Loading...
HomeMy WebLinkAbout0084 DEVON LANE - Health 84 Devon Lane Marstons Mills P �� _ - A = 057 002005 --- -- - - - - -- --- - -- c Commonwealth of Massachusetts 66 -LOG?60 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 84 Devon Ln. Property Address Arce Owner Owner's Name / information is required for every Marstons Mills N MA 02648 10/22/19 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 way. Please see completeness checklist at the end of the form. A. Inspector Information77 Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10/22/19 inspectbfs Signa ure Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts ,�-p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will'pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •v 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. CityTrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2016 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 18 i Commonwealth of Massachusetts (e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments L; 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form �~ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ El the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 I— Commonwealth of Massachusetts �. F Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for aH inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 f Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments •u 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Approved by Thomas McKean as a 4 bedroom system per letter in file dated 6/19/17 Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped spring of 2019 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? ' Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1997 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10' feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 16"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound, inlet cover raised to 6" of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: 10" Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness trace-1/4" �2 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? measured 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 suggested every 3yrs to prolong the life of the system t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts (e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �o•,� 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Lt5insp.cloc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 D-box is 32" below grade, cover raised to 6", no adverse conditions t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I� c� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments v 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2, 36 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts 9 Title 5 Official Inspection- Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Devon Ln. Property Address Arce Owner Owners Name information is required for every Marstons Mills MA 02648 10/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Pert pipe trenches were video inspected and are damp at this time, no indication of past hydraulic failure, piping is approximately 4' below grade 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i 1 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 c� Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 1 b ( fbao-4 v2. I ob t t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I �I Commonwealth of Massachusetts �. (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: 1996 NGW 126" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4'seperation per 1997 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping puts the site at 63'msl and nearby surface water is at 40'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 f Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �a 84 Devon Ln. Property Address Arce Owner Owner's Name information is required for every Marstons Mills MA 02648 10/22/19 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 ap ,r 00 cettll I&Qj 4 � ,s CD Cli .. A.�A... ' 1!. ,�",I, • Al r n g wr. -cft N oc gATN J � 1 V Pw__--- M P i f Common-wealth of Massachusetts Title 5 Official Inspection Form y _ s Subsurface Sewage Disposal System.Form'-Not for Voluntary Assessments 64 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name requiredfo is Marstons Mills MA 02648 03/29/12 required for every page. City/Town State Zip Code Date of"Inspection Ipspection results must be submitted on this form.Inspection forras may not be al>'ered jn any way.Please see completeness checklist.at the end of the form. Important:When A. General Inforimation filling out forms j I on the computer, I use only the tab 1. Inspector: key to move your cursor-do not Michael Kellett use the return Name of Inspector keq. —�, Aardvark EnvironmentEWinspectons Company Name PO box896 Company Address East'Dennis MA 02641 cityrromi state Zip Code. 508-385-7608 S13742 Telephone'Number License Number B. Certification I certify that I have personally inspected the sewage disposal:systet&at this address and that the information rep6rted bet-w is true, accurate and complete:as of the time of the inspectiiop.The inspection Was pertortmed:basedon my training and ekperience in'',the:proper function and'malnten nce o 'n situ sewage disposal systems. I am a DEP approve}system inspector`pursuant to Sect>pn 15. �4'0 of� Title 5(316 CMR 15.000).The system: 19 Passes ❑ .Conditionally Passes ❑ Fails = ,. r� *; YA TJ y. ❑ Needs Ftlfther Evaluation:by,the Local Approvingg Authorty aI 04/01/12 c:) r Inspectors signature Date The system inspector shall submit a:copy of this inspection.report to the Approving Authority(Board of Health or 1JEP)within 30 days of completing this inspectionAf the system is a shared system or has:a design flow of 1011000 gpd or greater,the inspector and the system owner shall aubmitthe report to the appropriate.regional office of the DEP.The original should be sent to the system owner and copies sent to the bgyer,if app'licabfe,.