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Commonwealth of Massachusetts
Title 5 Official Inspection Form
,�� ic► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is
required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
A. Inspector Information &L;I—_
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:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty address listed
above; the information reported below is true, accurate and complete as of the time of my inspection; and
the inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that
the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
11-13-19
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 has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time. This inspection does not address how the system will perform
in the future under the same or different conditions of use. a
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
c CommonwealtFi of Massachusetts
Title 5 Official Inspection Form
it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:'
® 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 is in good working order with no sign of failure.
2) System Conditionally Passes:
❑ One or more system components as described in the "ConditionalPass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
* A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ON ❑ ND (Explain below):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
I�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y El ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below):
❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
I
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18
c Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
(,
i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
a
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
[]The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
Commonwealth of Massachusetts
3 Title 5 Official Inspection Form
i-Ii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ Liquid depth in cesspool is less than 6" below invert or available volume is less
than 'h day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 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.
5) 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 CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA) or a mapped Zone II of a public water supply well
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes" or"no"for each of the following for all inspections:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Wasthe facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: 2017
Date
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
l
Commonwealth of Massachusetts
Title 5 Official Inspection Form
! r�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
T, ? 137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: N/A
Was system pumped as part of the'inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping: —
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address -'
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
Tank 1970's with new leach field in 2003
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. 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.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18
Commonwealth of Massachusetts
':o Title 5 Official Inspection Form
iM► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank (locate on site plan):
12"
Depth below grade: 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: - 1000 gal
Sludge depth:
12"
Distance from top of sludge to bottom of outlet tee or baffle
20"
Scum thickness
Distance from top of scum to top of outlet tee or baffle 6" j
Distance from bottom of scum to bottom of outlet tee or baffle 15"
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 leaklage.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank (tank must be pumped at time of inspecti on)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
icl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank (cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box (if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert 0
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Good condition with water at working level and no sign of back-up.
t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Commonwealth of Massachusetts
iFli
;w Title 5 Official Inspection Form
i l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
-0i 137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number:
2-500's
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
wa
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
_� ;> 137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cost.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach chambers in good condition and empty at inspection with no visible stain lines.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i�A ICI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction:
I
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
r�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
Commonwealth of Massachusetts
fw Title 5 Official Inspection Form
C�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12'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:
Original design plans show no groundwater at 12'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
L
Commonwealth of Massachusetts
3 Title 5 Official Inspection Form
(i
C�,l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
..�
%rI
_. > 137 Peach Tree Rd
Property Address
Hudson Homes Management (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-13-19
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
E A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
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TOWN OF BARNSTABLE ,
LOCATION / e,4.0 rR P-f RR SEWAGE #2 U 0 3_ O 7 9
VILLAGE C 01�L/ f T ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. J-' 119 /1/1 C (1 112 2 g . � E 0/✓
SEPTIC TANK CAPACITY / G 00 0 L Z)
LEACHING FACILITY: (ty ) 2`" /)4 l/ ( JeiL 5 (size) /.3
NO. OF BEDROOMS
BUILDER 0 0
PERMIT!)ATE: 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 leaching facility) Feet
Furnished by
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Fee$5 0.0 0
No.
THE COMMONWEALTH OF MASSACHUSETTS
Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for Mtgooal 6pgtem Construction Permit
Application for a Permit to Construct( )Repair(KX)Upgrade( )Abandon( ) El Complete System El Individual Components
Location Address or Lot No.1 3 7 P e a c h t r e Asikl Owner's Name,Address and Tel.No. Alice M o d r y
ACoto sMIp�azss. 02635 a � � 137 Peach Tree Lane
�Qg cel
Cotuit,Mass. 02635
Installer's Name,Address,and Tel.Nos 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.Nos 0 8—2 7 3—0 3 7 7
J.P.Macomber & Son Inc. JC Engineering 5 Roand Hill BLD
Box 66 Centerville,Mass. 02632 East Wareham,Mass. 02538
Type of Building:
DwellingXX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 350. 9 gallons per day. Calculated daily flow 3 X 1 1 0=3 3 0 gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Adding two 500 ga l l o n leaching
rrhamhcrc i-n the axistinq se.pfic SVStPm 2S ' 1 2 A ' X7 '
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu d by this BbarAjof Hpalth. 12
Signed �J Date 2 2 410 3
Application Approved by i Date 0
Application Disapproved or the following reasons
.r
Permit No. Date Issued
III # -„
i No: 0,� .. �# `�.m Fee$5 0.0 0 1
* r. Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS
01pprication for ;Diopogal bpelem Con!5truction Permit
Application for a Permit to Construct( )Repair K X)Upgrade( )Abandon( ) El Complete System ❑Individual Components -
Location Address or Lot No.1 37 Peachtree `mire Owner's Name,Address and Tel.No. Alice Modry
Cotuit,Mass.02635 1`37 Peach Tree Lane
Assessor.'s MapTarcel 1 J—
,,, (J Cotuit,Mass.0 2 6 3 5 j
Installer's Name,Address,and Tel.Nos 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.Nos 0 8-2 7 3-0 3 7 7
HJP.Macomber & Son Inc. JCaEngineering 5 Roand Hill BLD
Box 66 Centerville,Mass.02632 Easy Wareham,Mass.02538
Type of Building:
Dwelling XX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 350.9 gdlions pea day. Calculated daily flow 3 X 1 10=3 3 0 gallons.
