HomeMy WebLinkAbout0050 RASPBERRY LANE - Health F 50 RASBERRY LANE, MIL
MARSTONSILS
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s Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/14/07
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
Important: A. General Information oa �"
When filling out 91�c'
forms on the
computer,use 1. Inspector:
only the tab key
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC
Company Name
f� P.O.Box 763
Company Address
Centerville Ma. 02632
City/Town State Zip Code
(508)428-4028
Telephone Number License Number
1 •
B. Certification
certify that I have personally inspected the sewage disposal system at this address and that then--,
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 ma'intenance of on--Site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 1�5.340 of
Title 5 (310 CMR 15.000). The system:
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
t/ 3/15/07
Insp or'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.
50 Raspbeery lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is Marstons Mills Ma. 02648 3/14/07
required for
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
Leaching pit water level was 2"from invert at time of inspection.
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
I pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
50 Raspbeery lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is Marstons Mills Ma. 02648 3/14/07
required for
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
50 Raspbeery lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
1
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Raspberry Lane
M
Property Address ,
Linda Nelson
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/14/07
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform
bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
El ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
® ❑ 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
❑ ® 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.
50 Raspbeery lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is Marstons Mills Ma. 02648 3/14/07
required for
every page. City/Town State Zip Code Date of Inspection
N
B. Certification cont.
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply
El ® 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
❑ El 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.
50 Raspbeery lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15
Commonwealth of Massachusetts
x I; W Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is Marstons Mills Ma. 02648 3/14/07
required for
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done.You must indicate"yes"or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
El ® 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)]
50 Raspbeery lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/14/07
every page. City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 3
Does residence have'a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2005:80,000
g ( y g (gpd)): 2006:72,000
Sump pump? ❑ Yes ® No
Last date of occupancy: 3/15/07Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
50 Raspbeery lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is required for Marstons Mills Ma._ 02648 3/14/07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: Capewide Enterprises
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1500
gallons
How was quantity pumped determined? measured
Reason for pumping: System full
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
12 years
Were sewage odors detected when arriving at the site? ❑ Yes ® No
50 Raspbeery lane-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�^M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/14/07
every page. City/Town / State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
1
Depth below grade:
feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line. 10'+
feet
Comments (on condition of joints,venting, evidence of leakage, etc.):
Joints appear tight.No evidence of Ieakage.Ssyetm vented through the house vents.
Septic Tank (locate on site plan):
1'
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
---------------------------------------------------------------------------------------------------------------------------
Dimensions: 1 0'6"x5'1 0"x57'
Sludge depth: none
Distance from top of sludge to bottom of outlet tee or baffle na
Scum thickness none
Distance from top of scum to top of outlet tee or baffle na
Distance from bottom of scum to bottom of outlet tee or baffle na
How were dimensions determined? tank pumped at inspection
50 Raspbeery lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is Marstons Mills Ma. 02648 3/14/07
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pump septic tank every 2-3 years.lnlet and outlet tees are in place.Tank appears 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
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):
50 Raspbeery lane-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15
i
: ssachusetts Commonwealth of Ma
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/14/07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank(cont.)
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert yes
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 is level and has one Iateral.No evidence of solids carryover.No evidence of leakage into or out of
box.Pipe from D-box to pit is pitching back to D-box.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
50 Raspbeery lane-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M ,. 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is Marstons Mills Ma. 02648 3/14/07
required for
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
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.):
Leaching pit water level was 2"to invert pipe.Pit is in hydraulic failure.
50 Raspbeery lane-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/14/07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)I
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids Vayer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
50 Raspbeery lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
4M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/14/07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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.
50 Raspbeery lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/14/07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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.
1
1
1
1
?S ,C.k 11/ 1
/r
rr \1
50 Raspbeery lane•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
G _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 50 Raspberry Lane
Property Address
Linda Nelson
Owner Owner's Name
information is required for Marstons Mills Ma. 02648 3/14/07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
❑ Shallow wells
Estimated depth to ground water: 70'
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Used:Gaherty& Miller Model 12/16/94 ground water elevations.Used:USGS observation well data
June 1992.Used:Technical bulletin 92-000-01 plate#2 annual ranges of ground water elevations.
50 Raspbeery lane-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
i i
C.
TOWN OF BARNSTABLE
, o /
LOCATION 5-0 A446?r�ry L yP. SEWAGE# oZ 0// ^o ��
VILLAGE /'�,rJ o,s "4 ASSESSOR'S MAP&PARCEL 0"?S
a
INSTALLER'S NAME&PHONE NO. T C. A, �f9 Goy f'f
SEPTIC TANK CAPACITY /500
LEACHING FACILITY:(type) ;A-r:�/ra�torf —/G (size) /3 '3 X 02,6 X IJ
NO.OF BEDROOMS
OWNER av► Re4 6
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
A 13
r
��ooy
Vol-,
33'
3 �
8
,. : . y 600�� ®�-
��, '70t 3 y
poll— D*7fo
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ftpliLation for Mispo8al 6pstem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 570���s� p y L� Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel _
Installer's Name,Address,and Tel.No. Designer's Name)Address,and Tel No.
