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HomeMy WebLinkAbout0050 LITTLE POND ROAD - Health _,50 Little Poo l-Road., _ Marstons Mills P} A = 065 017 Ii -e-�_ -� Commonwealth of Massachusetts W Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �N Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification 1. Property Information: 50 Little Pond Road Property Address William Enright Owner's Name same Owner's Address Marstons Mills MA 02648 Citylrown State Zip Code Date of Inspection: 6/1/12 Date 2. Inspector: -; Matthew L. Childs `= x.. Name of Inspector �,:� ,.._ same t 'n Company Name 4 Orchid Ln. Company Address -- W. Yarmouth MA 62673 ~— City/Town State Zip Code 508-989-1479 Telephone Number Certification Statement: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was 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 t e Local Approving Authority 6/1/12 `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. enright.doc• 11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M A. Certification (cont.) 50 Little Pond Road Property Address . Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: passes B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: N/A enright.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 4„N A. Certification (cont.) 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William.Enright 6/1/12 Owner's Name Date of Inspection 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 Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: N/A ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: N/A C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh enright.dloc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection C Further Evaluation is Required by the Board of Health (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 the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: N/A enright.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form ,M . 0,. A. Certification (cont.) 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State ZipCode William Enright 6/1/12 Owner's Name Date of Inspection 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 '/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes No ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. enright.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts W Title 5 Official Inspection Form } Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. YES NO ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. enright.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M B. Checklist 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection 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. ® 0 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)] enright:doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of Massachusetts F Title t e 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form 'GSM C. System Information 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd. Number of current residents: 2 I Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d N/A 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: N/A N/A Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes El No Water meter readings, if available: N/A Last date of occupancy/use: N/ADate Other(describe): N/A enright.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name - Date of Inspection General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons How was quantity pumped determined? N/A Reason for pumping: N/A 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 20-25 yrs. old from previous inspection report. Were sewage odors detected when arriving at the site? ❑ Yes ® No enright.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 50 Little Pond Road Property Address Marstons Mills MA 02648 CityFrown State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection Building.Sewer(locate on site plan): Depth below grade: 2.5'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.): All in working order at time of inspection. Septic Tank(locate on site plan): Depth below grade: 5' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) Dimensions: 8'x5'x5' outside 1000 gal. Sludge depth: .2 Distance from top of sludge to bottom of outlet tee or baffle 2.8 Scum thickness .1' Distance from top of scum to top of outlet tee or baffle .5' Distance from bottom of scum to bottom of outlet tee or baffle 1' How were dimensions determined? sludge judge enright.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form a Not.for Voluntary Assessments ,A, SVe s Subsurface Sewage Disposal System Form C. System Information (cont.) 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank shows no signs of leakage and appears to have been maintained regularly at time of inspection. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A Tight or Holding Tank(tank mu st be pumped at time of Inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A enright.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts u Title 5 Official Inspection Form } Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection Tight or Holding Tank(cont.) Dimensions: N/A Capacity: N/A gallons N/A Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes❑ No Date of last pumping: N/A Date Comments (condition of alarm and float switches, etc.): N/A Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0.0' Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box is level with no solids carryover or leakage at time of inspection. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No enright.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form } Not for Voluntary Assessments iG^M Subsurface Sewage Disposal System Form C. System Information (cont.) 50 Little Pond.Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1 6'x6' precast pit was dry at time of inspection. Stain lines at 1-2'. SAS is not in failure. enright:doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 c Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth —top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A enright.