Plan Date Number of sheets Revision Date j
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
j
Nature of Repairs or Alterations(Answer when applicable) Adding two 500 gallon leaching
chamharq to the axi �t i ncx cant r• cy�f-Am_ ��' 1 _9 X� '
r
.Date last inspected:
I I
Agreement:
E r' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issu 'd by this oare)jof Health.
Signed Date 2 2 4 0 3 /
Application Approved by _ _ s , Date
i
Application Disapproved for the following reasons T
t l
f � 1
Permit No. Date Issued I
---------�—'---- ----�`�------ ———
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
i
"THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired gXy)Upgraded( )
Abandoned( )by J.P.Macomber & Son Inc.
at 137 Peach Tree Lane Marstons Mills Mass., has een constructed in accordance
f with the provisions of Title 5 and the for Disposal System Construction Permit No q dated
Installer J.P.Mae.omber. & Son Inc. DesignerJC Fn ineeri
The issuance of this permit h ,n otib �c°nstrued as a guarantee that the sy teem'Wi fu�nct��.•n as d�sf net '? /
Date / Inspector
---------/---------------------------------
i No. Fee $5 0.0 0
I
THE COMMONWEALTH OF MASSACHUSETTS
j PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
lwigotal *p!tem Construction 30ermit
'r Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
Systemlocatedat 137 Peach Tree Lane Marstons Mills,Mass.
and as described in the above Application for Disposal System Construction Permit-The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
i
Provided: Constructionpus a comp/)/te')d within three years of the date of t pe it.
Date: , / C/ Approved b
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c��V�letihtl grid LoAc6�It7�r Paciilty tY wetlands exist
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- Commonwealth of Massachusetts
Title 5 Official Inspection Form
A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address p.
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name - —
information is /
required for every Marstons Mills V MA 02648 11-15-17 t
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: .F
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Service
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
1 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 Furth y the Local Approving Authority
11-15-17
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 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.doc•rev.611, Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
w
w e �
Commonwealth of Massachusetts
:a=1 Title 5 Official Inspection Form
=' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is Marstons Mills MA 02648 . 11-15-17 .
required for every
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
•+ t •i 'L
p w -
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:
I
System is in good working order with no sign of failure.
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board'of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
a Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments
137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is Marstons Mills MA 02648 11-15-17
required for every
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
taa , Title 5 Official Inspection Form
11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
a
137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
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
El ® 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
El ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 'h day flow
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
a:=l Title 5 Official Inspection Form
�.i.
=' i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
g p y rY
137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
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: ,
❑ ® 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-
1 0,000g pd.
❑ ® 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 II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17
Commonwealth of Massachusetts
:a=�l Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form Not for,Voluntary,Assessments .
i;may 137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-m%6-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
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' .
❑ S. 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 man holes'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 In
Flow Conditions:
Number,of bedrooms (design): 3 Number of bedrooms (actual):
DESIGN flow based on,310 CMR 15.203,(for example: 110 gpd x#of bedrooms): 330
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
I
Commonwealth of Massachusetts
gill Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
VVA,�z:�"
137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy.@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
page. City/Town State Zip Code Date of Inspection
D. System Information -
Description:
Number of current residents: 0
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: Unknown
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:
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
�aa Title 5 Official Inspection Form
s q Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r�
137 Peach Tree Rd
L J
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is Marstons Mills MA 02648 11-15-17
required for every
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:
N/A
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: y gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy I
❑ 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.doc•rev.6/16 G Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
If;., Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -
`� �.s;!✓ 137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
Tank 1970's with new leach field in 2003
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 24"feet
Material of construction:
® cast iron . 2 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: 18"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:
1000 gal
Sludge depth:
12"
t5ins.doc•rev.6/16 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
l �F•.
