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HomeMy WebLinkAbout0128 OLDE HOMESTEAD DRIVE - Health 128 OLDE HOMESTEAD-WV,,MARSTON MILLS A I Commonwealth of Massachusetts �d w u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M s 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: � J Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: L ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9-3-1.3 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurf ce Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every 9 Marstons Mills MA 02648 -3-13 page. City/Town- State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: One or mores stem com ponents mponents as described in the Conditional Pass section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. I The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is.structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills . MA 02648 9-3-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y .❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or pondirig 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 . l Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name informat,on is required for every Marstons Mills MA 02648 9-3-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ IZ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"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 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts _ v Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 9-2013 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): canons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: :Sins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. City[Town State Zip Code Date of Inspection D. System Information (cont.). Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 7-20.13 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: - gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I Commonwealth of Massachusetts m v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GqM , 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 611 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont,) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16 11 How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. I i Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date, t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (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.): Good condition with water at working level and no sign of back-up from pits. Pump Chamber(locate on site plan): Pumps in working order: ❑ .Yes ❑ No Alarms in working order: ❑ Yes ❑ No* I Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'r 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2-600 gal ❑ 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.): Leach pit F was filled to capcity at inspection. Leach pit G was empty at inspection with stain lines at 30" below inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M5 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Q. V Pn d r t } ` r°-D_f G-ate / C-6- Y311.1 . t5ins•:d13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts 4 u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for every Marstons Mills MA 02648 9-3-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high round water: 16' p g g feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show no groundwater at 16'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Olde Homestead Dr Property Address Bruce O'Hara Owner Owner's Name information is required for everyMarstons Mills MA 02648 9-3-13 page. CityTTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 17 of 17 o�� R+ F Comm� -weal of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo -Not for Voluntary Assessments 128 Olde Homestead Dr. WZI� Property Address Bruce Ohara Owner owi er's Narrea informatiort' #ittarstons folls.' MRA 02 3-26s-07 =.equired for every page. Cityrrown State Zip Code Date of Inspection Inspection result must be subaAfte€on this fWM.€IspectioM Toms r; -,not be aft in any W°_ . General Information 1. Inspector Shawn:Mcelroy Dane of Inspector Shaun Mcelroy Enterprises Company Name 29 Atwater Car. Company Address E. Falmouth MA 02536 City/Town S=ats Z10 Code Telephone Number License Number N) r� B. Certification - # certify that# have personally inspected the.sewage disposal system at this address a d that!