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HomeMy WebLinkAbout0080 CRANBERRY RIDGE ROAD - Health 77`1 ` . •.r +_. 80 Cranberry Ridge Road - -i - Marstons Mills , •S-1°bb i.. A=030 — 057 J ICI d3B of, 3 7 No. Fee � > �® 7101 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i �// Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for 0igpoeal 6potem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(l!)Abandon( ) O Complete System "In vidual Components Location Address or Lot No. Owner's Name,A dress an Tel.No. o/'I` Assessor's Map/Parcel' Installer's Name,Address,and Tel.No. //►►//ff Designer's Name,Address and Tel.No. Y0 7— Type of Building: Dwelling No.of Bedrooms Lot Size 3 Z�z sq.ft. Garbage Grinder Other Type of Building 25 C No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow aJ J gallons. Plan Date ]Number of sheets Revision Date Title /7 D � �� G�� 10 r Size of Septic Tank leae 9411 Zg&4 Ty e of S.A.S. D /S Description of Soil 9i 3 3OX Z 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 issued h2v this Sign I Date Application Approved b Date I< .� Application Disapproved for the following reasons Permit No. rZ 3 1 Date Issued y 3 _ No. 3 - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes =o� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for ]Digpooal 6pgtem Cottgtructiou Permit Application for a Permit to Construct( )Repair`( )Upgrade(P Abandon( ) ❑Complete System LJ Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. + Assessor's Map/Parcel *4,13� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. z yam Gg1ae Gam, qz6—S9ZL 3V7 ��Sryf Type of Building: Dwelling No.of Bedrooms ,3 Lot Size 3i ,Zb Z sq.ft. Garbage Grinder Other Type of Building 'f ?OoVe `" No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //62 gallons per day. Calculated daily flow 3 3t�� gallons. Plan Date 41 D dumber of sheets Revision Date Title / l� 1017 © � �� �/!?°y/ �° l 1* Size of Septic Tank lew 9411 Ty e of S.A.S. —"Description of Soil 9i�`3/Y 3e:o.,r Z � 9 ¢T !- 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 issued this Board Sign G � Date `Application Approved b Date 4) 1�6 o Application Disapproved for the following reasons I Permit No. Pj6y - 1 10 f Date Issued 4411q70 3 r 19 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CE TIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded(41- ) Abandoned( )by at _-ell IT5 has been constructed i accordance with the provisions of Title 5 and de for Disposa System Construction Permit No. I dated Lf t( u Installer Designer The issuance ofthis permit shall not be construed as a guarantee that the s m will function as esigned. Date ! 1 t) Inspector `"' k1j• -1 ^-� No.9 00 J �/ &q Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS ;Di5pogar *pgtemc Construction Permit Permission is hereby granted to Construe( )Repair( �)U.grade(✓),'Abandon( ) System located at e G rq� �/f Y A'61 1_al i o_ , /111 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 t�hi�"pe t. Date:_ `t" �/ Approved b r TOWN OF BARNSTABLE C C LOCATION g0 G c �� � 44 rrr1 i e SEWAGE #AOv3'��9 VILLAGE 1�� !�/� l�f / ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. f/�'h�/o1�i �sw .�c�io✓ I. Q92e SEPTIC TANK CAPACITY 1L LEACHING FACII.ITY: (type) Sad Cr Z�,yy`zji 0,3 (size) la'Ka"',x-71 NO. OF BEDROOMS BUILDER OR PERMPTDATE: y/9 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 L1 4tI O J I 5� r i i j / Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mills MA 02648 April 19 2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any �3Important: way. When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your David D. Coughanowr cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364-0894 Pending Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection."The inspection was performed based on my training and experience in the proper function and maintenance of on.,site sewage disposal systems. I am a DEP approved system inspector pursuant to Sectiori=1:5.340=of Title 5 (310 CMR 15.000). The system: G� ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority i { , rn April 19, 2007 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 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. ****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. t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mills MA 02648 April 19 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> Aseptic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) 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 t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is Marstons Mills MA 02648 April 19 2007 required for P , every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ 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. t5-2607.