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M • C. System Information (cont.) 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection Sketch 0f Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. #50 geLlreLge O W/S A-1-28,6 B-1-13' A 2-14' B-2-21' A 11T B-3-32' Little Pond Rd. enright.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form M C. System Information (cont.) 50 Little Pond Road Property Address Marstons Mills MA 02648 City/Town State Zip Code William Enright 6/1/12 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 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: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: as-built ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database -explain:. topo maps You must describe how you established the high ground water elevation: Topo maps show an elevation of>60' to groundwater. enright doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 16 MAP RECEIVE® PARCEL , ® 17 _ SOT 9 D A TE.•_5/1_2 03 MAY 2 8 2003 TOWN OF BARNSTABLE PROPERTY ADDRESS-50 Little Pond Road HEALTH DEPT. - __ Marstons Mills,Mass. al PARCEL . --------------- LOT 02648 On the above date, I inspected the septic system at the above address. This system consists of the following: 1 . 1 -1000 gallon septic tank, 2. 1 -Distribution box. 3. 1 -1000 gallon precast leaching pit. Based on my inspection, I certify the following conditions: 4 . This is a title five septic system. ( 78 Code) 5. The septic system is in proper working order at the present time. 6. Waste water is 31 " below the leaching pit invert. SIGNATURE: _ G� - Name:-J_P_ Macomber Jr_______ Company: Jose_ph-P_ M_a_c_om_ber_& Son , Inc . Address: Box 66 Centerville , Ma .-02632-0066 Phone:- 508-775-3338 -------------------- THIS CERTIFICATION DOES NOT CONSTITUT&A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 0.2632-0066 775-3338 775-6412 • a� I ,per -\ COMMONWEALTH OF MASSACHUSETTS = 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: 50 Little Pond Road Marstons Mills.,Mass Owner's Name:Jeff Novak- Owner's Address: Same Date of Inspection:5 1.2 03 Name of Inspector: (please print) Joseph P. Macomber Jr. Company Name: Joseph P. Macomber & Son Inc Mailing Address: Box 66 CPnt ervi 1 1 P Ma 02632 Telephone Number: 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the-time of 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 appiroved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: J Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: The system inspector shall Lmmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:50 Little Pond Road Marstons Mil s,Mass. Owner:Jef f Novak Date of Inspection: 5/1 2/0 3 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: lf� 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: The septic system is in proper working order at the present time. B. System Conditionally Passes: ,0 One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes, no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. ,,0/ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally- unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: ,,JI Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: /( The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Little Pond Road Marstons Mills,Mass. Owner:Jef f Novak Date of Inspection: 5/1 2/0 3 C. Further Evaluation is Required by the Board of Health: AtO 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 envirotment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health,safety and environment: AS 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. •(�21 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 00 feet b t 50 feet or more from a private water supply well". Method used to determine distance /��,/,�j�2 "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 i Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 Little Pond Road Marstons Mi s,Mass. Owner: Jeff Novak Date of Inspection: 5/1 2/0 3 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 ; ogged SAS or cesspool /1tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or t/cesspool a'-iD�o C g),, 7 l Liquid depth in 4e%po4 is less than 6"below invert or available volume is less than %day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped C . Any portion of the SAS,cesspool or privy is below high ground water elevation. Tl-/Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. -ZAny portion of a cesspool or privy is within a Zone 1 of a public well. j� y portion of a cesspool or privy is within 50 feet of a private water supply well. /tny 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.] /to (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303.therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no /the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well W 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 I Page 5 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 50 Little Pond Road Marstons Mills,Mass. Owner: Jeff Novak Date of Inspection: 5/12.j n"1 Check if the following have been done. You must indicate".yes"or"no"as to each of the following: Yes No umping 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) —,Z/—/ Was the facility or dwelling inspected for signs of sewage back up v/ Was the site inspected for signs of break out? it_ Were all system components,.e`Kluding the SAS, located on site ? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions, depth of liquid, depth of sludge and depth of scum ? y — Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes/no 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 i Page 6ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 50 Little Pond Road Marstons Mills,Mass. Owner: Jeff Novak Date of Inspection:_5/12/0 3 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 C 15.203 (for example: 110 gpd x# of bedrooms): Number of current residents Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system (yes or no):t/P [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): 00 Water meter readings, if available(last 2 years usage(gpd)): 2 0 01 =1 2 4, 0 0 0 ga 11 on s=3 3 9 . 