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'f use. t5ins-11/10 Title 5 Official Inspection Fo 'urface Sewage:Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System:Form-.Not for Voluntary.Assessments 84 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information.is required for every Marstons Mills MA 02648 03/29112. page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) . Inspection Summary:Check. A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have:not found any information which:indicates that any of the failure criteria described in 310 C'MR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated:below. Comments: B) System Conditionally Passes:. ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y,N, ND)for the following statements_.If"not determined,"please explain. The septic tank is metal and over 20 years old``orthe septic tank(whether-metal or not)is structurally unsound,exhibits substantial infiltration or exfdtration or tank failure.is imminent.System will pass inspection.if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it.is structurally sound, not leaking;and if a Certificate of Compliance indicating that the tank is less than 20 years old,is available. ❑ Y ❑ .N ❑ 'ND(Explain below): t5ins•11/10 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary:Assessments 84 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information is required for every Marstons Mills MA 02648 03/29/12' page. Cityrrown State ,Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution;box due to broken or obstructed pipes)or due to a.broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ 'ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is Leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping.more than 4 times a year due to-broken or obstructed pipe(s).The system will pass:inspection if(with approval of the:Board of Health): ❑ broken.pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below) 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 it 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)thatthe system is not.functioning in a mannerwhich will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water Cesspool orprivy:is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 6 Official Inspection F-.grm:Su surface Sewage.Disposal System-Page 3 of 17 ge Commonwealth of Massachusetts Title 5 Official, Inspection Form 'Su bsu.rface Sewage Disposal System Form-Not-for Voluntary Assessments 84'Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information is required for every Marstons Mills MA 02648 03/29/12' page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health {and.Public Water Supplier,if any) determines that the system is functioning in a mannerthat 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 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- El The system has a septic tank and SAS_and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS'is less than 100 feet but 50 feet or more from a;private water supply well". Method used to determine distance: This system passes if the well water analysis,performed at a DEP certified.Laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered:.A copy of the analysis must be attached,to this form. 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 Tess than 6"belowinvert or available volume is less than day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth.of Massachusetts Title 5 Official inspection Form Subsurface Sewage,Disposal System form Not for Voluntary Assessments w 84 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information is required for every Marstons Mills MA 02648 03/29/12 page. City/Town State Zip Code Date of Inspection B. Certificatio:n (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ (E Any.portion of cesspool or privy is within 100 feet of a surface water supply or tributary to:a:surface water supply. ❑ ® Any portion of a cesspool.or privy is within.a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 2 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 S ppm, provided that no other failure criteria are triggered A.copy of the analysis and chain of custody must be attached to this form.]. ❑ Z 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 ownershould: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 4'00 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead,Protection Area—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. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposa6System•Page 5 of 17 i Commonwealthe of Massachusetts Y Title 5 Official Inspection Form s Subsurface Sewage Disposal System.Form-.Not for Voluntary Assessments 84 Devon Lane Property Address Jeffery Morrotta. Owner Owner's Name information is required for every Marstons Mills MA 02648 03/29/12 page. City[7own 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 ❑ JZ 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 o:r 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 ofconstruction, 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 ofthe failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design):. 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example- 11.0 gpd x#of bedrooms): 440 t5ins•11/10 Title 5 Official Inspection Donn:Subsurface Sewage Disposal System•Page 6 of 17 e f Commonwealth of Massachusetts Title 5 Official- Inspection Form Subsurface Sewage Disposal System,Form Not for Voluntary Assessments 84 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information is required for every Marstons Mills MA 02648 03/29/12 page. City1rown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑. Yes 0 No Is.laundry on a separate sewage system?[if yes separate inspection required] ❑: Yes Z No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings,if available(last 2'years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commeic aiTlndustriall 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: t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System,-Page 7 of 17 i Commonwealth of Massachusetts Title 5 Officiall Inspection Form ;i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 84 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information is Marstons Mills MA 02648 03/29112 required for every page. Cdy(rown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancytuse:. Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes [R No If yes, volume pumped: gallons How was quantity pumped determined? Reason for,pumping: Type of System: ® Septic tank,distribution box, soil,absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared.system (yes or no)(if yes,attach previous inspection records,if any) ❑ Innovative/Alternative.technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the UA system by system operator under contract ❑ Tight..tank.Attach a copy of the DEP approval. ❑ 'Other(describe): t5ins-11/10 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 l . Commonwealth of Massachusetts �7 Title 5 Official Inspection Form Subsurface Sewage:Disposal System Form-;Not for Voluntary Assessments 84 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information is required for every Marstons Mills MA 02648 03/29/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 11/18/88 per BOH. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.0 feet Material of construction: ❑.cast iron Z 40 PVC ❑•other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on,.site plan):: Depth below grade: 0.5 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: 1,500 gal, - 3„ Sludge depth: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 i Commonwealth of Massachusetts Titre 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 84 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information is required for every Marstons Mills, MA 02648 0329/12. page. City/Town 'State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom,of outlet tee or baffle 29" 3 Scum thickness 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 15' How were dimensions determined? measured Comments(on pumping recommendations,.inlet and outlet tee or baffle condition,structural integrity, liquid levels.as related to outlet invert,evidence of leakage,etc.): The tank was sound and.tight with tees in place and.liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete El 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 t5ins.•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official, Inspection Form a Subsurface Sewage Disposal System Form-:Not for Voluntary Assessments 84 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information is required for every Marstons Mills MA 02648 03/29/1.2' page. Cityfrown 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.): Tight or Holding Tank(tank must be pumped:at time of inspection)(locate on site:plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date oflast pumping: Date Comments(condition of alarm and float switches,etc.): *Attach copy of current pumping:contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurf ace Sewage-Disposal.System.-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspectian Form Subsurface Sewage Disposal System:Form-Not.for Voluntary.Assessments G1 84:Devon-.Lane Property Address Jeffery Morrotta Owner Owner's Name information is required for every Marstons Mills MA 02648 03/29/12 page. Cityrrown "State :Zip Code Date of inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert Comments(note;if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of-leakage into or out of.box,etc.): The box was under a paved driveway. Pump Chamber(locate on site plan):. Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Soil Absorption System,(SAS):(locate on site plan., excavation not required): If SAS not located explain why: t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12.of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form, Subsurface Sewage Disposal System.Form-.Not;for Voluntary Assessments 84 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information is required for everd Marstons Mills MA 02648 03/29/1.2 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number,length:. 2@36'x4' ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,, condition of vegetation,etc.): This system has two stone 4'x36'trenchs.There was no sign ofponding or failure in the stones. Cesspools (cesspool mustbe 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 scurn layer Dimensions of cesspool Materials of construction :Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official.Inspection Form:Subsurface Sewage Disposal'System•'Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form sr Subsurface Sewage Disposal System:Form-Not for Voluntary Assessments 84 Devon Lane Property Address Jeffery Morrotta. Owner Owner's Name information is required for every Marstons Mills MA 02648 03/29/12 page. City/town State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins•11/10 Title 5 Official Inspection form:Subsurface Sewage.Disposal System-Page 14 of 17 f C Commonwealth of Massachusetts Title 5 Official. Inspection Form Subsurface Sewage,Disposal System!Form-Not for Voluntary Assessments 84 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information is required for every Marstons Mills MA 02648 03/29/12 . page. Cityrrown State Zip Code Date of Inspection D,. System Information (cons.) . Sketch Of Sewage Disposal System:.Provide a.view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100'feet.Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately rpwi 36 �y as. 3g t5ins•11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-:Not for Voluntary Assessments 84'Devon Lane Property Address Jeffery Morrotta Owner Owner's Name information is required for every Marstons Mills MA 02648 0329/1'2 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 high ground water: 20.0 feet. Please indicate ail:methods used to determine,the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed:. pate ❑ Observed site.