaiwg wswul Clow rates during that period. Large volumes of water have not been introduced Into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or Industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,-Xuding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: 41 Existing information. For example, Plan at B.O.H. _ Determined In the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) The facility owner.(and.ocr1paats.Jf diffaraoi front.ov=ar).ware.pin vide d.with Ininunatiomon thaw M;i ntaD, ^f SubSurface Disposal Systems. i' i revised 9 2 98 Page S of I I i I R SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION p,opertyAckkeu: 17 Cranberry Ridge Road Marstons Mills ,Mass . Owner; Harold Harriman Date Of 4upecti0n:9/2 0/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: A0 g.p.ddbedr m. Number of bedrooms dd sign. Number of bedrooms(actual):,) Total DESIGN flow-: � Number of current residents: Garbage grinder(yes or no):Ar- Laundry(separate system) 1 s org:_; If yes,separstelnspection•required --. Laundry system inspected es or no) Seasonal use(yes or no):� Water meter readings,If ov liable(last two year's usage(gpd): `99� ,` mil r.. � � y , Sump Pump(yes or no): Last date of occupancy: COMMERCIAL/iNDUSTRIAL: Type of establishment: Design flow: /A oad l Basewn 15.203) Basis of design flow Grease trap present:fyes or no) Industrial Waste Holding Tank present: (yes or no)/60 Non-sanitary waste discharged to the Title b system: Lyes or no)VO - Water meter readings,if available: Last date of occupancy:--Zj OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Pum ed main cesspool and leaching pit at timp nf inspection . System pumped as part of ins action: (yes or no) If yes,volume pumpWA d 7 allon Reason for pumping: t ltwr" ( J�,G� ! or+yCt�OsO fF�Qx3.� TYPE OF SYSTEM �tl�Y 6�'e PC ,ef; /Z4 As 1r) Septic tank/distribution box/soil absorption system / Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous Inspection records,if any) I/A Technology etc Attach copy of up to date operation and maintenance contract A)a Tight Tank Copy 0 DEP Approval Other 7 9 APPROXIMATE AGE of all components,date Instaged{if known)-and source of4nformation: - Sews"odors detected when•arriving at the site:(yes or no),�p i revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM c PART C SYSTEM INFORMATION(continued) PropenyAddress: 17 Cranberry Ridge Road Marstons Mills ,Mass . Owrw: Harold Harriman, Date of Inspection:47/'#9 9 BUILDING SEINER:7 (Locate on site plan) 1! Depth below grade:] Material of consuuc on: \Iron 40 PVC other(explain) Distanca 1priv frorpate wet r supply well or suction line ID Diameter /// Comments: (condition of joints,venting,evidence of leakage,-etc.) - Joints appear stem 1,2 vented SEPTIC TANK: , (locate on site plan) ,q Depth below grade: Material of con6t1uction.4,f oncretel/ metal.(AFiberglassA�A Poly@thyl one{Wother(explain) If tank Is Instal,list age NA 1s.age.confumed by Certificate of Compliance (Yes/No) Dimensions: AJA Sludge depth: AM �� Distance from top of sludge to bottom of outlet tee orbaffie: Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: /M Distance from bottom of scum to bottom of outlet tee or baffle:42 How dimensions were determined: Ig Comments: (recommendation for pumping condition of Islet and outlet tee&or-baffles, depth of liqul` eves In relation outlet invert, suuctural integrity, evidence of leak ge`atc.), �epfir tank is not nrPaPnt GREASE TRAP.: rW (locate on sits plan) Depth below grade:. Material of constructlon;v,9concretevAmetapl�/9 Fiberglass�Polyethylen'A-A'other(explain) Dimensions: AN Scum thlcknes&: Distance from top of scum to top of outlet tee or baffle:—dg Distance from bottom of sc m to bottom of outlet tee or baffler Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet Invert, structural integrity. evidence of leakage, etc.) ,ease trap is not present Pse7orii revised 9/2/98 e f - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(corrtinued) Property Address: 17 Cranberry Ridge Road Marstons Mills ,Mass . Owner: Harold Harriman Date of Inspection:O/AY9 9 TIGHT OR HOLDING TANK-_&DTank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grader Material of construction:UconcreteVhmetalNAFiberglassq/,4Polyethylene other(explain) AIA Dimensions: Allf Capacity: V17 gallons Design flow gallons/day Alarm present Alarm level: Alarm in working order:Yes,( No4 Date of previous pumping:A_ Comments: (condition of inlet tee, condition of alarm and float switches,etc.) Tight or holdinp, tanks are not pr GPnt DISTRIBUTION BOX:A4We, (locate on