137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
, 20" ;
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness 211
Err
Distance from top of scum to top of outlet tee or baffle
1411
Distance from bottom of scum to bottom of outlet tee or baffle
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. Minor tree root intrusion at
outlet cover.
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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
:a=1 Title 5 Official Inspection Form
� I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd ^
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
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.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
l
Commonwealth of Massachusetts
:a=1 Title 5 Official Inspection Form
f.
;II Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
a'
137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
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 field. Minor tree root
intrusion.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes, ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins,doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
.a=1 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .„
137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448) _
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 2-500's
❑ 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 chambers in good condition and empty at inspection with no visible stain lines. Minor tree root
intrusion.
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.doc-rev.6116 „ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
l
Commonwealth of Massachusetts
Title 5 Official Inspection Form
9' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '
137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is
required for every Marstons'Mills MA 02648 11-15-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.) a
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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
I
Commonwealth of Massachusetts
(.,Z Title 5 Official Inspection Form
P. ICI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
ti.,�!✓ 137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
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
L) 0kt2 3e
J?e-3 3�6
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
� I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 12
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:
Original design plans show no groundwater at 12'.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
I _ _
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
�I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
137 Peach Tree Rd
Property Address
Caliber Home Loans (Contact Maiza Eloy @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for every Marstons Mills MA 02648 11-15-17
page. City/Town 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Commonwealth Of Massachusetts
Executive Office Of Environmental Affai 's
CD
'fob Department Of Environmental Protection -
TITLE 5
co �
Official Inspection Form -Not For Voluntary AssessmentP
Subsurface Sewage Disposal System Form
Part A rn
Certification
Property Address: 137 Peachtree Rd.Marstons Mills Ma.
Owners Name:Arnold Kaeppeler
Owners Address:28 Todd Rd.Nashua,NH
Date of Inspection: 1/4/2006 cSZ -:4/5-7
Name of Inspector(please print)Sean M.Jones
Company Name:Wm.E.Robinson Septic Service
Mailing Address:P.O.Box 1089
Centerville Ma.02632
Telephone Number:508-775-8776
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:
X Passes
Conditionally Passes
Needs further evaluation by the Local Approving Authority
Fails
Inspectors 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.
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.
Page 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A-
CERTIFICATION(CONTINUED)
Property Address:137 Peachtree Rd.Marstons Mills Ma.
Owner:Amold Kaeppeler
Date of Inspection:)/4/2006
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
_X_I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B.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 the 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 structurally sound,not leaking and if a Certificate of Compliance
Indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
Obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
Approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(S).The system will
Pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
2
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(coN• mAD)
Property Address:137 Peachtree Rd.Marstons Mills Ma.
Owner:Arnold Kaeppeler
Date of Inspectional/4/2006
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 31OCNM 15.303(1)(b)that the
System functioning in a manner that protects the public health,safety and the environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
Surface water supplyor 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 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:
3
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(comflNUED)
Property Address:137 Peachtree Rd.Marstons Mills Ma.
Owner:Arnold Kaeppeler
Date of Inspection:)/4/2006
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
_x_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
x_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool.
_x_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_x_ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow
_x_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
_ _x_ Any portion of the SAS,cesspool or privy is below high ground water elevation.
_x_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_x_ Any portion of cesspool or privy is within Zone 1 of a public well.
_x_ Any portion of cesspool or privy is within 50 feet of a private water supply well.
_x Any portion of 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 pp,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
_x_ (Yes/No)The system fails.I have determined that one or more of the above 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: N/A
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:
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 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 an large system considered a
Y p Y g Y
significant threat under Section E or failed under section D shall upgrade the system in accordance with 310
CM15.304.The system owner should contact the appropriate regional office of the Department.
4 J
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:137 Peachtree Rd.Marstons Mills Ma.
Owner:Arnold Kaeppeler
Date of Inspection:)/4/2006
Check if the following have been done.You must indicate"yes"or"no"as to each of the following_
Yes No
X Pumping information was provided by the owner,occupant,or Board of Health
X Were any of system components pumped out in the previous two weeks?
X , Has the system received normal flows in the previous two week period?
X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X_ _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
_X _ Were all system components,excluding SAS,located on site?
_X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tee,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
_ _X_ 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
X_ Existing information.For example,a plan at the Board of Health.