(abutting property/observation hole within 150 feet.of SAS) ❑ Checked with Local Board of Health explain: ❑ Checked with Local excavators, installers-(attach documentation) ® Accessed USGS database explain: You must describe how you established the high ground water elevation: USGS maps show an:elevation of over 20.0 feet. Before filing this Inspection.Report,please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal,System Form-Not for Voluntary Assessments 84 Devon Lane Property Address Jeffery Morrotta Owner Owner's Name requir required for Marstons Mills MA 02648 03/29/12 required for every page. Cityrrown. State Zip Code. Date of Inspection E. Report Completeness Checklist ® Inspection'Summary:A,'B,C,D,or'E,checked ® Inspection Summary D(System'Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high;groundwater ® Sketch of Sewage Disposal:System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Message Page 1 of 1 McKean, Thomas From: Palkoski, Christine Sent: Tuesday, June 19, 2007 10:37 AM To: McKean, Thomas Cc: Weil, Ruth Subject: 84 Devon Lane Tom, I am trying to research some information about 84 Devon Lane -as I have had a phone call from an attorney about this property. There is an apartment that was formerly a family apartment before the current owners purchased the house (in December of 2005). Do you think that someone could let me know what the septic capacity is at this property? Since the family apartment was a legally permitted unit they should be in compliance, right? Thanks, Christine 6/19/2007 Message J"`^ ;Ta '-of 1 McKean, Thomas From: McKean, Thomas Sent: Tuesday, June 19, 2007 11:45 AM To: Palkoski, Christine Cc: Weil, Ruth Subject: FW: 84 Devon Lane The 1997 permit was approved for three bedrooms. The engineering plan shows one trench of 56 feet long, 456 square feet with a capacity of 338 gallons per day. However,the as-built card indicates "4 bedrooms" and shows two trenches 36 feet long X 4 X 2. This calculates to 864 square feet and computes to 639 gallons. Also,the septic system passed two inspections in 2003 and in 2005 for four bedrooms. In addition, the site appears to be outside of any nitrogen sensitive areas and the home is connected to public water. Therefore, I have no objections to four bedrooms or more. -----Original Message----- From: Palkoski, Christine Sent: Tuesday, June 19, 2007 10:37 AM To: McKean, Thomas Cc: Weil, Ruth Subject: 84 Devon Lane Tom, I am trying to research some information about 84 Devon Lane-as I have had a phone call from an atto-ney about this property. There is an apartment that was formerly a family apartment before the current owners purchased the house (in December of 2005). Do you think that someone could let me know what the septic capacity is at this property? Since the family apartment was a legally permitted unit they should be in compliance, right? Thanks, Christine 6/19/2007 COMMONWEALTH OF MASSACHUSETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:. Owner's Name: 2� Owner's Address: 6 Date of Inspection: Name of Inspect • (plea Se pr'nt .b cqb , Company Nam Mailing Address: ),1 n Telephone Number: • ` _ 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 performej based on my training and experience in the proper function and maintenance of on site.sewage disposal systems..I am a DAP —; approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The syste�: Pas,*es1 Con 'tionally Passes N e Further Evaluation by the Local Approving Authq sty Co Fai -sa Inspector's Signature: Date: / ' E5 r-0 I— C) in The system inspector shall sue a copy of this inspection report to the Approving Authority(Boar of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments zz� , ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different. conditions of use. Title 5 Inspection Form 6/15/2000 page 1 l— 1 Page 2 of l I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 7` Owner Date of nspection: Inspection Summary: Check A,BC,D or E/ALWAYS complete all of Section D A. 7stem 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 1,5.304 exist.Any failure criteria.not evaluated are indicated,below, Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass",section need to be replaced or repaired.The system,upon completion of the replacement or repair;as approved by the Board of Health,will pass. ,i 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 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: 2 Pap--3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner ` Date of nspection: 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- - The system has a septic tank and SAS and the SAS,is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile'or'ganic compounds indicaies that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM-.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner Date o nspection: c:)i aoo�, D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ ✓1 Backup of sewage into facility.or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of efluent 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. _ Any portion of a cesspool or privy is within a Zone 1 of a.public well. _ V 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 5.0 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.] /t/©(Yes/No)The system fails. I have,determined that one or more of the above failure criteria.exist as described in 310 CMR 15.303,therefore the system fails. The.system owner should contact the Board of Health to determine what will be necessary to correct the failure. E:. Large Systems: To be considered a large system the system must serve a.facility with a design.flow of 10;000 gpd to 15,000 gPd• You must indicate either."yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 questibn 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. 