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HomeMy WebLinkAbout1515 RACE LANE - Health 1515 Race'Lane `1 -Marstons'Mills ' F/R ` A '=-047' 141 -- --- I I I I Dec 29 2016 00:03 Jim The Inspector Man 5085349919 page 19 Oq Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 3> 1515 Race Lane tv Property Address V Ken Tomasian Owner Owner's Name equiredon is r for every Marstons Mills MA 02648 12-27-16. Pa required page. Cityrrown State Zip Code Date of Inspection K3'1 CO Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:forms When fillip out f A. General Information ��, a D O7 an the computer, `� ,ZH CIFIMgs�'�i�� use only the tab 1. Inspector: �.�`��,N s_qc;' key to move your �2: y cursor-do not �. JAMES N use the return James D.Sears _ m key. Name of Inspector EARS Capewide Enterprises LLC Company Name 153 Commercial Street �'�,;�S INSPEGs Company Address Mashpee MA .02649 City/Town State Zip Code 508-477-8877 81623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-27-16 spector'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. f5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Dec 29 2016 00:03 Jim The Inspector Man 5085349919 page 20 Commonwealth of Massachusetts Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form - Not fl r Voluntary Assessments 1515 Race Lane Properly Address Ken Tomasiari Owner Owner's Name information is required for every Marstons Mills MA 02648 12-27-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I always complete all of Section D. A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal. Tank D Box and two chambers. I i l 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): i I t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Dec 29 2016 00:04 Jim The Inspector Man 5085349919 page 21 I • Commonwealth of Massachusetts Title 5 Official Inspection- Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 12-27-16 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms 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 replace& ❑ 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 Dec 29 2016 00:04 Jim The Inspector Man 5085349919 page '22 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 12-27=16 page. City/Town State Zip Code Date of Irispection 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 fleet 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. ❑ —he 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 ❑ z 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 a ® Static liquid level in the distribution box above outlet invert due to an overloaded y or clogged SAS or cesspool ❑ ® Liquid depth in go is less than 6" below invert or available volume is less than day flow tSins doe rev 6/16 TAIe 5 Official Inspeclion Form:Subsurface Sewage Disposal System Page 4 of 17 Dec 29 2016 00:04 Jim The Inspector Man 5085349919 page 23 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage,Disposal System Form -Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 12-27-16 page. City/Town Slate 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 of privy is within 50 feet of a private water supply well. 0 ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody,must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design'flow of 2000gpd- 10,000g 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 fee It 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 r rev 6116 Title 5 Official Inspection Form:Subsurface Sawage Disposal System-Page 5 of 17 Dec 29 2016 00:05 Jim The Inspector Man 5085349919 page 24 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form; Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian i Owner Owner's Name information is required for every Marstons Mills MA 02648 12-27-16 page. City[Town Statei Zip Code Date of Inspection C. Checklist Check if the following have been done, You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? i ® ❑ Were all system componentsl, excluding the SAS, located on site? ® ❑ Were.the septic tank manholes uncovered, opened, and the interior of the tank inspected,for the condition of:the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 i5ins.doc•rev.6r1 a Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 or 17 Dec 29 2016 00:05 Jim The Inspector Man 5085349919 page 25 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 12-27-16 page. City/Town State _ Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and two chamber. Number of.durrent 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 ears usage 2014-56,000Gais g ( y g (gpd)) 2015-43,000Gals Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Dale Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(ypd) 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.Hoo•rev.6/16 jille 5 Official Inspectlon Form:Subsurface Sewage Disposal System•Page 7 of 17 i Dec 29 2016 00:05 Jim The Inspector Man 5085349919 j page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is require&for every Marstons Mills MA 02648 12-27-16 page. Cityfrown 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: 2008-2015 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El 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•rec.6f16 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 8 of 17 Dec 29 2016 00:05 Jim The Inspector Man 5085349919 page 27 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l� 1515 Race Lane Property Address Ken Tomasian j Owner Owner's Name information is required for every Marstons Mills MA 02648 12-27-16 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: 2004 - Permit#2004 -555 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): ' 11" 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. Precast H-10 Sludge depth: 2" 15ins.doc-rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Dec 29 2016 00:05 Jim The Inspector Man 5085349919 page 28 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . a 1515 Race Lane Property Address Ken Tomasian ' Owner Owner's Name information is Marstons Mills MA 02648 12-27-16 required for every _ page. CityTTown Slate Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" I