_X _ Determined in the field(if any of the failure criteria related to Part Cis at issue approximation of
distance
Is unacceptable)[310 CMR 15.302(3)(b)]
5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:137 Peachtree Rd.Marstons Mills Ma.
Owner:Amold Kaeppeler
Date of Inspection:)/4/2006
FLOW CONDITIONS
RESIDENTIAL
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
Number of current residents:-2—
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no):—NO—[if yes separate report required]
Laundry system inspected(yes or no):—N/A
Seasonal use:(yes or no) NO_
Water meter readings,if available(last 2 years usage(gpd):_2004=64,000 2005=60,000
Sump pump(yes or no): NO_
Last date of occupancy/use:—CURRENT—
COMMERCIAL/INDUSTRIAL N/A
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:-
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping records
Source of information:
Was system pumped as part of the inspection(yes or no):_YES—
If yes,volume pumped:_1000_gallons--How was this quantity pumped determined? AS-BUILT
Reason for pumping: requested by owner
TYPE OF SYSTEM
_X 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 the 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:_Tank-1980,D-Box+SAS
post 1995_
Were sewerage odors detected when arriving at the site(yes or no): No
6
I� J
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:137 Peachtree Rd.Marstons Mills Ma.
Owner:Amold Kaeppeler
Date of Inspection:l/4/2006
BUILDING SEWER(locate on site plan)
Depth below grade:_2`_
Materials of construction: cast iron_X_40 PVC other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
Joints were in good condition,no signs of leakage venting was good
_
SEPTIC TANK: X (locate on site plan)
Depth below grade:_l8"
Material of construction:_X_concrete metal fiberglass_ polyethylene
other(explain)
If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: 1000 Gallons
Sludge depth: 0"
Distance from top of sludge to bottom of outlet tee or baffle: 0"
Scum thickness: 0"
Distance from top of scum to top of outlet tee or baffle:-0"
Distance from bottom of scum to bottom of outlet tee or baffle: 0"
How were dimensions determined: Tank was pumped at inspection,requested by owner
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
As related to outlet invert,evidence of leakage,etc.):
Inlet and outlet baffles were intact and in good condition,Tank was structurally sound,liquid levels were at the
correct levels,no signs of leakage.
GREASE TRAP: a N/A_(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene
other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
As related to outlet invert,evidence of leakage,etc.):
7
I�
f
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:137 Peachtree Rd.Marston Mills Ma.
Owner:Arnold Kaeppeler
Date of Inspection:)/4/2006
TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene
other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX:_X_(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.):
D-box was level and in good condition,no sign of solids cg=over,box was not leaking
PUMP CHAMBER: N/A_(locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
i
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:137 Peachtree Rd.Marstons Mills Ma.
Owner:Arnold Kaeppeler
Date of Inspection:l/4/2006
SOIL ABSORPTION SYSTEM(SAS)_X_(locate on site plan,excavation not required)
If SAS not located explain why:
Type
Leaching pits.Number:
_X_Leaching chambers,number:_2_
Leaching galleries,number:
Leaching trenches,number,length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternitave system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Soil was dry,no sigh of hydraulic failure,vegetation was normal. There was no water encountered in chamber
when opened at time of inspection.
CESSPOOLS: N/A (cesspools must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc):
PRIVY: N/A_(locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
9
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:137 Peachtree Rd.Marstons Mills Ma.
Owner:Amold Kaeppeler
Date of Inspection:)/4/2006
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or
Benchmarks.Locate all wells within 100 feet.Locate where water supply enters the building
REAR
A B
1 TANK
0 A-1=40'
B-1=24'6"
o D-BOX
A-2=46'8"
B-2=38"
SAS
3 2 A-3=40'6"
B-3=43'
10
V
.OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:137 Peachtree Rd.Marstons Mills Ma.
Owner:Amold Kaeppeler
Date of Inspection:)/4/2006
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 5+ feet
Please indicate(check)methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Groundwater was determined by accessing Town Of Barnstable Groundwater Contour Map.
11
TOWN OF BARNSTABLE C
LOCATION / � e 4 C# 7:94-f SEWAGE 4 0 0 3_ O 7 9
VILLAGE 01"Ll T ASSESSOR'S MAP & LOT T —
INSTALLER'S NAME&PHONE N0: J M h C AI 9 eye . � S gA
SEPTIC TANK CAPACITY / 0 00 Q L/9
LEACHING FACIL=: (ty C s (size)
NO. OF BEDROOMS
BUILDER O O
PERMITDATE: 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 20)feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
—P
Fr
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< ��
C( 0
f \
Lb C -f,2- SEWAGE PERMIT NO.