@e r� inforrnation forted below is tme,accurate ind complete as of the time of the inspe on. The inspection was performed based on my trairting and experiericia in the prod•function and penance€f on site se-wage disposal systems.i am a DEP appTovesi syshffR insMctolr pus€r2nt to SeCtl=15.340 of Tittle 5(310 CMR 15.000).The systern: ~ Passes [I Condi`dostally Pates F Fails I Needs Further Evaluation by the Local Approving Authority Inspector's Signature Date i he system inspector shall subud ashy of t1 is inspedon repox-1 to the Approving At cad (Board of Health or DEP)within 30 days of completing this in a lF the system is a shared system or has a design flow of 10,000 gpd or greater,the ir;spWor and the system owner shall submit the report to the appropriate regional office of the DER The original should be sent to the system owner and copies seat to the buyer,tf applicable,and the appruving autha tty. This report only describes condoms rz the a in-spection and un&--r tle conditions of use at that tifne.This inspection does not address hoer the systais will per°fbran in the Pu re cruder the same or different condKions of use. Commonwealth of Massachusetts _ u Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 128 Olde Homestead Dr. Property Address. Bruce O'hara Owner Owner's Name information is required for Marston Mills MA 02648 3-26-07 every page. Cityrrown state Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check-A,B,C,D or E/always complete all of Section D A►) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System has two leach pits. One is filled to capactiy,the other is has open capacity for one and a half days flow. 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 Heattti. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: '❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a'broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced a ❑ obstruction is removed t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 16 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Olde Homestead Dr. Property Address Bruce O'hara Owner Owner's Name information is required for Marstons Mills MA 02648 3-26-07 every page. CitylTown State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken,or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment.' 1...System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2.' System will fail unless the Board of Health(and Public water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. t5insp•08/00 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts ' •,- w W Title 5 Official,",Ins pectidn For , Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments 128 Olde Homestead Dr. Property Address Bruce O'hara Owner Owner's Name information is Marstons Mills. MA 02648 3-26-Q7 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) C) Further Evaluation is Required by the Board of Health (cont.): ! ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A.copy of.the analysis must be attached to this form. 4 . 3. Other: 'D) System Failure Criteria Applicable to All Systems: , ". You must indicate"Yes"or"No"•to each of the following.for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool k El ® Discharge ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑. g Static liquid level in the distribution box above outlet invert due to an overloaded or clogged'SAS or cesspool, 1.Liquid depth in cesspool is less than 6"below,invert or available volume is less ❑ ® than %day flow 0 - ® 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 orp'mry is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. t5insp 08= Title 5 OffieW InspecQon Form:Subsurface Seurage DPI System•Page 4 of 15' Commonwealth of Massachusetts ; Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Olde Homestead Dr. Property Address Bruce O'hara Owner Owner's Name information is required for Marstons Mills MA 02648 3-26-07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cunt.): Yes No ❑ ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. .