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Home My WebLink About0029 REDBERRY LANE - Health 29 Re [berry Lane, Marstons Mills p tw it i ASSESSORS MAP NO: ` -7 7 PARCEL N0: 12 9 ` Fims.....� ............ No.: �p.._._...._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �� ,a096 `^-- ^/......OF...............................................................O� q/:,ST/f,31-�' -•z 7�. IJ e5 .�vOr�a#ioat for Disposal Works Toatotratrtioat Prrutit Application is hereby made for a Permit to Construct ( +Or Repair ( ) an Individual Sewage Disposal System at: ...... T 2�eaTzo.D.r3iLyz) .._L.4r/ M �� _ A ....._-•........ .......... ...... ---- I Location-Address or Lot No. - - ,.... �O ff N G�3 a c. �}/ars�/ JAL R.Ss4n/T 4577 Zi4•v o --------------------- ---------•-----•-... ........_..------..._.._....•..----- ..... ....----•-•................ �w�^/S.w Address ........ f......................................... Installer Address U Type of Building Size Lot_____..3�. 3_�.Sq. feet Dwelling—No. of Bedrooms................3.......................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building �a f=...... No. of persons ............... Showers — Cafeteria a yP g --------------- P ( ) ( ) aOther fixtures ------------------------------------------------•-----••-•---••--•---•----•••---------...-•-••----••--•••••-•------•-•--•-••-............--•---•-••-•• Design Flow....................T457457.........gallons per person per day. Total daily flow------- -0.................gallons. WSeptic Tank—Liquid capacityZIPPOgallons LengthA......._ Width-f......�.'. Diameter................ Depth. ".�.. x Disposal Trench—No. .-_--__-____---_-- Width.................... Total Length.................... Total leaching area..........._........sq. ft. Seepage Pit No--------l............ Diameter.._/.. ........... Depth below inlet... .... Total leaching area.....2.4ssq. ft. Z Other Distribution box (P< Dosing toak- —7 '-' Percolation Test Results Performed b ._.C_!"_Q_!... �� _S�_�r _.......... Date./.o �f. __ . a y 9---------- ---------- ,, .,� ----- ,� Test Pit No. 1.__ Z.minutes per inch Depth of Test Pit---- _ _. Depth to ground water._/__ _ ..._.._.. (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..__._........_..--__ -------------------- ------------------ c. c. $ O Description of Soil I'�-=-?.!e.�i v- , i C oQ�-�.P 5'�'� ------------------•---• ----------•------------- :� T ------•-------------------------------------------------------------------------------------------------•----------------------....------------------------------------------------••-•--.........--•••- U Nature 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 iII= 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/off Health. / Signed..^�5 d� G .............8 Date Application Approved By.............. .. . .... 1-- ----------------------_----- .........& - —...--- D ate Application Disapproved for the following reasons:................................................................................................................ --•-•-•---.....•-•--•---•-•--•-••--•-•-......--•-•-••-•••-•-••-......-•-••--•-•••-•-.........••--•••---••-•--•---••••--•-•--•--•--•-••--••-•----••-------------••••••--••••----••---••---•••--•••-...._. Date PermitNo........�. '.'.... .................... Issued........................................................ Date I 2- 7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................................................... Appliration for Bhipooal Works Tomitrurtion Vamit Application is hereby made for a Permit to Construct ( b") or Repair ( ) an Individual Sewage Disposal System at: , ,., �9 A.,..•C„i "' " `Ct ij ''"a .`�., .,Ce , ? f ,G.,.v' r,.7 !��"..,. "'•"e�7'.s°_s "'J 1 x..5', �-. . J.". - �r Location Address or Lot No _..................... .......---••-------.......................... •......_.................---•-.......... •. - ............ ........ ►-a .............. aller .................................. .� ... A4 ems ddress U Type of Building Size Lot_ `.. . __ . '.Sq. feet Dwelling—No. of Bedrooms................%........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building -------- No. of persons__....._!-,t................ Showers — Cafeteria QI Other fixtures ............................ WDesign Flow...................�t`�-'�.........._•__gallons per person per day. Total daily flow-__--__.._._ .. .. ..._._..........gallons. WSeptic Tank—Liquid capacity 00.gallons Length. ----- Width: --- .�7_`_ Diameter................ Depth..*••'___.._._._.. Disposal Trench—No..................... Width .................... .. ..............._...... Total Length Total leaching area.................... ft. x Seepage Pit No-------+............. Diameter...1.Z__1--------- Depth below inlet.._:`..c_:"^...... Total leaching area....f. — ft. Z Other Distribution box (+k'j Dosing tank�--) �. '-' Percolation Test Results Performed by-.. '__ _.'�__1_.. l' .......................................... Date.%.4"'f_ r� ,4 Test Pit No. minutes per inch Depth of Test Pit...... e__.___ Depth to ground water.). -.