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Home My WebLink About0037 RASPBERRY LANE - Health 37 RASPBERRYi116A�,, MARSTONS MILLS A= 10�0.8.1_.. . r TOWN OF BARNSTABLE LOCATION��j1 RA5P LA5R&Y La SEWAGE# �tQ -33C? VILLAGE M(LL5 ASSESSOR'S MAP&PARCEL i®' INSTALLER'S.NAME&PHONE NO(2 ff w'LTX GnmuzzSA00 1477©SE77 SEPTIC TANK CAPACITY eAA ,LaM s LEACHING FACILITY:(type)►) 500 cy4L Q4N8%(size) 2.5 'X O?, NO.OF BEDROOMS e OWNERAayaw PERMIT DATE: 1 v 30-,Z0 L COMPLIANCE DATE: Separation Distance Between the: Maximum'Adjusted Groundwater Table to the Bottom of Leaching Facility K Feet IA Private Water Supply Well and Leaching Facility(If any wells exist on VIA site or within 200 feet of leac 1� A hing facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300.feet of leaching facility) ' Feet FURNISHED BY (2APE s-0C &l"r4WAISeS h- 6 - Ag•l A - 2o. 8' A •3 ?-51A A.q Q�l . 31•s o ° 3 2V.3' q o z No. gat& Fee C THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9ppliCation for ]Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(N Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 31 RkShp Y lANE Owner's Name,Addrc® esanT eN A%ODREW L fd.v cA Assessor's Map/Parcel �, + 3-1 R4!!�FA�. Ld'iA5 K4RS7005 AV LLS Installer's Name,Address,and Tel.No. 5709`f-r7 —V277 Designer's c� Name,Address and Tel.N-9. Pl®6 '�'LPZI$L�$�iZF�t� LGtI�/ C �fi. 4RtiLl ol`D K4Sa t �. — S'P (�-l�s P '0 LE-19 ROSc C.41 14 Sza�sS �iG.C� Type of Building: It Dwelling No.of Bedrooms Lot Size IC� — sq.ft. Garbage Grinder( ) Other Type of Building P—ES[DWTI* , No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) e'Z ® gpd Design flow provided 35 :3 gpd Plan Date Number of sheets Revision Date Title 3:11R,46p e g" `'A-lyE� wiZ5'Z?os k tL s Size of Septic Tank I LO®O GW4� oAA Type of S.A.S.(A 500 64{, G4"gems Description of Soil Nature of Repairs or Alterations(Answer when applicable) USE EW S—r( 11600 ,� NE� b�-�C)� �!� �� aS�O C.'1►'�.C.Lr3QJ L�.�(6.1� ��C (111 `�" GTE 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 of Heal Signed Date 3 a LneZ.OL5 Application Approved by �, Date 7 Application Disapproved by U Date for the following reasons PermitNo..20 1 Date Issued4�� -r No. Q 4_3 l Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplication for`Misposal 6pstem (Construction Permit b Application for a Permit to Construct( ) Repair( f Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. YANE Owner's Name,Address,and Tel.No. 3� RksPt rM M: AWDRG-W Coc.OV_A f Ba�vA Gv�ttpUJ Assessor's Map/Parcel O U g ` ' 31 RAS? L ksje (v AD-1701U5 M f"S Installer's Name,Address,and Tel.No. 5'08= `r7 S$77 Designer's Name,Address and Tel No. l�p�u�tOG �Nck'►2�S M•ISef�P62�' ,•'! ��n/ �'. H�r4RtLt ON RCS. i it 9 LzDA R056 (,A/ MAPSTDOS M14" Type of Building: t Dwelling No.of Bedrooms Lot Size 10 15_7 T sq.ft. Garbage Grinder( ) Other Type of Building kiK No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) A a.O" _ gpd Design flow provided �� gpd Plan Date Number of sheets Revision Date Title j� n, - Q. 4-AtJ6 kAQS"WwS k/[.0 S Size of Septic Tank 11000 CI&A.A9A Type of S.A.S.Gal 500 Etc. (::+t"&S txS Description of Soil Nature of Repairs or Alterations(Answer when applicable) USo* EWSTroCr ljoaa 6v_k FJ 556rCG 94A 70 n►6w h- 690 S y0 c- XC_L_&kj L IB c40c�_ rj.m-( 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 of Health. 1 Signed /~1�' _ Date 17"3o^A0n? Application Approved by � Date (.] `f Application Disapproved by / Date for the following reasons - Permit No.;)Q Date Issued '3d''t �' _• THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that thee On-site Sewage Disp2P, al system Constructed( ) Repaired(X Upgraded( ) Abandoned( )by CA p�'tU10& Pi(nj9tAt ICET IM at 37 A*586�c! L..a4,V&- Mgt has been constructed in accordance i t , with the provisions of Title 5 and the for Disposal System Construction Permit No. OU� 231 dated Installer l.ov&-tx b6 &U7tW- 1W6C /A60 Designer #bedrooms _ r� Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will funct�ign as esigned, Date Inspector -------------- No. a� 3 / Fee /&ob THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstent Construction i3erutit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at ?s, S/� � IQ_ (.J�r�j� J�'// S"7?`K)5 M 1 l.,Ls i M and as described in the above Application for Disposal System Construction*Permit. Tle'applicant recognized his/her duty to comply with t Title 5 and the following local provisions or special conditions:• ,, z Provided:Construction must be completed within three years of the date of this permit 1 Date Approved by l Town of Barnstable Regulatory Services Richard V. Scali,Interim Director BAR'SMI MASS. g Public Health Division 039. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 6 �� Sewage Permit# ad 12^ a 31 Assessor's Map\Parcel /0 Z Designer: Installer: 1 II 6-J C' l.It Address: Led-0- Address: L73 VVA - m On T-3 0 -4 O(-%- was issued a permit to install a (date) (installer) septic system at '7 wy L 41�� based on a design drawn by (address) & . HA_r j, dated Z 61 _'V(/L Z 491 (designer) I 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. Strip out (if required) was inspected and the soils were found satisfactory. 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 & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in co liance with the terms of the I\A approval letters (if applicable) 4��4F 1GL Installer's Signat HAPAINGTON No.1070 (Design is ign ure) (Affix Desi I re) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF `COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH'THIS FORM- AND AS= BUILT-CARD ARK RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. _w._ .. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable P# Department of Regulatory Services a' a Public Health Division Date �ArED MKS A�� 200 Main Street,Hyannis MA 02601 '^ / �: Date Scheduled- ! hs" 1� ' Time Fee Pd. Soil Suitability "Assessment for S e Disposal Performed By: tPr1n �. 0Pre.'t1g i-t/r7� •S , Witnessed By: LOCATION&.GENERAL INFORMATION Location Address Owner's Name 31 �s?n-�-r" C-e��e ANOPMW cOLX-LLA Address 31 RA_S P peTCjLy L-N. i 4CX7C-W 10- t�JTG L&W06- Assessor's Map/Parcel: - l (� ®� Engineer's Name GLQJ HAIRM-1 Nt tJ NEW CONSTRUCTION REPAIR — Telephone# Land Use I(.�I.dB.vt�l`0.X 96 Slopes 1 0 P ( ) Surface Stones /(� Distances from: Open Water Body ;;,-Z Possible Wet Area 7 z,0 ft Drinking Water Well ft Drainage Way i ft Property Line �S ft Other ft SKETCH:(Street name,dimensions of lo[,exact locations of test holes&pert tests,locate wetlands i'n proximity to holes) -- -- 047 RASPBERRY LANE �... tom Tj I I ' C.S.FNo B.M. I 100. Q'T.H. #1 LPFts9' A 97.30' :I a:.:... + 103.02' Z 1 T.H. #2 ��- } I g . ; 87 W I o I 1102.8W 101.27' Ch LL - in to LLJ �- , _ o Ideck IIIIII %�G,to 16 m g rM W NG:d o R tl I e I V 98.82'Q I Of I � ' r LOT 61 I AREA=1 0,575±SF - 100.00' I 96.26' V5 RASPBERBRpY LANE F Parent material(geologic) eV P AIA-d or, Depth to Bedrock ? -To Depth to Oroundwater. Standing Water in Hole: �� .. . Weeping from Pit Face Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONAL•HIGH WATER TABLE Method Used: Sd, E-Y'oV/ Depth Observed standing in obs.hole: In, Depth to soll mottles: In.' Depth to weeping from side of obs.hole: in, Groundwater Adjustment tt. Index Well-# Reading Datc: Index Well level Adl.thetor— Adj.OroundwaterLevel,,,e, PERCOLATION TEST date 2d f7 _Xlmu,fMPI Observation Hole# Time at 9" _ Depth of Pere ®� Time at 6" Start Pre-soak Time® Time(91)•66') End Pro-soak y�Z Rate Min./Inch Z Site Suitability Assessment: Site Passed _ Sitr Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-------_— ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICU'ERCFORM.DOC J DEEP.OBSERVATION HOLE LOG Hole# — Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency. Fo-ilz GZ DEEP OBSERVATION HOLE LOG Hole# Z- Depth from Soil Horizon, Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. -Consisten LS v y4eYjhU 7- 3Y 6 tiv r G Z- /0--L fed ,1 V y •macZa 4AL,'9 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. ConslatenoL DEEP OBSERVATION HOLE LOG Hole# Depth from Sol[Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,SSot►es;Boulders, Consistency. Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes r/__ Within 500 year boundary No= Yes Within 100 year flood boundary No.-,— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? . e Crti._ fiicatiou I certify that on 1 a I NT (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysts was performed by me consistent with j the required tr in ,ex Datepertise a Brie a described in 4 10 CMR 15.017. / • Signatur . Q:131EF nC%PBRCFORM.DOC t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 0 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: �I �I key to move your , cursor-do not Richard T. Johnson use the return Name of Inspector key. D&J Environmental Services Company Name P.O.Box 764 Company Address Buzzards Bay MA 02532 City/Town State Zip Code 508-735-8740 S113545 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: j ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluatio the Local Approving Authority 11/30/13 I ector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Fo urr Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3113 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r( 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 . page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I ' Commonwealth of Massachusetts FTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Raspberry Lane Property Address Allison Lahey Owner owners Name information is required for every Marstons Mills MA 02648 11/30/13 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220GPD t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I ' Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents. 2 II Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: PresentlyDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ..'