❑ ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 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. t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official. ln' s­ pection For ,�` a Subsurface Sewage Disposal`System Form -Not for Voluntary Assessments�` t - 128 Olde Homestead Dr. Property Address Bruce Ohara Owner Owner's Name information is required for Marston Mills MA 02648 3-2"7 every page. City/Town `° State Zip Code Date of Inspection C. Checklist Check if the following have been'done.You•must indicate"yes" or uno"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 ® El available note as N/A) ® ❑ Was the facility or'dwellidg 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? A The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ®` ❑ Existing information. For example,, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue ® El approximation of distance is unacceptable)(310 CMR 15.302(5)) t5insp•08M Title 5 Official inspection Fcmc Subsurface Sewage Disposat System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , y�< 128 Olde Homestead Dr. Property Address Bruce Ohara Owner Owner's Name information is required for Marstons Mills MA 02648 3-26-07 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 3 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(East 2 years usage(gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Date 7 Date Commercial/Industrial Flow Conditions: .Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): t5insp-08106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection i=orm ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Olde Homestead Dr. r . Property Address Bruce O'hara Owner Owner's Name information is required for Marstons Mills, MA 02648 3-26-07 every page. City/Town I State Zip Code Date of Inspection D. System Information (cont.) General Information, ' Pumping Records:,- . Source of information: Owner-pumped 9-06 Was system pumped as part of the inspection? •❑ Yes ® No If yes, volume pumped: gallons t How was quantity pumped determined? a Reason for pumping: Maintenance _ Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool El Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (f yes, attach previous inspection records, if any) Innovative/Afternative technology.Attach a copy of the current operation and maintenance contract(to be obtained frorn'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: 1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•01106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts _- W Title 5 Official-Inspection 1=otm e o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 128 Olde Homestead Dr. Property Address Bruce Ohara Owner Owner's Name information is required for Marstons Mills MA 02648 3-26-07 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 feet e Material of construction: r ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?'(attach'a copy of certificate) ❑ Yes ❑ No --------------------------------------------------------------------------------------------------------------------------- Dimensions: 1000 Gal Sludge depth: 21' Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 2" En Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16 How were dimensions determined? Tape t5insp.011106 Ti dte 5 Official tnspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 O.fficiW- IftpectionFotr : . Subsurface Sewage Disposal System Form -Not forVoluntary Assessments 128 Olde Homestead Dr. Property Address Bruce Ohara Owner Owner's Name information fo is Marstons Mills MA 02648 3-26-07 . required for every page. City/Town state Zip Code Date of Inspection D. System Information (cunt.) 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 (locate on site plan):,., i Depth below grade:jr.. -- ,t... t feet Material of construction: ❑ concrete ❑ metal ❑fiberglass. tr ❑ polyethylene- El other(explain): Dimensions: Scum thickness ° s Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle=» . `Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: ; Material of construction: ❑ concrete ❑ metal . ❑fiberglass 0 polyethylene ❑ other(explain): t5insp•08M 3itl'e 5 Official lrqpection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection, Forte , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 128 Olde Homestead Dr. Property Address , Bruce O'hara Owner Owner's Name information is required for Marstons Mills MA 02648 3-26-07 every page. Cityrrown w State Zip Code Date of Inspection D. System Information (cunt.) ' Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site,plan): Depth of liquid level above outlet invert 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.): Good condition. i } Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official, Inspection ..Forr i . �. o Subsurface Sewage Disposal System Form.