4 Pate 5 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of spection:� "�e� /Q,�� Check if the following have been done.You must indicate`yes"or"no"as to each of the following- Yes Pumping.information was'provided by the owner,occupant,o-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? -VI`Have large volumes of water been introduced to the system re:ently 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? V 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? y — 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 Existina 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 i unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: - Owner Date o nspection: �XWS FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number-of bedrooms(actual): L DESIGN flow based on 310 CMR 15.203 (for example: 11.0 gpd x;#of bedrooms): Number of current residents: Does residence have.a garbage grinder(yes or no):,�� Is laundry on a separate sewage system- (ye or no):j.[if yes separate-inspection,required]. - Laundry system inspected(y9t or no):All) Seasonal use: (yes or no):: Water meter readings, if av ilable(last 2 years usage(gpd)): 03 Sump pump(yes or no): Last date of occupancy: R COMMERCIAL/INDUSTRIAL � Type of establishment: Desigr..flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgfr,etc.): Grease trap present(yes or no):,— Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information- Was system pumped as part of the inspec (yes or no): If yes, volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TY OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Amroxirpate age of all components,date installed(if known)and source of information: Were sewageodors.detected when arriving at the site(yes or no): 6 Paee 7 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM:INFORMATION(continued) Property dress: Owner ' Date nspection � BUILDING SEWER(locate on site plan) o Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply.well or suction lines Comments(on condition of joints,venting, evidence of leakage, etc.): SEPTIC TANK:v(locate :)n site plan) Depth below grade: / Material of construction: . r/c��ncrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) r r Dimensions:1D • )C(a •�C 5 Sludge depth: ` Distance from top o sludge to bottom of outlet tee or baffle: Z Scum thickness: Vit Distance from top of scum to top of outlet tee or baffle: Z �� Distance from bottom of scum to bottom of outlettee or baffle: /I -How were dimensions determined: e Comments(on pumping recomme dation , inlet and outlet tee or baffle condition, structural integrity, liquid levels s related to outlet invert, idence of leakage,etc.): 60 ,� Ir' c >i GREASE TRAP:Abocate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION.FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Alin Y& Owner: > 1 Date o nspection: /d TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): .Dimensions: Capacity: gallons Design Flow: gallons/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: 1/ if resent must be o ened locate on site plan) ( P P )( Depth of liquid level above outlet invert: Comments(note if box is level and.distribu�tooutlequal, any evidence of solids carryover, any evidence of eakage into or out of box,et .):. % + ii PUMP CHAMBER: (locate on site plan). Pumps in working order(yes or no): Alarms in working order(yes or no): _. Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.). 8 i Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:&4L'�Ojx" Owne Date f Inspection: SOIL ABSORPTION SYSTEM (SAS): f/ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: ��Iea'aching trenches,number, length: ching.fields,number, dimensions: c� - a&'j_X "4)A ° 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 a P ` X X CESSPOOLS:46(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of.groundwater inflow(yes or no): ` Comments(note condition of soil, signs of hydraulic failure, level-of ponding, condition of vegetation,etc.): PRIVY:40(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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: t Owner: Date of nspection: 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. v�o 1 PO e . i 150 aIIon �3 -7aVAk 10 r: Page I I of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 7 Owner: Date of spection: J00 SITE EXAM Slope SurfF-ce water Check cellar Shallow wells UI Estimated depth,to ground water 7 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Boar]of Health-explain: Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: �� � �D MOZ-q72V 54W y LlIzJ71 i . Q 11 I Permit Number: Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Fq Ae�lollXe I Lot No. Owner: ` �. Address: Contractor: O�ll��/� C�G�✓�� Address: e STEP 1 Measure depti to water table ,. z to nearest 1/10 ft. ................................ Date 7 month/day/Year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: O Appropriate index well................................. 3 OB Water-level range zone .................................................:... C STEP 3 Using monthhi report "Current Water Resources Conditions" determine current depth to water level for index well ........................... 7( 7 month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 26) determine water-level adjustment .......................................................................................... 1 STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) .............................................................................................................. Figure 13.