J,C. A9 /fp Gvn 5f �f..i('ee ,�rw+N ,fir✓3 <o�.�i+c, �$A�Y.7dr Oro-
Type of Building: 0V q ciy^77w12
Dwelling No.of Bedrooms 3 Lot Size /0 f00 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) -33 0 gpd Design flow provided I"Y2 gpd
Plan Date S -,?0// Number of sheets o1 Revision Date
Title
Size of Septic Tank jo0 0:2 Ea!'s71 ems Type of S.A.S.
Description of Soil SPp �0
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of
Signed Date 401
Application Approved by r Date
Application Disapproved by Date
for the following reasons
Permit No. O Date Issued g'1&—C I
' No. zP a'I a ` ?�
s Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
r PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZippYication for Misposal 6pstenjjC nstruction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.50,�F Lh Owner's Name,Address,and Tel.No.
�'1ar57a�f�J-/j pl
�l� �o? y
Assessor's Map/Parcel _ pc)�r //y ,f�v�P /,y �J4,f��,�s ,0.71!Yf
Installer's Name,Address,and Tel.No. Designer's Name Address,and nd Tel.No.
J,4c. qs /,%,moo, rf % ,,,,•t 4 a ��,*� Z ,.;:,'.
Box 359 W 5,1a /lf/%o 6;o?6 �
Type of Building: OSfJ S c/�y7G 2 r
Dwelling No.of Bedrooms 3 Lot Size /(?Y010 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) '3 O gpd Design flow provided ��/�I gpd
Plan Date S— ,?O// Number of sheets Revision Date
Title
Size of Septic Tank /,V 0 y Type of S.A.S. �7 �jw�,f rs OZ
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of yeCalh.
Signed f Date
Application Approved by r C' Date
e
Application Disapproved by a Date
for the following reasons
Permit No. of Date Issued g/6-(f
� n
t
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V Upgraded( )
Abandoned( )by /;/,7 e ,,
at SD t 6sr r i yJ i f �/I //57 has been constructed in accordance
with the provisions of Title/5 and the for Disposal System Construction Permit No.a011.276 dated
Installer J t!, /9a l7'0 Designer G., _r ��„�
#bedrooms 3 Approved design flow gpd
The issuance of this permit shal not be co strued as a guarantee that the system func n �ie
s
Date t ) Inspector
--------------
-- ------------------------
No. got 1—9,7 b Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS
Misposal 6pstem Construction 31ermit
Permission is hereby granted to Construct( ) Repair(t/) Upgrade( ) Abandon( )
System located at Aw<,44e17 4104 A-
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this pe i
Ltj <S
Date ���6' �� Approved by '�
i
Town of Barnstable
��+E►�, Regulatory Services
Thomas F.Geiler, Director
Public Health Division
�i6:rk`0� Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-8 62-4644 Fax: 508-790-6304
Date: 1; " /W/— Sewage Permit# Oil -9 WAssessor's-Map/Parcel ��a _ �C
Installer& Designer Certification Form
Designer: Yu,-`e" L< / s<.v ray C ,L��., Installer:
Address: Address: /,-L 1 3 /
a issued a permit to '
.z �—/� .�, C. r4 � � s r install z
(date) (installer)
septic system at S 0 Re; Zj, . based on a design drawn by
(address)
_7, c dated
(design r)
Icertify 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. Stripout (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& Loca ations. Plan revision or
certified as-built by designer to follow. Stripout (if reTVA ected and the soils
were found satisfactory. y�{c.I ass
--- ----- _ _ o�' . I)A
� � p �Ao�s y
(Installer' S a e) F o C,
��srea� i
sq�/TRR1P�
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
q:%offlce formsAesignereertification form.doc
r
-.t d 1 LL lZ-££8-809 '- - ---` _ uose" uaelloo d l l l0 4 tc..dnd
DEEP.OBSERVATION HOLE LOG Sdil Color Hole#
Depth from Soil Horizon Soil Texture
Surface(in,) Y (USDA) � Soil• Other
(Munsell) Mottling .(Structure,Stones,Boulders.
--------------
tom/
v 7
c
DEEP OBSERVATION HOLE LOG Hole#
FDepthrom Soil Horizon Soil Texture
(in.) •,,.•. Soil Color 'Soil i '.`,•`,Other•
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
on i ten % ravel
-------------
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil
Surface(in.) (USDA) (Munsell) Other
Mottling (Structure,Stones,Boulders.