site 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, etc.)Distribution box is not nrT accent PUMP CHAMBER:&ve' (locate on site,plan) �,��,�A��A 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.) umD chamber is not nrPGPnt - revised 9/2/98 . Page 8or11 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM i PART C SYSTEM INFORMATION(cortdnued) PmpenyAddrass: 17 Cranberry Lane Marstons Mills ,Mass . OWrW: Harold Harriman Date of k4pecbw: 9/2 0/9 9 SOIL ABSORPTION SYSTEM(SAS):_ (locate on site plan,If possible,excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers,number: 0 leaching galleries, number:= leeching trenches,number, length: leaching fields, number, dlmensions:_ overflow cesspool,number: Alternative system:_n4 t Name of Technology: S 4 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Loamy san , Na SiglIS of fly ion is CESSPOOLS: (locate on site plan) Number and configuration: tJ Ospth-top of liquid to inle nvert: Depth of solids layer: ' Depth of scum layer: Dimenslons of cesspool: 49 r Materials of construction: Indication of groundwater: A 26 inflow(cesspool must be pumped es part of Inspection) Inflow c Comments: (note condition of soil, signs of hydraulic fallurs,.level of.ponding,condition of-vegetation. etc.) Same PRIVY:A&f- (locate on site plan) Materials of construction: Dimensions: 1/w Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) Privy is not nrpspnt - revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOR1dAnoN (con x+od) PTopMA""4: 17 ,Cranberry Ridge Road Marstons Mills , Mass . 0w^": Harold Harriman . D fu o 14upecocn:9/0 9 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include des to at least two permanent reference landmarks or benchmarks locate all walls wltWn 100' (Locate where public water supply comes Into house) 17 Cra,, e,-ry A,41C 1 AcK s W. 3 9' \ 1 cP 0 revised 9/2/98 Page 10of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ProgwyAddresa: 17 Cranberry Ridge Road Marstons Mills ,Mass . own«: Harold Harriman . .-' D-u of"""don: 9/2 0/9 9 NRCS Report name Soil Type_ Typical depth to groundwater uSGS Date webaite visited _ Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater5L Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record bsorved.Sits (Abutting props observation hole, bassmeot sump etc.) Determined from local conditions Checked with local Board of health Chocked FEMA Maps —;;'Chocked pumping records k Checked local excavators, Installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used water contours map . Gahrety & Miller model 12/16/94 i revised 9/2/98 Page It of 11 �a•1T.TTIt—RCTIrT—ti1.'.—JRf'RiTRJ9rTf1.'RT.t'Rlf tiT•r\it)f►JTIfTRIRTt T1i.TM1�tTtO"RTtOt.l�i •. �.��� TOWN OF Barnstable WARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL ,SYSTEM INSPECTION FORM - PART D .- CERTIFICATION I •••TtM�r•'.•::i—T.11T.�•�TTt 1t1:T.1•.f.'TSI 1'tllr iCTl/T1•TT:T.—.t'tT.•11R'T�in11t1T�1�i17R'Oef�.l�'�f RRRn •.Ttr1'T•T`1r—.••t -TYPL OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRES$ 17 Cranberry Lane Marstons Mills ,Mass . ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Harold Harriman PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber �& Soa-elnc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 . Street Town or Clty State Lip COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 790-1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . CheckY one: S steui PASSED j The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public healLh or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* J The inspection which I have con toted has found that the system fails to protect the public he,nith and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature C4'v1 / Date ' copy of this certification must be provided to the OWNER, the BUYER Dnb where applicable ) and the BOARD OF HUAL111. * If the inspection FAILED, the owner or operator shall upgrade ' the system. within o•ne year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 15 , 305 . partd.doc f' CrAh el-ry At4le 7— ,X ' 1 AcK 1 i 114' S y- �" aid C� R1pi N ep All co� DATE: .5/4/99 PROPERTY ADDRESS: 17 trnnber'ry Ri'dee Road Mars�ons Mi11s,MasG _ 02648 `. • r R6EI ED On the above date, I Inspected the "ptic eysto mot the ab 7 e address . Thla system conelets of the following: "~ 1999 I E 1 . 2-6 x8 block .cesspoAls . tawHoiT4AnEPTaa� 2 . 1-1000 gallon :precast leaching pit . � Packed in stone . �. J .�` Based bn my Inrc*actlon, I certify the following conditl sl Ei t (I 3. This is not a •title 'five• septic system. 