7 3 GPD Sump pump(yes or no): dib 2002=132, 000 gallons=361 . 65 GPD Last date of occupancy: C O M M E R C IAL/IND U S TRIA L Type of establishment: Design flow(based on 310 CMR 15.203): 0 d Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):10 Industrial waste holding tank present(yes or no):&.4 Non-sanitary waste discharged to the Title 5 system(yes or no)` /A_ Water meter readings, if available: _ Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:_ qj�'.T Al Was system pumped as part of the inspection(yes or no): If yes, volume pumped: O gallons--How was quantity pumped determined? Reason for pumping: lt�4 TYF-OF SYSTEM V Septic tank,distribution box,soil absorption system 42 Single cesspool oo Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records, if any) /Dmovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from systei;owner) _4)ZY'ight tank ii/ Attach a copy of the DEP approval ether(describe): Ity Appro mate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): .60' 6 Page 7ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:50 Little Pond Road Marstons Mills,Mass/. Owner: Jeff Novak Date of Inspection: 5/1 2/0 3 BUILDING SEWER(locate on site plan) Depth below grade:�— Materials of construction: Albcast iron _/40 PVC 4/0other(explain): Oil+ Distance from private water supply well or suction line: /0r' Comments(on condition of joints, venting, evidence of leakage, etc.): Joint-, apt7 _ar ; ght.No evidence of leakage The system is vented throught the house roof vents. SEPTIC TANK: (locate on site plan) /ddd 9/V'ZdW5' �l Depth below grade: �—� Material of construction: dconcrete ymetal& fiberglassy�Iaolyethylene ,Qaother(explain) A/T If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):4.0 (attach a copy of certificate) ) Dimensions: Sludge depth../�,.e— Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:1&'-� Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botto of outlet to or baffle: How were dimensions determined: 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 in lace.The tank is structurally sound and shows no evidence of leakage.Liquid level at the outlet invert is 5 GREASE TRAP�(locate on site plan) Depth below grade:.( Material of construction:9concreteJ,�YmetaLo fiberglass,f po lye thylene4, other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of sc m to bottom of outlet tee or baffle:-o Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): _Grease trap is not present. I 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:50 Little Pond Raod Marstons Owner:Jef f Novak Mass , Date of Inspection: 5/1 2/0 3 TIGHT or HOLDING TANM&J—L(tank must be pumped at time of inspection)(]ocate on site plan) Depth below grade: IV? Material of construction:A14 concrete 1/% meta)/Ao fiberglass polyethylene mother(explain): Dimensions: AA Capacity: allons Design Flow: gallons/day Alarm present(yes or no): Alarm level: 4A Alarm in working order(yes or no): Date of last pumping: Vie} Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present.- DISTRIBUTION BOX:Zif present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Ay 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.): Distribution box has one lateral.No evidence of solids carry over.No evidence ot ie---aTa—geinto or-out PUMP CHAMBER� VV locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Pump chamber is not present 8 f Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Little Pond Road Marstons Mi11s,Mass. Owner: Jeff Novak Date of Inspection: _5/12/0 3 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) 1 -1000 gallon precast le.�c ing pit. If SAS not located explain why: T,c)rafP-de See page 10 Typed , �'leaching pits,number:_ _leaching chambers,number: Q leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: AV overflow cesspool, number: innovative/altemative system Type/name of technology:%i Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Loamy sand to medium fine sand-No signs :Df hydraulic failure or pondina. Soils are dry.Vegetation is norma . CESSPOOLSt4t,e(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: AIR- 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. P R IV%&&-(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 Page 10 of I I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:50 Little Pond Road Mars tons Mi 1 1 1y1��;�s , Owner: W,' N,-.v¢k Date of lnspectioo: 5/17/O 3 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public.�water supply enters the building. s C. (Li/SL/10 D� z^gal 01 70 6 •6•d 1't�l.4-c ;; •� C�,Z fK—t C ly r'. 10 u- i Page 11 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:50 L.it.t.Pe bond /toad Naa6ton6 /7iP26. (7a66. Owner: leUP Novak Date of Inspection: 5172103 SITE EXAM Slope Surface water Check cellar Shallow wells yy��t Estimated depth to ground water 7U 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: 5 1�/0 3 Observed site(abutting property/observation hole within 150 feet of SAS) Te7 Checked with local Board ofHealth-explain: Rh &u.i.2t /2ian qfS Checked with local excavators,installers-(attach documentation) e6 Accessed USGSdatabase-explain:.htt/?://town. galtn6tatee. ma, u6. You must describe how you established the high ground water elevation: !bed: Gah.cety & fl.i.P2e2 Modei. 12176194 (/ILognd wate2 eievat.ion move 6ea P v i. '.6ed:11SGS:0&6e2vat.i_nn da.tn �unv 199P '.6ed:11SGS: 7vrhn1rn.P RuLPjP in 92-000- 1 i0F�ifo 4" Anal,« p Q'QgQ6 0,4 «Q1'Q l a.'a4n2 ewe))nfjon,,,�6OIVfOIT g 1292 Leaching Pit -eel � 0 Groundwater Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frim ter Method P P Therefore, the vertical separation distance between the bottom of the leaching pit and the adjusted groundwater table is feet. 11 -i•.r.+rr.—n.rsr�r errrmr•nmr�mrenmrrr-r`�rri�r.