�` 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is Marstons Mills MA 02648 11/30/13 required for every page. Citylrown 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: 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. ® Other(describe): septic tank, D box, leaching pit t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 ` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1977 BOH records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): joints structurally sound, no signs of leakage. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins-3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 16" Y Scum thickness Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 9" How were dimensions determined? Field measure/MFG Specs. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Sanitary tee in good condition, tank structurally sound, no evidence of leakage. 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 l5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is Marstons Mills MA 02648 11/30/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Raspberry Lane Property Address Allison Lahey Owner Owners Name information is Marstons Mills MA 02648 11/30/13 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box level, structurally sound, no evidence of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): no signs of hydraulic failure, no damp soil, normal vegetation. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I ' Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Raspberry Lane l — Property Address Allison Lahey Owner Owners Name information is required for every Marstons Mills MA 02648 11/30/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'y< 37 Raspberry Lane P �Y Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 page. Clty/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 - - - 'j MOAl i.JRrer�! 79 itil �5JCOa17" Z1(yt{ A2 Or 1„4 Ott g6 19 tip° it 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r ! Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 12+feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1977 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Obtained from site observation, visual elevation, review of plans on file at BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 37 Raspberry Lane Property Address Allison Lahey Owner Owner's Name information is required for every Marstons Mills MA 02648 11/30/13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 11 1 � 1 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r d DEPARTMENT OF ENVIRONMENTAL PROTECTION ye TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION pia s� Property Address: 37 Raspberry Lane Marstons Mills,MA Owner's Name: Edward Quinn 1 Owner's Address: 37 Raspberry Lane,Marstons Mills,MA - ;m Date of Inspection: 01/11/07 _ Name of Inspector: (please print) Ron Burlingame1 -= Company Name: Ron Burlingame - Mailing Address: 58 Oak Street ' West Barnstable,MA 02668 iw Telephone Number: 508420-2050 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: i X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: a ti Date: 01 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. r Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR 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: Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 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. Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for Al inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X 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.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well - 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition Of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 Number of current residents: 1 Does residence have a garbage grinder(yes or no):No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use: (yes or no): No Water meter readings,if available past 2 years usage(gpd)): 2_00S Z006 Sump pump(yes or no):No ZZi DOova 1� 060�a.Q, Last date of occupancy: Current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgtetc.): Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A 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 X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool —ivy _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: 1978 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 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: X (locate on site plan) Depth below grade: l' Material of construction: X