4. This is a sewage system that' .has bden. added onto , A leaching pit was added at a' later date . 5. ?1'-cesspool is not functioning . Overflo� line must be replaced'.- This will make system operational . , 81GNATUR 7, Name : J P..,H*acomber Jr. ` . • :. i , Company:_ J.Hacogber. b � onl 'Irtc Address ' Phon a: ------- ' I THIS CERTIFICATION DOES HOT CONSTITUTE A GUARANTY OR WARRANTY SOSEPH P. MACOMBER '& SON, INC, T+nkt-C�upoolt-L��chll�lda . Pump+d L Insu1W ' Town 5iwir Connictloni P.O, Box 60 ' Centervllls, MA 02632.0066 77.5.33JZ 775-6412 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.5500 TRUDYCOXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECT10N FORM PART A CERTIFICATION PtopertyAddress: 17 Cranberry Ridge Road Name ofowna.Harold Harriman Marstons Mil Mass . 02648 AddressofOwner: 17 Cranberry Ridge Road Data oflnspetic 4��9 Marstons Mills ,Mass . 02648 Name of Inspector:(Please Print) I nq p p h P M 2 c 0 tu b e r J r I am a DEP approved system inspector pursuant to Section 15A40 of Title 5(310 CMR 15.000) Company Name: J. P.Macomber & Son Inc . MaaiingAddress: BOX 66 Centervilla_, Macc 02632 Telephone Number: 2 7 7 5 3338 CERTIFICATION STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The Inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes ,Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: rl f Date: The System Inspect shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner 'shall submit the report to the appropriate regional office of the Department oKnvironmentai Protection, The original should be.sent to," system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS Once overflow line is replaced . The sewage system will pass inspection . revised 9/2/98 Page 1of11 A Q? Printed on Recycled Paper `.i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 17 Cranberry Ridge Road Marstons Mills ,Mass . Owner. Harold Harriman Data of Inspection: 5/4/9 9 INSPECTION SUMMARY: Check A, B, C, " A A. SYSTEM PASSES: I have not found any information which Indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: Ovprfl nw line to #2 cesspool is to high and must be 1e4A.4Q1-6Qd_a Rdrep1aeed—Wastt---wat-el- stafids--abe-ve in the invert and overflow lines . 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. Indicate�yes,'no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank Is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box Is levelled or replaced - The system required pumphig-more than four-dmes a yeardue to broken or obrstructed pipe(s). The system willjmss-- inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed d;14J-� Sewage is standing in the invert and outlet inverts of -the main cesspool . Overflow line to the # 2 cesspool must be replaced and lowered . #2 cesspools has only 6" at most of water in it . Present pipe is to high to function . revised 9/2/98 Page 2of11 , V -1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropanyAddrasa: 17 Cranberry Ridge Road Marstons Mills ,Mass . Owns: Harold Harriman Daze of Ir'a� 5/4/9 9 C. ,,FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: N(V 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 IN ACCORDANCE ACCORDANCE WH 310 CUR 15.303(1)(b)THAT THE SYS IS NOT FUNCTIONING IN A MARKER WH1C4j5MILL pAQ.IECT THE PUBUC 8FALTHAND SAFETY AND THE D i%a80N1.tEKT- IPP Cesspool or privy Is within 60 festof surface water �D Cesspool or privy Is within 60 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM Will FAIL UNLESS THE BOARD OF HEALTH(AND PUBUC WATER SUPPLIER,IF ANY)DETOWNES THAT THE SYSTE6 FUNCTIONING IN A MAURER THAT PROTECTS THE PUBUC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and toll absorption system(SAS)and the SAS Is within 100 fast of a surface water supply tributary to a surface water supply• The system has a septic tank and toil absorption system and the SAS Is within a Zone I of a public water supply well. The system has a ►optic tank and toil absorption system and the SAS Is within 60 fast of a private water supply w*U. The system has a septic tank and soil absorption system and the SAS as less than 100 feet but 60 fast or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates tha well Is free from pollution from that facility and the presence of ammonla nitrogen and nitrate nitrogen Is equal to or loss than 6 ppm. Method used to determine distance • "A- (approximation not valid).