•*e*m+ nern�u r.a•�vtim .. �' TOWN OF Ba2nhta&.r?e WARD OF HEALTH SUI)SURFACF SEWAGE DISPOSAL SYSTEM 18SPECTION FORM - PART D •- CEKTIFICATION0 I+ -TYPI OR PRINT CLEARLY- PROPERTY Il SPECTED STREET ADDRESS 50 Liti—ee Pond Road f1a2.6ton,6 ASSESSORS MAP, BLOCK AND PARCEL -------------- # = Qf OWNER' s NAME 1W Novak• PART D - CERTIFICATION r NAME OF INSPECTOR Jose h P. Macomber Jr. COMPANY NAME Joseph P. Macomber & Sc?fi ' Inc COMPANY ADDRESS Box 66 Centerville Mass 02632 Street Town or City COMPANY TELEPHONE (508 ) 775 - 3338 st,t. lIP FAX ( 508 ) 790 _ 1578 CERTIFICATION STATEMENT - Dr I certify that I have personally inspected the sewage diaposa7 system nt this address and that the information reported is true , accurate , and omplete as of the time of inspection . The inspection was performed and any ecommendaticrrs 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: % �i '. '• —LLck 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 sectio» of this form . System FAILED* \ The inspection which I have con acted has found that the system fails to Protect the j)ublic health and the environment in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this. inspection form . Inspector Signature Ali Date 1g; nd copy of t}Iis certification must be provided to the OWNER, the BUYER ( Where applicable ) and the I30ARD OF HEALTH. * If the inspection FAILED, the owner or"'operator shall upgrade ' within one year of the date of the inspection, unless allowed orthe requiredm otherwise as provided in 3.10 CPIR 15 . 305 , partd . doc �7-�)IL Corrvnonweatth Of Massachusetts Executtve Office of Environmental Atfalrs Department of '� 8 , p � Environmental Protect Wlillam F.wow J� 4%,, Core Aryeo Paul Ceiluccl to ,r �David {1 aa.ma ! O 0 e ti��lyoq ,19'9 er FAf�� J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSP FORM PART A CERTIFICATION '� t P,rop.rty Addreaa 50 Little Pond Road M a r s t o n s M i l l SAdduesa of Owner. D`W of i=P.ouon: 6/3/9 7 (If different) N&,me of inspector. Joseph P.Macomber Jr . Compagy Name,Addre" and Tele bone Number. J. P.Macomber & Son Inc . Box 66 Centerville ,Mass . 02632 508-775-3338 CERTIFICATIONr'STATEMENT I outify that I have persoaa$y inspected the"wage disposal system at this addre"and that the information reported below is true, aoaurats had complete " of the time of inspection. The inspection was performed based on my training and exyeriea" in the proper function Lad maiatsaanos of omits"wage disposal systems. The system: assay _ Conditionally Pass" Needs Furthar Evaluation By the local Approving Authority Fa1L r // Inspector's 8lgnatur� r fi` Date: Ths System Inspscw&hall submit a copy of this inspection report to the Approving Authority within thirty(30)days of camplsting this iaspeaion. If the Muni 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&ppropriate regional oMos of the Department of Environmental Protection. Thy original should be scat to the system owner rind copise sent to the buyer, if applicable and the approving&uthority. WSPEC'TION SUMMARY: Chock A, B. C, or D: A) SYSTEM PASSES: have not found any information which iadicat" that the system violates any of the fLUure criteria as dsfiaed is 310 CUR 15 303. Any f0ure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: __C1Q One or more system 00mpcaeats Used to be replaced or repaired. The system, upon completion of the replacement or repair, passes Indicate Y-,ao, or not determined(Y, N. or ND). Deacrube baaL of drtermination In&U instances. U'bot det4rminae, espuJA why hoc) =-sr Thy "ptic tLnk is autLL cra'-ked, structurally unsound, shows substantial inmtration or exAltration,:or tank fLaune is imminent. The system will pass inspection if the existing"ptic tank is replaced with a yonforming"ptic task &s &ppro vd by the Board of Health. (revised 11/03/95) I One Winter Street a Boston,Masaschu►etts 02106 a FAX(617) SW1049 a Telephone (617)292.5500 �� /miw on 14cycw rape D SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A .. CERTIFICATION (continued) Property Address: 50 Little Pond Road Marstons Mills . Owner: Gene Kimble Date of Inspection6/3/9 7 B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled 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 CJ 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. t) 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: BLS% 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 PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. �Q -he system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. .GD 1 he 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance .fJA (approximation not valid). 3) OTHER �R (roviaad 04/25/97) Pago 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: SO Little Pond Road Marstons Mills ,Mass . Owner: Gene Kimble Date of Inspection::6/3/97 DJ SYSTEM FAILS: You must indicate Ei;!:er "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 into 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 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 less than 6" below invert or available volume is less than 1/2 day flow. I Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe($). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the,well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No ,4Z 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 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddr.eK 50 Little Pond Road Marstons Mills ,Mass . owner: Gene Kimble Date of Iaspeotbna 6/3/9 7 • Check if the following have been done: �Tumping information was;requested of the owaa4 000upaat,and Board of Health. 