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1 TA LLER'S NAME i ADDRESS
• , L /DE R OR OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED���dvdzd
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
1 ..UD*�...................OF......... .0.......................................
Appliration for 11ispo,13 l Works Tonfitrur#inn Prrutit
06 Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
at
..:.. ............... ..1.. ...1.(0.......................................
Loca'on•Addcea� o No.
�...L��. -=:. ...�� -^-------------•---------: ...............• - 'k\� ...... :: ..
ner\ + / Addrgsg
W .........................
` . .....--•----••-••................a ... .......................
Installer Address
d Type of Building � Size Lot.�tG��.___..Sq. feet
aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
p� Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixt r s .
-
W Design Flow.........................��.............gallons per person per day. Total daily flow........�.... ............ Ions.
W Septic Tank—Liquid Li uid ca acit /. allons Len th C?.�... Width... _�_0.p. Diameter__ __._•-__.-__- De tl_ ._l:.'.
P 9 P Y -� g � � • - P
x Disposal Trench—No- -------------------- Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No..........1---------- Diameter...a. ... Depth below inlet... __.......... Total leaching area ------ ft.
Z Other Distribution box ( ) tank ( ) 7 �
Percolation Test Results Performed by '^Cfr ����_.._.1.4 �:� _....._.. Date....___..�.�_..���__...
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
. -••-•----•.................... ....1. ` - r
O Description of Soil... A�'� L�.�Ca.. t'�.t�► -- .................� �1_:..`.__-:`�•• •-.
f�......_ ......... t c..------. --.......................... ...........................................
V S r
W ....-•---------------------------•-.....••----....--•---•--•------•-•-----.......-----..........-------••----•----------•--------........---•--•---•----•-•-•-•--•---............_............_.........
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
----•-......--•-------------•--•-----------------•--•-•-•-••---•---•----•--............--•--•--....-----•-••-•-----•-----•---•---....--•----•----......................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in,accordance with
the provisions of TITLE, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance k a been issued y e boa o_
ned-•----. . - i
.Date
Application Approved BY•--• - �2 n�'M ................•••... ---,ICI I�'=
Date
Application Disapproved for the following reasons:--•-•----------•------•---•-------------•---•--..._.....------------------------•-----------------......-••••---
---•-•-•-•-•--•---------------••---------•--•------------•-•-----•-----------------------......_...........------------------•-••----•• --•------._..-•--••--•---•---•...•------••••----------------•----
Date
Permit No.. .. ...... Issued. g /--�--- -------------•--
Date
o ' r &0
THE COMMONWEALTH OF MASSACHUSETTS
BQA.R•D. O F- HEALTH
Appliratinn for Uiipuii al Workii Tnntrurtion Vanfit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
.N_ .__SyStezn at: .- t
...t�o 5-`- -- .``._..:%:f...............................................................
L ( or Lot No
.... ............................. f c 1�e�V--�
•---
Twner� a i ( Addr
r
r
Installer t Address
Type of Building k 'Size;Lot24.( ..-_'� � .....Sq. feet
a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) '� Garbage Grinder ( )
aOther—Type of Building .....7...................... No. of persons............................ Showers (' ) — Cafeteria ( )
Other fixt�u�es P --
Design Flow................... gallons per perso per day. Total daily flow...... .,) *" lons.
WSeptic Tank—Liquid capacityt'yQ '?gallons Length &...... Width.'5.....U.... Diameter................ Dept .. ': .;,
Disposal Trench—No.....................Nidth_......._...._..__ Total Length_____.."*, ___._ Total leaching area.._......--.........s ft.
�• r r. . g q-
3 Seepage Pit No.........1.......... Diameter ....lsl*...:.�,Depth below inlet.._.-.......... Total leaching area:Zg�a_:...sq. ft.
z Other Distribution box ( ) "---Dosi!&tank
Percolation Test Results Performed by _.+ ,?��� _` _ 1 t / G 0
-;* - ----..... Date... ......... .....1 ..........
Test Pit No. I................minutes per inch Depth of Test Pit.................. Depth to ground water........... _...........
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................. Depth to ground water........................
a' ................................... ................................
Dpf So x ,........... � ••h 1 t.