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mills MA 02648 April 19, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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. 3. Other: D) 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 ❑ ® 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. t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mills MA 02648 April 19 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® 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. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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 If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mills MA 02648 April 19 2007 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® 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)] t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mills MA 02648 April 19 2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 181 gpd 9 ( Y g (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: March, 2007Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other (describe): t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is Marstons Mills MA 02648 April 19 required for p , 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: 0 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 installed (if known) and source of information: Age: 1+year. Disposal Works Permit issued 7111105(Board of Health permit#2005324) Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mills MA 02648 April 19 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): Depth below grade: 1 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: 8.5 ft x 5 ft x 5 ft(1000 gallon) Sludge depth: 8 in Distance from top of sludge to bottom of outlet tee or baffle 26 in Scum thickness 6 in Distance from top of scum to top of outlet tee or baffle 7 in Distance from bottom of scum to bottom of outlet tee or baffle 11 in How were dimensions determined? Probe to top of tank t5-2607 do c 08/06 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 72 Hartford Avenue �M Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mills MA 02648 April 19 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is recommended at this time and maintenance pumping is recommended every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): t5-2607.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mills MA 02648 April 19 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert At outlet inverts 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.): D-box appears structurally sound with no evidence of leakage in or out. Distribution appears balanced. Few solids in sump. Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mills MA 02648 April 19 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate 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: 1— 15 ft x 30 ft ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching field appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mllls MA 02646 April 19 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is required for Marstons Mills MA 02648 April 19 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I LOCATIONS A B 1 29.5 Ft:- 46 FE 2 35 FE 52 FE SEPTIC TANK 3 39 Ft- 43 FE 2F---�I A EXISTING 3 DWELLING D-BOX # ? 2 a LEACH FIELD w z J Ir w F- 3 HARTFORD AVENUE NOT TO SCALE t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 k' a • Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 72 Hartford Avenue Property Address Zachary Gonsalves Owner Owner's Name information is Marstons Mills MA 02648 April 19 2007 required for /� , every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 40+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: 7/11/05Date ❑ 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: GIS Department records You must describe how you established the high ground water elevation: Design plan shows field above high groundwater. Town of Barnstable GIS Department records indicate that the property is 40 feet above groundwater table. t5-2607.