Scum thickness 0" • - Distance from top of scum to top of outlet tee or baffle 811 Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt Sludge Judge 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 and cover's at 11" below grade. In and outlet tee's. No sign of leakage or over loading. i Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain); Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc rev.W8 Ttle 5 Offiolel Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Dec 29 2016 00:05 Jim The . Inspect,or Man 5085349919 page 29 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is Marstons Mills MA 02648 12-27-16 required for every page. Cityrrown Stale 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.): I 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 i Date of last pumping: Date ' Comments (condition of alarm and float switches, etc.): I `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 Dec 29 2016 00:05 Jim The Inspector Man 5085349919 page 30 y Commonwealth of Massachusetts q Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i 1515 Race Lane Property Address Ken Tomasian ' Owner Owners Name T,i information fo is every Marstons Mills ' r8 wired for eve MA 02648 12-27-16 page. Cityrrown Slate 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.): J D Box is 16"x16"-T-7" below grade w/cover at 8". Box is clean and solid wltwo line's out. No sign of over loading or solid carry over i i I i 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: j 15ins.aoc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage.Disposal System•Page 12 of 17 Dec 29 2016 00:06 Jim The Inspector Man 5085349919 page 31 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 12-27-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number_ ® leaching chambers number: 2 ` ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelalternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 500 Gal. dry well chamber's(13'x25x2'). Chamber's are 42" below grade w/cover at 10". Chamber's are clean and dry like new. I 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 15ina.Aoc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I w i Dec 29 2016 00:06 Jim The Inspector Man 5085349919 page 32 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 1515 Race Lane Property Address Ken Tomasian Owner. Owner's Name information is Marstons Mills MA 02648 12-2743 required for every page. CityrTown State Zip Code Date of inspection D. System Information (cont.) y ' -A= Comments (note condition of soil, signs of hydraulic failure, level of ponding, Condit nro 'vegetation, etc.): t. . I - I 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.): 4 t5ins.tloc rev.6/16 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 i I I Dec 29 2016 00:06 Jim The Inspector Man 5085349919 page 33 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian _ Owner --- ----- --. �_.-- Owner's Name information is Marstons Mills MA_ 02648 12-27-16 required for every --. 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 + N 13 - L' 9 3 t5ins.doc-rev,ell 3 Title 5 Official,nspection Form:subsurface Sewage Disposal System-Page 15 of 17 i i I .Dec 29 2016 00:06 Jim The Inspector Man 5085349919 page 34 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments r 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 12-27-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water i ❑ Check cellar ❑ Shallow wells 0 Estimated depth t 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_ 9-17-85 Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database- explain: i j You must describe how you established the high ground water elevation: T.H. on Design plan 9-17-85 no G.W. at 12'+. Bottom of leaching at 6' below grade. Bottom of leaching at 6'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.00c•rep.6/1e Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 { 71 1 K I Dec 29 2016 00:06 Jim The Inspector Man 5085349919. page 35 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner .Owner's Name information is required for every Marstons Mills MA 02648 12-27-16. 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 F ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i 15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i No. G r� ' r Fee &� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLatlon for Misposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System Xindividual Components Location Address or Lot No. 5 V3 P444CG (—AAJ-C Owner's Name,Address,and Tel.No. , / Assessor's Map/Parcel O M I1,E&jAt6wj T(DMAS`A Installer's Name,Address,and Tel. o.S o S_ V 72_8 91*7 Designer's Name,Address,and Tel.No. CA k�G C-N7CD�SL�'L.z�Si��"� W/A Type of Building: IV/�r Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures y� Design Flow(min.required) y/ gpd Design flow provided gpd 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) 5iAt- S c—:;7 f c_ -A tj y 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 Certificate of Compliance has been issued by this Board o Hea ,J Signed Date Application Approved by Date -ty^ Application Disapproved by U Date for the following reasons Permit No. 2- 6 " Date Issued i y No. � � Fee �4 r THE COMMONWEALTH OF MASSACHUSETTS iEntered in computer: PUBLIC HEALTH.DIVISION TOWN OR',BARNSTABLE, MASSACHUSETTS Yes RpPlication for Disposal-Opsirm Construction Hermit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. L�NC Owner's Name,Aadress,and Tel No. Assessor's Map/Parcel Q N( M 1,CNN�T�{ TAM/�5(Ad� r. Q&a4wut0000 Avo 14 A0AJI5 Installer's Name,Address,and Tel.'No.Se�,r_ t f T g"17 Designer's Name,Address,and Tel.No. MAWN/A Type of Building: / 1 Dwelling No.of Bedrooms iv I Lot Size sq.ft. Garbage Grinder( ) Other Type of Building PJ57S I C!z_j J T(AL-No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided N �� gpd j 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) J`'t�AL s[?5r tj �a _ 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 Certificate of " Compliance has been issued by this Board ofnHea .. Signed Date .