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Home My WebLink About0526 FLINT STREET - Health .521e F�l k n-t-- - C V LOCATION A Si-` SEWAGE PERMIT NO. 186 A Flint St. 83-857 VILLAGE Marston Mills O2-- ®3X INSTA LLER'S NAME i ADDRESS Robert B. Our Co. Inc. Great Western Rd. North Harwich, Mass. 02645 B U I L D E R OR OWNER { Barnstable Holding Co. DATE PERMIT ISSUED DATE COMPLIANCE ISSUED z � `� ®�� a.' �-� 0 /�� r V•W TAn Y �� S� �o�. _ ,� �, . . #�a... c • t aZ= 0'6F .3_.'UY THE COMMONWEALTH OF MASSACHUSETTS BOARD ` F HEALTH, /✓ .. ....................0 F....... /ly ....,.......................... .t� liration for Disposal Works Tonstrurtion frrutit Application is hereb made for a Permit to Construct ( ) or air ( ) an Individual Sewage Disposal Sy at on-Address / or Lot No. .. :.`!_' _...... NJ ........... .s'?.. G�z .c'..z- f.�.^.�G;!�_......... � L�'G .... Owner Address /l aU!l .... -........ ...t..4.:............................. ........................... ......mac �:............ • Instal er Address Type of Building Size LotAQ. t.;-.0.....Sq. feet U Dwelling—No. of Bedrooms--...... .....Expansion Attic Garbage Grinder ( ) 'k Other—T e of Building No. of ersons...._`z:.................. Showers — Cafeteria a' Other fixtures _ W Design Flow.............-2t�..gallons per person Remy. Total daily flow......: � -4.2 _...... gallons„ WSeptic Tank—Liquid capacity/i.........gallons Length. _..:A.... Width 4 ...Diameter/4i ... Depth. .�...... x Disposal.Trench—No..................... Width.................... Total Length.................... Total leaching area...............__.sq. ft. 3 Seepage Pit No.....�........... Diameter....l4�......... Depth below inlet.....j55�.......... Total leaching area.2 ...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by................. ..... Date........................................ aTest Pit No. l..2:.,.:..minutes per inch Depth of Test Pit....Z.2........ Depth to ground water...... J. � Test Pit No. 2................minutes per inch. Depth of Test Pit..............,..... Depth to ground water........................ A+ ............................... .. ........................... ------._.---.............. . .... ..._.... O Description of Soil..-•---_..�'! �, ...............� ..... .............................................'' .. -J..... 7� ,�,��.i= ..... - UW ...--••--•-•---------------------------••-----.....---••-----............-•••------•----•--.........----••--••..........................-•---.....•--------•----•-•---•-•-•...... ...........-- ..... Nature of Repairs or Alterations—Answer when applicable...................................................................................•---••---... ..----•-•---•-----•----------------------------•-•-----•---•-•-••------........--•--................-----•-••--•------•--•--...----.............-----•---........-•----•-------•-------......._____-•-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to rhe system in operation until a Certificate of Compliance s _is ed by the b of h th. Signed.. l Kfeh ...... ............................................. Date ApplicationApproved By................................................................................................. ........................................ Date Application Disapproved for the f ollouring reasons:.........................................................................................................--- L_,,, Permit No............................ Issued..... G". �.�?:— ......_......._ Dace .Y Sao.g.3 rrs..7 F$B. D_..._.�_ ........ THE-COM-MONWEALTH OF MASSACHUSETTS BOARD OF HEAL H ds✓ic/....... OF.......... . � .. ........................ S e Iiration for Disposal Works Tonotrurtion �rrmit Application is herebov made for a Permit to Construct ( ) or air ( ) an Individual Sewage Disposal Sy at: 191 •Loe-ion-Address •-• / _ 1 a.. -�_., �j or No. /J �,� �•. .. ..�r �__.... r .. .�. —' .........._ ..�?.. Cam .. .. �G'� ._...�.� owner G / Aaar�9g i l�..4. .h d ................................ .................. .1�: �.e�<<�d..............._. S S:............ t Instal er Address Type of Building Size .....Sq. feet Dwelling—No. of Bedrooms......�.. ...............................Expansion Attic (�� Garbage Grinder ( ' ) p,I Other—Type of Building ............................ No. of persons..-..�X_................. Showers ( ) — Cafeteria ( ) Other fixtures is Design Flow.......`= '1�.... ,......gallons per person er day. Total daily flow---..` f�........................gallons W Septic Tank—Liquid Li uid ca aci � ..gallons Len ' P q P h' gal gth. ..-. .. Width�1. 