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 COMAI0?gVEALT _ H OF-Nb�-SSACHUSE T.Ts EXECUTIVE OFFICE OF E-\rT'ZRO-N-_%j IAi T DEPART T �R` ' MENT OF ENTVIRONME-N-TA, pROTECTIO 4"4M e\'lb TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEAVAGE DISPOS_4L SYSTEM FOR-NI PART A .q CERTIFICATION Property Address: a O d e ee ti e ohs ,' o a 6 SF8 Owner's Name: 2 Owner's Address: G °r !'a h gri � � C Date of Inspection: Name of Inspector• (please print} 4 e� Company Name: 4::1- Mailing Address: o oil ot8 Telephone Number p 6y.4 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that then r�at;e�repo*zd below-is tine, accurate and complete as of the time of the inspection.The inspection ;.as perorned used n p training and experience in the proper function and maintenance of on.site sewage disposal syste:r.,.t an a DEp approved system inspector pursuant to Se 'on 15340 of Title 5(310 C,,NfR 15.000) The st-ste__ N Passes --' Conditionally Passes Needs Further Evaluation by the Local Approi ing Au-h Fails w, Inspector's Signature: : a` Date: co N y The system inspector shall submit a copy of this inspection report to the Approving r W DEP)within,0 days of completing P Authort�-(Board o f IHealf�or mp ,thus inspection.Ifthe system is a shared system or has a des;` ; r ` gpd or greater, the inspector and the system owner shall submst the report to the a -e o z'T DEP.The original should be sent to the system owner and capies sent to the buyer, if an�1, _� appropriate regional afr_c�o=_ e authority. cable. and Notes and Comments ""'"`This.report only 3 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 Title 5 Inspection Form 6/15/ 2000 Dane t Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SVSTEIq I_N-,SpECTIo_FORZT PART A O CERTIFICATION/ (continued) Property Address: d C/Gti �rc'fe ozi a� Oer: oac �, Date of Inspection: 0 Inspection Summary: Check A.B.C.D or E/A,Y-ays complete all of Section D A. Sys Passes: I have not found any information which indicates that any of the failure criteria described 3310 CNIR 15.303 or in 310 C_VIR 1-5.304 exist.Any failure criteria not evaluated are indicated below-. Comments: B.A System Conditionally Passes: /V One or more system components as described in the"Conditional '° repaired.The syste Pass section reed to be replaced or m upon completion of the replacement or repair;as approved by the Board of Health, t 11_pass. Answer vest no or not determined(Y.1NT,NTD)in the_for the following statements. If"not determined"ulease explain. The septic tank is metal and over 20 years old*or the septic tank(R hether metal or not)is sn-ucturaLT unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. Systemiil pas. irL ectior if`:e 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 Co~_pl ape: indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage back-up or break out or high static water level in the distribution box due i0 obstructed pipe(s) or due to a broken,settled or uneven distribution box. System-will dll pass rspy f or f(z. approval of Board of Health): th 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 obstructe pass inspection if(t�ith approval of the Board of Health): d p''pe'' ?='e broken pipes)are replaced obstruction is removed STD explain: Title G Tncrontinn �nrir tih[hnnn Page ') of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS: :M:vTS SUBSURFACE SEWAGE DISPOSAL SYSTEiVI INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ra in b?✓ R e � J i ex s o Owner: Gh o Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation b the is failing to protect ublic heal Y Board of Health in order to detern��e;f_he P health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CIR 15.303(1)(b)that the system is not functioning in a manner which wiI1 protect public health,safety and the environment: — Cesspool or privy is within 50 feet of a surface water Cesspool or pricy is within 50 feet of a bordering vegetated wetland or a salt marsh ?. System;will fail unless the Board of Health(and Public Wa te Supplier..if any) deter system is functioning in a manner that protects the public healthrsafety and en<-ironmentnes that the The System has a septic tank and soil absorption system(SAS)and the SAS is wahin 100 f ea 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 sup:'!".-. — The system has a septic tank and SAS and the SAS is within 50 feet of a private Rater su-p.�-,V-ei _ 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**, vlethod used to determine distance *"This system passes if the well water analysis;performed at a DEP certified laboratory; for colifo_�n bacteria and volatile organic compounds indicates that the well is free from pollutian Lom hat facili , ad the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than J pprm pro-'sided thhat no 0-her failure criteria are triggered.A copy of the analysis must be attached to this for gin. 3. Other: Titlo G TT crontinn n i Page 4 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY AS SE S SAIENTS SUBSURFACE SEWAGE DISPOSAL SVSTE_vr I\SPECTYO_N'FORM PART A CERTIFICATION(continued) Property Address: �O ClG yi 62r R� Q _ J Owner: an c Dd b Date of Inspection: �s , D. System Failure Criteria applicable to all systems: You must indicate "yes"or"no"to each of the following for all inspections: Yes No,-,"- _ 11ackup,of sewage into facility or system component due to overloaded or clogged SAS or cess po ol — �/ Discharge or ponding of effluent to the surface of the round or surface waters due to an overloaded or ogged SAS or cesspool — !