=eo
j
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders.
Consistency,%Grave
Flood Insurance Rate Man:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No " es
Within 100 year flood boundary No Yes .
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious a exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth f n turally occurring pervio s material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Enviromflentil Protection and that the above analysis was perf rm by me consistent with .
the requirneding,expe se e e ence described in 310 CMR 15.017.
Signature Date
QASEP'nC\PERCFORM.DOC
Town of Barnstable P# 4?
Department of Regulatory Services
a Public Health Division Date "51/d A/
t639- �� 200 Main Street,Hyannis MA 02601
Date Scheduled T'. /�
Time /___—_ _ Fee Pd. �.
Soil Suitabili Asse or Sewage ge Disposal
Performed By: � � . �
Witnessed By:
LOCATION& GENE7Addre'
MATION
Location Address
me /'SOLD �i„aQ /�
'//9 i� ✓ <<�'j 2T �^Y-�f -lot"P"
Assessor's Map/Parcel.• 40Z pfi v2GG�
Nan ��NEW CONSTRUCTION REPAIR ✓ �'� &1�K.
SU✓
Land Use
Slopes(%) Surface Stones
Distances from: Open Water Body possible Wet.Area
ft Drinking Water Well ______-_ft
Drainage Way ft Property Line
—__ft Other ft
►SKETCII:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximi
ty to holes)
Parent material(geologic) r
Depth to Bedrock
Depth to Groundwater. Standing Water in Hole:
Weeping from Pit FACE
Estimated Seasonal High Groundwater
Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE
Depth Observed standing in obs.hole: In, Depth to soil mottlas:
Depth to weeping from side of obs.hole:Index Well# Reading Date: index Well level in, Groundwater Adjustment {
_. Adj,factor— ,rs
dJ.Groundwater
Levei,,,o
Observation PERCOLATION TEST Dgle Tithe_M^
Hole#
Time at 9"
Depth of Perc Time at 6" -
-__
Start Pre-soak Time @ Time(9"-6")
End Pre-soak
Rate MinJlnch
Site Suitability Assessment: Site Passed Site 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:4SEPTIWERCFORM.DOC
.y
Town of Barnstable
A �FtHE Tp
Regulatory Services
Thomas F. Geiler, Director
* BARNSFABLE,
9�A 6 . • Public Health Division
tEp_MA(_a
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
May 28,.2007
Ms Linda Nelson
50 Raspberry Lane
Marstons Mills,.MA 02648
The septic system located at 50 Raspberry Lane, MA was last inspected on
- March 14th, 20071 by Robert Paolini,a certified-septic inspector-for the State of
Massachusetts.
The inspection of the septic system showed that the system"Failed"under the guidelines
of 1995 TITLE 5 (310 CMR 15.00).due to the following:
Pipe from D-box to pit is pitching back to D-box.
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.
Pit is in hydraulic failure.
You have 60 days from the date of the system failure to bring the system into
compliance.
If there are any questions about this reminder,please feel free to contact the Barnstable
Health Department.
BARNSTABLE HEALTH DEPARTMENT
Thomas A..McKean, R.S., C.H.O.
Agent of the Board of Health ,
Town of Barnstable
CF IME 1p�
tia Regulatory Services
xsMB Thomas F. Geiler, Director
639buss. ••� Public Health Division
�BD MA'S A
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
April 4, 2007
Ms Nelson
50 Raspberry lane
Marstons Mills, MA 02648
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system owned by you located at 50 Raspberry Lane,Marstons Mills, MA
was last inspected March 14`h,2007,by Robert Paolim, a certified septic inspector for
the State of Massachusetts.
The inspection of your septic system showed that your system "Failed"under the
guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
=Pipe:fr`om D-Box to pit is pitching back to D-Box.
Box is level'ancl has one latefal. No evidence of solids carryover. No evidence of
leakage into or out of box.
Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool.
Liquid depth in cesspool was 2" to invert. Pit is.in hydraulic failure.
You have 1 year from the date of the system failure to bring the system into compliance.
If there are any questions about this reminder, please feel free to contact the Barnstable
Health Department.
BARNSTABLE HEAL H DEPARTMENT
� .-' -... .. . ..�i ,Ff f -•/ �...... 7 C,, 'li i�„ ,.v_ .t-...� y's ,..� T.�1�t� .....,+. •G
Thomas A.•McKean, R.S., C.H.O.
Agent of the Boardof Health
—1 t 1'� -•r,' S 4 f j
'f
REct
1v1 AY 3 2000
TOWN OF BARNSTABLE
\ HEN.IH DEPi.