..._. may` .......... ..........� `---...`9� T r( tM. ��: --•- .. ~ 4
.. --
W °fir k . 5 e w bw * °�
............... .........................................................................................................................._._......_
U Nature of Repairs or Alterations—Answer when applicable___---._ ---- .. ---_
........................................................................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewag\"Disposal,S:ystem in accordance.witl
the provisions of TITI:L 5 of the State Sanitary Code— The undersigned further agrees not to place the-system in
operation until a Certificate of Compliance has been issued by, he boalid('of'I%xitl"I,
ned...................t . t��r c�t ..t ....t sz. c � f11
... _. --z.. ... .,, �Date _
Application Approved By C ?` "' ..! %.._
....................................................•••-•-•--- .....Date
Application Disapproved for the following reasons:............................. ...........
....................•--------•-----------...........-••---.....-----•-----•---•--......-.------••-••----.._...-•••-•-•-•-------•------------...................•................. ......................
al Date
-------------------•........._......
Permit No......-•-•--•----•--• - ------•-•--- -•-•-----....--•---
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.C44•+..............................O F... e�• .................................................
Tntifirate of Tontplianrr
THIS IS TO CERTIFY, That the,individual Sewage Disposal System constructed $0/) or Repaired ( )
by--------------•....! r. .......... ................................-............................. ...............-•............................
...._
,/ Installer
at................... ,t • - d.r.-----•- .............
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit ............ dated__'_.! `-----l.�_.Alv...........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector........-..........................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.,�.�/ .......................... d v
No. "- 819 FEE.. .........
Disposal fur ion rnr�ion rrntit
Permissionis ereby granted...........- ..... -----••------•-----••••-•-•---.....-•-•...................................•
to Construct ( ),v°r Repair ( ) n Individual Sewage Disposal System
at No...................d.:•.... . ....i .....
Street
as shown on the application for Disposal Works Construct' rmit No..................... Dated..........................................
B of Health
DATE--- r..._ '`el.............................
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS "
MMASIGN tea-'A,
t�
S►�t_'� ��iryt►►..� - 3 �s»22noNt . . t7�Z•rA.••ta - I -
►\10 C�A2FSAC E &F-el QDE2 .• r 4t1' I f «S
10 G.P.V.
�EF'rIG TA�ik = 3`-jO.r IcJG °ro • A-9 �s.P.D.
USA: t 00C:�k SAL_
,tj2P5SAI_ PIT - Ust= loon Got /
S,MG�,vALL ACE = ISo s F. 142-I
!tom SF ,c 2.S * 3?S G.P.D. _•
ToTa L -C>e�>16Q = -d25 G.Pr-..>.
-r'oTAL U4tLam( Ftaw = iTU i r=
vs✓f1C_DL&Tto-.l 0,&- e : t"Iu 2.MtIJ•09ZtaGy6. ( ,olIle
= r
�/� Zf-. P;
• ., �y/ g 7?i�� ,�?f.% �•� _ � `jam
F f A. �
4700
r
Tor 174v Coo0 op
fi
• y/
SJI d�- lj�P.p� DKT. IW- 6AL. �8
-box.
6v•` Sepnc
14 �:
3 tNv T"Ak1C
1000 41&4t 9 buy. 1►1 .
GAL.
Q L�H .A •
IW24 FIT
K�ASWEU"' ;
STow,� �s�ej
}
CE2'C'tF=►ECG pI.C�T' L./�i`i_
EL9 �20F'1 Ll✓ l� 1"! l�l
LdGATtat,1 A � 1' (L•C.4
SCAI_t Itl-fin �ATt=
00 �dT - �2o?D<jt3D
C.13IZTII=-{ T�4A-r T14G "D4Ui;�1.YG, 5tao�vlJ S�LA►..I Ri_� �'E►.Ic_G
41F.1?t_n1..1 Cc�v1r1PL�(S W ITFA Ttac: �jlD�.l..t►-�� 1 .�. ��
AWL-> 5Cl"L>�Ci� QE-,c,cGWTy OF TIC-'
7'owU or- 1. Pit
PAYG .. '
RCG15'M- ZL-•D LAWO L)C'Va`(OI: r
�-1 CIS CaI_ALJ (� t_JOT t�iA►r>C-_D VI`-1 A�.I 0.,TCV-V11_L a �r(�`•S •,
tlJ,f�:J;n.l� .e; �,:�c:•/1:Y Y+a�: t�Fc-y T�, �I�l:�aJt L7 APPLI C. -4T
c �
vMIWI- _LD"C' hl`
l l a ELT" EJf�I t'
CONTRACTOR SHALL VERIFY SIZE AND
5" DIA. OUTLET(S) FINISH GRADE OVER CHAMBERS = 96.80'-97,68' GENERAL NOTES
, CONDITION OF EXISTING SEPTIC TANK REMOVABLE COVER SLOPE @ 2% MIN. OVER SYSTEM
FINISH GRADE OVER D-BOX= 97.10 4" SCHEDULE 40 PVC MIN SLOPE 1°l0 3/4" TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF (PIPE
1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
FINISH GRADE OVER TANK EL.= 97.64 2" OF 1/8"TO 1/2" DOUBLE WASHED STONE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE
ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES.