/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged S�S - jesspooi _� o_ �/ iquid depth in cesspool is less than 6"below invert or available volume is less than /day flow _ Required pumping more than 4 times in the last year iVOT.due to clogged or obstructed pipe(s).Hof times pumped '/9ny portion of the SAS,cesspool or privy is below high ground water elegy anon. _ ki y 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 weL. t/�y portion of a cesspool or privy is within 50 feet of a private water ater supply well. ?,ny portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private«:.- r 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 weIl 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 cetera exist as described in 310 C R 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 sen-e a facility with a design floes-of 10.000 gPd- gpd to 14.000 You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes n the system is within 400 feet of a surface drinking water supply the system is,«ithin 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—i�s-?A1 0- Zone II of a public water supply well - - _ if you have answered"yes"to any question in Section E the system is considered a.significant "yes"in Section D above the large system has failed.The owner or operator of any large a- �� : o. u_ Significant threat under Section E or failed under Section D shall s�`m`on=3d `d a. 15.304. The system owner should contact the appropriate regional office Of the system it acccrdar ,�- the Depa.�ent. Tula Tnc+�o +ice. Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR V OLL-`N-7-A-2Y ASSESSMENT_S SUBSURFACE SEWAGE DISPOSAL SYSTEM n-'SPECZTON FORNT PART B CHECKLIST Property Address: �� Cl �Yr /�te� �2� Owner:_ G y � Date of inspection: '-�/0' Check if the following have been done.You must indicate"yes"or no as to each of the folotking: 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 . 41 Have large volumes of water been introduced to the system recentI -or a/ 5 s part of this nsp ,On Were as built plans of the system obtained and examined?(If they were not available rote as\:Al v Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out? Were all system components.excludingthe S AS;located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inS'Dected for the co di=o 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 � _ maintenance of subsurface sewage disposal systems? )F ded a.t1 mfotYration on the ,rover The size and location of the Soil Absorption System(SAS)on the site has been,deternnined 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 p, r is unacceptable) f310 CMR 15.302(3)(b)] e ap roxi-marlo._of dis-anc= :/7nnn L Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLL1 I'_RY ASSESSMENTS SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION FORNT PART C SYSTEM INFORMATION Property Address: /49Ld A N / / /¢ ✓ C>o�G�� Owner: Date of Inspection: 0 RESIDENTIAL FLOW CONDITIONS , Number of bedrooms(design):3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x-`of bedrooms): �3 O \lumber of current residents: Does residence have,a garbage grinder(yes or no): /� Is laundry on a separate sewage system or no):�I if yes separate inspection required] Laundry system inspected(yes or no)-dA Seasonal use: (yes or no):_ Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): PS Last date of occupancy: C1it/�dw� COINIMERCIALIINDUS TRIAL 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): GENER4,I.INFORMATION Pumping Records Source of information: pZQp 6dLo� Was system pumped as part of If y the inspection(yes or no):Lf/� es,volume pumped: gallons--How was quantity pumped determined) Reason for pumping: TIT 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 mai,_tenance cc, `ac-; c. e obtained from system owner) —Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age o all components, date installed(if known)and ource of infona 'on: an (� on 5�� ti L ,),1 07 pp?