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HomeMy WebLinkAbout0135 DEVON LANE - Health "+ 135 Devon Lane Marstons Mills A = 040- 133T00 SMEA® No.53LY UPC 12943 ti � �i�1� a, �� ter✓ ��� �� C��) � � Commonwealth of Massachusetts Title 5 Official Inspection Form co PY Subsurface Sewage Disposal System Form -Not for Voluntary Assessments klpiw 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is required for every Marstons Mills MA 02648 March 5 2014 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. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Patrick T. Sullivan y use the return Name of Inspector key. Ready Rooter Excavating Company Name P.O. Box 89 Company Address Forestdale MA 02644 City/Town State Zip Code 508-888-6055 S1 12843 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority r= March 6, 2014 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 2 t5ins•3/13 Title 5 Official Inspection ubsurface Sewage Disposal S stem•Page 1 of 17 L Y , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is required for every Marstons Mills MA 02648 March 5, 2014 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR115.304 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 pasLIta Check the box for"yes", "no"or rmined" (Y, , ND)for the following statements. If"not determined," please explain. The septic tank is metal and oves old* r the septic tank(whether metal or not) is structurally unsound, exhibits substantial infr exf ration or tank failure is imminent. System will pass inspection if the existing tank is wit a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inif it is structurally sound, not leaking and if a Certificate of. Compliance indicating that the ts than 20 years old is available. ❑ Y ❑ N ❑ lain below): I i i I I t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is required for every Marstons Mills MA 02648 March 5, 2014 - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of ealth): ❑ 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 t e Board of Health: ❑ Conditions exist which require furth revaluation by the Board of Health in order to determine if the system is failing to protect pu Ic health, safety or the environment. 1. System will pass unless and 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 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owners Name information is Marstons Mills MA 02648 March 5 2014 required for every , 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 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 t e SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and he SAS is within 50 feet of a private water supply well. El The system has a septic tank and SAS and t e 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 anal sis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the resence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no o er failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is required for every Marstons Mills MA 02648 March 5, 2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (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: ❑ ® 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. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or" o" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 4 feet of a surface drinking water supply ❑ ❑ the system is within 00 feet of a tributary to a surface drinking water supply ❑ ❑ the system is to ed in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or mapped Zone II of a public water supply well If you have answered "yes"to any q stion in Section E the system is considered a significant threat, or answered "yes" in Section D abo a the large system has failed. The owner or operator of any large system considered a significant thr at under Section E or failed under Section D shall upgrade the system in accordance with 310 C R 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is Marstons Mills MA 02648 March 5 2014 required for every , page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 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: 110 gpd x#of bedrooms): 450 GPD t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is required for every Marstons Mills MA 02648 March 5 2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No 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 ears usage d 2012= 197 GPD g ( y g (gp ))' 2013= 170 GPD Detail: Irrigation system used lightly during summer months. Sump pump? ❑ Yes ® No Last date of occupancy: Current Date 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/s ft, etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank pre nt? ❑ Yes ❑ No Non-sanitary waste discharge to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 Devon Lane 'P,"- Property Address Herbert Rice Owner Owner's Name information is required for every Marstons Mills MA 02648 March 5 2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Ready Rooter records: Pumped 03/04/2013 + 03/2011 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® 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): t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is required for every Marstons Mills MA 02648 March 5, 2014 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: System installed 11/12/1996. Certificate of Compliance on file at Health Dept. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2'4" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1 8 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 I Dimensions: 10'6"x 5.5' x 5' 1500 gallons Sludge depth: 2" l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is required for every Marstons Mills MA 02648 March 5, 2014 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 35" Scum thickness 3"at inlet, 2"at outlet 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 12 How were dimensions determined? Tape measure and dip tube. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet and outlet PVC tees in place. Liquid level at outlet invert. Zabel 1801 Effluent filter in place in outlet tee. Recommend yearly cleaning of filter and pumping every 2 years. Risers bring covers within 6"of grade. 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 o top of outlet tee or baffle Distance from bottom of cum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is required for every Marstons Mills MA 02648 March 5 2014 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 of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspect on Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is required for every Marstons Mills MA 02648 March 5, 2014 page. City/Town 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 0" Comments (-iote if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): One inlet, two outlets. Light solids carryover. Not affecting system operation. No high water staining over outlet speed levelers. Equal flow. Riser brings cover within 6"of grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump c amber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owners Name information is required for every Marstons Mills MA 02648 March 5, 2014 page. Cityrrown 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'X 4'X 2' ❑ 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.): Camera used to inspect trenches. No standing liquid or high staining at time of inspection. No sign of past hydraulic failure. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments r 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is required for every Marstons Mills MA 02648 March 5, 2014 page. Cityrrown 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, si ns of hydraulic failure, level of ponding, condition of vegetation, etc.): Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 t5ins-3/13 w Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is MA 02648 March 5, 2014 required for every Marstons Mills page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 A I n I l o 01 r � V I " J I Qc� 5 i 5 � -0j J Titre 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 t5ins•3J13 c Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owners Name information is MA 02648 March 5, 2014 required for every Marstons Mills page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells >5 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: 08/31/1996Date ❑ 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: www.terraserver.com ma water usgs gov You must describe how you established the high ground water elevation: Test hole in 1996 to 120"found no ground water. Base of trenches at 54". (5.5' above base of test hole). Accessed local ground water contours and topo mapping. No high ground water in area of system. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Devon Lane Property Address Herbert Rice Owner Owner's Name information is MA 02648 March 5, 2014 required for every Marstons Mills page. Cityrrown State Zip Code gate 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 I Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 t5ins•3/13 /��/� ' //Q� /�//////D ' /1 �//v ✓ ( 1 I •'/s ,� ��� ,� °� ��� �� ��� ��� �� 211p COMMONWEALTH OF MA,SSACHUSE=S ExEmnriw OFFICE OF E\nfqRON E,\-_ALAFFmRs DEPARTMENT OF E1�'VTR(3�E3�►"i' LPROTECTION RECEIVED i i AUN 0 1 Z004 TOWN OF BARNSTABLE HEALTH DEPT. TILE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ® - MAP Property Address: Q r.-Q PARCEL, LOT Owner's Na me• in MZXm, ' Owner's Address: v ffliffs Date of Inspertion: p r I, Name of inspector:,Rlease rint) ` a �t Company Name: =7_ ,`r "SP& 1c) Mailing Address: - 4;01' Telephone.Number. g57- CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I ama DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Sigmatatre: --�� ate: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or 4 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 condition$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 5/15P-OW page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSFMM ENTS SUBSURFACE SKWAGE DISPOSAL SYSnM INSPECTION FONT PART A CERTIFICATION(continued) Property Address: 3S J7e von 1.A0--k to W. U16 Owner. 