91NOW of the system componaab have bean pumped for at least two weals and the system has been receiving normal flow rats during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection .L As built plans bave bees obtained and examined. Note if they are not available with N/A. z7W faality or dwelling was inspected for signs of sawap bash-up. _jr_�systam dove not receive non aaaitary or industrial waste flow ZTh site was inspected for sips of breakout. All system compoaaats.A". the Soil Absorption System, have been located on the site. Z/The septic tank manholes were unWvered,openad,sad the interior of the septic tank was inspected for condition of be M or tees,material of construction, dimeAtions, depth of liquid, depth of ahrdgs,depth of arum. 4The sise and locatioa of the Soll Absorption System on the site has been determined based on a dsting information or approximated by non•intruaive methods. facility owner(and ooaupants, if different from owner)were provided with information on the proper maintenance of sub. Surface Disposal System. (revised 11/03/95) 4 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION Property Address: 50 Little Pond Road Marstons Mills,Mass . Owner: Gene Kimble Date of Inspection:6/3/97 FLOW CONDITIONS RESIDENTIAL: Design flow: q..p.d/bedroom for S.A.S. Number of bedrooms: Number of current residents: ✓ Garbage grinder (yes or no):�P` Laundry connected to system(yes or no): c7 Seasonal use (yes or no).4 Water meter readings, if available (last two (2) year usage (gpd): 1��V ��� Gifi�/,o.0 -�77.y h• /n" Sump Pump (yes or no): Last date of occuparcy: COMMERCIAUINDUSTRIAL• Type of establishment: Design flow:_ gallons/day Grease trap present: (yes or no)A01 Industrial Waste Holding Tank present: (yes or no).ay Non-sanitary waste discharged to the Title S system: (yes or no)IV Water meter readings, if available: Last date of occupanry:_A&6_L OTHER: (Describe) A110 Last date of occupancy: 414 GENERAL INFORMATION PUMPING RECORDS an source of in rmation: .tIC✓ i /iY/.dQ /�i /'T ( /rff�S.t�✓�'G��� System pumped as part of inspection: (yesT o)&v< If yes, volume pumped: /lJd allon}} ,l Reason for pumping: (Jv �j�,CIGPS f hi4y�j Scti�-/ �i4yBJ-- TYPE OF STEM Septic tank/distribution box/soil absorption system Single cesspool 4717 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 of information: 'Os srZs G�i�./' A- Sewage odors detected when arriving at the site: (yes or no) /did (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Little Pond Road Marstons Mills ,Mass . Owner: Gene Kimble Date of Inspection: 6/3/97 BUILDING SEWER: (Locate on site plan) ll Depth below grade: Material of construction: cast iron J/ PVC _other (explain) Distance from private water supply well or suction line Diameter y Comments: (condition of joints, venting, evidence of leakage, etc.) y=aA) n lJ ;1-'- 4 1► �dw$e Lbw SEPTIC TANK:"5z, 5; (locate on site plan) it Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age -&�4 Is age confirmed by Certificate of Compliance�(Yes/No) t/ ll Dimensions: � �CD.yrt, Sludge depth:_42 Distance from top of sludge to bottom of outlet tee or baffle: aJ Scum thickness: F/( Distance from top of scum to top of outlet tee or baffle: �� Distance from bottom of scum to bottom of outlet tee or baffler How dimensions were determined: 6421 S'L!nge 'bY q4 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.) Pump tank every 2-3 ,years : Inlet & outlet tees are in place :Liquid level at the outlet is 5111 : The septic tank is st,rttr.t.,tra 1 l y sound: The tank shows no signs of 1pakaQa in nr aut.nf the tank. GREASE TRAP:.I'�ye- (locate on site plan) Depth below grade:A�-d Material of construction: &. concrete& rnetaloVAFiberglassA/APolyethylene/Zjother(explain) Dimensions: A)A Scum thickness: A14 Distance from top of scum to top of outlet tee or baffle:AL4 Distance from bottom of scum to bottom of outlet tee or baffle: VA Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Grease trap is not present (revised 04/25/97) Page 6 of 10 i i T SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) propertyAddrese: 50 Little Pond Road Marstons Mills ,Mass . owner. Gene Kimble Date of Inspeotloat 6/3/9 7 TIGHT OR HOLDING TANKA,td° (ms"ou site plan) • Depth bald*grada:L2R Material of coastsudion:/f�ooacrte'dAp�atal.�j�'RP. /otbas(esPlria) - Ti�zht or hoiina 7anks are not present Dimensions: AA Capacrtr. ,4 volm Deng flow na/day Alarm level: (N Commaut&. (ooaditioa of inlet toe,condition of alarm and float switch",etc.) Tipht or o ing an s are not present DISTRIBUTION BOXtX (locate oa ate plan) Depth of liquid level above outlet invert: A, Comments: (note if levsl mad distrt3ution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) D_Rnx line nnP 1nt.Pra1 :No 1Pa1agP in or out of the box. PUMP CHAMBER.A1641e- (locate on site Plea) Pumps in working ordar:(yw or ao) Cammaats: (note oondition of pump chambes,condition of lt=Pe and appurtenances,•tee) Pump Chamber is not present (revised 11/03/95) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyAddress: 50 Little Pond Road Marstons Mills ,Mass . Owner: Gene Kimble Date of Inspection:6/3/97 SOIL ABSORPTION SYSTEM (SAS):2 (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching Trenches, number,length: leaching fields, number, dim sions: overflow cesspool, number: Alternative system: OU Name of Technology: kfi Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Medium sand o fiHe sand. No suns of hydraulic failure or ponding: All vegetation is normal. CESSPOOLS: IlLkc' (locate on site plan; Number and configuration: Depth-top of liquid to inlet invert: AM _ Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: VP Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Cesspools are not preshVt Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) cesspoa j s are nt present PRIVY:Al-41e, (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 (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Little Pond Road Marstons Mills ,Mass . Owner: Gene Kimble Date of Inspection:6/3/97 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) 0 (revised 04/25/97) page 9 of 10 SUBSURFACE SEWAGE DISI SYSTEM INSPECTION FORM C SYSTEM INFO: ION (continued) Property Address: 50 Little Pond Road Marstons Milss ,Mass . Owner: Gene Kimble Date of Inspection: 6/3/9 7 r Depth to GroundwatWr r Feet Please indicate all the methods used to determine High Groundwa :vation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, ba 1 sump etc.) Determine it from local conditions heck with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groun . r Elevation. (Must be completed) i0 k, ld 6) t bC (revised 04/25/97) Pe; of 10 It / tom'„ // 35/t CoM oT�IDCT,I D 1. '� l l,(•�'`� .