- 3) OTHER 1 revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) PropeMAddress: 17 Cranberry Ridge Road' Marstons Mills ,Mass . Owner: Harold Harriman Data of Inspection: 5/4/9 9' D. SYSTEM a'FAILS: arid" -/ You must Indicate either "Yes" or"No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be.necessary to correct the failure. Yes N ./ Backup of-"Wage imoiecilitywr•aYeterrt component•due%to an overloaded orclegged-SAS•or-cesspool. y' Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. /,tWe- Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. 4-- Liquid depth in cesspool is less than 6" below Invert or available volume is less than 1/2 day flow. ZRequired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is-within a Zone 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: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes Now the system is within 400 feet of a surface drinking water supply 0!0 the system•(s-witWn 200 feet of-a-ttitwtary-to a surfao"Fk4aA9-watW-supply••• - - --- 10 the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area:IWPA) or a mapped Zone II of a public water supply welll The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further infortttation. Overflow line to the #2 cesspool must be replaced and lowered . This will omit failure . revised 9/2/98 Page 4of11 I f f' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:17 Cranberry Ridge Road Marstons Mills ,Mass . Owner: Harold Harriman. Date of Inspection: 5/4/9 9 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the system-compooanu.kauabaen puaNwd+foFatJeast two vvealw an&the-rystem hasbaeaasceiuiw9wsara!flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,.S iuding the Soil Absorption System, have been located on the site. _A12101 _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, materia:of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: 41 Existing information. For example, Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) — [15.302(3)(b)l The facility owner.(and.wculaaats,if difieragi from nyvnerl.>Keraprnyidad.with iafwmallomDn.th&4uz4w-aiaintanaaca.Qf SubSurface Disposal Systems. i i revised 9/2/98 Page 5orn 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION NopertyAdd —: 17 Cranberry Ridge Road ..Marstons Mills ,Mass . Ownw: Harold Harriman Dou of Inspection: 5/4/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: /!O g.p.ddbedroo Number of bedrooms(de}Ipr�): Number of bedrooms(actual); Total DESIGN flow d 61' Number of current residents Garbage grinder(yes or no): Pis Laundry(separate system) ( es or o _ If yes, separateJnspactlon.required Laundry system Inspected es r no Seasonal use (yes or no): r� � i.6�iV Water meter readings,if available (last two year's usage(gpd): 77 Sump Pump(yes or no): A10 fa;K ! Last date of occupancy::�1 COMMERCIAL AJDUSTRIAL• Type of establishment: Design flow: AA qpd ( Based on 15.203) Basis of design flow Grease trap present:(yes or no) Industrial Waste Holding Tank present:(yes or no)LI/4 , Non sanitary waste discharged to the Tide 6 s stem: (yes or no1 Water meter readings,If available: Last date of occupancy:_22d OTHER:(Describe) Last date of occupancy: IVAI GENERAL INFORMATION PUMPING ORDS a sou ce �nfor �ti ; 7 -- j '/ ec,71 Syste pumped as part of in pection: (yes or no')y&S If yes, volume pumped: C- gallons Reason for pumping: /'L TYPE OF SYSTEM 44 Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes, attach previous Inspection records,If any) I/A Technology etc.Attach copy of up to date operation and maintenance contract D Tight Tank A4 Copy of DEP Ap roval Other l—1 B ' Z i J AFT,ROXIMATE AGE of all components, date Installediif known)-and source o-iRformation:,Oyz — r � J Sewage odors detected when arriving at the site: (yes or no)ZP revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Propo yAddre": 17 Cranberry Ridge Road Marstons Mills ,Mass . owns(: Harold Harriman Data of Irtapectiort: 5/4/9 9 BUILDING SEWER: (Locate on site plan) 1/ Depth below grade:f Material of construc 'on:�;Iron 40 PVC other(explain) JAPI It Distance frorp/private wet r supply well or suction Ilne /D Diameter ���/ Comments:(condition of joints, venting,evidence of leakage,-etc.) - Joints a ear stem 14 vented SEPTIC TANK: Q, (locate on site plan) ,q Depth below grade!1 Material of constructi17a_�1 oncreteA-1 metaL) ,FiberglasaA'A Polyethylene 40other(explsin) If tank is Instal,list age VA ls.age.confumed by Certificate of Compliance (Yes/No) AJA Sludge depth:_ _ Distance from top of sludge to bottom of outlet tee ortratfle: XA Scum thickness: Distance from top of scum to top of outlet tee or baffle: AM Distance from bottom of scum to bottom of outlet tee or baffle:4_ How dimensions were determined: �1t� Comments: (recommendation for pumping, condition of Inlet