0. Date of inspection: Inspection Summary. Check A,B,C,D or E!ALWAYS complete all of Section D A. System Passes: x I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. Systems Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be or repaired The system,upon completion of the replacennent or repair,as approved by the Board of th,will Pam• ,answer yes,no or not determined(Y,N,ND)in the for the following statements.If of determined"please explain. Theseptic tank is metal and over 20 years old*or the septic tank(wh metal or not)is structurally unsound,exhibits substantial infiltration or exf ltratiom or tank failure is" ent System will pass inspection if the existing tank is replaced with a complying septic tank as approved by th oard of Health. *A metal septic tank will pass inspection if it is structurally sound,no Baking 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 "gh sta k water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or distribution box"System will pass won if(with approval of Board of Health): broken s)a m r* O _ is re moved box is filed or replaced ND explain: The system re pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(wi approval of the Board of Health): brokers pipes)are replaced obstruction is removed r NNID 2 I Page 3 of It OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMI EATS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: pe _ / Vo t f4 r"4 Owner: A Date of Inspection: 6 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to rinine if the system is falling to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance wit 10 CMR 15303(1)(b)that the system is not functioning in a manner which will protect public heal safety and the environment: _ CesspooI or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated tland or a salt marsh 2. System will fail unless the Board of Health(an ublic Water Supplier,if any)determines that the system is functioning in a manner that protects t public health,safety and environment: The system has a septic tank and soil tption system(SAS)and the SAS is within 100 feet of a Surface water supply or tribunary to a ce water supply- - The system has a septic tank SAS and the SAS is within a.Zone I of a public water supply. The system has a septic and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply we *.Method used to determine distance "This system if the well water analysis,performed at a 1'DEP certified laboratory,for coliform bacteria and vol a organic compounds indicates that the well is free from pollution from that facility and the presence o oria nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure crite ' are triggered.A copy of the analysis must be attached to this farm. 3. her- 3 i 1 Page 4 of l l OFFICIAL�tSPEMON FORM—NOT FOR VOLUNTARY ASSESSMENTS = . SUBSURFACE SEWAGE DISIOSAL SYSTEM INSPECTION FORM PART.A. CERTMCATI N{continued) ]Property Address: / s Vot,'t„g0-R Owner: G e Date of Inspection: yj W-0 D. System Failure Criteria applicable to all systems: You mast indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool jr Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool — X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow 0 Required pumping more than 4 tunes in the last year N 'T 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 crater supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a.Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water duality analysis.IThis system passes if the well water.analysis, performed at a DEP certified hd mratoM for cuff9m tmcteria and volatile organic compumub indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equaf to or lei than S pW,provided that no other failure criteria are triggered.A copy of the analysis mist be attached to this forut.] (YeslNo)The system fails.I have determined that one or more of the above failure criteria exist as descn'tied in 3 i0 CIVIR 15.303,therefore the system mails.She system owner should contact the Board of ]Health to determine what will be necessary to correct the failure_ It. Large systems: To be considered a large system the system m A serve a facility with flow of 1(1,00i1 gpd to 15,800 You must indicate either"yes"or`no"to each of the followin {The following criteria apply to large systems in ad a criteria above) yes no — _ the system is with 400 feet of drinking water supply — — the system is within 200 of a tributary to a surface drinking water supply — _ the system is t in a nitrogen sensitive area(interim wellhead protection.Area—MpA)or a mapped Zone II of a lic water supply well If you have airs "yes"to any question in Section£the system is considered a significant threat,or answered "yes"in n D above the large system has failed.The owner or operator of any large system considered a signifi threat under Section E or failed under Section D shall upgrade the system in accordance with 310 C NM 15.3 .The system owner should contact the appropriate regional office of the Department. A Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Ale er-t Date of Inspection: 0 Check if the following have been drone You mast indicate`(es"or-no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health 0 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 X 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 NIA) — — 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'? 