concrete— metal fiberglass_polyethylene other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: 1000 gallon Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 6" Distance from top of scum to top of outlet tee or bale: Distance from bottom of scum to bottom of outlet tee or baffle: 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.): Plastic tees were present. The liquid level was even with the outlet invert. GREASE TRAP:_(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 baffie: 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 bale condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 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: Qallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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-Bog was level. There were no signs of solids. PUMP CHAMBER: None (locate on site plan) Pumps in working order Ores or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type 1000 (0• 1 leaching pits,number: 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 f ,level of ponding,damp soil,condition of vegetation, etc.): 1000 a 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 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. ® p�N (,VRTQ.fZ (/l( �p�l' lZiCsf{ R-9-A 2 a F 14 o Q 5-E �i I g O , op 96 (Y s8 r Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 12 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: 1477 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Sub J 01 L- C 2fl�6G to , i No.. a�...... �� .. Fus...... ....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �,t/ .....................................OF........ � App ira#ion for Mipo al arkii Tiamitru.rtiatt 1hrutit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: L ation-Address or Lot No. J�' `' ...... .el� t1�',�,' �-A¢------..d eZ � -----1444A ....................... Owner Address 4w 4 Installer Address Type of Building Size Lot............................ q. t U Dwelling No. of Bedrooms...._.....A................ S g— .............Expansion Attic (�� Garbage Grinder Gj aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) � Other fixtures .----•--------•----------------•-----------------------•------•-•--•-------------------.._._._._..---•---•-•----•---------......................------ W Design Flow..1�...............................gallons per person per day. Total daily flow.......... WSeptic Tank—Liquid capacity/O gallons Length-__94.... Width.... Diameter________________ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------/---------- Diameter.../0------•-•- Depth below}inlet.-_. Total leaching area......c KKZ.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) O/p— /'"' ;t'7?- '"' Percolation Test Results Performed by.._ L�,4'� _.__ s�il� s'�. ... Date...l9/24,0Y.............. MTest Pit No. 1...;.�.....minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �` O Description of Soil -�--p �` ar"'.n_..1.----- ...-._ ...........2 -�--�----�`�-----.. ---- W =/ - f• Rl.rr� _ �he:G. -�9_- ------------------------•------------------------------------------------------•------------ ------------------------------------------------------------------------------------------------•--------------------------- ------------------------------------------------------------------...---- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual e Disposal System in accordance with the provisions of iI'i ITE 5 of the State Sanitary Code he unde ned fu r agrees not to place the system in operation until a Certificate of Compliance has bee ' s e rd o al Sig ed ...........D ��e... at Application Approved By...... .... ......f X-_.,2_-k.- .7.. Date Application Disapproved for the following reasons--------------------------------•------------------------------------------------............................. ••----.._._..-••---........•--•-•--------------------------------•-••-•-------......__......------..........-•-----•--••-•••-----------•----•----•--------•------•--------••--------Date-----•---•---- ..,� 7f PermitNo................. ------------------•------. Issued._..��. ----------------------------------...... Date A J� No.. .tD�l...... Fss.......�1(..::.:......_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH "..-... oF...-..... Appli ration for Disposal Works Tonstrnriiun Prrutit Application is hereby made for a Permit to Construct ()� or Repair ( ) an Individual Sewage Disposal System at: � • '444 ....... ......�1,�.e3�'"" ..._.. A A,�---------•-•------------............ Locati n-Ad ress r Lot No. ..... ...... - . e ........ . e rr�.�!, '. - ---------------------- may' caner Address iCr<i/ �fir' -•---- ..... •............... ---_____--------..._ --------- . Installer Address Type of Building Size Lot............................Sq. fee V Dwelling No. of Bedrooms.__.___.