_ 4�10/2L- Were sewage odors detected when arriving at the site(yes or no): �v f Page 7 of 11 OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSE e SIIRSURFACE SEWAGE DISPOSAL, SYSTEM ItiS3pECTIOI FORK I�- rs PART C .q SYSTEM I�'FOiZn'IATION(continued_) Property Address: O. © rcr n p� 49,�S-e_ Owner: Q✓� �^d i a Date of Inspection: tp p� BULDING SEWER(locate on site plan) Depth below grade: _Z7 Materials of construction: ast iron _40 PVC_other(explain): ©/2 G h Distance'from private water supply well or suction line: S Comments (or condition of joints,venting evidence of leakage;etc.): /. SEPTIC TANK:—(locate on site plan) . Depth below grade: Material of constriction:_concrete_-metal fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(az ach a cop 0- certificate) c� X Dimensions: Sludge depth: Distance from top of sludgge to bottom of outlet tee or baffle: Scum thickness: 1-454S Distance from top of scum to top of outlet tee or baffle: a � Distance from bottom of scum to botto -of outlet tee o ba y How were dimensions determined: o /�a `Q y�� Comments.(on pumping recommendations;inlet and outl tee or baffle condition,st7Lctural integr - iieuid levels as sated to outlet invert. evidence o lea ge. etc.): c t wt 40 'd eI�p !r f"e, �cr�� e44 GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete metal fiberglass�olyetyie e 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. struci ura'_ate_-;?;as related to outlet invert, evidence of leakage,etc.): = •- T;tio 1 Tncr cntinn T?n ch c,. _ Page 8 of 11 OFFICIAL INSPECTION FOR-N1—NOT FOR VOLL NT_ARY ASSES S:kIE:T c SUBSURFACE SEWAGE DISPOSAL :SYSTEM LNTSPECT-,ON FORAI PART C SYSTEM INFOR>dMATION(continued) Property Address: Q ra ors °"1 a,G Oo� 6 Owner Q A Date of Inspection: 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(explainl: 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: present must be opened)(locate on site plan) ) Depth of liquid level above outlet invert:V'Dly-l01'(--- Comments(note if box is level and distribution to outlets equal;any evidence of solids car7,7over. any vidence of leak ao to.pr out/ofet, ��/��� x o AV L �< PLAVIP CHAMBER:zVoocate 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.): i Titio G Tnencntinn �nriy �/1 G!'lnnn _ Page 9 of 11 OFFICIAL IN'SPECTION FORM—NOT FOR VOLL���RY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM][NSPECTION FORM - PART C SYSTEM INFORMATION(continued) Property Address: gO lG h�pg�• Ae c Rd •� ,Y /�,� p�6 Owner Gy o� Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation,not required) If SAS not located explain why: O Type FT, h H yr d.e�leaching pits,number:_ ►�leaching �f- chambers;number: leaching galleries;number: leaching trenches;number,length: leaching fields,number, dimensions: overflow cesspool;number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level ofponding,damp soil, condition of vegetation. etc.): - 0 h t.vr Les �G h � cs r"Ot /✓1 6 4. .o, poi r v//P CESSPOOLS: (cesspool must be purred as part of inspection)(locate on site plan) \umber 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 ofponding, condition of—egetanion. PRIVY:&(ocate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level ofponding,condition of egeta;o i_ -L.`: Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSZTEN TS SUBSURFACE SEWAGE DISPOSAL SVSTE-V iNsPECTIO_N, EOR-,�r PART C SYSTEM INT"ORMATION(continued) n � Property Address: �� G/a H Ly K C5 e )qc Owner: 44#1 o i �oZ6 Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference land-larks or benchmarks. Locate all «.ells �,N ithin 100 feet.Locate«-here public water supply enters the buildiuq. fe r� C� s in Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSAFLENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM-NSPEC'TION.FORM PART C SYSTEM ENTORMI ATION(continued) Property Address: 0 -"N 4e Owner: Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to round water S-3 feet o Pleas�iindie heck)all methods used to determine the high ground water elevation: �hObtained from system design plans on record-If checked,date of design plan rete�'ed: ecked site(abutting property/observation hole vt '15�,e of SAS) ith local Board o"Health-ex lain: 1/ Checked with local excavators;installers-(attach documentation) Accessed USGS database-explain: You my;t d s ribe how you established high ground water elev tion:�L CL l 2 O ol r ' T:+la S in cncntinr � n ` 1 TOWN OFr�\,21C,,, S LE LOCATION �i % SEWAGE # "VILLAGE L ASSESSOR'S MAP & LOTCJ30'��' INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER =!N PERMITDATE: 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 j (oCcR ;1s I quo o A EA Zt t TOWN OF BARNSTABLE OC LCC-ATION �qO�irlu i rj SEWAGE #o�003-�G q VILLAGE /' /��' llf J ASSESSOR'S MAP/& LOT INSTALLER'S NAME&PHONE NO.��' /OIS�i ew .r/c�/io✓. S�`l�� SEPTIC TANK CAPACITY & LEACHING FACILITY: (type) 330 Gf (3Z (size) %O x 11' Jam/ NO.OF BEDROOMS 3 BUILDER O PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by p2w 6 t eft .