20"MIN.ACCESS COVER , PLACE RISERS ON ALL CHAMBERS
(TYPICAL FOR 3) 36"MAX. TOP OF SAS= 94.68 TO 6"OF FINISHED GRADE
EXISTING 9" MIN. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD
93.85' 36" MAX. BREAKOUT EL = 94.35' OF HEALTH AND THE DESIGN ENGINEER.
-- PIPE 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL
-' 6"+ 3" PROVIDE WATERTIGHT BE USED IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED.
3" DROP MIN. 3� 9�� - JOINTS (TYPE)
pQ
o � 4" PVC IN FROM � � � Q � � � � � � oo � � � Q � � op 4. TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE LESS
14" 95.00± SEPTIC TANK 4 PVC OUT TO p o00 00 0o THAN ELEVATION = 94.35' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS.
LEACHING FACILITY oa o o TOP OF HEUNLESS A OLINER IS NOT LESSTHAN NE THE BREAKOUT ELEVATION.IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE
0
12 , 2' o op o po 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
48^ CONTRACTOR SHALL OUTLET TEE 94.50 MIN. 94.33 �� oa o
VERIFY CONDITION OF 0 6" CRUSHED STONE p 0 0 0 0 0 p o 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
14.1" EXISTING TEES OVER MECHANICALLY pp
AND REPLACE AS COMPACTED BASE 4' 8 5' - I-•-�. 7. LOCAL BOARD OF HEALTH TO BE NOTIFIED
NECESSARY 4' 4' PRIOR TO BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND
5 25.0' 4.9 READY FOR INSPECTION. SYSTEM IS NOT TO BE BACK FILLED
OUTLET DISTRIBUTION BOX (TYp.))
TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV= < 86.05' 12.9' WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH.
EXISTING 1000 GALLON CONCRETE SEPTIC TANK BASE. FIRST TWO FEET OF OUTLET 91 .85
PIPES TO BE LAID LEVEL. 2 - 500 GAL. CHAMBERS 5' MIN. 8. ELEVATIONS BASED ON ASSUMED DATUM OF 50.0'MSL OBTAINED
LENGTH 8 -6 WIDTH 4 _10 DEPTH 5 -7
CROSS SECTION VIEW TYPICAL CHAMBER PROFILE CHAMBER END VIEW FROM NAIL IN TREE AS SHOWN ON PLAN.
SEPTICDETAIL NOT TO SCALE 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
NOT TO SCALE NOT TO SCALE THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE
M AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY
p � DISCREPANCIES TO THE DESIGN ENGINEER.
TES,w y � T PIT DATA
10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE
AT
STRUCTURES SHALL BE MADE WATERTIGHT.
INSPECTOR:
' SOIL EVALUA"TOR: Samuel Philos-Jensen 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR
k � ; kF< y ' January 10,2003 ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN
' DATE: rY
§ SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
41
11; TEST PIT#: 1
_ 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
ELEV TOP - 97.05'
LOCATED UNDER PAVEMENT DRIVES OR TRAVELED WAYS IN WHICH
w. ELEV WATER = >11' BGS CASE THEY SHALL WITHSTAND H-20 LOADING.
M
MP PERC RATE _ < 2 MIN/IN 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND
iF
FINES.
DEPTH OF PE:RC= 42"-60"
14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND
TEXTURAL CLASS: 1 UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES
f � OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN
COARSE SAND FREE FROM CLAY FINES OR OTHER UNSUITABLE MATERIAL IN
ACCORDANCE WITH 310 CMR 15.255(3).
15
= 0 97.05'
15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES
a.
Sandy Loam
A FOUND IN SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
the" s 10YR 4/1
' 4" 96.72` 16. PROPOSED PROJECT IS LOCATED WITHIN:
�uj,�
� .