___ ___________________Ex Expansion Attic Garbage Grinder a g— P (/ .. aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures .....................-............................-- -----•-- ------------------•----•----•••-- -------••---------.......---• Design Flow___ __._gallons per person per-day. Total daily flow.............0 ...........gallons. WSeptic Tank—Liquid'capacity_ 4Wtallons Length-----Qr4_._ Width..... __.f!SQ Diameter________________ Depth................ Disposal Trench—No............_________ Width_ Total Length.................... Total leaching area__,_...............Sq. ft. Seepage Pit No........ -_ Diameter._../IV-- __ 'Depth below inlet.... �... Total leaching area.:_- t�l3r^,l__sq. ft. Z Other Distribution box ( . ) Dosing tank ( ) Q 1?'L 14 Percolation Test Results Performed by-____,� _ �,ex..._, ,�1 �, '�C __ Date_.__/ fl ........... � Test Pit No. 1___._.2 minutes per inch Depth of Test Pit.................... Depth to ground water_....................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ 7.1 ,,t ..i t O Description of Soil---'-'---•--.. • `1 �?-•. "�..........• .................... w U Nature of Repairs or Alterations—Answer when applicable_::__:_________________________________________________________________________________________ Agreement The undersigned agrees to install the. aforedescribed Individual S e Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— e under • ned fu grees not to place the system in operation until a Certificate of Com liance has been ue of It Signed --- � 4j ~� --- -- -- Date Application Approved By.......... --- •----• � Date Application Disapproved for the following reasons:.............................................................................................................. -•----...-•---•---------------------•---......__...----------.......__...---------...._..•-------....-•••--••--....................................................................................... � Permit No.... ...... Issued......... 3 — 1 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................................::.......OF..................................................................................... (Irdifiratr of Tom#lianrr THIS IS TO CER IFY, hat the Individual Sewage Disposal System constructed ( �r Repaired ( ) by f nstaller � has been installed in accoorldan�e with e provisions o TI 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.. _ _ .,2_ dated....... ._ �A_ '..__;Z"7__.___.__._ THE ISSUANC� OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....._... ----•----•---...-•------------------------------------------------ Inspector.... f THE COMMONWEALTH OF ,MASSACHUSETTS BOARD OF HEALTH .....OF...... .... .... .' ......_..-._........_._........._.. No.. ..._. .:�'./,�,.�J FEE........ " �' Disposa rks n , nrtion rrntit Permission is hereby granted .----. t .................................... to Construct /oor Rep • ( ) In, ivi ual wage sal SvStam at No..._ �Litl .. ` .- � - Street as shown on the application'for Disposal Torks Construction Permit ___ ______ ____ Dated___.__.___/..`._............................ .......... ---•---- Board of Health DATE--- -77J / /J r FORM 1255 HOBBS & WARREN, INC., PUBLISHERS- - 1 1« " � �, �' f 1 •, - _ _ i�` .ni=� � e.R^ r� .:ter 4��{?`�p "`'� �.`,' .r4tr •+� tr.` ; k '��' ,� .. • fx�. •n J. .�: , ,fir co r +.' f .. .. }:� 3'r rn., 't• s •fj` r4 E 4 A + xJ: 1',. '{,I.• ,`+ ( I Q �J �"' U 01 0 tm E .t,i � � , v.. fl r• ,fir *�� - +• r 1..1 O M .' ` ^1 ku i � s.. t.. t' � if l'n f '1' j ry�-r• �• ,,�y, 1. i r / hr' t4iv a _N c9 3 UO / U Q .. t ` r � ' ' � � .. . �y ..,•,. ,+` �. � .J:.. tip.. µ <l.: � t � ,. �i '" � •+�` ROBERT P. l ov 13UNIKIS 1 $ NO:22162 �'fjpr Y • ,�. . • ... LEGEND - >• t � �, Alt, t CERTIFIED ' PLOT �PLAN r T ATI 0 EX1 TING E EV 0 S S P O L N ,, - - _ < t' EXISTING CONTOUR --- - 0 _ L ©,. c _4ASPtrE--&P am x, FINISHED—SPOT -ELEVATION J s t' 57o 'y FIN.I.SHED CONTOUR 0 ;- IN , - APPROVED = .BOARD OF ;HEALTH � �'��,� �� •`ail� '�aAA,S5+ RATE AGENT SCALE DATE ! ' 2 77 LQR•EDGE E_NG/N_E_ ER/NG COIN CLIENT REx�UP _ I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED J.O8 NO. 771 BUIL61NG SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS t ENGINEER SURVEYOR' OF PARNSTA@LE , MASS. I ,.f 33 .N0 MAIN ST '712 MAIN ST. CH. 8Y -- I S0. YARMOUTN, MASS. HYANNIS, MASS. SHEETS OF �' DA E REG. LA; D SURVEYOR r - •f ®r ' JP -4 A -2� oir ;04 A A, 4,A &V V -rI Oyc-,P) pr Valm W yo_��'Zw,- M 4 "L.AYEK 7 777 p W"CAS 71 0 "A SH".570ME, x, OA Z- 'MIA V.P/ �4. j•40 SORrIC 7A e. i I 'A W. d'i WA SNA=&' J.". Z :e AZ444VON FT. S& 7; JrOA Am r 4,4/ C--ro4N)K GROUND )V,474IT TA&4f. -BOX sZVfa oN 6OX 20-7 esr&.0". ff 4CO" ,4H. l" % LEAC4 n , A Ooslsk "CR Tr A $CAE �w 4 t� Y. to 4, )V.S/ON" k, -c - 4 VVAf-drR Of&EPRooms TEST