COMMONWEALTH OF MASACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS ,
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET BOSTON MA 02108(617)292-3500
TRUDY COXE
Secretary
ARGEO PAUL CELLUCCI DAVID B.STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 50 RASBERRY LANE MARSTONS MILLS, MA 02648
Name of Owner JOSEPH GEARY
Address of Owner: SEND TO CHRIS MORELY BOX 636 CATAUMET MA.02634
Date of Inspection: 4/10100
Name of Inspector: JOHN GRACI
I am a DEP approved system inspector pursuant to Section 15.340 of Tide 5(310 CMR 15.000)
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02636
Telephone Number: 608-664-6813 FAX 608-664-7270
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
_ Conditionally Passes
_ Needs Further Evalua By the Local Approving Authority
Fails
Inspector's Signature: Date:4/10/00
The System Inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection.If th system is a shared system or has a design now 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.
NOTES AND COMMENTS
"The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My
inspection does not imply any warranty or guarantee of the longevity of the septic system and any of its component's useful life"
THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS FOR PROPER MAINTENANCE.
revised 9/2198 Page 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 50 RASBERRY LANE MARSTONS MILLS, MA 02648
Name of Owner JOSEPH GEARY
Date of Inspection: 4110/00
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
X I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria'not evaluated
are indicated below.
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.
Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not.
nla The septic tark is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance
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 complying septic tank as approved by the Board of Health.
n/a Sewage backup or breakout or high static water level observed In the distribution box is due to broken or obstructed pipe(s)or due
to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health).
_broken pipe(s)are replaced
_obstruction is removed
_distribution box is levelled or replaced
n/a 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
revised 9/2/98 Page 2 of 11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 50 RASBERRY LANE MARSTONS MILLS MA 02648
P Y r
Name of Owner JOSEPH GEARY
Date of Inspection: 4110/00
D. SYSTEM FAILS:
You must indicate either"Yes"or"No"to each of the following:
I have determined that one or more of the following failure conditions exist as described 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
- X Backup of sewage into facility or system component due to an 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 1/2 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 Q.
- X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
- X Any portion of a 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 I 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.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"to each of the following:
The following criteria apply to large systems in addition to the criteria above:
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
- X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone it of a public water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the
Department for further information.
revised 9/2/98 Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 60 RASBERRY LANE MARSTONS MILLS, MA 02648
Name of Owner: JOSEPH GEARY
Date of Inspection: 4/10/00
Check If the following have been done:You must indicate either"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 - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.
Large volumes of water have not been introduced into the system recently or as part of this inspection.
X As built plans have been obtained and examined.Note if they are not available with N/A.
X - The facility or dwelling was inspected for signs of sewage back-up.
X - The system does not receive non-sanitary or industrial waste flow.
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.The size and location of the Soil Absorption System on the site has been
determined based on:
X - Existing Information,For example,Plan at B4O,H,
X -
Determined in the field(if any,of the failure criteria related to Part C Is at Issue,approximation of distance is unacceptable)1 5.302(3)(b)]
i
li X - The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal
Systems.
revised 9/2198 Page 5 of 11
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 50 RASBERRY LANE MARSTONS MILLS, MA 02648
Name of Owner JOSEPH GEARY
Date of Inspection: 4/10/00
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 110 g.p.d.lbedroom
Number of bedrooms(design): 3 Number of bedrooms(actual):
Total DESIGN flow: 330 gpd
Number of current residents:0
Garbage grinder(yes or no):NO
Laundry(separate 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(last two year's usage): n/a gpd
Sump Pump(yes or no): NO
Last date of occupancy: 11/1/00
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow: n/a gpd(Based on 15.203)
Basis of design flow:n/a
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: n/a
Last date of occupancy:n/a
OTHER: (Describe)
n/a
GENERAL INFORMATION
PUMPING RECORDS and source of information:
n/a
System pumped as part of inspection:(yes or no):NO
If yes,volume pumped n/a gallons
Reason for pumping:n/a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorption system
_ Single cesspool
_ Overflow cesspool
_ Privy
_ Shared system(yes or no)(if yes.attach previous inspection records,if any)
_ I/A Technology etc.Attach copy of up to date operation and maintenance contract
_ Tight Tank Copy of DEP Approval
Other:n/a
v
APPROXIMATE AGE of all components,date Installed(if known)and source of information:
THE SYSTEM WAS INSTALLED IN 1993
geWage odofs detedted whoa afflVind at the site'.(yes 6f hd): NO
revised 9/2198 Page 6 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 50 RASBERRY LANE MARSTONS MILLS, MA 02648
Name of Owner JOSEPH GEARY
Date of Inspection: 4110100
BUILDING SEWER:X
(Locate on site plan)
Depth below grade: 12"
Material of construction: _ cast iron X 40 Pvc _ other(explain)
Distance from private water supply well or suction line: n/a
Diameter: 4"
Comments: (condition of joints,venting,evidence of leakage,etc.)