-Noffor Voluntary Assessments , 'f 128 Olde Homestead Dr. Property Address Bruce O'hara - Owner Owner's Name information is required for Marstons-Mills r'- MA 02648 3-26-07-= every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) ' �~ Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required):, If SAS not located, explain why: r , Type: f ® leaching pits number: 2-600 pits ❑ leaching chambers number ❑ leaching galleries - number. fi ❑ leaching trenches'. number, length: ' ❑ leaching fields number, dimensions: f ❑ j •t ' ' overflow cesspool number:' ' ❑ innovativelaltemative system , Type/name of technology- Comments(note condition of soil, signs of hydraulic failure,.level of ponding, damp soil, condition of vegetation, etc.): i One is filled to capacity,and the other has open capacity fof one and•a half days flow. t5insp 08/06' Ti rUe s Official fnsPection Farm:Subsurface Sarage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form:-Not for Voluntary Assessments �M 128 Olde Homestead Dr. Property Address Bruce O'hara Owner Owner's Name information is required for Marston Mills MA 02648 3-26-07 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cost.) Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5insp•08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts - -, - : ._ .•r W Title 5 Official Inspecti®n Fora ' Subsurface Sewage Disposal System,Form -:Not for Voluntary,Assessments M , 128 Olde Homestead Dr. Property Address , Bruce O'hara Owner Owner's Name information is required for Marstons Mills MA 02648 3-26-07 every page. City/Town a. , State Zip Code Date of Inspection D. System Information (cunt.) • . 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. -�- 27' -E- aa- -r 3�' F- 3a' UO L__ U t5insp•QW6. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Olde Homestead Dr. Property Address Bruce O'hara Owner Owner's Name information is required for Marston Mills MA 02648 3-26-07 every page. Cityrrowm State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked,date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Town maps show no groundwater at 16'. t5insp-08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 15 of 15 .�.� Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street Boston,Ma. 02108 John Gil-ad ' 11Lt, - D.E.P. Title V Septic Inspector ►n"► 2 It P.O. Box 2119 Teaticket, MA 02536, WILLIAMF.WELD (508) 564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A LTV CERTIFICATION `JAPE 2 6 1999 � Property Address: 128 OLDE HOMESTEAD DR.MARSTONS MILLS MAP 43 PAR 1013ress of Owner: Date of Inspection: 1118199 (If different) Name of Inspector: JOHN GRACI HARLEY STARK 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 _ Conditio all Pa55e5 code 310 CMR 16.303.my findings are of how the system is performing at the time of the inspection.My inspection does _ Needs ur er Evaluation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the septic system and any of its components useful life. Falls Inspector's Signature: Date: 1H8199 The System Inspector sh II 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: i 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 ND). 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 007.97) One Winter Street • Boston,Massachusetts 02108 . FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 128 OLDE HOMESTEAD DR.MARSTONS MILLS MAP 43 PAR 1013 Owner: HARLEY STARK Date of Inspection:1118f99 _ Sewace backup or.breakout or hiah.static water level observed.in.the distribution box is due to a broken, or obs-ructed 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. Oificharge or ponding of effluent to the eurfeoe of the ground or Surfeoe waters d�.le to nn ov�rinadPd rn r,ing0P�1 cesspool. SAS is in hydraulic failure. (revised 04117.97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 128 OLDE HOMESTEAD DR.MARSTONS MILLS MAP 43 PAR 1013 Owner: HARLEY STARK Date of Inspection:111118199 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 0427)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 128 OLDE HOMESTEAD DR.MARSTONS MILLS MAP 43 PAR 1013 Owner: HARLEY STARK Date of inspection:1118199 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 N/A. 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. Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is x — — unacceptable)[15.302(3)(b)] Irevleed 04127,97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 129 OLDE HOMESTEAD DR.MARSTONS MILLS MAP 43 PAR 1013 Owner: HARLEY STARK Date of Inspection:1118199 FLOW CONDITIONS RESIDENTIAL: d./bedroom for S.A.S.. Design flow: 440 g p Number of bedrooms: 4 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Ye: Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): n1a Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: nla 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: We Last date of occupancy: nra OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: SYSTEM WAS LAST PUMPEO TWO YEARS AGO System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: nra 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: 1998 Sewage odors detected when arriving at the site: (yes or no) No (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 128 OLDE HOMESTEAD DR.MARSTONS MILLS MAP 43 PAR 1013 Owner: HARLEY STARK Date of Inspection:118f99 SEPTIC TANK: x (locate on site plan) Depth below grade: 16' Pol eth _other(explain Material of construction:x con create_metal_FRP_ Y Ylene ) If tank is metal, list age nra . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: L10'6'-H6'7^wee•• Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness:"" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle:17" 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 AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: rda ( p lain _other lene Pol eth ex Material of construction: _concrete_metal_FRP_Polyethylene ) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:We Distance from bottom of scum to bottom of outlet tee or baffle: rda 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.) rda BUILDING SEWER: (Locate on site plan) I Depth below grade: 22- Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction llne:TOWN Diameter: nla_ QImments: (conditions of joints,venting,evidence of leakage, etc.) (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 128 OLDE HOMESTEAD DR.MARSTONS MILLS MAP 43 PAR 1013 Owner: HARLEY STARK Date of Inspection:1118199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of c,,onstruction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions nra Capacity: Na gallons Design flow:, nra gallons/day Alarm level:_nta 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 LEVEL wmIBOTrOMOFPIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) DISTRIBUnON BOX IS STRUCTURALLY SOUND PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_ves Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) nfa (revised 0427)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 128 OLDE HOMESTEAD DR.MARSTONS MILLS MAP 43 PAR 1013 Owner: HARLEY STARK Date of Inspection:1118199 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: Na Type: leaching pits,number: 2-6o0 GALLON LEACH PITS leaching chambers,number:Na leaching galleries,number: Na leaching trenches, number,length: Na leaching fields,number,dimensions:Na overflow cesspool,number:Na Alternate system: Na Name of Technology._nra Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) THE LEACH PITS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.ONE PIT WAS FULL AND ONE PIT WAS EMPTY. CESSPOOLS:_ (locate on site plan) Number and configuration: Na Depth-top of liquid to inlet invert: Na Depth of solids layer: rvz Depth of scum layer: Na Dimensions of cesspool: Na Materials of construction: Na Indication of groundwater: Na inflow(cesspool must be pumped as part of inspection) Na Comments.(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.) Na PRIVY:_ (locate on site plan) Materials of construction: Na Dimensions: Na Depth of solids: Na Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Na (revlaed 04127W) • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 128 OLDE HOMESTEAD DR.MARSTONS MILLS MAP 43 PAR 1013 HARLEY STARK 1I18199 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) 6 D a co O 6b�1 Cc:yy Pape 9 of 20 (revised 0412r197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 128 OLDE HOMESTEAD DR.MARSTONS MILLS MAP 43 PAR 1013 HARLEY STARK 1118199 Depth:of groundwater 10 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 (reviaed04rz719T) page 10 of 10 r q6r _2-- Low Y r l� i t 4 C� _ c !� S 1,. J cc- Fi j LA SQ.fT ci FT, 171 OIL j K i 1 i pQ 1 236 sq,Fr, {— f ..o_I _ __ 0 i 1 t I � T' i t 5 - I Ld i v� V I c, c I I� !' 