S88°02'45"W
dk qE Loam Sand ASSESSORS MAP 57 PARCEL 82
�t � F Y {.�
\ 4 �d � B 10YR 5/6
17. OWNER OF RECORD: ALICE MODRY
.fir ,
38' 93.88" ,
MAP 57x ( A ADDRESS: 137 PEACH TREE LANE
( MARSTONS MILLS MA 02648
d hi
PAR EL82 "h �` � � � Perc
22,636 S.F.
�� M-C Sand 18. PLAN REFERENCE: BOOK 337 PAGE 1
- _
_ � 2.5Y 5/4 DEED REFERENCE: BOOK 3225 PAGE 216
W 1, ^s4ii 'N :,Sv ,p. yt i wn e
2-500 GALLON i . � � � ,� ,
LEACHING CHAMBERS N o = 19. ALL DISTURBED AREAS SHALL BE RESTORED WITH LOAM AND SEED.
15 PINE Nlo Groundwater 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
rn LOCUS PLAN Encountered FOR US
16,, 10'° OAK ` 99 132" 86 05' FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
18,"O 98 .25.0 DECK
ES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
EXISTING SCALE: 1" = 1000'
TP 1 O 3-BEDROOM 1
'_': C9 12"'OAK DWELLING i o
t P
--97x0 11 � DESIGN
12.4' 26.9' w. E.� �. 6� TOF = 104.72' fl
;3 5€ PROPOSED SPOT GRADES
""Q""BOX _ - =_:......- ; 14.1'
M_.._ ��IG w--- 5 � EXISTING CONTOUR
EXISTING LEACHING PIT TO „_ ....,.. -- .-_...__.. . i�.._._. ... .. .__ : C
BE PUMPED AND FILLED 1 ",PINE ' " NUMBER OF BEDROOMS 3
WITH CLEAN SAND 5€ PROPOSED SPOT GRADES
i NUMBER OF PERSONS 3
18 OAK DESIGN FLOW 110 ,
11 GAUDAY/BEDROOM PROPOSED CONTOUR
o TOTAL DESIGN FLOW 330 GAUDAY __ _ _
_ T/C EXISTING UTILITIES
_ z
. - � cn M DESIGN FLOW X 200 % 660 GAL/DAY
EXISTING 1000 GALLON '_ *,;, _.__ . , ....__.
e, USE EXISTING 1000 GALLON SEPTIC TANK -"' -W............ EXISTING WATER LINE
SEPTIC TANK cn B.M. - r<S
o Nail in Tree ,
N M Elev. = 50.00' 'k `'
TEST PIT LOCATION
�. Assumed ��� � �°-�•T..........M -
�' m -_,.-.......-,,,.. Q Q EXISTING SEPTIC TANK
"' INSTALL 2- 500 GAL. CHAMBERS
r 's ' "
SI DEWALL CAPACITY 4" SOLID SCHEDULE 40 PVC PIPE
- - (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (.74 GPD/S.F.) = GAUDAY d DISTRIBUTION BOX
DRAIN EASEMENT (25'+ 12.9') (2) 1(2') (.74 GPD/S.F.) = 112.2 GAUDAY
10'WIDE �.
S88 02 45 W
500 GAL. LEACHING CHAMBER
158.90' BOTTOM CAPACITY
(LENGTH x WIDTH) (.74 GPD/S.F.) = GAUDAY
(25'x12.9') (.74 GPD/S.F.) = 238.7 GAUDAY I
TOTALS: REV. DATE BY APP'D. DESCRIPTION
TOTAL NUMBER OF CHAMBERS 2 PROPOSED SEPTIC SYSTEM UPGRADE
TOTAL LEACHING AREA 474.2 SQ.FT. PREPARED FOR:
TOTAL LEACHING CAPACITY 350.9 GALJDAY
ALICE MODRY
LOCATED AT
137 PEACH TREE LANE
MARSTONS MILLS, MA 02648
SCALE: 1 INCH = 20 FT. DATE: JANUARY 13,2003
0 10 20 40 80 FEET
-CN OF Min
gam° �oHr�L. PREPARED BY:
° cHURCHILL U JC ENGINEERING, INC.
ClV1L
No. 4180' 5 ROUNDHILL BLVD.
EAST WAREHAM, MA 02538
SITE PLAN 508.273.0377
SCALE: 1"=20'---_ -- - - _ -- _ _ __�_-... __. _. .-. .. _.: _ __._..._.r.,.,_ _,. e - ..._ ,., /1310
"' Drawn B : JLC Desi- ,... , / � Y gned By. JLG Checked By. JLC JOB No.360___
I _ _