THE SYSTEM HAS TOWN WATER.
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 8"
Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other
explain: n/a
If tank Is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO
Age: n/a
Dimensions: 160OG L 10'6"H 6'6"W 6'8
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle: 32"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 0"
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
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.)
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS.
GREASE TRAP: _
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other
Explain: n/a
Dimensions:n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle n/a
Date of last pumping: n/a
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.)
n/a
revised 9/2198 Page 7 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART.0
SYSTEM INFORMATION(continued)
Property Address: 60 RASBERRY LANE MARSTONS MILLS, MA 02648
Name of Owner JOSEPH GEARY
Date of Inspection: 4110/00
TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other
Explain: n/a
Dimensions: n/a
Capacity: n/a gallons
Design flow: n/a gallons/day
Alarm present: NO
Alarm level:N/A Alarm in working order:NO
Date of previous pumping: n/a
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
n/a
DISTRIBUTION BOX:X
(locate on site plan)
Depth of liquid level above outlet Invert: LEVEL WITH BOTTOM OF PIPE
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
THE DISTRIBUTION BOX IS STRUCTURALLY SOUND.
PUMP CHAMBER: _
(locate on site plan)
Pumps in working order:(Yes or No): NO
Alarms in working order(Yes or No): NO
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
n/a
revised 9/2/98 Page 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 50 RASBERRY LANE MARSTONS MILLS, MA 02648
Name of Owner JOSEPH GEARY
Date of Inspection: 4/10/00
SOIL ABSORPTION SYSTEM(SAS): X
(locate on site plan,if possible;excavation iot required,location may be approximated by non-intrusive methods)
If not located,explain:
n/a
Type:
leaching pits,number:(1)1000 GA=LON LEACH PIT 6'X6
leaching chambers,number: (n/a)n/a
leaching galleries,number: (n/a)n/a
leaching trenches,number,length: (n/a)n/a
leaching fields,number,dimensions: (n/a)n/a
overflow cesspool,number: (nia)n/a
Alternative system: n/a
Name of Technology: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE LEACH PIT APPEARS TO BE FUNCTIONING PROPERLY,THE SYSTEM SHOWS NO SIGNS OF FAILURE.THE PIT WAS EMPTY AT THE TIME
OF THE INSPECTION.
CESSPOOLS: _
(locate on site plan)
Number and configuration: n/a
Depth-top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer. n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater: n/a inflow(cesspool must be pumped as part of inspection)NO
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
PRIVY:
(locate on site plan)
Materials of construction: n/a Dimensions: n/a
Depth of solids: n/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/a
revised 9/2198 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 50 RASBERRY LANE MARSTONS MILLS, MA 02648
Name of Owner JOSEPH GEARY
Date of Inspection: 4/10/00
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
gae
Deck
n4
i
bC
�Y
AC
AD 63
� a7`
&010
revised 9/2198 Page 10 of 11
r -
L`
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 50 RASBERRY LANE MARSTONS MILLS, MA 02648
Name of Owner JOSEPH GEARY
Date of Inspection: 4/10/00
NRCS Report name: n/a
Soil Type: n/a
Typical depth to groundwater: n/a
USGS Date website visited: n/a
Observation Wells checked: NO
Groundwater depth: Shallow_ Moderate_ Deep_
SITE EXAM _ Slope
_ Surface water
_ Check Cellar
Shallow wells
Estimated Depth to Groundwater 10 Feet+
Please indicate all the methods used to determine High Groundwater Elevation:
_ Obtained from Design Plans on record
Observed Site(Abutting property,observation hole,basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
_ Checked pumping records
Checked local excavators,installers
X Used USGS Data
Describe how you established the High Groundwater Elevation.(Must be completed)
UGSS MAPS AND CHARTS-10+ FEET
revised 9/2/98 Page 11 of 11
TOWN OF BARNSTABLE
L-'v ATION S SEWAGE,#
VILLAGE- ASSESSOR'S MAP & LO
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rill
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY V Q 0
LEACHING FACILITY: (type) (size) L y®U
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: 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
PAN
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AD
FA
� aby
+ TOWN OF BARNSTABLE
LOCATION �� .�0. ��� �as SEWAGE # ,� — `-�
VILLAGE V` �� 1 U S ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NOC� �Ow �c�c��'t _ 4.1�lP 3
SEPTIC TANK CAPACITY I ��
LEACHING FACILITY:(type) ,G ��� 1 (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No ��
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Y
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No.. .... ...._............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH APPROVED
E TOWN OF BARNSTABL QXMzftn oWrtmr4
1 ApplirFation for DiupuiiFal Works C onli
Application is hereby made for a Permit to Construct ( ) or Repair (�) an I dividual Sewage Disposal
System at
.......---- __ .......................... .......... -•---•-----------_.. ........-^ ......--------- ..........