- l!� % / / p��' �� � / � �l / f I l jc) l / v l / / � / 11/////�• ��:.� // / / � / � % �y / r � / / r If / ✓ / // // //'_/ // 6 / P. 7c/Aj J / rp // J ; lam- � _�}��� �/ 'l l°�N�►I�Irl l 1 r I ! I 1 1 � � i l, ,, ' �' � '1 � ' ;I � -� �: .k*�� � /y '/ Irlr rl II , � f ' r• i _ _�` � ,Ii I� �. i � l� }�� ��� 7����i / l f!►111►►, III � ' L� ���. � I �, I j� ' ' ; �, i ��' - - SOIL TEST PIT DATA. VXJ INDICATES109 INI PERC. v OE P- 5 5 4_-dj TEST OF TP Lo T 9 TP TP TP GRD. EL. 1,,`LL GRD. EL. GRD. EL. GRD. GW. EL. Nu Wri i GW. EL. GW. EL. GW. E Sue'E�f►:.. 72 E RL +op �r .A-nF+ED F/Alk �Fi,V C, G. ✓E L i44 ti,3 w�rcP� 5, 7 DATE-' DATE: DATE: DATE: 4- 66 TEST BY: TEST BY: TEST BY: TEST E <-r-E., F_ VI) WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNE: To M PERC. RATE: PERC. RATE: PERC. RATE: PERC. Z _MIN./INCH MIN./INCH MINJINCH DATUM: VERTICAL DATUM: ASSUMED BENCH MARK USED: SEE PLAN 2E /I k_ -'V 1 i C�hzfK C ]'I.Rn Tom.-nT7�Tr- r►raw•n1TII�w+nnrnrnlr+►n►ITR.RIIIn n►'a71A-1�►�1�1 .. `� TOWN OF Barnstable BOARD OF HEALTH ,SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION ` �w•Tf1�T••.••.: —T.IIR'.TT'RTr'nl'ff.'1wt TIRJwl11iTRTT'rl'!T'11/tT��A�f—�'t�.�www,w.�'�'�7 �1 -TYPE OR PRINT CLEARLY- PItOPERTY INSPECTED STREET ADDRESS 50 Little Pond Road Marstons Mills ,Mass . ' ASSESSORS MAP, BLOCK AND PARCEL I OWNER' s NAME Gene Kimble PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J. P.Macomber & Sac, Inc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 strvvt Town or CSty state LIP COMPANY TELEPHONE ( 508 ) 775 3338 FAX ( 508 790 - 1 578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa41 system a this address and that the information reported is true , accurate , and complete as of the time of .inspection - The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent With my training and experience in the proper function and maintenance of on. site sewage disposal systems . Check one: ):XXXXXXXXXXXXSystem: PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or Llie environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con tcted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature y Date 6/5/97 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEAL711. + If the inspection FAILED, the owner or"* perator shall u d within one year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 3.10 Chin 16 . 306 . partd .doc w Ln - SSbj1f 3,'11 i THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8. 1995 Acting Director of the wn of Water Pollution Control HS6#ff WN OF BARNSTABLE 7%/qc 9—v LOCATION 2@ SEWAGE # 9.-A—. 54 VILLAGE �L ASSESSOR'S MAP & LOT 40/7 INSTALLER'S NAME & PHONE NO �eW ( f SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �1� �/ (size) NO. OF BEDROOMS-PRIVATE WELL O PUBLIC WATER BUILDER O WI�fE' DATE PERMIT ISSUED: �3 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ILI ` l3 N .------.-- Fx$...... THE COMMONWEALT ASSAC US TTS a� 0 BOAR® OF HEALTH O T'b.w.^..............oF.........B P�Rt�I S-rAB LE Appliration for Uiipnoal Works Tnn,otrmrtiun ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: L rrrLE POND RD.- BA R_Q s-rA»LE-AMA: I-O T. } I�.1 .1-PE-----Po M l) -EST AT'F.5 ................__..._.__.........,.......---- ---....._.. .. Location-Address or Lot No. C�sPR1��s�t�. --..RC!n. r.. ..-rR:us-z-........... -L.r,Zt_E-----T it - r.>........ ............................ ' Address w ------.... > w.�s�-a8 (n ►:�,sTas..Nt1t.�. ..l�llP�.... Installer Address U Type of Building Size Lot_444.QGQ_.tSq. feet Dwelling—No. of Bedrooms--- ...........................Expansion Attic (No) Garbage Grinder (LLD) Other—Type of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures --------------------------------------------------••-• •••- W Design Flow....... ...........................gallons per person per day. Total daily flow....... . .....................gallons. 1:4 Septic Tank—Liquid capacity];POQgallons Length.$"6..... Width4''.ln�� Diameter................ Depth_5'..V'. Disposal Trench—No..................... Vidth.................... Total Length.................... Total leaching area-------_............sq. ft. Seepage Pit No........I------------ Diameter.....1.......... Depth below inlet.. Total leaching area..�.57...sq. ft. Z Other Distribution box (>() Dosing tank ( ) Percolation Test Results Performed by..44A'PE._GOP..St,�R✓�__. •.C�AJSil4IAYYS Date._.4.".7-';5 ........... a Test Pit No. 1...., ........minutes er inch Depth of Test Pit....1-4.4...... Depth to ground wat- f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground r, ........". 1:4 ..........••......................... - ............... -------•-•----._._.._......._.........._....... r> a•� `�� O Description of Soil.:'rJ2 _.-C.rT9. O _ 25F----TOPSvIL Su 011..-------------- ;' -.......F,!-' I..-..... x ' -7 T . w _P A ._ ' fs1 .7Z-11 ..-J.4g'...._ T ►T1F'1F-D._.!•( ., A!JA.d�.�3RA�E�... - - . �-o.:--- VNature of Repairs or Alterations—Answer when applicable-----------------------------------•__-__--•.----.--.---_-_-_ 'y Agreement: Gsd�a ,3-�rl� The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT -5 th tate itar Code— he ndersigned further agrees not to place the system in o eration until n a- of health. Signe ... . ...... ......... --- •--•-------- ---; �% �2_- I 6 --� �? Appli tion Approved By......... -... ...-• `��--•--•-------------------------------•--------- ------µ------ Date Application Disapproved for the f ollo ' g reasons------------------------------------------------•-------------=............................................... -•..........................................•---•--•-----•-------------------•---•------............