and outlet tees or-baffles, depth of liquid level In relation to outlet invert, structuraHntegrity, evidence of leakage,etc.) Septic tank is not nrpgpnt GREASE TRAP]WC (locate on site plan) Depth below grade: Material of consuuctionAb9concrete lmetaVl�AFibarglass��Polyethyleneother(explain) Dimensions: AW Scum thlckness: Distance from top of scum to top of outlet tee or baffler Distance from bottom of scym to bottom of outlet tee or baffle:, Date of last pumping: Comments: (recommendation for pumping, condition of Inlet and outlet tees or baffles, depth of liquid level In relation to outlet invert, structural integrity, evidence of leakage,etc.) tease trap is not present revised 9/2/98 Page 7or11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17 Cranberry Ridge Road Marstons Mi11s ,Mass . Ownec: Harold Harriman Data of Inspection: 5/4/9 9 TIGHT OR HOLDING TANK:sir. [Q(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade: VIA Material of construction:U�concretebivmetal4*iberglass41i4Polyethylene4i other(explain) AIA Dimensions: Capacity: VP gallons Design flow gallons/day Alarm present Alarm level: Alarm in working order:Yesa1 NOW Date of previous pumping:A— Comments: (condition of inlet tee, condition of alarm and float switches,etc.) Tight or o ing tanks are not n PsPnt DISTRIBUTION Box: e, (locate on site 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, etc.) — -Distribution box is not pracant PUMP CHAMBER:A //7. (locate on site plan) /� Pumps in working order:(Yes or No)�i Alarms in working order(Yes or Not 4 114 Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) umD chamber is not nrPGPnt revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 17 Cranberry Ridge Road Marstons Mills ,Mass . owner: Harold Harriman Data of Inspec ion:5/4/9 9 SOIL ABSORPTION SYSTEM(SAS)z (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:1 leaching chambers,number: leaching galleries,number:_ leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: ,U Name of Technology: Comments: (note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Loamy sand to hnna3� Band to fines onpd ThPrP ara signg of hwdranlir e omitted by in sta frnln the CESSPOOLS: (locate on site plan) , Number and configuration: 1< Depth-top of liquid to inlet invert: 4=gI )IUl 7 O ?9 N(! Depth of solids layer: 1 Depth of scum layer: Dimensions of cesspool Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Inflow cess=nnl was i—ped Dl- a-J darka e E urQ.ter Intl Ils}eP : Comments: (note condition of soil, signs of hydraulic failure,.level of ponding,condition of,vegetation, etc.) Same as above - PRIVY:'d/'Vo t:— (locate on site plan) Materjals of construction: Dimensions: Depth of solids:A4 Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.) Privy is not present revised 9/2/98 . Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(con x;Qd) PropeMAd&"4: 17 Crat;berry Ridge Road Marstons Mills ,Mass . Own&(: Harold Harriman . Date of U-P*Cdon: S/4/9 9 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells wlWn 100' (Locate where public water supply comes Into house) I? CrAx el-& Rj*e19e 1 Acx v' / y. \ l NN p 0 1 G Q fgPi N cP O revised 9/2/98 Page 10of11 f T- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropenyAd&"s: 17 Cranberry Ridge Road Marstons Mills ,Mass . Owner: Harold Harriman Date of Impection:5/4/9 9 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.S:ite(Abutting property, bservation hole,basement sump etc.) determined from local conditions Checked with local Board of health Checked FEMA Maps �hecked pumping records _Z/Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used Water Table Contours Map . Gahrety & Miller Model 12/16/94 J' revised 9/2/98 Page 11of11 I SOJ R.fl'1 TI 1-1{1'R�'TT—\i1I�JT1f'I.TiR I'�"1TR SIR.IT.RI`.7TT:lIfT1TIRR'lIIT1 ffLT1.7N 1�f'R1LT•IPl1 .T'R'TT4�.�I�Tr"...�•,r—• TOWN OF Barnstable BOARD OF HEALTH 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CEwrIFICATION r�•T!NET••. ;;t—�...T.�.�lT11ST:T.1'R.TTI TIPSR1fTP'.T,'T.•.'I�ttTR��IT'Rr1TtT..Stf«LTt ItM.J{TnTlTAtiv+TTrrtr,•.+sr T'^.1. ... -TYPE OR PRINT CI.EARL1•- PROPERTY INSPECTED STREET ADDRES$ 17 Cranberry Ridge Road Marstons Mills ,Mass . ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Harold Harriman PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber & Sam' Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 1 790 - 1578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the information reported is true , accurate , and complete as of the time of inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . :%steui ne : PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con tcted has found that the system fails to protect the public health and the environment in accordance with Title 6 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature ew,0, Date One copy of this certification must be provided to the OWNER, the BUYER ( Where applicable ) and the 130ARD OF 112ALZ'11. If the inspection FAILED, the owner or•"�o' orator shall u * i ti p pgrado ' the eyetem within one year of the date of the inspection , unless allowed or required otherwise as provided in 3.10 CMR 15 . 305 . partd .doc '�.� O 3 G ---ere No. O Fss... .... 0.:.00... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town........................O F.............Ba rns.ta b 1.a....------------------....-----•----........ Appliration for Mipwial Works C umtrurtion punfit Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: 17 Cranberry...Ride .Road Marstons Mills . Location-Address or Lot No. Harold Harriman Owner Address a ....f7...P_..Ma=mher............................................................ ......---•--------•-------•-•-•....--•---------••----------------------------._............._..... Installer Address dType of Building Size Lot--_--_--------------------Sq. feet U Dwelling X-No. of Bedrooms................................ .Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ...................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width............._._.... Total Length Total leaching area...__._....._.......s ft. p ---- g g q• 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................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+' ------------------------------------•---••-•------------------------.......................•................................................................. 0 Description of Soil....................................................................................................................................................................... VSand&Grave 1------------------------•---•---------•----------------..........._...........-•------...- W -----------------------------------------------------------------------------------•-------------=-----------------------------------------------------------------------------------•-••-•..••---- UNature of Repairs or Alterations—Answer when applicable................................................................................................ -- ---------- ----------------------------------------------------------•--•---•--•---------------------•• 1_-1.0 0 0-- a 1_l on...1 e a ch 1 ........................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI I':.r: 5 of the State Sanitary Code— The lindersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issue y rd of he Signe ...: f.. .- -A..................... .••---. Date Application Approved BY `""'."'�J ............. ---------- -yE�- Date Application Disapproved for the following reasons:................................................................................................................ ....................••-------........-------•--------••-----......••----....--•--------......--------------••-•------•------•-----------•-------•--•------•---•---•----•-------•--------------•--------- p Date PermitNo.........a.. ..'.�- yj�-•.................... Issued....................................................... Date FES...$.....r.Q.z.7 ... No......:.."�:`.. ? THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TO.w..n..........................OF_...........Ba.rn-st w1 l_e-------------_____.._-_._-_.__..----------__ Applira#iou for Disposal Works Tomitr trtion "truth Application is hereby made for a Permit to Construct ( ) or Repair kX) an Individual Sewage Disposal System at: 17 Cranberry Ridge Road Marstons.Mi.I.��------------------•-•--••---....-•--•- .---......_................................................................ --....------•-------------•---•--.........._------ Location-Address or Lot No. Harold Harriman Owner Address WJ kq C ? �e?c............................................................ .•--•-•--•-------------•--_______-____-________--------••--------_____-____-•-•---•---•------____- Installer Address d Type of Building Size Lot............................Sq. feet U Dwellingy No. of Bedrooms....................................... ____Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria QI Other fixtures --------------------------------------------•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............