�� � ;- �, �t�� � '. ��, �s a�6 {� �b 0 i �` 5� � I / 1, i Y. I l 5 �I�O��i� i < I I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION F m } l F ti Y� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ; CRANBERRY RIDGE RD.MARSTONS MILLS,MA 02648 Property Address: 80 CRANB � Owner's Name: ANNA HURLEY Owner's Address: 80 CRANBERRY RIDGE RD.MARSTONS MILLS,MA 02648 , t Date of Inspection:2/12/01 RECEIVED r Name of Inspector: (please print), ; 30HN GRACI Company Name: SEPTIC INSPECTIONS FEB 1 s ZOO1 { Mailing Address: P.'O.BOX 2119 TEATICKET,MA.02536 TOWN OF BARNSTABLE Telephone Number: 508-564-6813 FAX 508-564-7270 HEALTH DEPT. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: i X Passes _ Conditionally Passes Needs FurtheyEyaluation by the Local Approving Authority Fails 4 Date: 2/12/01 Inspector's Signature: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within I 30 days of completing this inspection. If the system is a shared system or has a design now of 10,000 gpd or greater,the i 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 #<s THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE i SYSTEM'S USEFULL LIFE. >. 4 ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This e inspection does not address how the system will perform in the future under the same or different conditions of use. � 3 l Tills G lncnrrtinn Form 015/�f1(1(1 =:9 Page 2 of I V I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 80 CRANBERRY RIDGE RD.MARSTONS MILLS,MA 02648 Owner: ANNA HURLEY Date of Inspection: 2/12/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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. a ec , Comments: THE SYSTEM PASSES TITLE V INPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)`in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 year' '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: n/a n/a Observation of sewage backup ot'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 t.. _ distribution box is leveled or replaced ND explain: n/a n/a 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: n/a Page 3 of 1.1 �s OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 80 CRAN BERRY,RIDGE RD. MARSTONS MILLS,MA 02648 Owner: ANNA HURLEY Date of Inspection: 2/12/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ 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 f 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: I _ The system has a septic tank'ah'd 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 n/a "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: n/a 1 t ' l C:.` Z i Page 4 of L I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 80 CRANBERRY RIDGE RD.MARSTONS MILLS,MA 02648 Owner: ANNA HURLEY a 3 Date of Inspection: 2/12/01 s, D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Y , Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the'distribution box above outlet invert due to an overloaded or clogged SAS or cesspool F i X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow X Required pumping more than 4 times in the last year NnT due to clogged or obstructed pipe(s).Number of times . pumped 2000. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy'is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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.] a't,y (YesMo)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 x 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. r 4 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: P. (The following criteria apply to large systems in addition to the criteria above) 1i yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet ofa tributary to a surface drinking water supply X 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 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 li4"s failed.The owner or operator of any large system considered a significant throat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner "i a �k 4;. should contact the appropriate regional office of the Department. A Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE_ ,SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 80 CRANBERRY RIDGE RD.MARSTONS MILLS,MA 02648 Owner: ANNA HURLEY Date of Inspection: 2/12/01 Check if the following have been done.You must indicate"yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of'Health X Were any of the system components;.pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS,located on site? X _ Were the septic tank manhoies"uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construktion'dimensions,depth of liquid,depth of sludge and depth of scum? X _ 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 X Existing information.For example.,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is { t , unacceptable) [310 CMR 