-------....•-•••--•-•--••••--•---•••-•••••-••--••-•-•-----••--••---•-•----••----•••••••-•-••-•------ Date PermitNo.... .. ...................... Issued....................................................... Date No. - .-.�}._ Fis..... l .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q ...................OF.........5-AV�w-5T'AS.L^..�E�'.......................... Appliration for Disposal Works Tnntrnrtinn rumit Application is hereby made for a Permit to Construct OK) or Repair ( ) an Individual Sewage Disposal System at: L.iTT�C PQ - irZ�� -a*a _ �-0T-..�9---.-_L). .T4.F...-FcaND ESTA-M-s Location-Address or••-•-•----- �-.� -.....F J D A ......................................... _�.,__----•�-. Own Address ---------- ----��,��..r. _.. 3C V1--------.._........-----.--••• AjJ��' PtB1, �MF15' c�E►4,�, Installer Address ,�qq V Type of Building Size Lot-44_z_� t_Sq. feet ., Dwelling—No. of Bedrooms.......... ..............Expansion Attic (No) Garbage Grinder (go) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures --------•---------------•--------------•---•----------•-------•----•-•------•----••••------••----•---•---•-------- W Design Flow.........?r ............................gallons per person per day. Total daily flow.__.... . Q..... .................gallons. W Septic Tank—Liquid capacity}+000.gallons Length 4.%..... Width 'JQ" Diameter................ Depth_`'�---j elf x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. � Seepage Pit No........ _---____-• Diameter..... De .Z Depth below inlet. !. . .pag p ._ �.T..._. Total leaching area._4_.•a__7...sq. ft. Z Other Distribution box (X Dosing tank ( ) '-' Percolation Test Results Performed by.(Z:a Date.. -7-84 ............ � minutes per inch Depth of Test Pit.... �... Depth to ground water.Test Pit No. 1___.�.....__. - f3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wat tS w <ac"' V D Description of Soil-rF'*_�-�'�----Z1'.".Z `]�© t�• ``?t,t SCatl.. --p --7r r1 = R:. �, . x Z4".-'.? '' �`^�; U .I ���-----t,•iit_�t,rr 1 � .-..-�__'('! !�1_T_.I_I^ter ...��.__. _. �� ..414RASI..66................................•.•_-................E.......,�^�ti� Nature of Repairs or Alterations—Answer when applicable................................................................ '101.111o"_.e<``_' ...---••--------------•----.----..........--------------••--..................•....... L S; Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T 5 - th ,tate S ita Code— he ndersigned further agrees not to place the system in operation until r een y , oard of health. Signed...................................................................................... . Date Appl' tion Approved By--•---... .... ..+--------------••-•----------.....-•----....-•-- 6..^ n Date Application Disapproved for the follo g reasons:................................................................................................................ -----•--....--•---------------------------------•--•-------...------.....-•------•------•--•-••------------------------••-------•---------------...--------------------------------- == Date:.. :. Permit No.......... �.-----•---•-- ... Issued... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......1 t.1. :1.W.................................................... Trrtif iratr of TuntpliFanrr 5, THIS LS_Z'O­CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) . �f'1 .,1 t�ti`4�t9Sr�•• by-•----••-------•---.. ---•-•••---•.._ ...... _ � Ins at-----I.a.T----• . --••••---- ' !-T L ---•-- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary C de as described in the application for Disposal Works Construction Permit �To._. �._.. .. .................. dated-_".66--_.Y.:.._ ------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............... ............................ Inspector........ ----------------------------------------- ....... Z THE COMMONWEALTH OF MASSACHUSETTS B04ARD . 3:...U... -j OF HEwALTH o wOF... ..-2 AA-K-i\�c .... N ' �7Jr� FEE........................ �b 3 Disposal Works Tonstrnrtion rrntit Permission is hereby granted........ = -. `= K ' vJ-�l-' U+, -•--------••-------------•---------•--•---------------- to Construct ( ) or Repair ( ) an Individual Sep e DisposalM stern. at NoAP:r..�_.......-L.a..�"�.�:E'�........ i7.,J�' -z�-= - ►!11 �15 Street 7-36- U as shown on the application for Disposal Works Construction Permit No............. . Dated..____......._......................._.... .............. 1C' ............ DATE. Board of Health FORM 1255 HOSBS & WARREN, INC.. PUBLISHERS -- -_ _ -1W SOIL TEST PIT DATA: SEPTIC . TANK DETAIL: ( ; O 0 c . . . DISTRIBUTION BOX DETAIL: EA!CH1NG PIT DETAi1..: REVISIONS INDICATES INDICATES „r PERC. �_ OBSERVED : NOT TO SCALE NOT TO SCALE NOT TO 8CALE NO DATE P- -.! TEST GROUNDWATER NOTES: I. SEPTIC TANK SHALL BE STEEL 4. INLET AND OUTLET TEES TOBE CAST IRON, /l.-�i NO. OF OUTLETS: MANHOLE COVER LOAM 8 SEED - ' TP LET TP TP TP REINFORCED CONCRETE. SCHEO. 40 PVC OR CAST-IN-PLACE CONCRETE. TEES BROUGHT TO FINISH GRADE OR PAVEMENT TO BE CENTERED UNDER MANHOLE COVER. NOTES: GRD. EL. 6_-4• GRD. EL. GRD. EL. GRD. EL. F 2. SEPTIC TANK TO WITHSTAND H-10 LOADING r--J--�--- I. DIST. BOX TO WITHSTAND H-IO LOADING 2°�MtN OfIJB"` �� GW. EL. N� wr=ref. GW, EL. GV1I, EL, GW. EL. UNLESS UNDER PAVEMENT, DRIVES OR I j UNLESS UNDER PAVEMENT, DRIVES OR TO 1/2 - TRAVELED WAYS,WHEREIN H-20 LOADING ' PRECAST 1 TRAVELED WAYS WHEREIN H-20 LOADING WASHED.,. � 12 MiN. .FILL TGa f 501 l.. SHALL APPLY. fl F- STONE , j I SHALL APPLY. .._i_,. 3. ALL PIPE CONNECTIONS AND CONCRETE MANHOLE COVER Z/ . I DIST. I Ib y-' �?�o;ih _;r Sum> 1:. , CONSTRUCTION TO BE WATERTIGHT. BROUGHT TO FINISH GIRADE -i BOX I-_ 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF o t d o •tom n Q p INLET PIPE EXCEEDS 0.08FT./FT. OR IN - PvC INLET PIPE- 6` .7I 1 E PUMPED SYSTEM. CUMC".i I2"MiN. 1----r-y----� ^! `' o r C� "d c c� d a o °• GENERAL NOTES: COVER 3. FIRST TWO FEET.OF PIPE OUT OF DIST = J° �b• �t3� NOTE. -d"-r BOX TO BE LAID LEVEL. i° O �' ° LEACHING PIT TO 1. ' THIS PLAN IS FOR DESIGN AND .. - A .fey i .' .'