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Home My WebLink About0047 RASPBERRY LANE - Health 47 RASPBERRY LANE Marstons Mills A = 102 — 082 I I Commonwealth of Massachusetts F Title 5 Official Inspection Farm Subsu rface Sewage Disp osal posal System Form - No t for Voluntary Assessments 47 Raspberry Lane _ Property Address Manuel &Juvencia Owner information is Owner's Name / required for every Marstons Mills V Ma 02648 page. Cityrrown State Zip 1 1 or Inspection Code Date onspection 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 A. Inspector Information forms filling out p 6/* on the computer, �P use only the tab -Raymond Dumas key to move your Name of Inspector cursor-do not Dumas Lands-pa Const. Inc. use the return key. Company Name 564 Old Stage Rd. Company Address Centerville, Ma. Citytrown 02632 508-509-0210 State Zip Code Telephone Number S1437 License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3• ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Inspectors signature 1/12/2021 Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5irxp.doc-rev.M 8l2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts - (P Title 5 official Inspection Fora ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r� ,• 47 Raspberry Lane Property Address Manuel &Juvencia Owner owner's Name information is required for every Marstons Mills Ma 02648 1/12/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) 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): Snsp.dw•rev.7128P20 i 8 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 2 of i8 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 47 Raspberry Lane Property Address Manuel &Juvencia Owner ' information is Owners Name required for every Marstons Mills Ma 02648 page. City/rowwn 1/12/2021 State Zip Code Date of Inspection C. Inspection Summary (Cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if Pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced [] Y ❑ N ❑ ND (Explain. below': ❑ obstruction is removed ❑ Y ❑ 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): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.irearetii3 Title 5 Ofricia;inspection Form:Subsurface Sewage Dispose;System•Page 3 of i8 COmmonwealth of Massachusetts - p Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Raspberry Lane Property Address Manuel&Juvencia Owner owner's Name information is required for every Marstons Mills Ma 02648 page. Cityrrown 1/12/2021 State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fall unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: " This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged -SAS or cesspool t5irrr-p.dec•rev.7/26/2618 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of!Massachusetts vP Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments - iw�-V47 Ras be Lane Address Manuel &Juvencia Owner information is Owner's Name required for every Marstons Mills Ma 02648 page. City/Town 1/12/2021 State Zip Code Date of inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No (� a St tic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ® Any portion of the SAS, cesspool or privy is below high ground water elevation. (� ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ® Any portion of a cesspool or privy is within a Zone.1 of a public water supply well. ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 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 CA. Yes No ® the system is within 400 feet of a surface drinking water supply ® the system is within 200 feet of a tributary to a surface drinking water supply ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection ESinsp.doc rev.7�6P267o Area— IWPA,) or a mapped Zone I I of a public water supply well • Tibe 5 Official Inspection Form:Subsuriaoe Sewage Disposal System•Page 5 or is Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments f .• 47 Raspberry p RY Lane Property Address Manuel &Juvencia Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/12/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cunt.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate .regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ 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)] binsphoc•rev.712W018 Tide 5 Official inspection Form:Subsuriace Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Raspberry Lane Property Address Manuel &Juvencia Owner Owner's Name information is required for every Marstons Mills Ma 02648 1/12/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 16.203(for example: 110 gpd x#of bedrooms): 330 Description: 1000 gallon septic tank, D-Box and one 1000 gallon leach pit Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes 0 AIQ Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: 2020 48000 gallons, 2019 72000 gallons, 2018 13000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Occupied now Date 15insp.doc•rev.7n6roj8 rue sciai i nspedion Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of !Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .- 47 Raspbegy Lane Property Address Manuel &Juvencia Owner Owner's Name information is required for every Marstons Mills Ma 02648 page. City/Town State ZipCode 1/12/2021 Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 GMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Noh�sanitary waste discharged to the Title 5 system? Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: no records available Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping` i5inap.669•rev.712sn018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page o of is Commonwealth of Massachusetts P Title 5 Official inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 47 Raspberry Lane Property Address Manuel&Juvencia Owner Owner's Name information is required for every Marstons Mills Ma 02648 page. City/Town 1/12/2021 State Zip Code Date of Inspection D. System Information (cone.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ OverFlow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: 1988 as per permit on file at Board of Health Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth'below grade: 4 feet Material of construction: cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: approx 10 ft. feet Comments(on condition of joints, venting, evidence of leakage, etc.): ood. .. t5ii4.ddc Wv.7na2018 Tide"5 of diei faioa n FbPiH si&-6 4d'd Sewage DiSposai System.P-.,a is Commonwealth of!Massachusetts P Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Raspberry Lane Proper`.y Address Manuel&Juvencia Owner information is Owner's Name required for every Marstons Mills Ma 02648 page. City/Town State -- 1/12/2021 D. System Information (cont.) Zip Code Date of Inspection 6. Septic Tank(locate on site plan): Death below grade: 2 feet Ma-erial 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) Yce Q No Dimensions: 1000 gallon 8'6"x 4'10" Sludge depth: none all water Bistarce from top of sludge to bottom of outlet tee or baffle none Scum thickness none 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? removed cover dip tank with 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.): not needed,at th[4 jime ', _ f5ihsp.doc rev.7/28/2018' Todd 5 O ficw`i I1i3P 6fi Faun.Sub3uriace aeri&ge Disposal Systefn•Faga 10'oF i$ Commonwealth of!Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .• _ 47 Raspberry Lane Properly Address Manuel & Juvencia Owner information is Owner's Name required for every Marstons Mills Ma 02648 page. City/Town 1/12/2021 State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensors: Capacity: gallons Design Flow: gallons per day +��.a� rep.�rzsi2oia 'rifle 5 official fi#sPW6iii FdW.-SuFf3ilfFaae Sewage Drc�dsa(systefi-Peg&1 t f 18 f Commonwealth of Massachusetts Title 5 official Inspection Fora ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Raspberry Lane R6pery Address Manuel & Juvencia Owner Owner`s Name information is required for every Marstons Mills Ma 02648 1/12/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cunt.) Alarm present: ❑ Yes ❑ No -Alarm level: Marna in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach Copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at level Comrents(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.): Inspected with camera from outlet tee on septic tank f5msp.ifoc•iev.7TL6P2018 Tithe 5 Orfiaierfrisi9ection Form:SUtisUffabe"sea%$'" D�ge {idsal Sys".PdO 12`or 18' Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •f 47 Raspberry Lane Plrope4 Address Manuel &Juvencia Owner Owner's Name information is Marstons Mills required for every Ma 02648 1/12/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * if pumps-or alai Errs are not in,Working oroirr, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: removed cover and measured water level 48 inches below bottom of pipe Type: leaching pits number: 1- 1000 gallon ❑ leaching chambers number: 11-eachng gatleries- number- - ---- ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: rv+rrflow-cesspool number ❑ innovative/alternative system Type/name of technology: pre cast i5i :dac•iev.7f181Z045 Tide s Offit Wrirtpecfdi rtlFifi SiffiswPace seWuge Ms{szss�FSyetti Fatje 13af io Commonwealth of !Massachusetts j = ,? Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,. 47 Raspberry Lane PFbperfy Address Manuel&Juvencia Owner Owner's Name information is required for every Marstons Mills Ma 02648 page. City/Town 1/12/2021 State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): all good 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuratiof, 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 El Yes [] No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): W :uac o dv.71261"2018` rua 5 ofiiBiarli9sjSecticir Fi Pili.sub fi�aoe suwa 13"sy�ti P�0614 t is Commonwealth of!Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Raspberry Lane Property Andress Owner Manuel &Juvencia information is Owner's Name required for every Marstons Mills Ma page. Cityrrown 02648 1/12/2021 State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, etc.): level of ponding condition of vegetation, 5intp-d6d•iev.7PI&W2 T100 5 O fiedl 6 046tiu'h Fdffti s ; a s va ass ;sr�m' Pa gu rs of to Commonweslth of Massachusetts Tide Official Inspection Form Subsurface Sewage Disposal System Forrlp _Not for Volunta ry Assessments 47 Raspberry Lane Property Addreg Owner Manuel&Juvencia information is 6ner's!Name required for ev Marston ery s Mills Page. City/I own Ma 0264$ State! Zip Cod 1�_a_leo_fl 1 D. System information (Cont.) nspection 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent refer landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply the building. Check one of the boxes below: reference pp y enters hand-sketch in the area below drawing attached separately TOWN OF BARX87ABI,R LWAIJON � VILLAG AS_,RSWR'S REAP 4 LOT � INSTAY.LSR's HAM.4 PHONE No,SEMIC TANK CA.PArcm 00/7 ��J LUCMNG FACtL.TY.jtM) / P ORl3oaCS`.7' PRIVAYTS WELL OR PUBLIC. WA�TFR BUILDER OR oWhfsR_`�_ �6/, DATE PPRMIT t5pltxp. DATE CottPLtANCs ISSI7L+P5•� �� "`--- VARIAiBCSGRAIVTED: yes --.--___ r -- 0. , r fS7:ffP.d6e fBV.7128fjQla ... .- -.._... . S U�Fi t�germ.s+I63ffff8E9'slfiY6�Dlspss�i syfititiiY�Pd�test t8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .< 47 RR aispberry Lane Property Address Manuel&Juvencia Owner information is Owner's Name required for every Marstons Mills Ma 02648 page. City/Town 1/12/2021 State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12 ft+ 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: 6/17/86 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: no water at 144" per test hole on permit ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Certified Plot Plan on Record shows no water 4 ft below bottom of leach pit Before filing this Inspection Report, please see Report Completeness Checklist on next page. �n�v.aae•`rsv.�rzsrtoia Tilled 5 61116 i Wg"h F6k sdu"a6 Sews ai5 idsal sy .rise i of to f Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 47 Raspberry Lane Property Address Manuel &Juvencia Owner Owner's Name information is Marstons Mills required for every Ma 02648 1/12/2021 page. Cltyrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. B. Certification: Signed& Dated and 1; 2, 3, or 4 checked i ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5Fsp.doc•iev.728R018 Title 5 Official Inspection Forfi:SUbwrface UWage Dls posat System•Page 18 of 18 S�t16tE ,FAM tr 3 SCDIZ06f OA1L1(- Coi :. O x 330 G.PO. , %vG y.. /� Z. — SEPTi c: ;TAN :* 330 t5o7 * S G P.O / �2 `v"'sc iooa =s DtSPoAL:.PST- - �t se'; 4006 6-ALO -. _.. _ � /AREA:i;ISo: S.F /"5 .3 zz `f IS'o S G P, O: : 2v J`n[' ZA TcTALi>jA1Lyy��- G:P,0. 1,i 02 LESS ERR ' t i -t FI(Ht1RD o StlC IiH""" —y; c ff / ��- '• - /0�.;� _� - �fssro �E�`��. :-�• 4�eras ,�o _ �. �,_.....,,-. q9-.:� .-- . --gy.3-- __ - TEsr'/ro�E P�S7 / ; :MgTEejciL: cl�ysE' //. Alv r. bt/t� ':GAG•:' /Not Awl: RT' TAN�ri /tN 3� yo//+ •, /a'.Z /60:�1 GE.&'F7F1---4 PLOr^ . 74:44o' 77. IVA 721-,/S /.GE,ereEY TN.4T T.�►rE "�/Ss.1aw.v,'.. A49725-1- .Q.vo.405r�Aeoe., Qvjz"&,vrs vea 7;'J4 ,PEcsrsr, ED.�tvo s�,e✓ems TDWiV GL��i'+4 1t3'LLC':tliVA_%S'�t/d7�. C.�fY�.CMA4— LOC�TE.O TJ�I� f3iQfErO4")Ao / �— ' -//.NF.vs�T.svero�YstN®THE aFiriS.E� shd�.vy�,P.�ivs.4✓®v4p.s/c�-t•,tE usEc� Tv E..�G�.tiS/:CciT-•r/NHS: L� �7 TOWN OF BARNSTABLE LOCATION -cb SEWAGE # ` Y[LLAGE /Y,5-lc,j IT ASSESSOR'S NAP & LOT�� INSTALLER'S NAME & PHONE NO._ 611mGe_ L S SEPTIC TANK CAPACITY/O00 941 LEACHING FACILITY:(type) (size)�� NO. OF BEDROOMS r PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER y ej �y 2t,6 Q(A- DATE PERMIT ISSUED: ellZ.G/ei DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 5 7 f —ASSESSORS MAP NO: � PARC EL NO.: O Fes$ THE COMMONWEALTH OF MASSACHUSETTS �- BOAR® OF HEALTH ..1, ........OF.._........... ............................ . ' ....... AVV ira iun for Uiipusal ur"or trur#iun rrutit Application is hereby made for a Permit to Construct ( ) Repair ( } an Individual Sewage Disposal System at: 1,.:.................................. ._._.__1 � --------- ------•------------------------------------------------------------------------------------------- Location-Address or Lot No. .................. ' ........................................... ............._................................................................................... Owner Address a .... .... ............................... ------•-•-------•------------------••----...----•----- Installer Address d Type of Building —7- Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.................•..._.._ -Expansion Attic ( ) Garbage Grinder �- .. ..._ No. of ersons____________________________ Showers — Cafeteria p`�, Other—Type of Building ............. p ( ) ( ) a Other fixtures ..---•-••--•......--•-...-----•. w Design Flow...._.(_ _��....................•.__gallons per person per day. Total daily flow_.._....�..a�-.... ._..........gallons. 9 Septic Tank—Liquid capacity/6?.O.._..gallons Length................ Width................ Diameter-----------------Depth................ Disposal Trench--No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No. k_(P______ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (Nja,� Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1�. inutes 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........................ ODescription of Soil..... ®- & �.VM. ..... &........................................................................................................... x U w VNature of Repairs or Alterations—Answer when applicable.-------------------------------------•_____________----__-______-__________-___--•--_-•---•___. -----------------------------------•---------------------------------------------------------•--------------•---------------------•-------------------------..•-------------------------------...---••- Agreement: The, undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of HI HE "of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. J Signed..... o._.. ..r............................................. �1/A Date Application Approved B % ---------------------------- ---•-•-- Date _' Date Application Disapproved for the following reasons:_...----•--•..............•----•---•------•------•-•---•---------•-•---•-•-----•-••••-•-•-•......-•-......----- ------•------•--•-•---•••-•---•--------•------------•••••••-----------------•-•------.......-•----------.---------------------••----••••----••-•---•-••---•----•--•----•--....•-•-------•--••----------- Date PermitNo.---.. .. .�.. -- Issued_....................................................... Date t 7 1 THE COMMONWEALTH OF MASSACHUSETTS _._ BOARD OF HEALTH , ppliration for DiiiVo5al luorks nstrurtion Prrutit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address J or Lot No. ...... ......................................... ..........------------....---^__-•---........-- -.........-----..._.........----••---......--- Owner_ Address r,---1__--.=................................ ........................•------...._..............-----...--------•--------------------------..._. Installer Address d Type of Building Size Lot.............................Sq. feet `1 Dwelling—No. of Bedrooms__—_________........____-____ --- N Expansion Attic ( ) Garbage Grinder 04 Other—Te of Building *�^ l o. of Expansion Attic Showers — Cafeteria T�-c`=�`�____.._.___ al Other fixtures ---------------------------•••-- - -----... WSeptic Tank—Liquid capacityl ..____.gallons Length................ Width..........:----- Diameter................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit -------- Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (Y/ j Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 11--_.7�R.--- ':minutes per inch Depth of Test Pit____________________ Depth to ground water..................... __- r4 Test Pit No. 2..._............minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil...--Nit�2-�_�`-"f-�---�� - - - - - - - - x W UNature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------------------•----------------------------------------•---•--•--•-•---........•-••.....-•---------••••------•-•...............................••---•----•------•------------•-•• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T-I IPIL4 5,of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..... ------------------------------------•--- ...... �''"•��• y.., / Date Application Approved By_-'' _/�- --�-=- '�� -•-•-_ ........... `'-�---•-- •-•-----------------•--------- Date Application Disapproved for the following reasons:.............................................................................................................. ..----•-•....................•-----•--------_•_._....--•••-•---------••--------------••-----------.....•-•-------------------------••-•------•-••-----•----------•---••-•••-•-------••••••--•--....-•--- _ _ Date Permit No..-•- Z�-(.-a.._r:.. � ...... Issued_ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... U:l. ............OF.......... C�..--•--•-• Tnrtifirate of Tomplianrr THIS IS T`O,CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( } Insyller at.......... ......... ................ — z �y y - ` �""'' = i -, =/-�C�' -------------------------------- -,A----- �l has been installed in accordance with the provisions of T i T%.,i ':5-6 The State Sanitary Code,as described in the application for Disposal Works Construction Permit No.___w'.rya___.e __Z date.i.._.. _-2- 0 r, `-- ----� ` THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................... --1--_ ..................................... Inspector....................... *1'_0.......................................... THE COMMONWEALTH OF MASSACHUSETTS BOAR-D OF HEALTH r .....C 2..f - FEE........... Uppoo9l orb T-Fonstr tion "until Permissionis her y granted........................................................................................................................................ to Construct or Repair ( ) an Individual Sewage Disposal System t --� VStreet as shown on the application for Disposal Works Const'gfion Permit No .................. Dated____ �� 2----.- .--- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r i r. SicaLE'"rAMi. ,Y 3 '6C1j12ooiy , ,N4::GAIZt3 --�'Gti2;�iJDCR.:��- �•�-� /� DAl LYt-�� . __.a__ o _ . — SEPT'i c: }TAN1 s 336 r;4q5 .__. USCG-IpOQLT'AIJ{C.. . : ,r 1 _ , t , tea..,: •�.,.�,«!�r;�=� btspo'SAL::. PST: � vsE ; lo`oO Cell... SiOEV�tA 1... tZEpa 1:j5a' S, P. A.SO 'S.; 375' G1�.;P. O. �: Zv f �,. , f- 1 ,._ - a G.P. 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