SO 1 40' A7 GAL k, X L7 1 -1 FDA. TE S _ I FT. -:*,cdz^,r/o" A,47�� '"k-57' IvIW NCH BOTTOM 4.94 CwiNo,PLC R,P/ rA &M4 - 6 MA r 7,S'* 4 C�flW �,ARC AtRXERV,C-4M4C - . - / - '7 w f5 rk L.)14 A c 4 ROSERT't 4- qAvor z4L, �A `Tee Althi Lj--- 5A . P. L4101 % - 4 W X A A 1 Al- "'ONA _44 -SW 4FI.. VT f ' e Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street,Boston,Ma. 02108 John Grad D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)754--6813 Govemor ARGEO PAUL CELLUCCI Lt.Governor �c( r� , SUBSURFACE SEWAGE DISPORT ASYSTEM INSPECTION FORM �iECE�VEC� CERTIFICATION krsy o AVc `1 3 1998 nY Property Address: 37 Rasbe Lane Marstons Mills L Address of Owner: TOWN OF BARNSTABLE Date of Inspection: 7/22198 (If different) HEALTH DEPT. Name of Inspector: John Graci Karen Maitland I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) 6 P. �r Company Name,Address and Telephone Number: 0 - CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In Title V — Condition Ily Pa Ses code 310CMR16303.My findings are ofhow the system is performing at the time of the inspection.My inspection does — NeedsF rther valuation By the Local Approving Authority not Imply any warranty or guarantee ofthe longevity ofthe Fails septic system and any of Its components useful life. f Inspector's Signature: Date: 7127198 The System Inspector shall bmit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127/97) One Winter Street . Boston,Massachusetts 02108 • FAX(617)556-1049 e Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 37 Rasberry Lane Marstons Mills Lot 61 Owner: Karen Maitland Date of Inspection:7122198 — Sew.aQe backup or.breakout.or high static water level observed.in.the distribution box is due to a broken, or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ _ Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (reylsed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 37 Rasbe Lane Marstons Mills Lot 51 P Y RY Owner: Karen Maitland Date of Inspection:7122198 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. — — Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy Is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (rewlsed 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 37 RasberryLane Marstons Mills Lot 61 Owner: Karen Maitland Date of Inspection:7122198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. x — As built plans have been obtained and examined. Note if they are not available with NIA. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. —x_ — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x — The size and location of the Soil Absorption System on the site has been determined based on The facilityowner and occupants, if different from owner were provided with information on the proper maintenance of ( p ) p p p Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)] (revised 04127197) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 37 Rasberry Lane Marstons Mills Lot 61 Owner: Karen Maitland Date of Inspection:7122198 FLOW CONDITIONS RESIDENTIAL: Design flow: 220 g•p•d./bedroom for S.A.S. Number of bedrooms: 2 Number of current residents: 1 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): n1a Sump Pump(yes or no): No Last date of occupancy: n1a COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow.o gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings, if available: n1a Last date of occupancy: n1a OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: nla System pumped as part of inspection: (yes or no)No If yes,volume pumped:o gallons Reason for pumping: nla TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other: APPROXIMATE AGE of all components, date installed(if known)and source information: 1978 infomtatlon from As-built Sewage odors detected when arriving at the site: (yes or no) No {revised 04127)97) iL SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 RasberryLane 11,11arstons Mills Lot 61 Owner: Karen Maitland Date of Inspection:7f221g8 SEPTIC TANK: x (locate on site plan) Depth below grade: t' Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age nia . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: I_e•6"Hs'7^wa'10^ Sludge depth:e" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness:T" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 13" How dimensions were determined: Measured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tanks and all components are structurally sound.Recommend pumping septic system now and then maintained every two years. GREASE TRAP:_ (locate on site plan) Depth below grade: nra Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nla Scum thickness:nia Distance from top of scum to top of outlet tee or baffle:Ma Distance from bottom of scum to bottom of outlet tee or baffle:rva Date of last pumping;,r, Comments: 1rP..r:nmmP..nrfafinn fnr niimninn nnnrlitinn,nf inlPf Rnri rnitlaf fPac nr hafflPc rtanth of liniiiri lavPl in ralRtinn to rnitlat invert cfnirtiirRl intenrity L_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 RasberryLane Marstons Mills Lot 61 Owner: Karen Maitland Date of Inspection:7122198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene—other(explain) Dimensions: n1a Capacity: rda gallons Design flow: rda gallons/day Alarm level:—rda Alarm in working order?