. . , .. :.: ..!'. •_-': :.' PLAN VIEW w I cl c tm GJ C= C^. d o ❑ o WITHSTAND H40 LOADING CONSTRUCTION OF THE SEWAGE -�� NORMAL WATER LEVEL F�MOVEABLE _l- PRECAST r{ UNLESS UNDER DISPOSAL FACILITY ONLY. COVER w 3/4"TO f-t/2" a ci c� o c� n ro ❑ �, ° / PAVEMENT,DRIVE OR �� +f t ti > + TRAVELED WAY WHEREIN 2. ALL CONSTRUC f10N METHODS AND r - - - - - - - - - - - - - - -::- - - -� DOUBLE ' F "rjerC,7/ ; LEACHING PIT •gib H-20 LOADING SHALL MATERIALS SHALL CONFORM TO MASS. i I / U WASHED o °� AP D.E.Q.E. TITLE 5 A a - PROVIDE > r;.. .. ...::... w rs [ c o c d c c CP PLY. NO LOCAL BOARD 72 58.7 I — _ I I INLET TEE 4 STONE O 1lATERTIGHT w y p , WyRAY_,, OF 'HEALTH REGULATIONS. �, ,;OINTS(tYR) ,1 L:, (no (ineel a to d d C1 CJ C7 ei 0 " �. uY�� PR[CAST 1 a'.o".MIN. OUTLET {i r-� SEE I:; . ►<�. po• °. 1 3: ALL PIPES LOCATED UNDER PAVEMENT f SEPTIC I�, /, , , LIQUID DEPTH TEE 4" INLET NOTE 2 _ I , I.. �, , Q �;/ OR TRAVELED SHALL BE SCHEDULE F RG I _ TANK _ i `r /U 4"OUTLET 1 � :r q5 o CI C3 C� :id o KO A 40 OR. EQUAL. ►�� -af 7STR_.A77 F')F-D :.'. . .. .. . -BOTTOM OW FIAlE SF�AiL f oo BOTTOM ON LEVEL STABLE BASE O_ � � C'�r,'�••rV'EL. �.� oS'Q�, -a v o< LEVEL STABLE 1 ir�/�i-�r CROSS-SECTION .. i�d�// BASE /U 01A. PLAN VIEW CROSS-SECTION VIEW NrJ Wei T- R.. ' `c t44 " 52.7 . CONSTRUCTION NOTES: DATE: DATE: DATE: DATE: / J I / N/F // / // / f// J // //j INVERT ELEVATIONS. C IF ENCOUNTERED, ALL UNSUITABLE SOIL --7- S , I '�?, 1 I I CAPR/CORN REALTY TRUST � /� � , / / / / SHALL,,.BE REMOV..D WITHIN A 10'wrD� TEST BY: TEST BY: TEST BY: TEST BY: l 1 / I / / r J / / / �� , //`h // �/ T BUILDING L�./3: / �j / 4" INVERT A (�3, 5� AND AROUND.BTHE LEACHING FACILITY 3 3�( AtJD SHALL BE REPLACI=I] WITH CLEAN / / / , , / // 4" INVERT AT SEPTIC TANK(in) SAND AND GRAVEL rr� acco�DAHc� wrrH WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: / _ / / / / / O / �O / / / T-oM, /,�c K rJ / l � ,/ l I / l I l / / / / /� / / / / / / - / 6� TITLE sr. i> l �; / l I l /' I / / / / / / f/ 1 4 INVERT AT SEPTIC TANK(out) �. 14 / l / l / / / � / / i e , / / - - , / / / i / ��},, / / / / • / / / hN / / / PERC. RATE: PERC. RATE: PERC. RATE: PERC. RATE: / / / / I l l l I , �/ j , / / , $� 4g 1 / 1 / �, / �� 4 INVERT AT DIST. BOX(in) _MIN./INCH MIN./INCH MIN./INCH MIN./INCH / / / / ° / / ° / A, / / 577 4 INVERT AT DIST. BOX(out)169-191 INVERTS AT LEACHING FACILITY: DATUM: It1t/e-k - A-r GEA_,� P/ rVERTICAL DATUM: ASSUMED BENCH MARK USED: SEE PLAN 1 v`/'' / / / � �// / r / / / �, / { / / ! � / ' 1 OBSERVED GROUNDWATER ` — �c. -------- / iro I / / / 3S/t / !/ / !/ 6ZpAt�// / /° J ELEVATION / �►� �. �c"' ? ' 6 S,j�COM #CT/1 0 / I ---• .. , -•-_._ 5 Lour: I l o . l /, � / I F- ° er`' =iceeyij -, , � � l l I / `Q•z�>w , I I I I, /�r � / � �- / / / / ,, �CCJf�- .j � / / / � / � � / / / / � rn I ,,,.j ZONE: RF . / i w / /�' r-�� / �' �r z �'. / / f; I / / I a - SET BACKS: • �, Y TEFRONT 30 ., DESIGN CRI - RIA. SIDE 15, v REAR 15' / / I qq�p�/ DESIGN FLOW OSTE9VILLELOT /6 CENT RVILLE - BEDROOMS AT /�C G.P.B./D :-- G.P.D.Fri ! FIRE DISTRICT _ f! . - N/F rI l I l I Ill ll/li CAPRICORN REALTY TR TiS I A I lft i lI .Il l/ l -_- - // //�1..I�I/ rltrrl�lll✓ //� - // / � , / � 1 .I; / � �t ,� ` ' � ' � he BSC GroupE 4f //// // I REQUIRED SEPTIC TANK: - /- I / , o / o x, I r 1 I .� - x /E _ - ¢ ,' GAL. NOTES: l SEPTIC TANK PROVIDED: /� 0O GAL. 1 Cape Cod Survey Consultants / , 1 ., / J l l I ( ,\ SIZE OF LEACHING FACILITY REQUIRED: PROPERTY LINES SHOWN HEREON W ERE COMPI LED / h / l / / 13 / f /r r bf� I I \ DESIGN PERC. RATE: MINJINCH FROM A PLAN RECORDED AT THE BARNSTABLE REGISTRY OF DEEDS IN PLAN BOOK 429 PAGE 58 /f l l Q , / I I l 1 r/ / t /o/ lr l / 3261.� J / � / l l 1 /I!I f l � I / 1 � � •� ` , k` � �. � Route 6An Street AND DOES NOT REPRESENT AN ACTUAL SURVEY ON /'� , I / , I I i THE GROUND. /�i ►� J / I / / ,. / I /�/llil�f/ I / 1 ---' 6I 1 ; r ! , \ \ Barnstable Village MA / l Q l I I / I I Jr r!1//► -� 1-: /._. f ,1 1, I \ 02630 WAS ADE ON / !' / / I �i I I l l / l U�t t l��t i J I it # ► I l i i �� �' \ THIS TOPOGRAPHIC SURVEY M l I� l l l I t 11►I 1 , �I I I ( \ 617 362 8133 THE GROUND BY TRANSIT AND STADIA METHOD / Ill I W i �Ir �i 1 , ► i - ~-- �+ ' ► l� \ \ , ON MAY,1970 Q l J 1 J ° , LPo I 1 `� _ ! : ' ► I I; I n , I (V I I 1J�011J��! ,1 ( 6 I i �� -t , ',� a. ': 6 PROJECT TITLE: I' '� / `!� / 5 / ► �' I � , _: T I 1 ' � 1 I I � � � � � SIZE OF LEACHING FACILITY PROVIDED: r \, i l / , / 1 ( i ► , t I i I f �` • C� - ,� l - � / , cvr � ' i f rJ SEWAGE DISPOSAL I I W I I I,'11 f► J I �, / / i,,sll,tl I .. � I Ifi► � ,, �� SYSTEM DESIGN to 4j o / lit I ll) 11 ► , I c ` .� l I l N / /l 1 I 1 �T'I_ � -� ( I y`` ` 'w z�Er�?ALL /78 s,x x 4 l /j `" __ 1 / 1. I I ——_ '�, v \ .rr�>«; 79 x L� ,?`� �. ?z=- r l / Jr ► I � �;`' .� . 6 1 i ' ,' r �r 1 '`� .._ — _ —_` \ ,�. \ O° N_ _ FOR l �. LOT 9 �`.� LITTLE POND / _ �_ _ — �-- \\�` `. SCALE: l"-20831+ ESTATES / / I , , LOCUS PLAN: IN I I S �� \ • \ B.M.EL.-I00.00' - C.B✓D.H. AT N.W. BARNST ABLE, MA. / / t COR.OF LOT 7. (MARSTONS MILLS) 1 588' 3/' 3/"W —--— 'T R I / / / l / "'? l 1 r ► I . I I , \ \LOT 17 -� — _ f � ~\� \ _ -�l ' 1 /'j/,/r ,� ° I / l / / I ' I ► I I y. ` \ � �� i 1 \ \ - — _ \O 7` -. ` 1 `��� PREPARED FOR: r. / / / ° r , \ N/F, — — 1 �t `� - CAPR/CORN REALTY DATE PROF SS/ONAL ENGINEER - CNIL , , / t� I >\ 1 , i rn : r \ o _ - f \ �, ,, o .r-LOCUS / ► ► i ` CAPR/CORN REALTY TRUST ._ l ° I ' r 1 TRUST r . it l / / / / � '- �._..4 ..._.. ;,....„; -�- " �• , ' I � ' � � � ,` o , `` _; { LIITLE POND d RACE l / / , / • I LANE�.,I ' .LOT l0 i`.q• rlo. `��' �," � . f I � t • / / I � I i I1 � f � I PP % ✓ - .' DATE: FRANK MYST �WHiTIN IC LAKE COMP/DESIGN J. A\° P� CHECK: ,A.W,DRAWN a PL N VIEW , ��.. -- �'. DATE PROFESSIONAL LAND SURVEYOR FIELD- SCALE: / 1" = 2 ~—B.M.EL.-63.8/' - C.B✓D.H. AT N.W. / CDR. OF PUSKIN LOT. FILE NO: FEET ,/ DWG. NO, 7 SHEET 0 to zo 40 60 /, JOB NO: I OF J3 .06 i / 1