1� _ 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? In_ Was the facility owner(and occupants if different from owner)provided with information on the proper tenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no — Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CUR 15.302(3)(b)j 5 f € FFICIAL INSPECTION I ORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � PART C SYSTEM INFORMATION Property Address: Owner: Af Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMS 15.203(for example: I 10 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 no):_ [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): 03 61Y 1V.1 9ys�c Sump pump(yes or no Last date of occupancy:ay[ COMMI RCIAL(INDUSTRIAL Type of establishment: Design flow(based on 310 CN1;Z 15.203): gpd Basis of design flow(seam1persons/ c_): Grease trap present(yes or no}: Industrial waste holding tank p t(yes or ro):_ Non-sanitary waste disc to to the Title 5 system(yes or no):— Water meter readings,if ailable: Last date of occupan use: OTHER(d }: GENERAL INFORMATION Pumping Records 'Source of information: (0 l Aq I Dot �-5 J.Z j Was system pumped as part of the inspection(yes or no):AAD If yes,volume pumped:_____gailons—How was quantity pumped determined` Reason for pumping: TYPE OF SYSTEM 0( Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a ropy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):A*40 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSIM ENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3s 1�e✓o M d..a"'� Owner:_Ac.,5kAC. �7 Date of Inspection BUILDING SEWER(locate on site plan) Depth below grade: �P76 Materials of construction:—cast iron X 40 PVC_other(explain): Distance from private water supply well or suction lane: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: 'r (locate on site plan) Depth below grade f$ Material of construction:,r�conerete metal fiber- glass__polyethylene _other(explain) — — If tank is metal Iist age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) / Dimensions: 15z->o Sam Sludge depth: OZ" - Distance from top of sludge to bottom of outlet tee or baffle: 4TO Scum thickness: . t u Distance from top of scum to top of outlet tee or baffle: O i Distance from bottom of scum to bottom of outlet tee oj baffle:_f� How were dimensions determined: Aewcz/'C�K Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to utlet invert,evidence of leakage,etc.): f G i e hJ GREASE'TRAP:_(locate on site plan) Depth below grade:— Material of construction: concrete metal TibberI —polyethylene`other (explain): — — Dimensions: Scum thickness: Distance from top of scum to top of o et tee or baffle: Distance from bottom of stunt to from of outlet tee or baffle: Date of last pumping: Comments(on pumping mmendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet inv evidence of leakage,etc.): 7 i 1 ' fr Page 8 of H OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM FART C SYSTEM INFORMATION(continued) Property Address: i'3 Jo . 115 Owner: Date of Inspection. &I I ftAt) TIGHT or HOLDING TANK: (tank must be pumped at ' e of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: all Resign Flow: onslday Alarrn present(yes or no): Alarm level: Al in working order(yes or no): Date of last pumping: Comments(conditio f alarm and float switches,etc.): DISTRIBUTION BOX:-(if present must be openedXlocate on site plan) Depth of liquid level above outlet invert: �r1 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakageto or o of box,etc.): (� �"� ! tAar- S.t u J� �+C f uJ L v� S 4 U� coy('try. C) PUMP CHAMBER: (locate on site Pumps in working orde�(yes o o):. Alarms in working orde or no): Comments(note condi n of pump chamber,condition of pumps and appurtenances,etc.): _ g Page 9 Of i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSIVIENTTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM FART C SYSTEM INFORMATION(continued) Property Address: l Owner: AC Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type Ieaching pits,number:_ leaching chambers,number_ leaching galleries,number. _W_leaching trenches,number,length: oQ� 3 b 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 pond_ing,damp soil,condition of vegetation, etc.): t( t S 8 ;� V•�d t �Y��-U►'Q t v�2tJ�t�tt 4 . u. r CESSPOOLS: (cesspool must be pumped as part of ins n)(locate on site plan) Number and confi4uration: Depth—top of liquid to inlet invert: Depth of solids layer. Depth of scum layer. Dimensions of cesspool: _ Materials of construction: Indication of groundwa inflow(yes or no): Comments(note c tion of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site pt Materials of constructio Dimensions: Depth of solids: Comments(not condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 r - Pap ICJ of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS F SUBSURF4CE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address- / : 4 '-"""I Owner: Date of Inspection- SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet_Locate where public water supply ehters the building. co ` - ' 36 6 J `36 3 t� OFFICIAL INSPECTION FORM--NOT FOR VO€��,�°�' Y A ESS?�I�1�`TS SUBSURFACE SEWAGE IDISPOSAL SYSTEM INSPECTION FORM, PART C SYSTEM INFORMATION(continued) Property Address: .00 k Owner: e Date of Inspection: SITE E;� Slope Surface water Check cellar Shallow-wells plb Estimat_d depth to ground water 3 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 propertylobservation 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 roust describe how you established the high ground at elevation: �� _ MAP C)4 F T PARCEL : B YS T r. LOT ; DATE : 11 /23/02 PROPERTY ADDRESS:135 -Devon Lane __ Cotuit'MaGs__tMlbresTo S 1uliL1.� ' 02635 ®qd ------------------------ On the above date, 1 inspected the septic system at the above address. This system consists of the following: RECEIVED 1 . 1 -1500 gallon septic tank. 2. 1 -Distribution box. 3. 2-leaching trenches. 1 -4 'X30 ' 1 -6 'X4 ' UEC 1 0 2002 Based on my inspection, I certify the following conditions: TflVuf�C)F BARa'�STABLE HEALTH DEPT. 4. This is a title five septic sy4tem. ( 95 Code) 5. The septic system is in proper working order at the present time. 6. Pumped the septic tank at time of inspection. SIGNATUR Name :_ J .