Locatio ddress or Lot No
w-----•--- rA
OW ...to lal Q Ad` ' !_K_1.
Installer Address
d Type of Building � Size Lot......:...................S q. feet
U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( )
PLI Other—T e of Building No. of persons............................ Showers — Cafeteria
a' Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter-__---__-___-__..._- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--___-__-__._-_--_---_--
�T4 Test Pit No. 2................minutes per inch Depth of Test Pit---:................ Depth to ground water........................
a ------------------------------------------------------------------------------•-----•--............----•----•-•----......_--•--
0 Description of Soil.......... .+� t -------------------------------•--------------------------------------.
U ---.....--•------------------------------------------------------------- --- -------------------------•-•-------•----....-----...----•--•-----•---------------------...----•-----•-------------------
W ------------- ....................................................................................................... -------------- .............................
UN ure of Repairs or Alterations—Answer when applicab}e_____--_--_�c5� _� 1= + w _
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Enviro ental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Co lian has keen issued by the board lth.
Signed ..
�o 9 a
Dare
Application Approved By ------ --- ---------- --- -- c�
Date
Application Disapproved for the following reason - ---------------- -- ---- .....................................----------- - . ----....--------------------------
.....................................................-------- --- ......-...-...--...-.. .... ---------------------------------- --- ---------......,,---------- --- ------------
�, Date
Permit No. � .----- - ...............------ Issued a�
Date
woo fT
3
No......- -- ._. FIc$..... ..� .(��
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applira#iun for Diipusal 19urkg Tvao F, d
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System a^ Z
Vet s .
Location,—Address or Lot No.
.... -
Own r 1 Address i
Installer Address
' Q Type of Building Size Lot............................Sq. feet
Ca Dwelling—No. of Bedrooms........... ..........................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
r 1 Other fixtures ............................ .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.•-•________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY------------------------------------•...................._................ Date---------------------- ........
Test Pit No. 1................minutes per inch Depth of Test Pit-----------._....... Depth to ground water_-_-_-_______-__--.._.-.
f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
.x ..................
Descriptionof Soil........... . . ----•------------------------------------------------••---•-•--•••-•....------•-•-•--•---.............._..
(xj -••-----------------••-------•------------•------------------------------� ---------------••------•---------•-•---------------------------•---------•--•-----•------•-------------------•-----------
W -----------------------------
pairs
-------------------------------------------------------------------------------------------------------------------- --- -------
U N ure of Re or Alterations—Answer when applicable------------------ =± 'r?___ ._.._ ._�= � ..... . _.
= w-sue�� �. .----��- _------------►--Q°° -b` ...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code.—The undersigned further agrees not to place the
system in operation until a Certificate of Com( lia ce has been issued by the board of health.
Dace
Application Approved BY _ :. - ------------ ----------------ve - Date
Application Disapproved for the following reason - -------------------- ------------------------- ------------------------ ----- -- ......---------------
....................................------------ - ---------- -- -- -----...---...........----.......------------------------------------------------------------- ----------------------------------------- -------------
Permit No. .......... . �.......... Issued ......o .."-. .-... .. L.-..Da-------
Dare
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Tertift.ett#E of Compliance w..`
THIS TO CERTIFY, That th Individual Sewage Disposal System constructed ( ) or Repaired
by .. ..... .... ........................... t..--------c------'r--`- c..-(...........
O S � Installer -
at . l'\ ' �' ` .....W.............�---..-
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ................................................ dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. r�\
DATE............ .................................. ---.........------.------ --......--...... Inspector . ---------------- sl .................. .........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�` TOWN OF BARNSTABLE f
No._.. . FEE... .....
Disposal urki �no#rnrtiun amit
Permission is hereby granted............. ............................................._. �^'_�'.�.:..._
SI to Construct (� or
R�- it '- an Individual Sewage Disposal System � � 1�S
atNo. ................ �''- ,----------------•--� --- -----------------------..........
Street (� '
as shown on the application for Disposal Works Constructio rmit No.-= - .._. tee_.�:....___............ '......
1J� ...
Board o ealth
DATE......--- p----------------1---- -......--------
.-.-•-•••-•-•-----•_---
FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS
I
T
LEGEND -
IRON PIPE (FND) 0
EXISTING CONTOUR 00
WATER SERVICE LINE —W
Y !