_Yes No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) We DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Ye: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 37 Rasbelry Lane Marstons Mills Lot 61 Owner: Karen Maitland Date of Inspection:7122198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: nfa Type: leaching pits, number: 1o00 gallon leach pit leaching chambers, number:nla leaching galleries, number: rda leaching trenches, number,length: rda leaching fields, number, dimensions:rda overflow cesspool, number:nla Alternate system: rda Name of Technology:_rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) The leach pit was atructurally sound and functioning properly.The leach pit had T of water In It at the time of the Inspection. CESSPOOLS:_ (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert: nla Depth of solids layer: rda Depth of scum layer: rda Dimensions of cesspool: nla Materials of construction: rda Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) nla Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) rda PRIVY:_ (locate on site plan) Materials of construction: rda Dimensions: rda Depth of solids: rua Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda I (revised WOW) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 37 Rast-ry Lane Marston MIUO 60tet Karen Mmitand 7/21,/!i$ SKETCH'OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references,landmarks or benchmarks locate all wells within 100-(Locate where public water supply comes Into house) C) g � AB �.a go 4 . 1111e404rrW) Page, t e>>' 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contlnued) 37 Rasberry Lane Marstons Mills Lot 61 Karen Maitland 7122199 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from loca l conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (revised04f27197) Page to of 10 TOWN OF BARNSTABLE LC �ATION �� `— SEWAGE # ASSESSOR'S MAP &LOT l—o-p coe)-I INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (ty ) R C Q J (size) f()0 0 NO.OF BEDROOMS BUILDER OR OWNER Y=fAle,(N � �.C,\ PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by CZCCe�.e � a 69 It h 117 G��j LO C A'T'ION S E W A GP; FPERMIT NO. ' u S / blur q VILLAGE IINSTA LLER'S NAME & ADDRESS JOHN A. AALTO BACKHOE SERVICE 169 West Barnstable, Mass. 02068 B U I'L D E R OR OWNER r , DATE PERMIT ISSUED / _ r—7-7 DAT E COMPLIANCE ISSUED -� �' r _ �r � . .�� ,� � � _ � .; /� N � ' Lakeside Drive m SI E A SHUSAEL PROPOSED SAS GENERAL NOTES POND �r Hollld a HIII 2 H-10 500—gal chambers 97.24 ' 1. ADDRESS: #37 RASPBERRY LANE, MARSTONS MILLS � 5 With 4 stone all around In I 2. ASSESSORS NUMBER: MAP 102 PARCEL 081 3.25' x 13' x 2' leach trench. I 4. TOPOGRAPHIC NFORMA ION1 WAS COMPILED FROM AN ON THE \ #47 RASPBERRY LANE ( GROUND INSTRUMENT SURVEY. town water I 5. TOWN WATER IS PROVIDED TO THE SITE & SURROUNDING PROPERTIES. flint Street 6. NO WETLANDS ARE LOCATED WITHIN 150 FEET OF PROPOSED SAS. "MARSTONS MILLS" 0 0 0 I 7. REFERENCE PLAN: PLAN BOOK 138 PAGE 25 C.B. FND '" oB. M . I 8. UTILITIES LOCATED BY DIGSAFE. LOCUS 103.19 ` 100.0 Q iF 9. THIS DESIGN PLAN IS TO BE UTILIZED FOR SEPTIC REPAIR PURPOSES ONLY. NO SCALE o 103 I,P. ` 9 .59, 10. THE PROPERTY IS LOCATED WITHIN A GP GROUNDWATER ,PROTECTION ZONE/ZONE II. T. 102 H #2 ::;:; a� 97.30 X. 102.98 ,.. . DR � 10 3 02 z O.•::::-:•: NOT li 1 103........... . :•.........•...•.::•:•:. 97.19 E out the backyard. Required d r' De Heated area inside the 02 contour to the septic setback shall be excavate ::•r�•:� :� � Q '' down to the elevation of 101.5' to 102.0' to levelkya equ' _f cover over the proposed SAS shall be provided. :•:. 0 Z o o_' o �'� 2 : I° m j 3102.85 ce or wall 1012T E' I— 'f U 0 C Ln I I I° � �- o ° dek jjj/ W o Lo ,EXISTING �, m 00 p I I I ici I DWELLING. o O I°, [�P „�' 1 w 96.62'Q qN/T Aki�.P, 48' I ; GAS GAS LEGEND LOT 61 I Test Hole Location s AREA= 10,575±S I PROPOSED SEPTIC SYSTEM REPAIR yFp I —GAS— Approximate location PREPARED FOR 9 I gas line CAPEWIDE ENTERPRISES, INC. —w— Approxi�natr i� location 100.00 I wa ene AT )� 96.26' '°" Proposed contour #37 RASPBERRY LANE ...........is Existing contour (MARSTONS MILLS), BARNSTABLE, MA CD 00 #25 RASPBERRY LANE o °) a' Ex.1,000 gal. H-10 loading 102-080. °' ° o septic tank OWNER: ANDREW COLELLA ET UX town water _ PREPARED BY: -,1, Existing Leach Pit 1 Glen E. Harrington, R.S. SITE