- P . Macomber_Jr _____ Company :IQ5 tehM�gQmt2tr 8 Son, Inc . Address :__@Qx __Ce_r t.e Na-_QZ.632-0066 Phone : 508- 775_ 3338 ___ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY I IOSEPH P. MACOMBER & SON, INC. Tanks•Cesspools•Leachfields Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632.0066 775.3338 775.6412 �-\ 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: 1 35 Devon Lane Cp±-uit, Owner's Name:Kevin mcs ea Owner's Address:Same Date of Inspection: 11/23/02 Name of inspector: (please print)_ Joseph P.Maeomber Jr. Company Name: J_p.Macomber & Son inc. Mailing Address: Rnx Fti 02632 Telephone Number:508-775-33 8 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true. accurate and complete as of the time of the inspection.The inspection was performed based on my ;raining and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes _ Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: t Date: Il -1-r, il The system inspector shall s mit 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 now of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the D=P. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authoriry. Votes 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 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 135 Devon Lane Cotuit,Mass. Owner: Kevin McShe:a Date of Inspection: _ 1 1 /2 310 2 Inspection Summary: Cbeck A,B,C,D or E/ALWAYS complete all of Section D A. S Passe 1 I have not found any info_ rm_ a`� hick indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 Clvflt 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The septic system is in prgper working order It the present time 0- B. System Conditionally Passes: L69 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 explain. . If"not determined"please Wd 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 existifig tank is replaced with a Y�8 se com 1 tic tank as approved by the Board of Health. P P •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: �f) 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: 14b 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 Page 3 of I I -er OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1 3.5 Devon Lane r'nt>>i t M;; C Owner: Kevin McShea Date of Inspection:1 11 [2'1 f 02 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system , is failing to protect public health, safety or the environment. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner wbich will protect public bealtb, safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 50 feet of a bordering vegetated wetland or a salt marsh i 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functionirrg 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 rributary to a surface water supply. 42, The system has a septic tank and SAS and the SAS is within a Zone I 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 $\stem passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and vola:ile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nirrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are rriggered. A copy of the analysis must be artached to this form. 3. Other; 3 Page 4 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:1 35 Devon Lane Cotui ,Mass.. Owner: Kevin McShea Date of Inspection: 11 23 02 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 oe—,t;md), W"rle,s _ Liquid depth,in sompegl.is less than 6"below invert or available volume is less than 'r day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number f times pumped L , _ ✓,o_>Pvly portion of the SAS,cesspool or privy is below high ground water elevation. y portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ater supply. ✓Any portion of a cesspool or privy is within a Zone 1 of a public well. 9rty portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) (Yes/No)The system fails. 1 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 Vthe 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 11 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 Page 5 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1 35 Devon Lane Cotuit,Mass. Owner:Keyin McShea Date of Inspection: 11 /21/0 2 Check if the following have been done.Yoo 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 componenjs 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 ? -Z 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;"�Ivcluding the SAS, located on site? d _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of tKe 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: Yes no ;Existing information.For example,a plan at the Board of Health. _✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1 35 Devon Lane Cotuit,Mass. Owner: xevin Mr-Shea Date of Inspection:1 1 f 2-,(n2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):AL Number of bedrooms(actual): 41 DESIGN flow based on 310 CMR 15.2034or example: 110 gpd x # of bedrooms): ` xyle'�7vw Number of current residents: _7 Does residence have a garbage grinder(yes or no): AA,.) Is laundry on a separate sewage system (yes or no):,� (if yes separate inspection required) Laundry system inspected(yes or no):7e S Seasonal use: (yes or no): VO Water meter readings, if available(last 2 years usage(gpd)): 2000-200, 000 gal lons=572. 