1 ... D>ameter/�! r.4?.... Depth. ........... x Disposal Trench—No..................... Width.................... Total Length................... Total leaching area_.._......._..•--_sq. ft. 3 Seepage Pit No..... ........... Diameter....l..o......... Depth below inlet.............. Total leaching area.�.j<e..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Re .Results Performed by................ .. .............. . ._................. Date.._.. -'............... Test Pit No. L.:2:. :..minutes per inch Depth of Test Pit....Z2........ Depth to ground water.....° G4 Test Pit No. 2................minutes per inch. Depth of:Test-Pit.................... Depth to ground water........................ O Description of Soil...........�2-.-- 3............. � C�. ...... 2. � 4...... -........ .- 2...._.._.�12. i. .r±._:. .t1r�JN!,? ..... !.!. ........��?.�'c ... =r'.. ...9 W ...-••••-•. .••.................................................•••-•••••-...............•-- r ••-••••----...- ---........_ .................__................_..... U Nature of Repairs or Alterations—Answer when applicable.................................................._......................_..................... j.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the.State Sanitary Code—The undersigned-further agrees not to pl Ee.he system in operation until a Certificate of Compliance as ed by the b of health. �� _ l �� i Signed'�-.��G�,.�...... ..........•-----...........---............... �'�/....... f 3 V.. v Date ApplicationApproved BY--••--------------•-----..................---...•........------•---------...._.........-••------ ....................Date.............. Date Application Disapproved for the following reasons:.......................................................................................................... .........................................................................................._.........._................................ .......... •.............. D -Permit No..................................._.................... Issued-.... �s== ..._ .... Day .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................. ti Tvrttf utttr of Tomplionrr TH TO CERTIFY, That the Individu Sewage Disposal System constructed (,,)--or Repaired ( ) by----- ... .... ............................-• -- -----� taller ..._.........._... -- - - ................... ._......---- ..---- _ at.--• ..lQ............. y' ...... ....._ ..... ..-• ---..... ................. has been installed in accordance with the provisions of TI 5 of The State Sanitary Co asA a ribed in the application for Disposal Works Construction Permit No..__ �,.37.......... dated�'� -..-z ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A GUARANTEE THAT THE SYSTEM WIL"UNgtION SATISFACTORY. -. r DATE ........---•------•-•------•--•------.... Inspector._.. .... . .. .................................. ....... - - THE--,COMMONWEALTH OF MASSACHUSETTS 4" BOARD 'OF HEALTH Nc>ll...?�. ��",? ......................................:...OF..... `............................. FEE..4................ 3 ispos / rks Tono#rurtion hermit Permission is h granted...... C/-------- --------- .............. ................................................................................. -- to Construct Repay ( ) an d v wage s o System atNo....-... .... p-6- . .......__ .. * . ... ---------• •-•--••••------•--••---•--......--•........................ i street as shown on the application for Disposal Works Construction er ................... Dated.......................................... ....................••, --••-•-•-_... ..............--••-•--••-•••••........... DATE.. _ A 1 l4 � Board of Health CCdd''....................................:...................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �1 i p� E-dXF ur 9� , - - ........... E 0. ;y cl . 9 � / \i f o N �,D/Jin.c. r3Y-[Awl. *6 MA CERTIFIED PLOT PLAN �1A f MA Sp � A R ROBFR7 MORSE y BRUCE " 'No.10951 a ELDREGG IN tv� Q- v � i�li �`� v� J •rV ,.n ."fir �!J . ):J t SS/ONAL y su�`+�' SCALES DATE I3 A-RN:s r,4 6 ct.`. IELDREDGE ENGINEERING COl IN CLIENT I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB N0. ... BUILDING SHOWN ON . THIS PLAN CIVIL LAND CONFORMS CONFORMS TO THE ZONING LAWS. ENGINEER R Y DR.BYl ......*..._.._. OF ARNSTA8LE MASS. 712 MAIN STREET CH. BYE HYANNIS� MASS, / REG. LAND SO EY R SHEET OF A E RV 0 20 FT. M/N_ /1lOTF /F E/TNER TKE SEPTIC TANK DR L,Ei4CN1,0KG P/T .4,tE IyORE TNA."V /2 SELO)OV /O pr ly/A.A, lRAOE�A 24'O1.4ME7-ZR CONCRETE LONER lE---. S/,rALL BF OMOU(SqT TO 4MAOE.6.SN EXTR.q Co/VCR1'TE 4'IaYC P/PE l e,4 V y CA S T/RO/Y G 0{/E/? S/1A L L OE CJ S -.0 AH/N. P/TCN. COYE4 lR5 �B. /F/N OR/✓EH/A)e �•. OFiQ FT. 2� ,W Af. CO/VCRL�TE .4oE Go VER CL 1-,EA' .SANG 2*LAYER RON P/PE`, �-fg t� G�1C 1 00, /� T1CN • ► 'e Q b MI11l.P/ ' • f:e • • • /i i s •s WA SHED S71?!YE' r z DIS low. Pon pr. BOX : e, . . !' B • f • 1 1 r .ff, r Or r.