1 +4 Sew I 1 p I I I I I I f I I a P -r+ a - 3 � 'i 9 ti F F g[[ 1{{: k r 1tf1� 5 t � FI�OR C+W l'13ARNSTAB LOCM'ION VILt'a��E ASSESSOR`S MAP II35T ERIS NAB i'HOh1E Y+I�7 SEt'I"XC TAX K CA P ACITY i. ►cgrrNG ACi it : cue) P' c5 x�3 �. . No'OF tEDROONS DER.0 Pt✓RtCT17AT „CC91bIl ; 1a1G S��saratson , itaoc+; Ptv�eeit tdae Maximum.AcijusterJ Cbauodwatec Tatsle to therntot�i pt•S�cauhsn L��uitity feet Pitv6s: at4 Sutatal �Jc1t°flfs Lxtsi 4 c�tii site car rritbin 0A felt of losching fstc lcty�) t:;ciLi cy��i►letian�sold�.eacQuo�facility�Yk'aoy wetlands exit r1111aasa:i(��c.et t1 sr�ixn��'us•ststYa � u �ur�i3lacd by --�------�---- G Vc,( A 13 G ri co F A-Vo/6 - !�10-i7 A iA. -3� TOWN OF BARNSTABLE LOCATION ia� ole e 51o� SEWAGE # VII.LAGE G! 5 ("(�� ASSESSOR'S MAP& LOTO�� —02 213 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)?^�60 d's (size) NO.OF BEDROOMS BUILDER OR OWNER - PERM TDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of I aching facility) ,,� _ by ,� Feet Furnished aG� e�`s SPf�`l`� 1�S ��ibylS s L3 W\_„ q� TOWN OF B STABLE r LOCA i lON 0 �S 1' SEWAGE # VILLAGE M&& MLS ASSESSOR'S M &eOIg�t3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ZaQ LEACHING FACILITY: (type) S (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: CQMPbb%NCE DATE: I ZS Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �\� Feet Furnished by __ J GC-, PA A D 3� TOWN OF B.ARNSTABLE T.i)CATION L # (4C D I r e 401-1 i'�J.w-i SEWAGE # VILLAGE Mai k�Ov+) L'V- 4�5 ASSESSOR'S MAP & LOT__A__ 4 � t INSTALLER'S NAME & PHONE NO.` ) -!• tk'5C 0 0 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) V,/+5 (size) NO. OF BEDROOMS , PRIVATE WELL ORrPUBLIC WATER , UILDER OR OWNER DATE PERMIT ISSUED: �D Z•-/ �a DATE ,COUPLIANCE ISSUED: l® — 3.1 -�^7 VARIANCE GRANTED: Yes No ✓ �.- -�-� 4 r-, �� �• i� i� �+� Ii �� �� ` �� �; No..EZO..7_V` F:ms..... THE COMMONWEALTH OF MASSACHUSETTS ��`� BOAR® OF HEALTH � b .7oG.[..:V........OF........... ::�;?9.V .T..f'40�.4 lirtttiun fur Mipas' al arks Ton.strurtiun Prrutit Application is hereby made for a Permit to Construct ( vYor Repair ( ) an Individual Sewage Disposal System at: ..... .:......__. .. ...._ 1.,�_.....? s....... ..............._. Location-Address or Lot No. --................ �� Q� a.X..2 '154tll7.—rP✓_!.��. ... H.�. ..:...... W Owner Address ,.l -•....................................................•--..........._..•---------------------_...• ----•-••--____._._-•--••-•••••---..._------•------_-J$--•-_ ---------•-•----- Q....._.. Installer Address Type of Building Size I (t_...__/__'j..,Z66.....S feet Dwelling—No. of Bedrooms----___3-_______________•-___-__•__-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building A-CALMM,6. No. of persons.........4............... Showers ( ) — Cafeteria ( ) Other fixtures ........................................................... W Design Flow................... ............... per person per day. Total daily flow............... :¢°_..................gallons. WSeptic Tank—Liquid capacity./-',00gallons Length__/a-G__ Width...Sn6... Diameter................ Depth..4_n4a... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........Z......... Diameter......../Z'_.... Depth below inlet.....,fu4r_..___ Total leaching area----¢XB...sq. ft. Z Other Distribution box (v') Dosing tank ( ) Percolation Test Results Performed by_.10,c4!CE-_, 1-4—_ ..........1.0 ....................... Date....... flo.............. W Test Pit No. 1......2-......minutes per inch Depth of Test Pit......13_.-r ...__. Depth to ground water..__6/A24_1.__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix .....---•-••--------•-----------------------•••........._....•-•-•-........._..._---•......__---••-----------•.......--------_•-•-•......................................................... Description of Soil.............. _-_.4........ ........................ x V ........................................•---••--•--•..........-•••••-•-•-----._..............---•----•••-.._-•-------._..._...--•----...---••-......_...._._-•••-._..-•-•_....---._..._.....-•-..__.._... W ---------------------------------"-----•"""-"-----"-------"--------------""-------•--"-"""""-"----""----"------"--------------------"-"-----"---"---""--""""-"-"-""...-""_.------_..••------•-•-----_... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •""""--"""-"--------""-"-"--•---......"--"•""""""""-"--"-"-"------•"""-"---""""•-"---....---•--.....-----•------------------------•-•---•....._.•----•-•----....__.....-------..._.......•-----------•-- Agreement: The undersigned agrees to install the afore s ibed Individual Sewage Disposal System in accordance with the provisions of TIT E 5 of the State Sanita de—The undersigned further agrees not to place the system in operation unt a ertificate o ance has is ued by the board of health. Date Applicatio _ ued BY E ' k/ .........