61 GPD Sump pump(yes or no): A)O — j-50, 0u0 gallons=904. 1 1 GPD Last date of occupancy: kaj Sprinkler system present COMMERCLAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.)4� Grease trap present(yes or no): 164 Industrial waste holding tank present (yes or no):4M Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: 1644 OTHER (describe): 414 GENERAL INFORMATION Pumping Records Source of information: None available Was system pumped as pan of the inspection(yes or no):A5 If yes, volume pumped:1696 gallons -- How was quantity pumped determined?,/i Reason for pumping:Heavy scum & soilids layers were present. TYPE OF SYSTEM OF tank, distribution box, soil absorption system 42A Single cesspool AM Overflow cesspool Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) ,&�2 Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank. 4b Attach a copy of the DEP approval Other(describe): Approximate age of all omponents, date installed (if known) and source of information: Were sewage odors detected when arriving at the site(yes or no):i 6 Page 7 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 135 Devon Lane Cotuit,Mass. Owner: Kevin McShea Date of Inspection: 1 1 /2 3/0 2 BUILDING SEWER(locate on site plan) Depth below grade: �f / Materials of construction: cast iron ✓ 40 PVC.t10 other(explain): '410 Distance from private water supply well or suction line: /d"�- Comments(on condition of joints,venting,evidence of leakage,etc.): Jai nt-G appear tight No Pvi derino of 1 PakaaP ThP system is vented throu h the house vdnts. SEPTIC TANK: locate on site plan) Depth below grade: AiL :r Material of construction: i concrete W metaLL�fiberglass polyethylene 4�2other(explain) ,dg If tank is metal list age: is age confirmed by a Certificate of Compliance(yes or no):.t4b (attach a copy of certificate) Dimensions: /0` 6'`00"dam 'e Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:0 Scum thickness: 6— 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: Liquid measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of.leakage,etc.): Pump the septic tank every 2-3 years Inlet & outlet tees are i n l 1 anP ThP tank i s Gt-rnrt-1ira1 1 V cnunrl and shnws no Pvi dence of leakage-Tank pumped at time of inspection. GREASE TRAH/dft (locate on site plan) Depth below grade:&L Material of construction:4Qconcrete✓&metai4//9fiberglassi polyethylene.�other (explain): A�Q Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ t/x Distance from bottom of scum to bottom of outlet tee or baffle:_�i� Date of last pumping:�j Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Grease trap is11et present 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 135 Devon Lane Cotuit,Mass_ Owner:Kevin McShea Date of Inspection: 1 1 /9 n 2 TIGHT or HOLDING TANK(tank must be pumped at time of inspection)(locate on site plan) Depth below grade:_J&_ Material of construction: concrete metal d4 fiberglass,�j2l polyethylene_dAother(explain): Dimensions: AW Capacity: AM gallons Design Flow: AM gallons/daye .Alarm present(yes or no):_ e4 Alarm level: A)h Alarm in working order(yes or no): 124 Date of last pumping: AO Comments(condition of alarm and float switches,etc.): Tight; or- hel di ;iq to;iks are net present DISTRIBUTION BOX:Z(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: AIZ) 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.): DiSt-rihutinn hnx hag two latPralG_Nn PvidencP of solids carry over Na PvideneP of 1Pakage into or nut of the hnx_ PUMP CHAMBEPtj&(locate on site plan) Fumps 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.): Pump chamher is not prPgPnt- _ 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 35 Devon Lane Cotuit,Mass, Owner: Kevin McShea Date of Inspection: 11 /2 3/02 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) 2—Leaching trenches-,- 1 _ 'IQ ' X4 ' #2 Fi 'Xd ' If SAS not located explain why: T,ncat ed; Scram ?Aqe 10 Type _A(a leaching pits,number: 0 �, Alp leaching chambers,number:0 JM aching galleries,number: Q ;7 leaching trenches,number, length f x'y AZ—/q�x- leaching fields,number,dimensions: a &/Qoverflow cesspool, number: B&innovative/alternative system Type/name of technology: r QE Lg Jr� Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): Loamy sand to sandy loam to fine sand No signs of hydraulic failure or ponding-Soils are dry, Vegetation 'is normal CESSPOOL$02ej((cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration:_ Depth—top of liquid to inlet invert: 4)11 Depth of solids layer: &4 Depth of scum layer: AA 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.): Cesspools are not present, PRIVY4"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.): Privy is not present, 9 f Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 35 Devon Lane Cot.uit,Mass, Owner: Kevin McShea Date of Inspection: 1 1 /'2 3/0 2 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the pewage disposal system including ties to at least two permanent referenc landmarks or benchmarks.Locate all ells within 100 feet. Locate where public water supply enters the buildi g. I ` v � les 36 ZJcv n tz, . 