•- Application Approved by Date 4 Application Disapproved by U Date - for the following reasons a Permit No. 2- il r (7 L( I Date Issued ---- =------------------------------------------------------------------------------------/------------------------------------------ _,; THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS r Certificate of Compliance rY - ._- . . THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by C a c W!n—C=�P.P 0, L.LC at 16 1 `�,��,yC- Al M - - has been constructed in accordance with with the provisions of Title 5 and the for Disposal System Construction Permit No. 0/ " V' {,dated Installer e�B�C,J �—j �('�' WC Designer M 1A , #bedrooms Lei Approved design flow A N /j`, gpd The issuance of this permit shall not be construed as a guarantee that the system will ction designed. Date 1D Ins ector 0S r --------------------------U----------------------------------------------------------------------------------------------------------- No. o _ ( Y Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -Misposal 6pstem Construction permit Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( ) System located at jRk-G1' LA-/Jg=—: M A4STfliVS If,,, and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Constru ion must be completed within three years of the date of this permit. Date ►Z � (�`/�.� Approved by �) r AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION 1SIS P�Q ckn SEWAGE#SOD N -_SSt VILLAGE—J2aQ= or-\ M 1 1- ASSESSOR'S MAP&LOTS 7-I'!J INSTALLER'S NAME&PHONE NO. RoSc M G Floc Tog-q 7?_ n- SEPTIC TANK CAPACITY O ~ ,LEACHING FACILITY: (type )ST OO qca i 'G�+o�,• (size) 3 X �S'x ADO.OF BEDROOMS_ 3 vBUILDER OR OWNER_ PERMITDATE: 10 -Zo -O L/ COMPLIANCE DATE: -2, - 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 3W feet of leaching facility) Feet Furnished by C1 ` 13` c2 - 9' Az= ar' A3- ay' gccK C g3 Ay -age Fron-1 y A,5 -33' (3 O s C�acc Lri http:Hissgl2/intranet/propdata/prebuilt.aspx?mappar=047141&seq=1 12/14/2016 Y' Town of Barnstable Barnstable Regulatory Services Department A"ffffl`qaC j II • HARNSTABLE. Public Health Division ATfD""AYp 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 8292 December 6, 2016—2nd Notice Albert Robustelli 1515 Race Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1515 Race Lane, Marstons Mills, MA was inspected on 10/13/2016 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Septic tank is leaking; Must seal or replace septic tank. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH l� omas McKean, R. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\1515 Race Lane Marstons Mills 2 notice-Copy.doc Town, of Barnstable Barnstable .~ Regulatory Services Department i a'caC j IUMSTAHM Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V c it V.S1'a�,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 8254 November 16, 2016 Albert G&Rita H Robustelli 96 Greenwood Avenue Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1515 Race Lane, Marstons Mills,MA was inspected on 10/13/2016 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE V(310 CMR 15.00) due to the following: • Septic tank is leaking; Must seal or replace septic tank. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline.period will result in future enforcement action. PER ORDER OF THE BO OF HEALTH L c ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\1515 Race Lane Marstons Mills.doc Town of Barnstable • E&MSTAELE, ';� ,b� Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA � ❑Discharge or ponding of effluent to the surface of the ground ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ' ❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) ' . OTHER le ' S �, �- I nn uSF Seal �� re? I"� ti C�n c� PP t art C.. Repair deadline: y e rn r S Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc i Oct 18 2016 22:19 Jim The Inspector Man 5085349919 page 36 g 3. Commonwealth of Massachusetts 39 Title "5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary' Assessments c 1515 Race Lane Property Address ' Ken Tomasian cr) Owner Owner's Name information is Marstons Mills MA 02648 10-13-16 required for every page. City/Town State Zip Code Date of Inspection CAI Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information / a���/� �• \` on the computer, ```�� OFt � ��o use only the tab 1. Inspector: .,`��``A'' key to move your o�� •. '•yG S cursor-do not James D.Sears 3 JAMES R,_ use the return Name of Inspector :- key. Capewide Enterprises, LLC Company Name X lZ�'�'� , .. .. 153 Commercial Street �ry,,,"'Iff INsp ��a`` Company Address Mashpee MA 02649 City/Town State Zip Code 50477-8877 S1623 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10-18-16 spector'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 a; 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 z at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. `x 15ins.doc•rev.6116 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 1 of 17 1 i Oct 18 2016 22:19 Jim The Inspector Man 5085349919 page 37 G l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1515 Race Lane _ Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 10-13-16 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) I Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments:. Conn Pass-Tank Leaking. The system is a 1000 Gal.Tank D Box and two Chambers. 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 z 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): i t5ins.doc•rev.6116 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 2 of 17 i Oct 18 2016 22:19 Jim The Inspector Man 5085349919 page 38 oMassachusetts Commonwealth f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 10-13-16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpslalarms.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 o I r 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): Tank leaking. ❑ 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): I 3 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 16.303(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 l5ins.doc•rev.6116 Title 5 Official Insaection Farm:Subsurface Sewage Disposal SVstem•Page 3 of 17 Oct 18 2016 22:19 Jim The Inspector Man 5085349919 page 39 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 151 S Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 10-13-16 page. Cityrrown 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 El ® 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 ❑ .Z Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in 031q=is less than 6"below invert or available volume is less than %day flow J-Ed etl/NG l5ins.dcc rev.6116 Tile 5 Ofd I Inspection Form:Subsurface Sewage VsposM System-Page 4 of 17 Oct 18 2016 22:20 Jim The Inspector Man 5085349919 page 40 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name informationIs requiredquintfor every Marstons Mills MA 02648 10-13-16 for page. Cityfrown State Zip Code Date of Inspectlon ! 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,] 0 ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10.000gpd. El ® The system fails. I have determined that one or more of the above failure criteria exist as described in 31 D 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 1 ❑ ❑ 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 i If you have answered"yes"to any question in Section E the system is considered a significant threat, . 4 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.cloc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Oct 18 2016 2220 Jim The Inspector Man 5085349919 page 41 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 10-13-16.. . page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two.week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part is at issue approximation of distance is'unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpdx#of bedrooms): 330 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Oct 18 2016 22:20 Jim The Inspector Man 5085349919 I page 42 Commonwealth of Massachusetts - Title 5 Official Inspection Form A Subsurface Sewage Disposal System Form= Not for Voluntary Assessments rf 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills - MA 02648 10-13-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and two chamber. i 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 2014-56,000Gais Water meter readings, if available(last 2 years usage(gpd)): 2015-43,000al's Detail: SUMP,pumP? ❑ Yes ® No NA Last date of.occupancy- i 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: 15ins.ddc•rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Oct 18 2016 22:20 Jim The Inspector Man 5085349919 page 43 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F 1515 Race Lane Property Address Ken Tomesian I Owner Owners Name information is required for every Marstons Mills MA . 02648 10-13-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): i General Information Pumping Records: Source of information: 2008 -2015 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system. ,- ❑ Single cesspool ❑ Overflow cesspool ❑ Privy . ❑ . Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ,t ❑ Other (describe): a 15ins.doc•rev.611E Title 5 Official Inspection Form:Subsurface Sewage Dlsposal System-Page 8 of 17 Oct 18 2016 22:21 Jim The Inspector Man 5085349919 page 44 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required For every Marstons Mills MA . 02648 10-13-16 page. City/Town Stale Zip Code Date of Inspection D. System Information (cons) Approximate age of all components, date installed (if known) and source of information: 2004.-Permit#2004 -555 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron Z 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan); 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. Precast H-10 2" Sludge depth: t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 17 I i Oct 18 2016 22:21 Jim The Inspector Man 5085349919 page 45 Commonwealth of Massachusetts Title 5 Official Inspection Form g Subsurface Sewage Disposal System Form- Not for Voluntary Assessments �<0 1515 Race Lane Property.Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 10-13-16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont,) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle . Tank Leaking i Scum thickness j Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? 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 and cover's at 11". in and outlet tee's. Tank leaking, level at T below cover. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: t 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.W15 - - Title 5 Official Inspection Form:Subsurface Sew•sge Disposal System Page 10 of 17 Oct 18 2Q16 22:21 Jim The Inspector Man 5085349919 page 46 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 10-13-16 page. Cityrrown State Zip Code Date of Inspection 3 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.): I '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 Oct 18 2016 2221 Jim The Inspector Man 5085349919 page 47 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required For every Marstons Mills MA 02648 10-13-16 page. City/town Stale'' Zip Code Dale 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.): D Box is 16"xl6"-3'-7" below grade w/cover at 8". Box is clean and solid w/two line's out. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order: i ❑ 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: I t5ins.doe-rev.6116 Title 5 Official Inspection Form:Subsurfa_e Sawage Disposal System-Page 12 of 17 �a Oct 18 2016 2221 Jim The Inspector Man 5085349919 page 48 Commonwealth of Massachusetts i Title 5 Official Inspection Form F Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 1515 Race Lane Property Address Ken Tomasian I Owner Owner's Name information is required for every Marstons Mills MA 02648 10-13-16 page. citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ; ❑_ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: i l Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is two 500 Gal. dry well chamber's (13x25x2). Chamber's are 42" below grade w/cover at 10". Chamber's are clean and dry like new. 