� f rc • o WA E STOX E : o s/� o E�7-t+ s� I v • : . a: 1 1 r -7 ". a •.. _ _ t / • f f PRECAST S.,EPAGE ,..r � "4 ii:.Y a + . ..�,�� ,it"+:• / �,;. , ) ;+. x�- �` a•, �:. • � f •'-. •_ • f e."� i "D.. - 78' • • p/ C6iPA-<.•.•�?�-;-: 548� Gs4-t'` Dc��! • ►. . 1 f � s . 1 • i s� e ' P/T OR mL11V. y /NV&Apr EL EYAT/ON T i. • • G�.-; g 3. v NYERT AT`4 LD 6 FT by �€ ppy _ O p /► SELr T7IBULA7_ :,, fNLET� .SiEPTirC .Ti4NIG :•�FT;�,_ ^ � = ;, t. v ., � 1 k ,, x A�K..L � Y •L .� y � •J. f .T .. r .x'• .�::" <:" $1 y., i"2' ,Ge'.'`"` .'7K sr S •' .r>r "t +,t« OUTLET SEPT IC TA/Vit., 71z ' 'GROuNO.jt�ITER TAa6CE s INLET DISTR/A!/T/®N BaXf-g � f7 :fi - �t=-ioni e0ur 3 :`. .SECT/O/V:OF i ouTL�ro�srRre fl�lLET:LEAtNlNG PIT .SEA VAS& QISPO�S.�L: SY.SITB�M < rt LEi4 CH!/Y� Ia/T x Ti481lLAT/OM m f scstE _ %s" _ D/MiENS/ON .i� =. DES/6N CR/TE/�I� ry o/.yEnrsi.ory 8�-�..• i1Pt/MdER.DIb BEGiROO/'!S 3 D/HENS/ON 'C _FT M/N G4Rd 4GED15POSA4 UNIT !+/n^� SOIL LOG TaTAL ES1YM�4TED FLON/ 33 O GAL. SO/L TEST At/ S01L 7,FST*02 SO/L .TEST A141MBER QF 4rACX/N4 P/TS_' fELEK � d`� �`-EL1�Y, PATE OF SOIL TEST I �-3 SIDE Ll'ACN/NG PER.401T r FT O RESULTS AwrVzSSED BY�T� �l A /� 3 5-4 BOTTOM 104CAllNG PER P/T_ SQ. N7. G f Gv „r AeVCOLAT/OJv RA7-4ff#/ ZOT.�►G LEACH/NG �4REA 26�'SQ iT. ,n AERCOL^T/ON RATE .4E5ERVE4&ACNIN6 AREA `Z `�S? FT � c_?ram{' TiE:W7 7 OF 414s M c� 7- /8 6 �t ��E n/7- ROBERT N i �2 A E�� G 7��C "�� g _ SRtiCE . �i F (5PR' r/ ,�. � ( ELDRED o MORS.E n << no.1095 �o EL DREDGE EW&I NI ERING CO,I MC. A9pFFGlSTEP��?�' W2 MA/N ST. , AeYANNIS, AMASS. JVDF p yo / ` v" ' PATE 7YE /EN '' 7 GM0UVO c WATE.Q AT ELEi/• - 1106 ND Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection John Grad One winter Street Boston Ma. 02108 ' D.E.P. Title V Septic Inspector kip P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor ARGEO PAUL CELLUCCI _ Lt.Governor SUBSURFACE SEWAGE DISPOSALO ASYSTEM INSPECTION FORM Pro 1 3 1997 CERTIFICATION Property Address: 526 Flint St.Marstons Mills L4 R 102-38 Address of Owner: Date of Inspection: 12/8/97 (If different) Name of Inspector: John Graci USDA Rural Development Service:'21 Spring St.Suite 3 Tauton Ma. I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In Title V code 310 CMR 16.303.My findings are of how the system is _ Conditionq,lily P sses performing at the time of the Inspection.Myinspectiondoes _ Needs F he Evaluation By the Local Approving Authority not imply any warranty,or guarantee of the longevity of the F2115 septic system and any of Its components useful life. Inspector's Signature: / Date: 1219197 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no,or not determined(Y, N, or NO). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 007197) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 l_ f - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 526 Flint St.Marstons Mills Lor R 102.38 Owner: USDA Rural Development Service:21 Spring St Suite 3 Tauton Ma. Date of Inspection:1218197 _ Sew.acie backuR or.hreakoutor hioh.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four 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 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. — The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an 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 cesspool. SAS is in hydraulic failure. (revised 04117)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 526 Flint St Marstons Mills Lor R 102-39 o ment Service:21 Spring Owner: USDA RuralDevel p P 9 St Suite 3 Tauton Ma. Date of Inspection:1218197 D]SYSTEM FAILS(continued) 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No — _ the system is within 400 feet of a surface drinking water supply the system 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised OW7l97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 526 Flint St.Matstons Mills Lor R 102-38 Owner: USDA Rural Development Service:21 Spring St Suite 3 Tauton Ma. Date of Inspection:1218197 Check if the following have been done:YOU must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with NIA. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is — — unacceptable)(15.302(3)(b)] (revised OWD97) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 526 Flint St Marstons Mills LorR 102-38 Owner: USDA Rural Development Service:21 Spring St Suite 3 Tauton Ma. Date of Inspection:1219197 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g•p•d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available:(Iast two(2)year usage(gpd): nia Sump Pump(yes or no): No Last date of occupancy: Approximately one year ago. COMMERCIAL/INDUSTRIAL: Type of establishment: nia Design flow:0 gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: nia Last date of occupancy: nia OTHER:(Describe) Ma Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: nia System pumped as part of inspection: (yes or no)No If yes,volume pumped:a gallons Reason for pumping: nia TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date Installed(if known)and source Information: 13 years Sewage odors detected when arriving at the site: (yes or no) No (rsvleed 04l27)87) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 520 Flint St Marsions Mills Lor R 102.38 Owner: USDA Rural Development Service:21 Spring St Suite 3 Tauton Ma. Date of Inspection:12097 SEPTIC TANK: x (locate on site plan) Depth below grade: 4" Material of construction:x con create_metal_FRP_Polyethylene—other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L e.6..M,r,w4•10" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle:25" Scum thickness:U Distance from top of scum to top of outlet tee or baffle:S" Distance form bottom of scum to bottom of outlet tee or baffle:a How dimensions were determined: Measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Septic tank end ell components are structurally sound.Recommend pumping system every two years. GREASE TRAP: (locate on site plan) Depth below grade: Wa p ( p lain_other ex Material of construction: _concrete_metal_FRP_Polyethylene ) Dimensions: Wa Scum thickness:Wa Distance from top of scum to top of outlet tee or baffle:Wa Distance from bottom of scum to bottom of outlet tee or baffle: Wa Date of last pumpingr,_ Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Wa BUILDING SEWER: (Locate on site plan) Depth below grade: v Material of construction:_cast iron_40 PVC_other(explain) Distance from private water supply well or suction lino— Diameter: 4^ Qmments: (conditions of joints,venting,evidence of leakage,etc.) (revised 042797) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 525 Flint St Marstons Mills Lor R 102-38 Owner: USDA Rural Development Service:21 Spring St Suite 3 Tauton Ma. Date of inspection:1219197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: nra Capacity: nla gallons Design flow: rva gallons/day Alarm level:_nra Alarm in working order? Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: Liquid levelwM bottom ofpipe. Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) Dbox Is structurally sound. PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)rdo Alarms in working order(yes or no)_Yes Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) rda F (revlaed 04127l87) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO RM PART C SYSTEM INFORMATION (continued) Property Address: 526 Flint St Marstons Mills Lor R 102.39 Owner: USDA Rural Development Service:21 Spring St Suite 3 Tauton Ma. Date of Inspection:1218197 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: n1a Type: leaching pits,number: 1000 gallon octagon leach pit leaching chambers,number:n/a leaching galleries,number: rda leaching trenches,number,length: nta leaching fields,number,dimensions:rda overflow cesspool,number:nla Alternate system: nla Name of Technology:_as Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) The overnow is structurally sound and Functioning properiy.lt was empty at the time of the Inspection.Shows signs of being 3m full. CESSPOOLS: (locate on site plan) Number and configuration: nla Depth-top of liquid to inlet invert: rda Depth of solids layer: nla Depth of scum layer: rda Dimensions of cesspool: rda Materials of construction: nla Indication of groundwater: Ma inflow(cesspool must be pumped as part of inspection) nfa Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) rtla PRIVY: (locate on site plan) Materials of construction: We Dimensions: rda Depth of solids: rda Comments: (note condition of soil,:signs of hydraulic failure,level of ponding, condition of vegetation, etc.) nda (revised 04J47)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 520 Flint St Marstons Mills Lor R 102.38 USDA Rural Development Service:21 Spring St.Suite 3 Tauton Ma 1218197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) A 12 � (Do a AC 7 41) FA L �4 Pap• f of 10 (ravived 0CT19T) i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 526 Flint St.Marstons Mills Lor R 102-38 USDA Rural Development Service:21 Spring St.Suite 3 Tauton Ma. 12/8197 Depth of groundwater 12• Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revised04R7197) )aye 10 of 10