10 Page 1 1 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:1 3 5 Devon Lane Cotuit,Mass Owner:�Kevi n McShea Date of Inspection:11/2-3/0 2 SITE EXAM Slope , Surface water Check cellar Shallow wells Estimated depth to ground water.d' feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: NA YES Observed site(abutting property/observation hole within 150 feet of SAS) N_Q_Checked with local Board of Health-explain: NA yy.S_Checked with local excavators,installers-(attach documentation) YFS Accessed USGS database-explain: http1/town_harnstable.us.ma. You must describe how you established the high ground water elevation: Used: Gahrety & Miller Model 12/16/94 Water table elevations above sea level. Used: USGS; Observation well data June 1992 Used: USGS; TaGhnica_ h bin 92 000 1 Plate 92 Tam,ar1999 Anneal ranges of gr n 1 . 30 'X4 ' 2. 6 'X4 ' Leaching Trench s :eet Groundwater:' Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore,the vertical separation distance between the bottom v of the leaching pit and the adjusted groundwater table is feet. 11 f - '1T.t•{TI�Rt7f.—.Tr1TRTlR•R79wlf'TR Tt'T.!'R1fRT7tTTtlTtt�fRR1RTFl{7i 1�17.�NfRT TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I•••rn-r••.-: t—r.ta�.-rnmrte•R.•+>r+raR+rs'rrnr'R�->r-t•frtttrRti arnvt^`.+,R+�+sr one's t�R •.+-rrr•r•.t, —..A -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 135 Devon Lane Cotuit,Mass. ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Kevin McShea ,ttt� PART D - CERTIFICATION I NAME OF INSPECTORJoseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Incer * COMPANY ADDRESS Box 66 Centerville,Mass. 02632 Street Town or City Stat• r1P COMPANY TELEPHONE C08 1 775 - 3338 FAX 508 � 790 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the ti6e of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one. t System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection whic}I I have con acted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . � . Inspector Signature Date ne copy of this t.ifieation must be provided to the OWNER, the BUYER ( where applicable ) and the 130ARD OF HBAL711. * If the inspection FAILED, the owner or.thoperator shall u d he within one year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 3,10 ChJR 16 . 305 . partd .doc /fZtX /3S TOWN OF MtNSTABLE LOCATION I Q Duos) L.1ar44J SEWAGE # 96 — S68' VILLAGE Mi�2SiatJS �. 5 ASSESSOR'S MAP& LOT dM IO /33 Tv c� INSTALLER'S NAME&PHONE NO. 1A10-Y-_mot (204SI -7 7l-,41-L%- SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 1'�-�iN N (six ).2 N.X y X 2 NO.OF BEDROOMS �IL�bi�OR OWNER PERMIT DATE: 1 COMPLIANCE DATE: _-;-2 J9 J 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 ` lit �Cf X( 0 6' f �_.` SEW INSPECTIONS ,V // LOCATION' 1 -4� D) unn T.a n a DATE 1 1 /2 3/0 2 4�' Mkv-%lbt4:S "O'k& VILLAGE C` -Ett t.,Mass_ 02619 ASSESSOR'S MAP & LOT -INSPECTOR Joseph) P.Mdcomber Jr. SEPTIC TANK CAPACITY 1 500 gallons + Box LEACHING FACILITY: (type) 2-Trendies (size)30 'X4 ' NO. OF BEDROOMS 4 BUILDER OR OWNERKevin McShPa ` w ' .OWNER MAILING ADDRESS . Same r 126 Z)cvo n t& IhLAe 0- TOWN OF BARNS T ABLE ` ,ATIUN 1-0 T 4 �V'ON t�arJ4J SEWAGE # �6-S�� VILLAGE #I t\Ac. ASSESSOR'S MAP & LOT 0- � ' INSTALLER'S NAME&PHONE NO. i CAL ��s `� -q I Zbb r6 SEPTIC TANK CAPACITY � r LEACHING FACII,II'Y: .(.ty.pe) -1IL - I t: A (six NO.OF BEDROOMS �R OWNER 94-S'00 4-2CS goo P PERMTTDATE: ? L `► 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 i 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 � Q 'i r V � No. to ' lyd .--,W. �^ j 1..4 ` FEE /00 THE COMMONWEALTH OF MASSACHUSETTS �`- Barnstable MASSACHUSETTS w �yyfirativn for PisVvsa1 ,*Vstem C oustrurtion jhrrait Application is hereby made for a Permit to Construct (X )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Lot #9 Devon Lane , The Norman Trust House #135 Box 599, Mashpee, MA 02649 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �pK _Q -Pt6k_j FerreirA Associates 131 Spring Bars Rd. Falmouth, MA Type of Building: Dwelling No. of Bedrooms 4 Garbage Grinder(n 9 Other Type of Building No. per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 55 gallons per day. Calculated daily flow 4 4 0 gallons. Plan Date 1 0—1 9—9 6 Number of sheets 1 Revision Date Title Sewage Disposal System Plan prepared for The Norman Trust Description of Soil Test #1 0"-3 " "A " sandy loam, 3 "-2411 11R11 sandg loam, 24 "-12011 "C" sand. Test #2 o "-1 " "O" 1 "-4 " "A " sandy loam, 4 "-24 " "R" sandy loam, 24 "-120 " "C" 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 Da e P �� Application Approved by l / ate Application Disapproved for the following reasons Permit No. S Date Issued l y�' _�,`.�.. '. `;f _ -. .. « 70 '""i ( �<�•r 'Y±"R!"Y-,•��i«r�C'�-.•,t"-.d h.r.�:,y.�y. w .. /00 No. '1.�1— r ^f;a,,.. FEE THE COMM,ONWEALTW OF MASSACHUSETTS Bar`nstab%lo MASSACHUSETTS _ �Vyifirativn fur 'tspusal "'igste a C onstrurttun Ferntit 7 M Application is hereby made for a Permit to Construct (X ) or Repair( )an On-site Sewage Disposal System at: y Location Address or Lot No. Owner's Name,Address and Tel.No. - Lot #9 Devon Lane M►Y1 The Norman Trust --� House 1135 Box 599, Mashpee, MA 02649 Installer's Name,Addr ss,and Tel.No. Designer's Name,Address and Tel.No. I� O� P K(A, FerrefrA Associates I31 Spring Bars Rd. Falmouth, MA .r Type-of Bwlding f r _. Dwelling No. of Bedrooms 4 Garbage Grinder P o)/ Other Type of Building No. per Persons Showers( ) Cafeteria( ) c Other Fixtures Design Flow 55 gallons per day. Calculated daily flow 4 4 0 gallons.. .