PLAN , ��, (to be pumped & backfilled) 9 Leda Rose Lane SCALE: 1 " = 20' — Marstons Mills, MA 02648 B.M. = 10 0.0 0' (ASSUMED) ON Tel: 774-238-1813 o 6' stockade fence Email: gharr880hotmail.com TOP OF I.P. FND. ° . —•°• 4' picket fence SCALE: 1"=20' DRAWN BY: GEHRS DATE: 26 JUL 2018 DATUM: ASSUMED FILENAME: 37RASPBERRY SHEET 1 OF 2 Existing _Dwelling SYSTEM PROFILE Not to Scale PROPOSED 3 HOLE H-10 DIST. BOX Existin2 Grade = 101't Finished grade over system=2% slope away Proposed Grade = 101.5-102'f CELLAR Septic tank covers must be D-Box cover shall be One chamber cover shall be Min. 2"-1/8"-1/2" Double-Washed Stone WALL S = 0.02' ft. within 6" of finished grodg within 6" of finished grade i within 6" of finished grade or geo-textile filter cloth TOD of Peastone Elev.=99.5' for 2' S=0.01 ft/ft �v-�:- -...•1::..�. ==.:.. ' ' EXISTING 1000 GAL. 32, Invert Elev.=99.0 ' t3' ` SEPTIC TANK EXISTING H-10 = Level 1' P-99.22 ® ® ® ® G 1--3C3 24"Bottom of L ach Facility Elev.=97.09' Install Gas �af a 20 8'-6" = 1T Ex. = 99.96' or a ua P=99.39' 3/4"-111" Double-Washed, Crushed Stone 5' Min. (5.09' PROVIDED) 6" OF 3/4"-11/2" STONE H— 10 1 Bottom of t Hole Elev.=92.0' 6" OF 3/4"-11/2" STONE LEACHING -CHAMBERS . Design Calculations CONSTRUCTION ' NOTES o DI OUTLET PIPES FROM THE Number of Bedrooms: 2 EXISTING DISTRIBUTION BOX SHALL BE Garbage Disposal: Not allowed with this design SET LEVEL FOR AT LEAST 2 FT. 12" CONCRETE COVER 1 . Contractor is responsible for Digsafe notification Septic Tank Capacity Required: 1,500 gallons (min. per Title V) `' " '" 3 - 5" OUTLET r•.:•. 2" and protection of all underground utilities and pipes. Septic Tank Capacity Provided: Existing 1,000—gal H-10 septic Tank KNOCKOUTS 2. The septic��tank and distribution box shall be set Leaching Capacity Required: 330 gpd x LTAR= 446 SF Req'd Area — 15.5" ouTLEr 12" INLET- level on 6 of 3/4 —1 1/2 Stone. Long Term Application Rate for <2 min./inch = 0.74 gal/sq. ft. :- 3. Backfill should be clean sand or gravel with no Proposed Leaching Structure: 1'-25 x13 x2 Leaching Trench 6" e" " Bottom Leaching Area Provided` = 325 Sq.Ft. " stones over 3 in Size. Side Leaching Area Provided = 1152 sq. ft. 1s.5 2" 4. This system is subject to inspection during installation Total Leaching Area Provided = 477 sq. ft. > 446 sq. ft reqq'd. PLAN—SECTION CROSS SECTION by Glen E. Harrington, R.S. Leaching Capacity Provided =477 sq. ft X 0.74 gal/sq.ft. =353 gpd. 5. The contractor shall install this system in accordance 3 HOLE DISTRIBUTION BOX with Title V of the Massachusetts Environmental Code SOIL EVALUATION & PERK TEST (P15719) NOT TO SCALE and local Board of Health Rules and Regulations. Date of SOIL EVALUATION & PERK TEST: 13 JUL 2018 6. If, during installation the contractor encounters any Evaluation Performed By: Glen E. Harrington, R.S. soil conditions or site conditions that are different Witness: Donald Desmarais, R.S., BOH A ent from those shown on the soil log or in the design, Excavator: Bruce, Copewide Enterprises, Inc. Percolation Rate:< 2 mpi the installer shall halt installation and immediately notify Glen E. Harrington, R.S. Test Hole Test Hole . 7. No vehicle or heavy machinery shall drive over the No. 1 No. 2 PERK RESULTS septic system unless noted as H-20 septic components. DEPTH SOILS ELEv. DEPTH SOILS ELEV. begin ld soak 8:32 PROPOSED SEPTIC SYSTEM REPAIR 8. Install Tuf—Tite gas baffle or equal on septic tank outlet tee. 0 A. LS o A. LS 24 PREPARED FOR gals applied in 9. All piping. shall be SCH 40 PVC. 6" 10YR5/1, 102.5' 7" 10YR5/1 102.34 15 min presoak CAPEWIDE ENTERPRISES, _ INC. 10. No wells are located within 150' of proposed SAS. loamy wsan oamywsan Use <2 mpi for AT 11 . Provide 1 H-10 DB-3 distribution box and 2 H-10 50.0—gal. 31" 1oYRs/s 00.42. 34" 10YR6/s oo.o design purposes. #37 RASPBERRY LANE chambers by Wiggin Precast or equal. m-c lsand m-c lsand (MARSTONS MILLS), BARNSTABLE, MA 25%fine- 25X flne- 12. The existingleach it shall be pumped and backfilled. 't1A F med. grad med. gravel p p p " 10YR5/4 . � OWNER: ANDREW COLELLA ET UX 80 10YR5/4. 5.33' 78" 6.23 a 58" 13. Re—grade backyard as shown on site plan. C2 j PREPARED BY: C2 -� s Glen E. Harrin ton, R.S. friable m—e friable m—e g q sand, 15X B0"d' 'Ss 9 Leda Rose Lane .1 al f—m grovel' f—m gravel V 4 132" 25n/4 92.0' 120" z.5n/a 92.9' 1 Marstons Mills, MA 02648 No Observed Ground Water Tel: 774-238-1813 ITAfkk Soil Evaluation Certification Email: ghorr880hotmail.com I, Glen E. Harrington, hereby certify that on October. 1995. 1 passed the soil evaluator examination approved by the DEP and that the analysis was performed by SCALE 1"=20' DRAWN BY GEHRS DATE 26 JUL 2018 me consistent with the required training, expertise and experience described In 310 CMR 15.017. DATUM: ASSUMED FILENAME: 37Raspberry SHEET 2 OF 2