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 I Materials of construction Indication of groundwater inflow ❑ Yes ❑ No I t5ins.doc-rev.6116 - Title 5 Official Inspection Form:Suosurtace Sewage Disposal System•Page 13 of 17- Oct 18 2016 22:21 Jim The Inspector Man 5085349919 page 49 Commonwealth of Massachusetts jigTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is Marstons Mills MA 02648 10-13-16 required for every page. Cityrrown Stale Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i Privy (locate on site plan): Materials of construction: Dimensions Depth of solids i Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I l E t5ins.doc•rev.6/16 Tlde 5 Official inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Oct 18 2016 22:21 Jim The Inspector Man 5085349919 page 50 Commonwealth of Massachusetts Ila Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name ation isrequired for every MarstonS Mills MA 02648 10-13-16 page. CitylTown 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 3 i { II' A -a =. c r -3 _ so, C- 3 = - y o 0 0 r t5ins.doc•rev.6116 Title 5 Official Inspection Pam:Subsurface Sewage Disposal System•Page 15 of 17 S • F Oct 18 2016 2221 Jim The Inspector Man 5085349919 page 51 �. Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 10-13-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells . /V0 12'+ Estimated depth t high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 9-17-85 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:, i t You must describe how you established the high ground water elevation: T.H.on Design plan 9-17-85 no G.W. at 12'+. Bottom of leaching at 6' below grade. Bottom of leaching at 6'above T.H. Depth. ;i „s 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 - - - s IL 3 Oct 18 2016 2222 Jim The. Inspector Man 5085349919 page 52 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1515 Race Lane Property Address Ken Tomasian Owner Owner's Name information is required for every Marstons Mills MA 02648 10-13-16 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 i a A i 15ins.doe-rev.6116 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 i -TOWN OF BARNSTABLE ` LOCATION 'j " mac=- LcknG SEWAGE # 0700�I -SSS" VILLAGE (00,1_54POS r— l 1S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. R-oSc r� G }�o� SAS- DES 3 SEPTIC TANK CAPACITY'teLo a LEACHING FACILITY: (typ qa c�arn3 - (size) 13 X 51S' X 7 NO.OF BEDROOMS__3_' BUILDER OR OWNER PERMITDATE: 10 -ZO - O�COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by CI = 13` CZ g .# Az - al ' A3 1 ay, �«K C 33 ay A R yF'Fron-1 .. , .. 3 yO AS = 33' � .BS = as O S �O�CC. Lrry TOWN OF BARNSTABLE LOCATION 1Sl5 Rac c- L.anc--- SEWAGE # 900 y SSS VILLAGE r0c%75i0r\5 frl, 1 15 ASSESSOR'S MAP & LOT 6 q7'I INSTALLER'S NAME&PHONE NO. ROSG 1--J G i K6s4 509-W)7- O&S 3 SEPTIC TANK CAPACITY \ 00 ,LEACHING FACILITY: (type? (size) /3 x o75 x 7— �NO. OF BEDROOMS 3 IUILDER OR OWNER Frank F—-J MQ2')Zk k PERMTIDATE: /O -20 - O y 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 - - pp 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 I _ CI = 13r C2 A7- 91 ' A3. ay, C 33 - ay �«K A A y Bq rod) 3 O As = 33 No. J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for aigpogal 6pgtem Conotruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. IS/a ®►e r 4-/.,) Owner's Name,Address and Tel.No. . In. rn"11s Fd'anK rilzpa.-tr,c.i't P 11 Assessor's Map/Parcel -7' r/ R Q C C (,AJ" Installer's Name,Address,and Tel.No. RaScr"1 a, i 4 oci Designer's Name,Address and Tel.No. 0i,BExcavcL-lia,,\ iy-rr-,%S-r-rry L&%J -parrcn Mr-Hcr- •�" Forr-s44oJ c InA " ®a46/z/ SobY,7 oes3l 143 v►'n r- 53 " Da 3 0p9 Type of Building: Dwelling No.of Bedrooms %3 Lot Size a3 i/I sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow Sao gallons per day. Calculated daily flow gallons. Plan Date 9' a G ^ n Number of sheets Revision Date Title Size of Septic Tank 100 R G3 Type of S.A.S. 1.2 5VI jj,, ._ Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 issued by this Board of Health., Signed Date 9" Application Approved by Date Application Disapproved f the following reasons Permit No. rd Gd S'S Date Issued t U—-240 ~O`- (� No. �� 1 ' .� - _ Fee / A THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH.DIVISION -TOWN OF BA14NSTABLE., MASSACHUSETTS Yes ZLpprication for Migozar *p.5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /•5 A C ZWJ O aer's Name Addr s and Tel.No. Assessor's Map/Parcel O q -7_ /C lst s- R a C c L K J. fyl j rj� 0,1,S !fir')Is Installer' Name,Address,and T_efl.No. �! �" 6r t Designer's Name,Address and Tel.No. R 8p,1iExcwva�'ic�,\ /yTcaJ-_rry LAJ Darmi-N /hcHcr .S• f ores-4-I-.1 c ,nA oaGyy sob y?-7 oGS3 q3v z , yr SSA . 0a33 2 7 8I SF�5o�9 Type of Building: Dwelling No.of Bedrooms 3 Lot Size a3/1 1 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date 2 G - 0 Number of sheets Revision Date Title 1 J Size of Septic Tank /000 9a Z06,1 ?ii°Type of S.A.S. � Y w Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 is d this Board of HeaJth. p Signed Date�Y 9 D y Application Approved by '' S. Date Application Disapproved for the following reasons Permit No. aG� ✓�S-r Date Issued u� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS _- (Certificate of (Compliance THIS IS TO CgRTIF-9,tPAt the On site Sewage Disposal System Constructed( )Repaired (�)Upgraded( ) Abandoned( ) irk Cau rn at I S �Ca C e G�P /V►, cM f ha&beef constructed in accordance U i L, with the provisions of Title 5 and the for Disposal System Construction Permit No. a' S S dated / d_G Installer Designer r\ XN The issuance of thi" ermtt 11 not be construed as a guarantee that the Sys em . ill fun, ton as de tied. Date J O . Inspector AA/' — �U�—— --=----------------=--=--- . . .. - No. Fee M)— THE COMMONWEALTH OF MASSACHUSETTS, PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS li5po5at *p5tem (Construction Permit Permission is,hereby gr4nted to Construe( )Repair( X�Jpgrade( )Abandon( ) System located at j 5 S c G-O'n e, 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. Provided:Construction must be completed within three years of the date of thi p rm1,2 it. r Date:_ G r2 d—U`� Approved by J Town of Barnstable 4.SHE T ~�w Regulatory Services Thomas F.Geiler,Director • naruvsrnBI � AMASS. �0 Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: �U ZS 10'`Y Designer: �,rr,�� GVl Installer: t- &x(ayn tick T' 0 ,Address-. . -go (, c9-A..