15.302(3)(b)] S "5 Page 6 of 1,1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 80 CRANBERRY RIDGE RD. MARSTONS MILLS,MA 02648 Owner: ANNA HURLEY Date of Inspection: 2/12/01 _ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):220 Number of current residents: I Does residence have a garbage grinder(yes or no); NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIALANDUSTRIAL ' Type of establishment: n/a 's Design flow(based on 310 CMR lh= .208): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no):NO Water meter readings,if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information:2000 Was system pumped as part of the inspection-(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X 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): n/a Approximate age of all components,date installed(if known)and source of information: 1970 Were sewage odors detected when arriving at the site(yes or no): NO x 6 Page 7ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 CRANBERRY RIDGE RD. MARSTONS MILLS,MA 02648 Owner: ANNA HURLEY Date of Inspection: 2/12/01 BUILDING SEWER(locate on site plan) s , I Depth below grade:30" Materials of construction:_cast iron 40 PVC Xother(explain): ORANGEBURG Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade:24" Material of construction: Xconcrete_metal fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) ids;l Dimensions: 1000G L 8' 6" H 5' 7" W 4' 10,"" Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: 33" ' Scum thickness:0" `f.F Distance from top of scum to top of outlet tee or baffle: 6" , Distance from bottom of scum to bottom of outlet tee or baffle: n/a q How were dimensions determined: MEASURED Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related t=4" to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE a GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a + Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet.tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a ',:. Page 8 of a 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM I1-ISPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 CRANBERRY RIDGE RD. MARSTONS MILLS,MA 02648 Owner: ANNA HURLEY Date of Inspection: 2/12/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(expla?n): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and'float switches,etc.): n/a DISTRIBUTION BOX:_(if presentmust be opened)(locate on site plan) Depth of liquid level above outlet invert:;n/a 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.): n/a PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,,condition of pumps and appurtenances,etc.): n/a R Page 9 of 41 i i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) i Property Address: 80 CRANBERRY RIDGE RD. MARSTONS MILLS,MA 02648 Owner: ANNA HURLEY Date of Inspection: 2/12/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system ,Type/name of technology: nla fi Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY.THE PIT ; HAD 3' OF WATER IN IT AT THE TIME OF THE INSPECTION.THE STAIN LINES IN PIT INDICATE THE LIQUID LEVEL HAS BEEN AT 4' THE SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (cesspool must be"Pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a f Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): u/a 4 Page 10 of 11 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 CRANBERRY RIDGE RD. MARSTONS MILLS,MA 02648 Owner: ANNA HURLEY Date of Inspection: 2/12/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. QQ �, ph�ks as Lj O� riv NHS J� { � HST k ; v in Page 11 ofl I i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 CRANBERRY RIDGE RD.MARSTONS MILLS,MA 02648 Owner: ANNA HURLEY 4 Date of Inspection: 2/12/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 10+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators., 'installers-(attach documentation) YES Accessed USGS database-explain,,m/a j You must describe how you established the liigh ground water elevation: USGS MAPS AND CHARTS- 10+FEET �° i f E •O J - �f /V�jam'g o _ 0 L 1— A < a. q 0 . S s) 1U r a .... o O ......r o � � z L o I.law Y+m wgllfar 0 � v } a•cand floor ptumbinq aWNGFOQ7 O L • _ P 9Yn'a to sold bw'.,q I�R-GHCW PAI'jLL-Y�oahl ,___.______________________-- . PCuFOaH'Y« j C LNMgR'oor'II.._CD m ry i h P •_ o O L L ♦U V Y. ° • d- a - P qq• If II_�oo3 N u�u�mO� Q aN ON P E R �OO V s�O �N • r% P f�'/y�j zI s1 r=t���- i=�oo�. P •• P,EPR000CTION•e �✓� g 9 o °m /42 CC SE PLANS BY 0.1g! O i et� P �G ale: I /4" I_�- '� a ANY MLANS 1S PROHIBITED • S m _ .E a.