LOT 89
:y
LOT 78 (�.
a
a
0 30 F
96, g 9 S 87'00'00" E 100.00' cp EXISTING LEACHPIT TO BE REMOVED LOCUS MAP
EXISTING SHED TO BE REMOVED PLAN REF: 138-25
DEED REF: 25257-23
ASSESSOR'S MAP: 102-098
LOT 79I - P 1 .1ft ZONING: RF
NOTE:. UNABLE TO PERFORM DEEP SOIL SETBACKS: 30'-15'-15'
10400.0 SQ. FT.I I M� TP #2 Not REAoKfOU TESTS AT SYSTEM LOCATION DUE TO FLOOD ZONE: C
• 0.2 ACRES #1el I EXISTING STRUCTURE AND LEACH PIT. PANEL NUMBER: 250001 0015 C
I PROPOSED S.A.S.
DATED: 08/19/1985
W o.oft OVERLAY DISTRICTS: RPOD, GP, ZONE II
o I MASS ESTUARIES
n
0 21.1ft I � 1
Q o l5115;11; SEPTIC REPAIR
4 0
W , ,. ft PLAN OF LAND
Z EXISTING D—BOX
o I O O 1 1.1 Z w TO BE REPLACED LOT 88
o 50 LOCATED AT:
o , , # w o �Q�,tH oF�gss 50 RASPBERRY LANE
o I EXISTING 1000 GALLON TANK o�� DAVID 9�Z
Z ��, �, B. MARSTONS MILLS, MA
I
O MASON m
W o���- z p NO.10660 (y PREPARED FOR:
m W�--W W 20.8f LARSON REALTY CO. , INC.
32.5ft Q
BM: SURVEYOR'S SPIKE OU/O9/2O1
v ELEVATION: 85.19
Lq I DATUM: ASSIGNED
REV:
�^ �® REV:
\ aQ�c�'�Tc'F
® �`S STEPr"El" REV:
DOYLE V I
98 96 7* 92 90 8 ® j�,, _ YANKEE LAND SURVEY CO, INC.
N 8T00'00" W 100.00' � - �'
119 ROUTE 149
MARSTONS MILLS, MA
LOT 80 LOT 87 v
TEL: (508)428-0055 FAX: (508)420-5553
ya'nkeesurveygcomcast.net www.yankeesurvey.com
SHEET 1 OF 1 JOB#: 54729 SH
SEWAGE SYSTEM PROFILE VIEW N . T . S .
T.O.F. EL. 90.31
FIN GRADE _' 89'
RISERS FIN GRADE = 86't
20" 20"
DIA. DIA. � PVC INSPECTION PORT WITH SCREW CAP
tIN
FIN GRADE = 86'-84't GEOTEXTIL FABRIC TO WITHIN 3" OF FINISHED GRADE (4 TYP)
SEE PLAN VIEW.
INV EL. 10" MIN. 14" MIN. INV EL. INV EL. EL.82.00'
88.3' —� �— 88.05' INV EL. " INV EL. 81.59' ° o °BELOW FLOW LINE 85' 84.8' ° °
LIQUID LEVEL 48" ° e ° ° ° °
°°e
t
l GAS BAFFLE 6 STONE 1 6„ °° °°°°° °° EL.80.67'
DISTRIBUTION BOX °°° °
EXISTING 1000 GALLON TANKS 34" CLEAN MEDIUM SAND
PRECAST REINFORCED CONCRETE DISTRIBUTION BOX 6" SEPARATION BETWEEN ROWS (TYP.)
TEES SHALL BE CONSTRUCTED OF SCHEDULE 40 PVC AND SHALL EXTEND A INSTALL ON A LEVEL BASE WITH WATERTIGHT COVER 1 3.83'
MINIMUM OF 6" ABOVE THE FLOW LINE OF THE SEPTIC TANK AND BE ON MINIMUM WALL THICKNESS = 2"
THE CENTERLINE OF THE SEPTIC TANK LOCATED DIRECTLEY UNDER THE MINIMUM INSIDE DIMENSION = 12" USE FOUR ROWS OF (4) HIGH CAPACITY INFILTRATOR CHAMBERS N
CLEAN—OUT MANHOLE. OUTLET INVERTS SHALL BE EQUAL TO EACH OTHER AND AT TOTAL CHAMBERS = 16
THE INLET PIPE ELEVATION SHALL BE NO LESS THAN 2" NOR MORE THAN 3" 2" MINIMUM BELOW INLET INVERT. 1
ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. THE DISTRIBUTION LINES FROM THE DISTRIBUTION BOX SHALL ALL HAVE IF NECESSARY PERFORM 5' STRIPOUT DOWN 1
SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9" EQUAL INVERTS AS DETERMINED BY FLOODING THE DISTRIBUTION BOX TO TO Cl HORIZON PER TITLE V REQUIREMENTS.