�tu � ia b e c 'V—LaPp e ! 'aO WIct� M , 02537 fd�� +�ln��� G d),6q�} i On fro bey I0�� ( hn was issued a permit to install a (date) (uista ler) septic system at LAN PIbased on a design drawn by (address) ��Pi dated designer) T-certify that the septic system referenced above was installed substantially according to the design, which may include minor approved-changes such as lateral relocation of the distribution box and/or septic tank. — SyS a( Mo1/ ,� L o' L,A I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& lions. Plan revision or certified as-built by designer to follow. N OF,yyssq oo� DARREN cyN M. NEE (Insta er's ignatur �F �o � TE tR 4N17AR11a � !� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH -THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE.BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form (TOWN OF BARNSTABLE ICIQCR- f -C _ LOCATION SEWAGE # VILi.AGE M t S ASSESSOR'S MAP & LOT� � INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY )LEACHING FACILITY: (type) Y- •T �X�� (size) Uw NO.OF BEDROOMS IiUMDER OR OWNER rAA 1 'AZ 4�r l ck PERMTTDATE: 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 leachin�facility) ) Feet Furnished by .L n 'Of. W 1 do �. �0/G A 3 y - uk _0 ol a as a 3 r ► _ FAILED INSPECT10N -a 5 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION Ap RECEIVED )T :w - SEP 0 12004 �r TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1515 Race Lane Marstons Mills. MA 02648 4 > Owner's Name: Frank Fitzpatrick ; Owner's Address: ; tfs T• Date of Inspection: August 25, 2004 i Name of Inspector: (Please Print) James M Ford m Company Name: James M. Ford - Mailing Address: P.O. Box 49 ca m Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Nee Further Evaluation by the Local Approving Authority ✓ Fail Inspector's Signature: Date: August 28, 2004 The.system inspector shall subrri4 copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and.the system owner shall submit the report to the appropriate regional office of the DEP.. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1515 Race Lane Marston Mills. MA Owner: Frank Fitzpatrick Date of Inspection: August 25, 2004 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: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage.backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1515 Race Lane Marstons Mills. MA Owner: Frank Fitzpatrick Date of Inspection: August 25, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. T The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: i 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1515 Race Lane Marstons Mills. MA Owner: _ Frank Fitzpatrick Date of Inspection: August 25, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 1I of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1515 Race Lane Marston Mills. MA Owner: Frank Fitzpatrick Date of Inspection: August 25, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ _ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1515 Race Lane Marstons Mills, MA Owner: Frank Fitzpatrick Date of Inspection: August 25, 2004 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): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): and 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 occupancyiuse: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped 2 years ago-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box, soil absorption system Single cesspool. Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Unknown Were sewage odors detected when arriving at the site(yes or no): No 6 F Page 7 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1515 Race Lane Marstons Mills, MA Owner: Frank Fitzpatrick Date of Inspection: August 25, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 10" Material of construction: ✓ 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 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be an signs gns of leakage GREASE TRAP: None (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 Page 8 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1515 Race Lane Marstons Mills, MA Owner: Frank Fitzpatrick Date of Inspection: August 25, 2004 TIGHT or HOLDING TANK: None (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: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: -- 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.): The D-box was broken down structurally and dirt was caving in. The D-box needs to be replaced. PUMP CHAMBER: None (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 Page 9 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1515 Race Lane Marstons Mills, XM Owner: Frank Fitzpatrick Date of Inspection: August 25 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 Qal.) leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The leach pit was full Liquid was up to the bottom of the inlet pipe The leach pit was in hydraulic failure. The bottom to zrade was 8.5'. CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (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 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1515 Race Lane Marstons Mills. MA Owner: Frank Fitzpatrick Date of Inspection: August 25, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. y O O a(p ly e 3 10 Page 11 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1515 Race Lane Marstons Mills, MA Owner: Frank Fitzpatrick Date of Inspection: August 25, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 35 +/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic maps and water contours maps, the maps were showing approximately 35'+/-to ground water at this site. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 1 L0 _P-ATION mow SEWAGE PERMIT Nil. VILLAGE 4 5 01V5 INSTA LLER'S NA E i ADDRESS S aka ro • , Sd , BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ' � �� l '��' � � j; a V� y � +� a� . � � w�` oq7—) ql T NWEALTH OF MASS SETTS 6/- BOARD OF HEALTH - .C�1/ 1• ..................OF............