+ •BY FEDERAL LAW VIOLATIONS Y n`m ` > E • (L ARE PUNISHABLE BY FINES UP •: a u w v s Q A!Af:FN:AN INSTITUTE �' • gs OF BUILDING 0f51GN d • • t c c c / •o._a. �._o. TO$100,000 PER OFFENSE • DRAWINaor Plan . v• • CALL THE DESIGNER TO Q' First Floor plan OBTAIN LEGAL COPIES ••'�y� OF THIS PLAN SHEET NUMBERv A 2 00 i ' 1 I'-9 1/4• ' i aP 3� P A x�l f m 6` B: r d — ---------- — — ——————————— ____________-________________________________ ______________=====c------____-=______ '--------------------------------I • I " d` x r- I I I '01 0 I '•lu><•VP 90m I '°"' I -0 1 S'-O•Y-.us wdl rc. o 0/p•r A.O/e• I LP 1 =I @ r 0 I I �j • ,� fl I. e � �` ---- --- --------------- e � WAI -------------------------------------- ----------------------------------- �� DK 0 ' putt-in i I I I 0 •• .�.x.c.u.`.,s s� •� a v.w.•vm•om I 3 I I 6 I P -------; 17 1 I 11 I 3 �� ��GOt.�17 FLOOD pL�N v. •REPRL)DtrTION• �'•�, •OF THESE PLANS BY •, MY*ERNS IS PROHISITEO ;s i'p* ••BYEE;tFRkt.LAW VIMATFONS • ��� 1 e o k.RE PLkNiSKkKE BY FINES UP • S- > • • AMEP.iCkH INSTITUTE • J � �.D OE EM- : j+ r rto 1/4• i m-1• ii 'A• g(yS,00,00PERO TENSE • '� heGondFloorf'IAn Ei- • CALL THE DESIGNER TO e• spy • OBTARII LEGAL COPIES • 14�'" 7ti/• OF THIS PLAN ••��jsC• 4 4'-9• 14'-I '1/p• O'-1 0 1/e' • 'e I 9 I TOP FNDN. 104.7 SYSTEM PROFILE TEST HOLE LOGS = ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) IF NEC. ACCESS COVER (WATERTIGHT) TO ENGINEER: D.A. OJALA, SE WITHIN 6" OF FIN, GRADE SAM WHITE (BOH) z� MINIMUM ,75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 104.5' WITNESS: EL.102.9' RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE\� DATE: 3/31/03 FOR FIRST 2' < 2 MIN INCH IEXISTING 1000 3' MAX. PERC. RATE _ GALLON SEPTIC * CLASS I SOILS P# 10449 101 A f 101 .5 ASA MEIGGS � TANK (H- 10 ) RE-USE BAFFLE 100.92' C] EI 177 EO 0 0 CO CJ � 100.67' OCIL ED O C71:3CJzi 6" CRUSHED STONE OR MECHANICAL 0 0 m m m m m 0 ELEV. �° 4' COMPACTION. (15.221 (21) $ 2' 0 [] E� E D 0 [] 0 0 EQ 0 98.67' 0" � DEPTH OF FLOW ( 1 + % SLOPE) ( 1 % SLOPE) TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STONE A INLET DEPTH 10„ SL OUTLET DEPTH 14" " 10YR 3/2 LOCATION MAP NO SCALE FOUNDATION- EXIST, SEPTIC TANK LEACHING 44' D' BOX 10' FACILITY B ASSESSORS MAP 30 PARCEL 57 *APPROXIMATE INVERT OUT OF SEPTIC TANK. CONFIRM PRIOR TO INSTALLATION OF ANY 36" 7.5YR 5/6 PORTION OF SEPTIC SYSTEM. 5.17' 101 ,5' Cl VARIABLE DEPTH SILT LOAM o + 104.4 04.8 105.5 2.5Y 6/2 93.5' 72" 98.5 c? PER!C C2 + 102.2 COARSE + 104.2 - SAND BENCH MARK - CORNER OF o`� o + 105.8 10YR 7 6 CONC. PATIO. EL. = 104.8 to3.o 1 / + 105.3 cr 132" 93.5' + t .e �2 59 NO WATER ENCOUNTERED NOTES: ' SHED + 103.3 104.6 LOT 98 i . i✓HI Uivi i F 36,262t S0. FT. 008 / 2. 5 _FXI�TIN 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. + 104.8 + tos.9 106.0 4, DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 + 101.5 0 EXIST. ST L•P + 1 .2 5. PIPE JOINTS TO BE MADE WATERTIGHT. 10 103.8 (RE-USE) 1 � 10ro + toss 6. CONSTRUCTION DETAILS TO BE 1N ACCORDANCE WITH MASS. +\102.7 � o�, + 105.8 ENVIRONMENTAL CODE TITLE V. aaLA TER s 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE 104.1 PLAN 4.4 104.8 TH I + 1 USED FOR ANY OTHER PURPOSE + 103.1 p 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 104.3 104,8 - --�' S' REMOVAL OF UNSUITABLE SOIL EXIST. + 105.4 REQUIRED AROUND PERIMETER OF 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT 103. DWELL. 04.1 ld . + 1 4. LEACHING FACILITY. DOWN TO INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED SUITABLE SOIL LAYER. REPLACE FROM BOARD OF HEALTH. \\,� 04. WITH CLEAN MED. SAND. NOTE:W 04.2 \ - VARIABLE VERTICAL REMOVAL - 10. LEACH PIT TO BE PUMPED AND FILLED WITH CLEAN SAND OR SEE TEST HOLE LOG, REMOVE AS NECESSARY. 04.8 104.8 Z1) LEGEND ��\'� ��� 10 100.0 PROPOSED SPOT ELEVATION `°s o TITLE 5 SITE PLAN 9� i / 10ox0 EXISTING SPOT ELEVATION 3 104.0 OF 80 CRANBERRY RIDGE RD . 2F"10.1 + 105.2 MOPROPOSED CONTOUR �S 104.2 100 EXISTING CONTOUR IN THE TOWN OF: to 05.3 ( MARSTONS MILLS) BARNSTABLE PREPARED FOR: TAD AND CELESTE DANFORTH < <9 4.0 > t BOARD OF HEALTH o?'' \ �° SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED 30 0 30 60 90 �+ 1077 NOT __-) , MA APPROVED DATE DESIGN FLOW: 3_ BEDROOMS (?i k GPD) = 330 GPD "APPROX. WATERLINE LOCATION. USE A �30 GPD DESIGN FLOW SCALE: 1" = 30' DATE: APRIL 2, 2003 CONFIRM PRIOR TO EXCAVATION SEPTIC TANK: 330 GPD (_2 _) = 660 GALLONS FOR SYSTEM USE A 1_000_ GALLON SEPTIC TANK (RE-USE EXISTING) fox s�-si=sue' SIDES: 2(30 + 9.83) -9 (,741 = 118 down cape engineering, inc, �� °��, o' BOTTOM: 30 x 9.83 (.74) = 218 CIVIL ENGINEERS A��• yN �o ARM Jy`{ TOTAL: 454_ S.F. _3.36 OJ _ GPD LAND SURVEYORS � io �V1� �� � H ALA „ USE (3) 500 GAL. LEACHING CHAMBERS WITH 2.5' 939 vain st, yarrlouth, ma 02675 STONE AT SIDES AND 2.25' AT ENDS s� ---- 03-057 H. OJAL�; '' ., P.L.S. DATE