TWO 20" MANHOLES WITH READILY REMOVABLE IMPERMEABLE COVERS THE HEIGHT OF THE DISTRIBUTION LINE INVERT AFTER ALL LINES HAVE BOTTOM OF SOIL PIT E EL. 78.3'
OF DURABLE MATERIAL SHALL BE PROVIDED WITH ACCESS PORTS. BEEN SEALED IN PLACE. NO GROUND WATER OR
MIDDLE ACCESS PORT SHALL BE 8" DIA. MINIMUM. INVERT ADJUSTMENTS SHALL BE MADE BY FILLING WITH DURABLE AND REDOXIMORPHIC FEATURES OBSERVED
THE OUTLET TEE SHALL BE EQUIPPED WITH GAS BAFFLE. NONDEFORMABLE MATERIAL PERMANENTLY FASTENED TO THE LINE OR
RECONSTRUCTING THE LINES UNTIL ALL INVERTS ARE OF EQUAL ELEVATION.
DESIGN DATA:
SEPTIC TANK CAPACITY: EXISTING THREE BEDROOMS — NO INCREASED FLOW � ll 4 PVC
REQUIRED — 330 GALLONS AT 200% 3 X 110 = 330 GPD REQUIRED FLOW q �V VENT1.0
PROVIDED — 1000 GALLONS TO REMAIN
USE 16 HIGH CAPACITY INFILTRATOR CHAMBERS
IN FIELD CONFIGURATION WITHOUT AGGREGATE FIN GRADE 84'-86't
=
(1 6 X 6.25) X 4.72 SF/LF = 472 SF EL.82.o0'
472 X 0.74 = 349 GPD TOTAL DESIGN FLOW 7S�AN
GENERAL NOTES: MED1 . ALL THE WORKMANSHIP AND MATERIALS SHALL CONFORM TO DEP RESERVE FLOW = 19 GPD SAND
TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS GARBAGE DISPOSAL NOT ALLOWED ° °°
FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 25
2. ACCESS PORTS OVER TANK TEES SHALL BE ACCESSIBLE WITHIN 6" 26'
OF FINISHED GRADE
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF USE FOUR ROWS of (4) HIGH CAPACITY INFILTRATOR CHAMBERS
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' TOTAL CHAMBERS = 16
OF DRIVES OR PARKING. H-20 LOADING SHALL BE USED UNDER OR WITHIN T.P. #1 PERC <2 M/INCH T.P. #2 PERC <2 M/INCH
10' OF DRIVES OR PARKING, UNLESS NOTED.
4. THE EXCAVATOR/CONTRACTOR SHALL CALL "DIG SAFE" AND VERIFY THE LOCATION EL. 90.3' 0" EL. 90.3' 0" � �3a
OF SITE UTILITIES PRIOR TO ANY EXCAVATION, AND SHALL BE RESPONSIBLE FOR
"FILL' "LS„ 10 YR 4/2 "FILL' "LS„ 10 YR 4/2
ALL MATTERSRELATING TO ELECTRIC AND/OR GAS EASEMENTS. 35" SOIL DATA:
35"
5. SEWER PIPES SHALL BE SCHEDULE 40 PVC. (4" DIA. UNLESS UTHERWISE NOTED) „BW„ "LS" 10 YR 6/8 „BW„ "LS" 10 YR 6/8 TEST DATE: 5/6/2011
6. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE 57" 57 SOIL EVALUATOR: DAVID B MASON
MORTARED IN PLACE. EL. 85.5' EL. 85.5'
7. FINISH GRADE SHALL HAVE A MINIMUM SLOPE OF 0.02 FT. PER FOOT. MEDIUM MEDIUM APPROVAL DATE: 10/94
8. EXISTING SYSTEM COMPONENTS — IF ANY — SHALL BE ABANDONED PER "C1' SAND C1. SAND HEALTH AGENT: DON DESMARAIS
TITLE 5 REQUIREMENTS. 10 YR 7/2 10 YR 7/2
9. THE EXCAVATOR/CONTRACTOR SHALL BE RESPONSIBLE TO CONTACT YANKEE EL. 78.3 144„ EL. 78.3' 144"
SURVEY 24 HOURS PRIOR TO ANY REQUIRED INSPECTIONS.
10. ALL COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR NO G\WATER OR NO G\WATER OR
COMPARABLE MEANS IN ORDER TO LOCATE THEM ONCE BURIED. REDOXIMORPHIC FEATURES REDOXIMORPHIC FEATURES
SHEET 2 OF 2 JOB NUMBER__ 54709