-"---------------- ...--::I f-1; C Date Applic -ion Disapproved for the following reasons:--"-""-"----""....-""-"""----"--""---""-"---"-""......"-----""-"--"---"----"--.....•-•---..__..-•---•-----_.... .."""•"•-•-"--"-""""•-•"••-•-•"-"-----"--...-•------"---"--"".............•----""-"-----•-""•""....------.-""--......."------"-"-"""---•--""----"..."---""-------"--""--------.._•---........._____-•--•- PermitNo.....-`. --.._..�5 ..._._.. Issued-....................................................... Date Fim............. `ZZA!af THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ........OF........... vim' 1/ T r1.r"................................ Appliratinn for Bi ipasal Murky Tomitrnr#ion ramit Application is hereby made for a Permit to Construct ,)-or Repair ( ) an Individual Sewage Disposal System at: ................_.._ter ?..../ ....©G ! ..11�.�_.._1.!i?�L�?. 7f.��1. ... ?.��--� ........................... _.. •------- ........ .,�..... Location-Address or Lot No. •--•---••---------/��Y��q,� r;�i�ray�ic..r�,ca_... ,�"ao..��?�_.-y�•--�::�:�:! .!=�err f.�---•="�.�?��..:------ ..... --'-----•----•----•--•- Owner Address W Installer Address U . Type of Building Size Lot.....5 ...�, ,5a.....Sq. feet Dwelling—No. of Bedrooms........ ..............................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building lft) A�. No. of persons.........&............... Showers ( ) — Cafeteria ( ) Q' Other fixtures ................... ----------------=-------------- W, Design Flow.....................1'`�..`3--�................gallons per person per day. Total daily flow.._........•..44!?•...•..............gallons. t4 Septic Tank—Liquid capacity./>- gallons Length../- ?-�.. Width___S.- i... Diameter................ Depth_.... Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........Z--------- Diameter........ =.'..... Depth below inlet..... .•...... Total leaching area...4-y l-..sq. ft. Z Other Distribution box (1/) Dosing tank ( ) Percolation Test Results Performed by... ................................. Date....... .� .............. Test Pit No. 1......2.......minutes per inch Depth of Test Pit.......! ....... Depth to ground water__62-- Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R'+ •-•-----•-------------------------------------------------••---•------••--•......_-••••-•--•--............................................................... D � ` r �escrpton o o .....----•-. � . � ' ---------= = --- ---•--•-------------------------•--._......------•--•----•--------...--•--•--••--............••--•--------•--------•----•...--•-.....---------------------------------.....................-•----------. w --------------------------------------------------•--------------------------------------•-------•------=--------------------------------------•----•-------•--..................._......--...--•........ UNature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------------------------------•-•---••--------------------.....----:..--------.....--------------------•--•------------------------------------............._..._.....•---- Agreement: The undersigned agrees to install the afore scribed Individual Sewage Disposal System in accordance with the provisions of T ITIE 5 of the State Sanitarjy ode—The undersigned further agrees not to place the system in operation until a Certificate off,Co iance has en issued by the board of health. r. ned.... ` -? .. ....................... ........ .... Date a - _ ............L � Applicat n Apprrdved By---•--.... �.t - �� r................. �I Da e ' Application Disapproved for the following reasons_________________________________________________________________________________________________________________ ..............•----.......------------.........--•-•----------...----------..................-----.....------------•----•--•-•--...•------•----.....-----------....-----------------•---•---•-•••-•-•-•. Date PermitNo.......• . .........:-7.6_f`'. ----•--• --------------•--•Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH .........r...... d.................OF...... ..... .............................. Tatifirtttr of Tumplianrr ,� THI IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ................��----`?+ v��....................•-•. at L ..... ... IL.......�{�?r'�.