`. *' '. Appltration for UhiposFal Works .Tonstrnrttnn runtit Application is hereby made for f Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at ..�, L ........ . ..... .... ....---- ------------ Address - � ...- -- • Owner Address W Installer Address d Type of Building Size Lot�A.11Z_::�)......Sq. feet Dwelling No. of Bedrooms.......... ............................Expansion Attic Garbage Grinder '�a Other—Type of Building ...._..__._. No. of persons............................ Showers O ( ) Cafeteria O Otherfixtures --------------------------------------------------------••-------------------------------------------------- ----------•-•----------------- W Design Flow.........;5 ..........................gallons per person per day. Total-daily flow----___.......q ...........--_-._.gallons WSeptic Tank—Liquid capacitA� -_gallons Length-."� . Width.•�'.s� ... Diameter................ Depth�.....`.J.... x Disposal Trench—N o. .................... Width.....f....._...... Total Length.......i.........._ Total leaching area.....}..............sq. ft. Seepage Pit No_____ ______________ Diameter.'.-]-'-•.-�...... Depth below inlet__ .o`i__ Total leaching area... ... _....sfHt!GPD Z Other Distribution box ( ) Dosin tank ( ) _ '-' Percolation Test Results Performed by...__.�_�._..!.!...-�?�� �/.� _�I C,Date.. ..............................- a — Test Pit No. 1.._4.........minutes per inch Depth of Test Pit.... g........_ Depth to ground water.' Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil.___-Q K_ �--'-----------�C?t�-- ------------ � U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -------------------------------•--•---------------------------------•••------------•.........------------.....-------•-----------------•---------------------•------.................................. Agreement: The undersigned agrees to install the aforede ibed Individual Sewage Disposal System in accordance with the provisions of iITLL, 5 of the State Sanitary d e undersigned further agrees not to place the system in operation until a Certificate of Compliance ha d by . e boarre iealth. Sine ----- ......................................................... Date Application Approved By..........�I. _ ..-- z �--� rs ---...--••-- - ................. Date Application Disapproved for the f ollowi g reasons:............................................................................................................... ....---•----------------•--...---•-••---............------....---•--------•--•----------•--------•------.._...--------------------....---•------ ------------------------------------------------------•- Date j Permit No...........E -.I -��... Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................OF... Appliration for UiopooFal Works Tonotrtirtion Vamit Application is hereby made for a Permit to Construct Repair ( ) an Individual Sewage Disposal Systemat.....� ...... --------------------•-•-•. ---•-------•------ -•-•- --- o " __ * 4f1.i!n AddF � p 1 . u r LoNo� A e - ess Owner Address W Installer Address Type of Building Size Lot__.___...�.�_��..:..........Sq. feet Dwelling—No. of Bedrooms........... .................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of ersons._.__..__.__._.__.._.._..__. Showers - ----------------------------------P ( ) Cafeteria ( ) 04 Other fixtures --------•------ W Design Flow______.__.r ..............................gallons per person per day. Total daily flow.............. -- ___.._______.__. gallons WSeptic Tank—Liquid capacityi: -->_gallons Length�_:__�___. Width.`�.�. -_ ``. Diameter________________ Depth_ :_:___._.. x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area......a.............sq. ft. Seepage Pit No......1-------------- Diameter.__ ____ Depth below inlet_._ ; Total leaching area_____- _____sq:- Z Other Distribution box ( ) Dosing°Rank_( - '-' Percolation Test Results Performed by._ r: ____ � t =� ki6. _ Date_._��_ J � Test Pit No. L___d»:........minutes per inch Depth of Test Pit....._ '______. Depth to ground water---- -------1 ='. raq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x D Description of Soil-•--•C -1 ..........?.... ....;-=--------------------------•-___-----------------------------•------ ...------..... vW ---____._ '�Et�as- ! �� •' -_'. - ` .......................................... -- ----- ----------'---------- �-----•---------------•------- U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ -•--------------------••----•------.....---•---------------•---•--••------••--••--••---------_--____._--••---•-•---•••--•••••-----•-••--••-•••••••••-•--•••--••••-••••-••-•-•-•••-••.._....----------•-. Agreement: The undersigned agrees to install the aforedes ibed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary dew e tmdersig ed further agrees not to place the system in operation until a Certificate of Compliance has�8 by t e board oS ealth. Signed ----..... ----•----------•--- .......................... W� ~ro Date Application Approved By........ ._ -_! -_ !'' --•--._.....-•-------•..._.._•-•-----------------• ............. 1-- -`-" ----------- Date Application Disapproved for the f ollowi reasons:--------•------•-•------------------•-------------------------------------------•-----_..--•••-•-••----......... ---------------------------•-•----....-------------•-•-------••-•---------...---•-•••--------•------......._..•--•••-•--------••-•••--------••-•-•••-••----••-•---••-••••------•-•••-•---•-••------_-•--- Date .. Issued_ Permit No.---...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............�,�.UJ�...............OF.......".: .`" �;%.:. "....... ...... (IntifirFa#le of Toutplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by.................................................................................................................................................................................................... ...* i nn Installer 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 No.-"" '__-_` _:'._f_(.{ _.____. dated___!