� Plan Date .1 0—I 9-96 Number of,,sheets 1 Revision Date ; Title Sewage Disposal System PIan prepared for The Norman .Trust Description of Soil Test #1,: 0"k3" "A " sandy loam, 3 "-24 "B" sandy Ioam, 24 "-4--20" "C" sand. Tesbt#2P o"-1 " "O" 1 "-4" "A " sandy. Ioam, .4"-24" "B" sandy loam, 24 "-120" "C" sand. So groundwater encountered. Nature.of Repairs or Alterations(Answer when applicable) - . r 4 Date last inspected,,. . y,.• I Agreement: g 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 ovu - 'Application Approved by rate / / Application Disapproved for the following reasons x C r Permit No. SG Date Issued' :'� 96 THE COMMON &ALTH OF MASSACHUSETTS ,,THE MASSACHUSETTS C�erttttcttte IIf 'ITIIm�ltttn>ce „ THIS IS TO CERTIFY, that he On-sate Sewage Disposal System installed(><) or repaired/replaced(• ) on byti for T j1.4Vf_7�7L'i r 1S at 3 v6 a t !� has been c structed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9 S& dated 46 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 a� / f DATE / Inspector �� G / THE COMMONWEALTH OF MASSACHUSETTS No. g�' �✓ , MASSACHUSETTS FEE wy r Disposal 1$Vstem k0lonstrurtion permt# Permission''is hereby granted to �� -�'� to construct,��) or.re air( )an O site rel �--S-ystem located at z �57 �"` 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 :Z Approved FORM 1255 Rev.3/95 A.M.SULKIN CO.-BOSTON,MA 1 e x f • t 7CC AREA PL A N , .. sCCE s a S YSTE M PROFILE, /6/ T SC ` FINISH SRAOE O ALE E AL UA IO V T NS . "t. FINISH GRADE FINISH'6RA APPLICATION NO. P-8756 .._ 7.5 OVER TANK O VER TRENCHES S,,7!U AUGUST 13, 1996 TOP FN ED ARD BARRY TOAFN OF BARNSTABLE • c n 4 P V'SCH 0 C 0 c.. t CAST IRON TEES O .. I • O B D O o • • o ' TEST 2 0 0 00 00 E s o TES `. 4 . t°E 1 s � e r t .� oo s• �? a 0 a o oe o . P 0 0 o•.t 0 o v P o v I CA ENDS .4 s 0 BSM T FLR - o r• . . o 0 0 �C� O ,.0 0 O 00 • 0 a o v A ELEV. . ♦ .t a o � GAL. EQUALIZERS o 0 0 •.. �'T..Sd 0 0 ° o.. • O A .• ♦ a o e o ° oo .. r 1 a-. N ®oo ma.�.W. �- REI FORCED o e o SANDY LOAM J ..► 00 oe � o r� I GAS DIST.° OX o o o o a.. e .0 0 . 0•° Q • - v - JOYR s 2 .. CONCRETE v im • o 0 0 o0 BAFFLE e •.v v o o • . ...•,.• N 09 Q •1 P O a a e A �. •.•• ... ,,� a as e o n o 0 eoov.o o •o f .. ...... TO BE INSTALLED; n o m e SANDY LOAM ON o0004 _0 9ao, 00 o ve°ao°m •o:o° .,; 0 0 0 0 0 o n o o o oa oc •000 9. 6 O. a o 0 JOYR s/2 `LE EL STABLE BASE ID, ° a o S T C T e EP I ANK 5 . 4 TRENCH L ENGT SANDY LOAN H JOYR 6/4 TO BE INS TALLED ON A SANDY LOAM > LEVEL STABLEAS BASE ., 24' JOYR 614 4 I G M N.HEIT H T NO Er DO NO T V V 'C' 24 r RUN HEA Y EGtU.IPMENT O ER SYSTEM aeovE OBSERVED .`.SAND A"GROUND AA TER _.v. r --, 25Y64 C SANG .120 2.5Y64 . -LEACHING TRENCH SEC T _ E ION. r NO T TO SC A L E SOIL AND PERCOL A 'T J20' ION DA TA FOR FINISH GRADE E S ; NO 6AOfAvO ATER t T APLLICA 8756 SEE YS T IAN NO• P- E S EM FPROFILE EAC O AT'd8 ^ 2HIM/INI � ` -C MIN N/I - � PERC. RA TE S_ 12"MIN. TAKEN BY ..:.. .. ., • . . , I MESSEDY — A TE. B MIN.2- 1/6 1/2 D 4 DIA.PIPE r 11 T , T V ; TEST P ELE . WASH STON --6�:-9—ED E TEST T 0 ES PI ELEV. 56.8 NATURAL SOIL— .. _2-MAX,AXEFFECI E . � NOTES P TH , LINE v BEA RING STANCE ,. 4 DI � -112 >. ., � h:4SHED STONE • • • }S 54 24 4� M 22.00 ' MIN. L T . 1. _E EVA IO/kS BASED ON M.S.L 3x • W F CT T EFE 1 � IDH_ N cA VA T wA 2• TOl✓N ATER ON SITE EX ED SIDE LL � r . . OR DEPTH . ; 9. FLOOD ZONE. C : 4 4 G40MOIATE4 ELEVAT ION.20.7 EFFECTIVE WID TH NUMBER OF 'TRENCHES r DEVON ---LAN LOT 8 .. r.,,. . DESIGN DA TA S. F. S DEWALL AREA � GALS/SF GALS.0 2370 . - , NO.OF BEDROOMS , 0AO -� l 0 � _ S. F. BOTTOM AREA Zd GALS _SrF GALS. DISPOSAL 5° r EST. TOTAL DAILY EFFLUENT GAGS. L 1 _ . SEPTIC W TANK. GAL ; S. F.SF -TOTAL :AREA GALS. 1 CATCH BASIN z > _ It ORA 1 QW ' 5 N l 59 1 , e 2 . 'GENERAL NOTES r se 1 � 9.OD _ NQ 1 T 1. ALL SYSTEM COMPONENTS ,SHALL BE INSTALLED IN ¢1 30.00 WIDE O O INA 6 E EAS 9 tACCORDANCEWITH' , EMENT i a�wasEn tag I TI TL E ,5 OF THE STATE. SANITARY CODE .�t EX CA r r r V. M s A LFawzNs rRs E C A E O EL OR `LO ERA AEQUIl�EO —i — _ w DA TED�caNs 4 zv�2� -AND ,r4NY LOCAL RULES' APPLICABLE � TO REMOVE ALL LOAM AND `CLA Y CONTAINING MARCH 1995 lsFE gaaFrtE1, , - -..- MATERIAL-BENEATH THE LEACHING AREA. 2. ANY' CHAP✓GE IN THIS.. PLA�►V UST V M BE APPRO ED E . O o-Bax r. XC �ATEDMAT R AL ITHCL AN CLAY;FREE GRAVEL o � '� � .,._ � m � E A E I E F BY THE, BOARD OF HEALThI, oI Go ECH�NICALLY C P CT LACE 1 I � M OM A ED IN P BEPTIC'TAAK .. N N C T T >- . �. e 3. HE CONS RUC. ION IS COMPLETED :PRIOR TO :BACK _ _ FILLING rz _ ti E LOT 9 _ I s t � NO TIFY 190ARD OF HEAL TH FOR INSPECTION 1 o w O 600 F 4` ND EL MIDST 1�� 1 � ti F BE CHECKED WHEN ,COMPLETED 5. THESE NO W IN y N BE CHANGED I TROUT LEGEND THE BOARD OF HEALTH APPROVAL I B m t � �o BOARD 0 HEALTH. INSPECTION.-RE© .D THEN E.�CCA VATED t } � r EXIST.GROUNa EL V. 1 , cx- t WISH 6ROUl0 ELEV.UNDERLINED 1 1 � SEA � DISPOSAL -, � AL SYSTEM PLAN r v v PIPE INVERT . RD 1 PREPARED FOR 1 TES T.PIT L OCA T ION 'I 1 � 7 , l 3 r . t o PT C TANK, o SE I AN , i 1 1 0 , THE IAENE TRUST .• e DISTRIBUTION BOX 22.00 cBB.25 ❑ � CDT 9 DEVON LANE _ L1 S 54 24 41 M 1 n r V R 4 C .._ - , i � ? 4 C.I.OR SCH 0 P '. I �� �L - �� � �3A RNS TA BL E ..:. .MASS. r < C V ]F H L ES N . S Y }} ,NSF AR A AR 4'BIT.FIBER"PIPE TIGHT JOINTS � < PROPERTY LIJES < ., TG�FR !9 5996� � D4 TE CDES 6NEDAP , .. FERHE S C . 45 IRA AS O IA TES , � M.M.CODE DISTANCEDRAWN .' = • ' SC L AS. A E. A .� 131 `S G S PAIN BAR ROAD _ - soss� L UT =- , CHECKED Dt�AM.,rNG No. FA MO H MASS. MAP SEC PCL LOT HSE CDs