��'• �! �i�� Installer)...................................................... *��........... a�-��.�: ..•....... has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-�, .....'1_(G... ....._... dated_._ .......... THE ISSUANCE THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANTEE THAT THE o: SYSTEM WILL FUNCIVION SATISFACTORY. DATE...................../,-.-...3.e.:r.JL.7.............................. Inspector........ ---- ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH c-- / ........... ................... .......oF...... . ......................... •rk4onstrudion rrmit Permission 1, hereby granted................ ....... ' �_..------------------• ---------•........................................... to Construct ( or Repair ( ) an Individual Sewage Dis o System r at No.4 _... . '-- - 4'm Zit?�Y 1 . sy i°,�A___ _� _$.......... Street as shown on the application for Disposal Works Construction Permit No,, _ fi Dated.._..... �_� 1. .......... �._ fir /I« Board of Health DATE.............`............ ........e.( ................................. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS. SITE PLAN SHEET I OF,? SCALE: /"= ¢o k is w s 77, 1 67_10.P,2ECRS7' 1 _��-�-- � n io• - , � � � � � it N 1_ i � .. Tory.or- .FGVNb9J7GW r } N D N G9P. z � 11 1I i � 11 I � l E'gA \o N._ DPI vc �. tH OF Mq WILLIAM' yes o .`WARWICK H _ 19771 �SlA`ti ®g`1 REGISTERED LAND SURVEYOR FORAf /D/-. J/LG'/�t/C� _ LoT /8 17 "I_=5TEA0 D!Z . ZONE ,A� Ile PLAN ,REF.. 4.O ,f"CL I DATE 9 /7/0 `BENCH MARK DATUM ZJ5,:75 /929 MsL 9.UruM WM. M. WARWICK 8 ASSOC., INC. � DOMESTIC WATER SOURCE- 7-e N/�./ LV14 T,E/Z BOX 801 NORTH FA L MOUTH FLOOD ZONE. NG'�- �/-�zA�D G` MASS. 02556 - (6/7) 563 -2638 LEACHING ©AS/N SECTION NOT TO SCALE shcel Z -f Z 24"C./.MH COVER EARTH f/LL BRICK AND MORTAR COURSES AS REO'D• TO BRING COVER TO GRADE B'FLOW LINE / INLET L_ _ __ __ _ 2' TO/' WASHED PEASTONE FREE OF IRONS, PIPET FINES AND DUST /N PLACE OPENING WITH 4%B" 314 TO I%2 WASHED CRUSHED STONE FREE OF 5.3 43 OUTER DIAMETER IRONS, FINES AND OUST /N PLACE A ND l 3/4"INS/DE DIAMETER 1. CONCRETE`TO BE 4000 PSI 28 DAYS ' 2. REINFORCED WITH 6"x6° NO. 6 GA. W.W.M. 3. 2'AND 4' SECTIONS ARE AVAILABLE FOR GREATER DEPTH REQUIREMENTS 4_0.. �--- 3 - --s'o" 4, NUMBER OF PITS REQUIRED z MIN. i NOTE: EXCAVATE TO ELEVATION 2.4 OR - _ EFFECTIVE DIAMETER +�� (NOT TO EXCEED 3 TIMES EFFECTIVE DEPTH) NINE LOWER AS REQUIRED TO REMOVE ALL WATER TABLE - LOAM AND CLAY BENEATH PIT. REPLACE EXCAVATED MATERIAL WITH CLEAN TYPICAL PROFILE GRAVEL TO DESIGNED GRADE. =Z'7Z'j I8"STD. LT. WGT. C.I.MH COVER 71 .; 64.o G4,o G4•o 4"C./.PIPE . r+- -ram,. 4 B/T.FIBER PIPE OUTLET LEVEL DWELLING FLOW LINE TIGHT JOINT o TO FIRST JOINT 00 C.I. TEE 3 9 I 10 00 1 1 6¢.0 1 11 000lOa 1 1 1 1 G/.4p RECAST CONC. Gl.o7 �O/ST. BOX TO BE GO.O ' If 000 p 0 I I i I AL.SEPTIC TANK I I 1 0 0 0 0 0 0 1 1 1 INSTALLED ON LEVEL, 1 1 1 000 00 1•l 1 1 STABLE BASE I I I f00 00 1 1 1 SEPTIC TANK To BE 1 1 1 000 00 1 1 1 INSTALLED ON LEVEL' I I f 100100 1 1 ' ' STABLE BASE. I I 1 0 0 0 0 0 0 1Ill 1 1 LEACHING BASIN 1 1 Q OQ 0 00 0 1 1 1 BASE TO BE LEVEL 1 1 I 0 O 0 0 1 1 1 i ' SOIL AND PERC. DATA PERC. RATE 2 MIN. /IN. 0„ TEST PIT NO. I O'� TEST PIT NO. 2 TEST BY: �ruc� Ne/d 4 Top E and ao. WITNESSED. BY Mc,�ecnQy cGEc�v TEST PIT GR. EL. 64.0 ili16l7. eA9A1.0 DATE— 4EZZ /e6 No GXA119 W4 T,E ,EL DESIGN DATA GENERAL NOTES BEDROOMS NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. DISPOSAL - 11aA1E SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD EST. TOTAL DAILY EFFL.40 GPD. PRECAST REINFORCED CONCRETE UNITS. SEPTIC TANK 1504*9 GAL. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE TO REVISED TITLE, 5 OF THE STATE ENVIRONMENTAL CODE, SIOEWALL AREA 2 s GAL./SQ.FT. MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA_L•Q_GAL. UT. SANITARY SEWAGE EFFECTIVE ON JULY 11 1977. .LEACHING REQUIRED :244_SQ.FT. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ACTUAL LEACHING AREA OF HEALTH. 4 �SQ.FT. AT COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE BOARD OF HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES I/41 / FT UNLESS INDICATED OTHERWISE. ., U SEWAGE DISPOSAL SYSTEM MAff v=• �; FOR - �3/aY.SioE /3yi�,aiiv o . MORAN 1?3417�Q �O TUAL ��'�:,;� �o SG/S'f E�G�?��� _/►�A.257'o.vs M/LLB ��7eti/STAr� � MASS sty SCALE AS INDICATED DATE- �i7 . WM. M. WARWICK 8 ASSOC., INC. 8OX 801 - NORTH FAL MOUTH ` MASS. 02556 (6171 563 -26.38 PROFESSIONAL ENG/NEER