=,%Rjt ,� - 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 -�, ..........................................OF....................... :...___..._......._._....____.._........ Diops al Works TonotrurflottYprrutit Permission is'hereby granted•••--.----••-••-••--•-••••---- to Construct (��or Repair ( ) an Indiv3•�al Sewa Disposal System at No.__ " .... {._ . ._. � .,.---_f! .... . ._.. Street as shown on the application for Disposal Works Construction Permit NcK? 'df.'_ Dated._�' -_ _ � DATE. Board of Health C .......... J) F_Qmm 1255 HOBBS WARREN, INC., PUBLISHERS GENERA 4, NO T,E'S 44 k Ekj-J14TI0N5 SHOWN ARE - I �Sug�ot� i ' 0 � Z. P/TCN Ak 4, LINES A MINIMUM OF '/a"FT. (2) Q C O OO O (3 (10 ZIN4 ESS OTHERWISE SPECIFIED • \ \ �� 3. ALL 10/PE5 TO AND IN THE S YSTEM SHA4,4, - + J G (D (D O �D O (1) (D BE CAsr IRON OR SCHEDU,CE 40 PVC. -TIC (D O © O (3 (D 4 A� .L sE T,4N�4`S, O/STRlBUT/ON BOXES, 7 AND 4 EACN11V6 P/T5 S g441, BE DES/CNEP o. _ O O O O FOR H zO &HEE.C. 4 0,4OING S WHEAl G , _ h sn�� r. = O UNPh R PAVING. (D O © O CD 0 S. REMOVE ,4�,�, UNSU/TABI,E ,HATER/A4, _---- _ + BENEAT/-/ THE INVERT E4, YATION,5 O OF THE DIFFUSORS FOR A D/STANCE OF 2011 _lO SANITARY TEE j: �j i O O O O O _ ( Q O O O rs1 /0 AND BACKFII-k WITH CkA Y-FREE q 2�4 :j `U SAND AND GRAVEL 1-44VIN6 A PERCO4ATION TYP/G'Q�(., oisTR�BUTionr BOX RATE OF Z MINUTES PER /NCH OR LESS. ----- - _ _-- TYPICAL ,GEAC'N/�I/G P/T 6. OF HEA�G,THMUST / ti.�, �:�.T .. _ -, ��._�►e t-�- 2 r� NO T TO ,5C4/.E ,� - NOTE hiSTR/BUTION BOX AW L)C)O GAS.. -r NOT TD SCAGE BE NOTfF/E� WHEN THE SYSTEiLf/S ME,dR OBSERW T/ON PITS REINFOf�CED SEPTIC TANK BY T yp/GAS /��,, ���, SEPTIC TANK COMP�C,Z ION ANO PR/OFf TO BACffF/�,L/NG. PERCO.LA T/ON iPATE _ � ►Jt�►J/i+-jam AMEi�'/CAN P�t'EC.4S T <7R EQ UA�, 7. UN�,ESS OTHERWISE NOTED,A�,�, SYSTEM NOT TO 5C,44 E COMRONENTS SR,44,1- BE /NST-441,EO /N GAB SE'RV54 TIONS B Y: Co,.I._.( No TE 7,4NA S REI N FORCEP T,14 '00GHO U T 4000R.04NCE" W I TN T/Tk E .Y OF THE STATE �.i-LF- BOARD OF HE,4,C.TH W17-H WITH Z4, %z SANITARY CODE ANO ANY 4,0CA4. RLJ4,E3 ENGINEER ARROW ENGINEERING INC ,, L Z PPZ P STEED, 1?00,' /N TOP� BOTTOM. !NH/CH •ff,4 Y 4PP1,Y. G,4 TE- - 1 7 r� CONCRETE /S OOO f'S f TES T ,VOrC ACC,E55 MANI-/D,LES TO S'EOT/C TANK A NO L EACH/IVC7 P/TS TO 3,6 3VI,LT 61P TD I ' C��,r�w' F/N/SH G,eAD,E. FfN/St/ GRADE --FINISH GRADE OVER TANK F/N�H GRADE F/N15 H O RA D,E O V,E,Q E�C.EV r : j E� EV : -t.'��s E EV Q B4X L EACNING F'lT fNV=q7,.o� INY�7+ _ _ moon o0 ___ _ cD O O o INv== ?f Lo /oo o G.4�,. //V ._� `!' ti"�/ST 80X Yf po° oo Cc 0 0 0 ®00l "�oX� o!" 3/4 / REINFORCE© (TO r�£ -E�F,� ° o n O �gC �"1 C2u51 ,E9 STONE i CONCETE (IJ O U O () o coo STAB,CEi o a l(r) O O O m do` SEPTIC TANK 8i [tDO ® O (2) _ ('TO BE .LEVEZ C ST494r N � ,1 ,EACHING /--,'T TO BE 4 E'VEL I-,c 5TA,63L-E) M ,�. cp2 TYP/CAS.. 5EWAGE 5V5T,EM PQOFILE NOT TO SCALE 4UP SECTION FA CEO(, ko r _ ADDRESS AJr , `' ` ZONING D/.STRICT F400P 9,4.ZARD .Z'ON'E �E"S/GIv CR/TEI�r/A �-vr�7-,L OC,d T10N OF f��l/EZ,G//YG NUMBER OF BEDROOMS EX/sr CONTOUR --- G6e 6EWQ6EPI5100S.44 SYSTEM PERSONS PER BEDROOM PROPOSED CONTOUR — ----- --- - GA�,,LONS PER PERSON PERDAY ~EXIST SPOT E�,EVATION 6-D �, 9, �C EACN/NG REQC///�E D �O GFGPROPQSEO SPOT EEC,EVAT/ON 8 t0 `.� ,�-�' - � ` 'i:. Mt�• `�"T`�� MILL) M A. LEACI-IING PR0V1PEO 4Z?;:vqo PERCOLATION TEST m .4PPiL/C,4NT ENGINFER NO O/SPOSA,- OBSERVATION PIT J 14-VIP 7 L 4RR0ff ENG1NEE91A%L1NC. F.44*04YTY HWY, �S'El�YER oFS/G�c/ ! 1 -'A e-"If-V I rya. E. F.44MDUTH AM.02536 SOLE : = 0� �- Tz -4 n K �� - -�77 C'YP ,Rav r..r��� SCAG E DATE SHEE T BOTTOM = Tr - 42 - to l4i19fi �� ` _ � - ..� fi � AS NOTED TO TA OR,4WN BY: CHECKED eY AP,4, e Y: Rk,4N NO. ,eC'vr SQ7; 5/p NOTES: ASSESSORS MAP : 4-, TEST HOLE LOGS W.0411,11 PARCEL : 141 -� 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH Z 5 1� N' FLOOD ZONE: SOIL EVALUATOR :I I. WI �� S, � THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF � NON C�A�O WITNESS : pT 1 ltST BOARD OF HEALTH REGULATIONS. LA r RACE : & t REFERENCE: ullP DATE : 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES � PERCOLATION RATE : 2"^'" I111.N SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO Pd INSTALLATION. a C�ltSS z S o IL,5 [: rw70 - � y TH- 1 _ IoS iA TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION LDA M.1� ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE c ® e I SN-tv ID` Oil,- 1 DETERMINATION. 51 ,07.E v Q �A � I��S/ •) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS SPECIFIED OTHERWISE) L O CA T I ON rJ T S MAP 3�" J5 ZZ THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A C S) GARBAGE DISPOSAL. C S '� '� b) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) 2.Sy'/, C ;�� r�7 MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON l A BASE OF 6"OF CRUSHED STONE. °7,14 _ _ 8) o owl ?pVA�w W/10 150 OF- PRof. L6tcfflA)q . MILL RA CE R fA D SEPT I C SYSTEM DESIGN ��i� w n�-_lellte�1511'�F_P_ �- b6At#1 A14 - _ FLOW ESTIMATE A ' g7-77 r, - - BEDROOMS AT IID GAL/DAY/BEDROOM - ?J3� GAL/DAY SEPTIC TANK / ')�;�GAL. DAY x 2 DAYS - � GAL / j oo Gallo✓) USE GUG GALLON SEPT I C TANK - EK?3 RA))J 2EPL-xrZ w/ i �� S E_P n c TA-A> r G F fir LE►9, C�AMA.0 SOIL ABSORPTION SYSTEM EL `1 C.Ght(,� «F,+MQ�Ar-j �, ► tiN �' ;n,,7c CN 11Z1._ �t��f;s r25I-Y- t3��� k2 C0 CC ) l o. 1l z. o mug LEA S1Gt AREA: ZS Zt' l3 i. kZ x _ _ PIT, BOTTOM AREA: Z� k 13 x 0� 7�1 = �doTE 7) 1 +o 353 Gn-0 SEPTIC SYSTEM SECTION > 33oGPo �� � N II � _ ✓, SDI= = EL �10 `►I RI Q — - - -- Z C vEYr g Ttr. — ,• �-1 AILI 6 n Wllhl t'o D� IrI�Sy ^ 9 �MIK z ► ►3 zw� I I0 lhsf�ll �¢ ���� �3b ',Iy4X �c . a >7_1 1 w � S r w 1 15 T - m mw� I ,2$ 8arf 10(a,7Z Z"-3/ e e n2 s` I (- S�anc W o ' `� /Qc,97 UOU GAL D-BOX w - I �-- �D 5,�7 U;el�t1-�CSf U o N SEPTIC TANK V1 "� w 11� ��/✓ kit/•clrlcSS) N 3�¢' lip I�vble cr— I o , o v,� 3 waSGred S1 e J � '--- Z S 'L x Q 1 I w ',HOF9,SIP �bTT�•vI of 7�Si—H�� 9���y RRE P C ::11 SITE AND SEWAGE PLAN f 00'06 0. 1 140 - G STEa0Q LOCAT I ON : f cle LA"\/ SgN�rAR1�N // MA-4STOAIS �/I1!-�h /Vb� '%�ibl` 11PREPARED . FOR P A O P DARREN M. MEYER, R.S. SCALE : z 43 VINE STREET DATE : 9 �-OY z DUXBURY, MA 02332 J U Z W DATE HEALTH AGENT (781) 585-0293 Z