--Reproducible computation form. 15 ZSX- p 1, • f 4 0 • . i r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT (SAP PARCEL AUG 1 4 2003 r.Y TOWN OF BARNSTABLE HEALTH DEPT. TITLES OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:. g '4,2.1 ,4 Owner's Name: Owner's Address: d� � Date of Inspection: Z� ( �-�_ Name of Inspect r• please print) Vr t'Vlr"� Company Name: , ,� �. Mailing Address: 1j4 oo&vg, Telephone Number: d' - "7 GCC CERTIFICATION STATEMENT 7 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: V Passes Conditionally Passes Needs.Further Evaluation by the Local Approving Authority 7Fails Inspector's Signature: Date: �c4 3 v The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP).within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will.perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/20-00 page 1 Page 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date o nspection: Inspection Summary: Check A,B,C,D or E/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: 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 pipes)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board;of Health):. broken pipe(s)are replaced obstruction.is removed ND explain: 2 f Page 3 of 1'1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) , Property Address: Owner: Date of I spection: -' 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 Wanner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.. _ The system has a septic tank and SAS and the SAS is less than 100,feet but.50 feet or more fi,om a private water supply well**.Method used to determine distance **This system passes if t)e well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that tiie 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 trigger!d.A•copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART A CERTIFICATION(continued) Property Address: 4 Owner: Date of inspection: V �,300 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes Nq 1J 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 '/z day flow G/ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number / of times pumped V 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. _ t/ An onion of a cesspool or privy is within --� Y p p p y 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 ofa.cesspool or privy is less than 100 feet but.greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen,and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (-(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what.will be necessary to correct the failure. E. Large.Systems: To be considered a large'system the system must serve a facility with a'design flow of 10,000 gpd to 15,000 gPd• You must.indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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—I WPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes".in Section D above the large system has failed. The owner or operator of any large.system considered a significant threat under Section E or failed under Section'D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 L ' Page 5 of I.I. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART B ;, . CHECKLIST Property Address: dQ Owner: ... . Date of In pection 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 ayailable 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: Ye Existing information.For example,a plan.at the Board of Health. / Determined in the field(if any of the failure criteria related to Part C.is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL.INSPECTION•FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION:FORM PART C ' SYSTEM INFORMATION Property Address: c � Owner: Date of. spection: RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design):1. Number of bedrooms(actual): , DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes or nif yes separate inspection required] Laundry system inspected(yes or no)14& Seasonal use:(yes or nQ�/- Water meter readings, if available(la3t 2 years usarye(gpd)):D 1`93��D ® 1 6,E Sump pump(yes or no . y Last date of occupancy: COMMERCIAL/INDUSTRIAI� Type of establishment: Design flow(based on 310 CM11.15.203) gpd Basis of design flow(seats/persons/sgft,etc.): . . . Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system'(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(.describe): GENERAL INFORMATION Pumping Records Source of information:. �. O Was system.pumped as part of the f6spection(yes or no): � If yes,volume pumped: gallons--How was quantity pump ed determined? Reason'for_pumping: TYPE F SYSTEM eptic tank, distribution box,soil absorption system Single cesspool _Overflow cesspool _:Privy _Shared system.(yes orno)(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): proxi ate a e o Il co pone s date i stalle f known) source of inf rmation: - � }'t Were:sewage odors'detected when arriving at the site(yes or no): F L Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property dress: Owner:, Date of nspection: BUILDING SEWER(locate on site plan),A& Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain):. Distanc: from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:-1f,'Ziocate on site plan) Depth below grade: /& It Materia= of construction:_leebncrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list_age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a.copy of certificate) e Dimensions: 16, Sludge depth: Distance from top of sludge to bcttom of outlet tee or baffle: r Z 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 Ta ffle. f N How were.dimensions determined: 4 doyz T�� . Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels related to outlet invert, e idence of leakage etc.): 4 - / GREASE TRAP. ocate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: ' Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: 2 Comments(on pumping recommendations,.inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidencz of leakage,etc.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL: SYSTEM INSPECTION FORM PART C SYSTEM INFORNLkTION(continued) Property Address: Owner:. Date of nspection: TIGHT or HOLDING TAN&tank must'be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass Polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: V Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribu�tooutletqual, any evidence of solids carryover, any evidence of akage into r ou of box, e .): /� PUMP CHAMBEER (locate on site plan) Pumps in working order(yes or no): . Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property dress: Owner a4�4v 2411711API-4-11 Date nspection. SOIL ABSORPTION SYSTEM (SAS): ocate on site plan,excavation not required) If SAS not located explain why: Type leaching.pits,number: leaching chambers,number: leaching galleries,number: R aching trenches,number, length: leaching fields,number,dimensions: overflow cesspool;number: innovative/alternative system Type/name of technology: Comments(note condition of sail, signs of hydraulic failure, level of ponding, damp soil; condition of vegetation; etc. X `GuxC;)' ce c fie. &4* `' J CESSPOOLS:/ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet inert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no.): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY/jCt''(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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: j , Owner: 11, Date of nspection 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. aU a 10 Page I 1 of I 1 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION(continued) Property Address: r aie.19J0 �/� 7 Owm�r: Date of I pection: SITE EXAM. Slope Surface water Check cellar Shallow wells! Estimated depth to ground water Zy feet Please indicate(check)all methods used to determine the high ground.water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Obecked with local.excavators, installers-(attach documentation) Accessed USGS database=explain: You must describe how you established the high ground water elevation: X� r �z 11 Permit Number: .,; �Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Lot No. Owner: - Address: Contractor: G CpG�s. Address: Notes: f�n�� -91 f * STEP 1 Measure depth to water table to nearest 1/10 ft. ...................... Date 7/Z$`�✓� �7 ............................. .. month/day/Year . STEP 2 Using Water-Level Range Zone and Index Wefi'Map locate site abd determine: A Appropriate index well................................J.�� �i/� OWater-level range zone ..........._...................................:..... S T c° o Using monthly -eport."Curren; Water Resources Conditions" I. determine current depth to --� Irl D/ water level sor index well .......::............ . . month/year STEP a Using Table of Water-level Adjustments for index well (STEP 2A), current depth to Water level for index.well (STEP 3)., I 'and Water-level zone (STEP 2B) determine water-level adjustment............................:..... L STEP 5 . Estimate depth _o high'water by subtracting the water- level adjustment (STEP 4) from measured depth to water. ) level at site (STEP 1) .:.................'.......-.................•.:. ✓ / Figure 11--Reproducible computation corm. 15. i . ,. ]li, ,w..r_. 14 .«.-.,.,,...r....�,....r....,r.......>.e..r,.. �..:� �..?�........._..........._w.r.........r.......�..-,.._........�......n��. .�.:........^-.....'...� ...,...,.riN_.....n..r^'i•,..:_�...... ,,..... f,�{!!:�� �" .......m.......,�.. g .-................`..._... /♦ /1� I ....�...-�...._�..__._.....__._..._•�....�... ._..�.....�.,.._..,..,,.M....W.,.a....-.�..�F li:::L-'l� :r�rJJ' J i I i TOWN OF BARNSTABLE LOCATION/ . - tJ SEWAGE # VILLAGE 'r 1 ASSESSOR'S MAP & LOT 057• oi-OQS ;� a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACM=: (type) b X V ra (.Z1 TAowcA size(2 r- V)(Z NO.OF BEDROOMS BUILDER OR OWNER )6g0J P'O PERMIT DATE: 9`/7 9"7 COMPLIANCE DATE: Separation Distance Between the: ,- Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by f 3c, '. p r { No. - b 1 FEE — �d 7 /s THE COMMONWEALTH OF MASSACHUSETTS Barnstable , MASSACHUSETTS (�Vpliration for Disposal $Vstem Tons#rurtion Ilermit Application is hereby made for a Permit to Construct (X) or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. 1?Sg Owner's Name,Address and Tel.No. Lot �5 Devon Lane The Irene Trust Cotuit Box 599 , Mashpee , MA 02649 ( 508) 477-0023 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Ferreira Associates 131 Spring Bars Rd. , Falmouth, MA a _ Type of Building: Dwelling No. of Bedrooms 3 Garbage Grinder 110) Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 5 5 gallons per day. Calculated daily flow 3 3 0 gallons. Plan Date 1—2 3—9 7 Number of sheets 1 Revision Date Title Sewage Disposal System Plan prepared for The Irene Trust Description of Soil Test ;`1: 0"-21° "0" , 2"-4" "A" sandy loam, 4"-20" "B" sandy loam, 20"-1.26" " n n n "Oil, n-41, n " an-20n "B" sand loam, C medium sand. Test , 2: 0 -2 0 2 A sandy loam, y 20"-120" "C" medium sand. No groundwater encountered. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed /Jl ��+--� Date 2ZZ21f 2 Application Approved byea.,.�.....�`' Date Application Disapproved for the following reasons Permit No. ` l� Date Issued °'�,r r.�.-a-..`-.. :*3���•...�.;v�"4_...•. t^�r•..�,plr,�:�J,I;,�- --�d;.sS'.:-"yt+»� ,��"4•ta�sYYr�i, �•r �,,,. s �� - � _x -xy a ,� -. 1 ""_ � Q� -asp-.•-.--...,Vi_. r m,M ! •Ky No. ! �- FEE �c�d Q �7 THE COMMONWEALTH OF MASSACHUSETTS Barnstable MASSACHUSETTS ,t �kpyfirativn for Pieposal Sgstem Clunstrnr#ton Ilerrait Application is hereby made for a Permit to Construct (X) or Repair( ) an On-site Sewage Disposal System at: Location Address or Lot No. O ner's Name,Addres.and T I.No; Lot #5 Devon Lane The Irene '> rush Cotuit Box 5,99 Mashpee, MA 02649 (.508) 477-0023 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Ferreira Associates P` 131 Spring Bars Rd. , Falmouth, MA y, - 3699 Type of Building ;f _ • r Dwelling -No: of Bedrooms" ` 3 m*�x `' Garbage'Grinder0) Other Type of Building No. per Persons Showers( ) Cafeteria'( ) Other Fixtures Design Flow 515 gallons per day. Calculated daily flow 3 3 0 gallons. Plan ' f Date 1-23-97 Number of sheets 1 Revision Date Title Sewage Disposal System Plan prepared for The Irene Trus Description of Soil Test #1:. 0"-21' "0", 2"-411 "A" sandy loam, 4"-2011 "B" sandy loam, 20"-126" "C" medium sand. Test #2 011-21, "0", 2"-4" "A" sandy loam, 4"-20" "B" sandy loam, 2011-120" "C" medium sand. No groundwater encountered. Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental'Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed r1Xe.l Date -Application Approved by Date f Application Disapproved for the following reasons t 3` Permit No. d Date Issued _ THE COMMONWEALTH OF MASSACHUSETTS J MASSACHUSETTS CEerttftrate jof (VILTI-umyltttu.ce THIS IS TO CERTIFY, that the On-site Sewage Disposal System installed( or repaired/replaced( ) on by for at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No, dated Use of this system is conditioned on compliance with the provisions set forth below: The-issuance of-this certificate shall not be construed as a.guarantee that the system,will function as designed. This Certificate expires on i DATE �� 1 Inspector 3� THE COMMONWEALTH OF MASSACHUSETTS No. � J ® � �� +• � , MASSACHUSETTS FEE d n Ptsposal *gstrm C�nustructtou IlPrmtt Permission is hereby granted to to construct(,, r or repair( )an On-site Sewage System located at 42 7 wt 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. All construction must be completed within three years of the date below. DATE _��� 9.. � 7 s Approved by FORM 1255 Re,3/95 A.M.SULKIN CO.-BOSTON,MA TOWN OF BARNSTABLE LOCATION � °'� f N SEWAGE ? VILLAGE Co `j t + ASSESSOR'S MAP & LOT 051- (?off-OOS INSTALLER'S NAME&PHONE NO. Jt �� ��� � �'' C VT)-oi 77 SEPTIC TANK CAPACITY L J LEACHING FACILITY: (type) 3 6 X V YA 67J Taa„cti'°�(size�a� .�C t y x2 NO:OF BEDROOMS L 'BUILDER OR OWNER a FSo��� j ��0 ►" PERMTTDATE: I l l— q 7 COMPLIANCE DATE: Separation Distance Between the:. r. Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet .Private Water Supply Well and Leaching Facility (If any wells exist `".:on site or within 200 feet of leaching facility). Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Famished by f` { , f e , 3C ��- �IahMC.h POA1� �.-- 3 ..n a.:. ..r. , u......,...f ..:... :•.. ,....,-> +r ..,e,. ,.. Y ... -,... -. 9 ... : r.. ... _ ... t l:. .t.. �. .•.., w .:: ., ..six _.. .:r '..: .... :. ':,.. , M1.-... - .. .,. -m ♦ .. :,,,.z.. t'.. .., •: ,.3. AREA PLA f SYSTEM PROFILE FINISH 6AADE Nor To SCALE B _ S .f VAS.UA_T_LONS____ ,. , , •;• FINISH GR.40E , � .'. FINISH GRADE APPLICATIAN MO B Go7.o -:.••� OVER TANK ,° k , OVER TRENCHES . ��.0 ' �L 1•a�, SEP71 2lm 19916 • •. fbN TOP FND / - �f�A BAfAR7Y TOMN AF BA .STABLE .�r•_: , SCH 40 PVC +. '• : �i - TEST MOLE t TEST MOLE 2 •.o 0 0. , G�.d�S7 is OR •i • ..,,. .;w...r:• -:c �, ,, 'o' �..., p '+ CAST IRON TEES ��• - 2 �' .p., p '�a'..r •:°`.•,C I'i ' /� ©°�O�°OooO°OG°Q •oo O u '. L„k„ •` }. : . - �G� iQ :, ,I r0�_}"7 p ,so ooeil� � .. •_ 'i G2.54 G2.3Cs , CAP .A. .A. BSM'T FLR °•;►:�• ;� 1500 �: E[ii!/ALIZEAS ogoaaPv000°°`�:o°o SAMDY LOAM SAMDY LOAM 5 7•6 e o 0 •.� .. 6AL• G�.Csf� oo a og o 0 10ra 9/2 >•,.� ..: REINFORCED i ,c oo ,a oo° o°. °ao oc•mea. •o .: Cora 8/z CONCRETE �.. 6As � OIST.BOX °ao'or.°o o.°o o:�°o a pCo (01.4U o°• �� `'`�` � :`� ,. *• 4' ••►•,.- ,,,�... ,. �: BAFFLE -� ,.... � . . oQ�s,a.i a�.Dope mi -: 0000`�°•::� '° c, '� ° { +k;�`' ,. . ,.° .. . ....:. f..,...... .., • : -. TO BE INSTALLED ON A _ °°Doan' ao a 's •B• LEVEL' STABLE BASE o tr e` o ao o:v a..,eo. e • ' t , z • oa 4.0 p0 " ° oe o 00 O?f00° saeoe s-�: SAM7Y LOAM lOYa '3/B SAMCY LOAM �xr fora ale. SEPTIC TANK , • TRENCH LENGTH TO BE INSTALLED ON A : � , �,rua•sAMv C. LEVEL STABLE BASE MEDIGW SAMD 4'MIN.HEIGHT 2•ar 6/' NO DO NOT RUN HEAVY EOUIPMEN T O VER SYSTEM Aeo vE oesERVED � . ' k 20Aa COBBLES 2.6Y.6/I lox coeeLEs a,BROUNO !✓A TER >z 120, NO saouwvwATEa LEACHING TRENCH .SECTION NOT TO SCALE _ SOIL AND PERCOL A'.TION DA MOTE.• FOR FINISH GRADE APIoILICATIQN 11b. P-0773 t AERC'D AT 48' SEE SYSTEM PROFILE { ' -e2 MIN/IN PERC RA TE MIN/IN �2"MIN. TAKEN By: RSQSfAI�'FEf�IRA -�- _ WITNESSED BY ''EONAAD 8AA4Y DA TE MIN a'DIA.PIPE TEST P T ELEV. 1 64.@ ? 'Q6 P " `� ,. �• }t, ' . WASHED STONE _ f~-NATURAL SOIL--� 2'MAX EFFECTIVE O ti r „� �� �•� .DEPTH WASHED STONE 3. ELEVATIQIV$ BASED !�V N:$ L.' `• s ,~ x F4,r�a r� , ��, _ _ MIN.= 3X _ • 2. TOMrJ.XA7`t�9'AM S.TTE E FEC ✓ -3 EXCA VA TED SICEWA L L _ ,. ._,._ . ,- OR DEPTH , �. Br90LN�bMA TQ9`EZEVA TIAN,20.:7 _ ,`u.. :. . R,. :AP' t '... ,' . .: � .. . .. A�JIAI�LE. _ TiAA NE!L, r.. . `FROk Md71NI F T T FEC I E IO NUMBER OF REN E ' . . N 67'22'S0'E 74 GALS/SF 172 GALS. DESIGN DA TA 232 S. F. SIDEWALL AREA NO. "BEDROOMS 3 LOT 5 224 S. F. BOTTOM AREA • T4 GALS/SF .i66 GALS. Esr�orALL DAILY EFFLUENT � GALS:` SEPTIC TANK GAL. 43, 729 Spy' 456 S. F. TOTAL AREA 338 GALS. , •..... ;, GENERAL NOTES x tp � ► o h LOT 4 NO 1 . ALL SYSTEM COMPONENTS SHALL BE INSTALLED SETBACK LAVE-� • to �_soo_ BUIL_OIN6 __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ � � ACCORDANCE WITH TITLE 5 OF THE, STA TE 'SANLTARY CODE EXCAVATE TO EL EV. SS.ts-OA LONER AS REQUIRED • t � DATED MARCH, 1995 - AND ANY>LOCAL RULES APPLICABLE, v ►� O � N TO REMOVE ALL LOAM AND CLAY CONTAINING �• � ' MATERIAL BENEATH THE LEACHING AREA.REPLACE 2. ANY CHANGE IN THIS PLAN MUST BE APPROVED .` 2 __ -`� �°� EXCA VATED MA TERIAL WITH CLEAN, CLAY FREE GRAVEL VEL B Y THE BOARD OF HEALTH ,: 93.66 Br• MECHANICALLY COMPACTED IN PLACE 3• WHEN CONS TRUCTID/V IS COMPLETED, PRIOR.;`TO BACKF`ILL pwaw. rsu • 6 l ! �,�„ �+•�• 79' NOTIFY BOA F)D OF HEALTH .FOR INSPECTION h l PGtG @9�I'7 t yMr 4. FND.EL EV.MUST BE 'CHECKED WHEN COMPL ETEO 5. THESE ELEV« MUST NOT `BE CHANGED WITHOUT - - LEGEND _ , P'' 50• 1 I THE BOA RD OF HEALTH APPROVAL eso0 s� I C ? � : v-B�x ; �� �rc I ; �r�� �'""s N 6. BOARD OF HEAL'TH INSPECTION REO 'D, WHEN EXCA VA TED + �sfi$.! awr�ea ' pwa�n f:� �� I ���1 sae a.e�.so .._ GG--EXIST.GROUND ELEV. - :' l /EA�IT LEAGHIMB I B6'LLY�L f'MID�P'QEEP �^ r* F - � (9EE PrvctFILE1 � 7 - � P :� I 3r FINISH GROUND EL EV•UNDERLINED y , � ,�• � 4g41?07"M L4 ,,� �� SEWAGE DISPOSAL SYSTEM ' PLAN : � 50.S4 A 97.75 � S B k. �„� _ S 68 41 'OB`N �A�R­s400.00 G3.Ob PIPE INVERT £LEV. ��8�`��', f ( "� r`�� PREPARED, FOR TEST I T OCA TI N su u. - Y R y 4 v EPTIC TANK �V. o o s � FT N T US T } O DISTRIBUTION BOX ..�� ,�¢ ` , ,` _ LOT 5 � DEVON LANE: �4 4'C.I.OR SCH a40 PVC r. • BARNS TABLE °MASS.° T a• o'�nv ®e 4'BIT.FIBER PIPE-TIGHT JOINTS � � � J2 •1 ._. PROPERTY LINES.. .E �➢���� `M�r DESIGNED: SAP � DATE : ✓Al1KlARY 2$ ; �9187 E, , . fl:,,f: •-a°-env '+ .,, -i t :n l - : FERREIAA. � MIN.CODE DISTANCE ORA1�N: hP SCALE.•AS SHOMN " ,� .�.:;:,r.�,,,� >,P � a3�'::SPA2'NG "'BRAS ,:�1`OAD i d t ^FALMOUTH .- .MASS --. CHECKED . Q0.S DRAMIN6 NO. 01 ` H S MAP SEC. PCL L O T E r r