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........................................ aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 93, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ------•--••-------------------------------------•--•-------..........----------..........---•--•---...---------.....---.._..--------•--••-•--------.......... ODescription of Soil.................................••--...._.....-•--••--•-----••-------------••-----------------------•---------------------•-••--------------------------....._.....--- v --------------- --------•--•--------------------------------•---•------------�andS-GaVEl--•---------------- W ....--•---------------------------•••-•---•-•-•---......--•--------••--•----•--------•-----•------------•--------------------- ---•----------•--••----•----•-••-------------------------•--------•-•---. UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ............................................................................................................1--10-00---g.a11.on---leach...R .....•-----•-•---•-•---. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT i E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance enn issue y e ,board of he th. Sign ! _ fi ••--------- -----•- Date Application Approved B .................. ,,( ae Application Disapproved for the following reasons---------------••----•-------------------------------------------------------------------...----------------•-•-- .......................................•------•------•••-----------------•-------•-.....-••--•----------_.__....---------------------------------------------------•-•--•-------•--------_...------------ Date PermitNo........Ke y----------------------- Issued_..................- ............................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...............Tow.?...............0F.......... l,rn2it.cad'le........................................... (Irtifiratr of Toutlrfiaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XX) by J-P.naComber Installer at. ....1:7_..Cranbe.rry Ridge Roach bfarst_ons Mills has been installed in accordance with the provisions of TITLE, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... rz JL/___..__. dated--.............................................. THE ISSUANCE OFT IS 'CERTIFICATE SHALL NOT BE CONSTRUED AS A G. ARANTEE THAT TH SYSTEM WILL FU,N4TI N A 1 FACTORY. o DATE.................... --- Inspector....... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town.................:OF...------Barnstable ........................................... $ 20 00 Nq,'1.,J...... FEE...................... Disposal Works Tonstr tion rrutit UsP•MaComber Permissionis hereby granted.............................................................................................................................................. to Constru t ( ) or Repair {� ll an Individual Sewage Disposal System at No...__1-7 Cranberry R dge Road Marstons 'Mills ................•-•----.----•------------------•------------•---------•---------•--••-•--•-•--------•----............-- Street as shown on the application for Disposal Works Construction Permit No-0)o---- Dated.......................................... ................................... .'.__-___ _ _______________-_____._.__._..__..------...._____-- oard of Health DATE. 1 .............. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS I 1 t ASSESSORS MAP TEST HOLE LOG S PARCEL: . .., FLOOD ZONE: � / ✓ '� ', � SOIL EVALUATOR: t IM1/�1 i '` b WITNESS : HOT REFERENCE: ,! _..c -- .` 1 _ :. ,. . ;/ .., C _ nDATE:► t i 2 ... , PERCOLATION RATE: 2 p`'7l4-11 -- -- ? a TH- i TH-2 -�—., r-" , —l" �, --_ � �t4 , : � f i i 'Lcl .� { LOCATION MAP �a� Itoll 1 C � 7 ........... SEPTIC SYSTEM DESIGN , .'' FLOW ESTIMATE ZX � �n cj %4 , BEDROOMS AT fi I GALfDAYIBED tJOM - 1 GAL/DAY , pv'T. ? GAUDAY x 2• DAYS &!�60AL . ' USE ALON SEPTIC TANK OIL,AB RPT ON: SYSTEM gap -~ 10 r SIDE AREA: .�C .. , BOTTOM AREA: :- y , \6 NJ 1 ,lhq �. a E.. I G SYSTEM SECT ] ON - �7 JkA „ v t e e„ : D-BO q ,�Jj - - 1 F �'V', ,y i`a"-k�,sk!'��1z." w.d✓ .y.: 6.Y«1.1 ' l�5 SEPTIC TANKq3S Q �-.__. �1 " IIL !.•a 7 4w . „r b I ' :,k. •. e __'_. _�;v✓fe."y .r._...,. :..- �-5mct?w �+'"e'°"• ^N'yy^B �����'tlffig; w pr, �• �Y n j -- / .T S ! TE AND SEWAGE P LAN . I LO AT ION : C � � .�• ''""" ""�, i'�°�"'�'_�,�'""`""Fes:..,,,,.=�-•'K'y^�+��+t,:'�r- w�'��`.`".,"� t�% ,uts +;gc r. M> PREPARED FOR : IN M bor SCALE: . �``'--.�. DAV I D B . MASON A5 DATE: 02 o DBC ENVIRONMENTAL DESIGNS z x EAST SANDWICH . MA W DATE HEALTH AGENT ( 508 ) 833- 2177 W Z