•-•....._.. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water............... ._..---- aCts1 a, . ,., Description of Soil-------- "----...-------•-------•--........--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 TITLE 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 o healthh.. Signed ' = =' -----._�r ..-------••-•--•--- --•� .....�-�.'........ Date- Application Approved BY ... � -ate,•*-�_. _r ,_�: _- ----------------•---•---•--•--- ............................ ...... J Date Application Disapproved for the following reasons-------------•------------------------------------- ............................................................. ........................•....--------•--...••--------••---•---•---------------•-•-•----••--•-•--•-------•--••-•-----•-••-••.----•-••-•-----•------•----•-•-•--•-••------•----------••--••-••----------- Date PermitNo.-----. -Y.......... -----•-•------------ Issued--------------------------............................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................................I................................... Trrtifiratr of Tompfianr� _ THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( '"S or Repaired ( ) -_ ` by =-'' = '= = j. - ................:..... ....--------------------------------------•---•-----------...-----...------•--------------------------................ Installer at ,... -•-----------------••-------•--------'="-------_-•-•---------------- ---.----------------------•--------------------•..............................................e....... has been installed in accordance with the provisions of TIT�r6 5 of Xhv State Sanitary 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 V811LL FUNCTION SATISFACTORY. CTORY. �� / DATE................................... .��C -•-•--......---•------••---. Inspects -.... . .. ---------------•-•. ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH :.......'�.".�?...h�"...........OF.....`-�`Z.:..Z..-�.` �:'..................................................... No......................... FEE......................... Elispooal or�� onotr rtion permit Permission is hereby granted..._d 77'7.1_ ............................................................. to Construct ( 4<or Repair (F ) an Individual Sewage Disposal System at No..... .. ?. .' ice. • /.Z '"....... '� , '�� 7 Q='-' `S =, '// 4 d- .5 . ( .. Street,� •. as shown on the application for Disposal Works Construction Permit6. _....___ Dated_.__. ------------------------- .� ' 7/ Board of Health J DATE....... .................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS i 1 i8 J l`OT• �,ram qq x ``� . FouwOAT�N .......... T L per.Zg `CIL G / LOT 3 g joB # 91-132 CERTIFIED PLOT PLAN PREPARED FOR: LOCATION: RED BERRY LANE MARSTONS MILLS SCALE: 1 =60 + DATE: 05/20/91 REFERENCE: ASSC SHEET 47 PARCEL 1272 RANDOLPH REALTY TRUST I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. o MOELV tFE down cape engineering, inc ° .336.2 CIVIL ENGINEERS A,�� o LAND SURVEYORS A6y Z('Z9q/ .F Fr!ST R nA TG Fr. EYO f i Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 Redberry Lane,Marstons Mills Owner: Robert Cyr Date of Inspection: July 31,2006 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. Redberry Lane Water Service 42 27 13 22 T6W 10 F w TABLEsp VILLAGl's a0 n S /'l �'SSEsOIVS &LOT IP S.T,JU S NAAIJ A.FROM NO: 513c TArr�CAP.�C�rY �,.. 13RA�ITOA,T'E• Cpmm,lA►l$(i ATE, E Sep�at,h��3esta�e Bctveen k3io. D2nxlmumA tjwste t.Gtautidwatei Tabk4ti�e Baitamo LeaGhin N�uilit eer ff - y .�...W.. .. 1'lva4e'woor 5upPly 1P4t1_ m Le�tuas Facmry Oeay clslls axial ' an adta ac:wltrbin�Qfl foot al;ta�bir►�faclbty) l�eai cy�'�detlatttd and x.caci�lu�Mcititi4yr(tEuny wetWd�e�ssc f i dllsl Soo feetaf kaQw AWury} Rae ih irnishad:by k r' c 1 Fro„fi o � o a ag, , IZ Commonwealth of Massachusetts ,,. Title 5 Official Inspection Form l I, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is `� required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information i 301-+Lf Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);1 have personally inspected the sewage disposal system at theproperty address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 7-12-19 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 L Commonwealth of Massachusetts ' r� Title 5 Official Inspection Form Ii. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes:-,.; ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 2) System Conditionally Passes: ❑ One or more system components as described in the "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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 i Commonwealth of Massachusetts 4. Title 5 Official Inspection Form '1 ICI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y El ❑ ND (Explain below): ❑ obstruction is removed ❑ Y El ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,w Title 5 official Inspection Form • i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments VW ' 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts ,. Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow ❑ I® 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. ❑ -Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in 'Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts r7 ;w Title 5 Official Inspection Form ICI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '� ry " 29 Redber Ln ., Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? i ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Wasthe facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts r� ,w. Title 5 Official Inspection Form I�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >1 ;: 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection 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 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: - t5insp.doc-rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form �) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1980's Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 14"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 6"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 l Commonwealth of Massachusetts 2. w. Title 5 Official Inspection Form 't'j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: . feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts ;. Title 5 Official Inspection Form l:. I�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Lin Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working 'level and no sign of back-up from pit. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 I r Commonwealth of Massachusetts r� 3 Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "mac' 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1-600 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts w Title 5 Official Inspection Form ! i6l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town 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.): Leach pit in good condition and empty at inspeciton with stain line at 16" below inlet invert. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 f 4 ,� Commonwealth of Massachusetts r� ,w Title 5 Official Inspection Form Mi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town 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, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts w Title 5 Official Inspection Form ! ICI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �40 Eo a A + " '4 .3 - 371 r 4 ce t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts �.1 ra Title 5 Official Inspection Form 1.1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope p ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked date of designplan 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: USGS and town map show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Redberry Ln Property Address Hudson Home Management LLC Owner Owner's Name information is required for every Marstons Mills MA 02648 7-12-19 page. City/Town 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 ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 i TOWN OF BARNSTABLE LOCATION ton r0, gE*6-6-W S p VILLAGE J _ r SESSOR'S M P&PARCELO'&-0/a Dol- IA&TA44�RRS NAME&PHONE NO. l.� Ic k- SEPTIC TANK CAPACITY LEACHING FACILITY: (type)'—Rlt (size) b6c) w1 NO. OF.BEDROOMS OWNER 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 I Redberry bane Water Service 42 27 13 / 22 ' r R i f � i� TOWN OF BARNSTABLE ® lo/q 9l LOCATION SEWAGE VILLAGE ASSESSOR'S MAP 6z LOT C� INSTALLER'S NAME & PHONE NO. ( t Ct-c�-, SEPTIC TANK CAPACITY tjO-o O LEACHING FACILITY:(type) (size) 60-0 NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER BUILDER 08,,LCOWNS DATE PERMIT ISSUED: ZL6 417 ( DATE COMPLIANCE ISSUED: I'` VARIANCE GRANTED: Yes No V I � LI 3z� • i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION r) ij 1,/_' it 14 er .... �e y�e TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION p 4�1 Property Address: 29 Redberry Lane Marstons Mills MA 02648 Owner's Name: Robert Cyr Owner's Address: Same Date of Inspection: July 31,2006 Job#06-208 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: OF _X_ Passes ��:: '•9C�% Conditionally Passes •'• G Needs Further Evaluation by the Loc 1 Approving Authority FA NI ';m Fail "0 9 �v Z Inspector's Signature: IM Date: 7/31/06 %*�i • .LF��;�p �4i •5INSPEr, The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of He '41%t,,\`` DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Leaching pit has 14-16"of effective leaching,recommend pumping tank. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 29 Redberry Lane,Marstons Mills Owner: Robert Cyr Date of Inspection: July 31,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: r Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 29 Redberry Lane,Marstons Mills Owner: Robert Cyr Date of Inspection: July 31,2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of i l OFFI CIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 29 Redberry Lane,Marstons Mills Owner: Robert Cyr Date of Inspection: July 31,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow —X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. —X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone I1 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 29 Redberry Lane,Marstons Mills Owner: Robert Cyr Date of Inspection: July 31,2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period ? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up _X_ _ Was the site inspected for signs of break out _X_ _ Were all system components,excluding the SAS, located on site _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] i Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 29 Redberry Lane,Marstons Mills Owner: Robert Cyr Date of Inspection: July 31,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220 Number of current residents:3 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Two years total: 56,000 gal.=76 gpd. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank has never been pumped. Source of information: Owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from 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: Compliance date: 5/6/91 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 Redberry Lane, Marstons Mills Owner: Robert Cyr Date of Inspection: July 31,2006 BUILDING SEWER:XX (locate on site plan) Depth below grade: I Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 6" Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:8.5'long x 5.2'wide—1000 gal. Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle:24" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle:9" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees are intact and liquid level is at bottom of outlet invert Observed some solids in outlet tee recommend Dumpine tank now and every three years to properly maintain system GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 Redberry Lane,Marstons Mills Owner: Robert Cyr Date of Inspection: July 31,2006 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Trace of solids carryover,no high stains. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 Redberry Lane,Marstons Mills Owner: Robert Cyr Date of Inspection: July 31,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 4x6(600 gal.) pit. _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 has 14-16"of effective leaching and some solids carryover was observed CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 29 Redberry Lane,Marstons Mills Owner: Robert Cyr Date of Inspection: July 31,2006 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. Redberry Lane Water Service 42 27 22 13 f Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: p ty s. 29 Redberry Lane,Marstons Mills Owner: Robert Cyr Date of Inspection: July 31,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 40 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) _Checked with local Board of Health-explain: _Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el.55 and topo map shows property at el. 100. 9 co COMMONWEALTH OF MASSAC14USETTS AUG 13 1997 ow EXECUTIVE OFFICE OF E?:V1RONME'NTAL AF S HDFBDNsraelt EAIiHDEPT. ' DEPART�IENT OF E1VIRONME\TAL PROTE \ �j OBE WV1NTER STREET. BOSTON. htA 02108 E W'ILLI.AM F WELD TRUDY CO)T Govemc• Se:retar% ARGEO PALL CELLL'CCI D.AVID B.STRCHS Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A Lows CERTIFICATION Property Address: 6-101 stayt�'MMl��st�r. �� 'Address of Owner: t- pa -, U NAr.- 1111ii-XV, Date of Inspection: t( 1 (If different) Name of Inspector: H, 40 A E;D' (EDC�o I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name:A16T v,-1-l'c E+r rr'rrJ Vt f"P AA-,44C*�/ Mailing Address: Rep Acnx P 339!f H ASN,Ee—v— a-C4-q Telephone Number: e- 4& Zp CERTIFICATION STATEMENT I certirl that I have personalh inspected the sewage disposal systern at this address and tha: the information reported belov, is true, accurate and complete as of the time of inspec,o-.. The inspection was performed based on my training and experience in the proper iunction and maintenance of on-sae sewage disposa systems The systern7 K Passes Conc!tlonaii% Passes tieec> Further E%a!uation B\ the local Approving Authont\ Fa•�s Inspector's Signature'- Date: % The Svste- Inspecto, sha" submit a copy of this inspection report to the Approving Authoritv within thirty (30) days of completing this inspection. It the system is a share,' c\•stem o• ha; a design flow of 10,000 god or greater, the inspector and the system owner shall submit the repo^ to the appropriate regional office of the Department of Environmental Protection. The origma! should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authorim. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: BI 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 NDi. Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is meta!, 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 conforming septic tank as approved by the Board of Health. (re%-;,S•d 04/25/91) Page 1 of 10 DEo o^the woma wine weo htt0 irwww magnet state ma.uwoec r r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t , PART A �w ' CERTIFICATION (continued) rata ;'L Property Address: ,ti 10 Owner:. ` Date of Inspection: B) SYSTEM CONDITIONALLY PASSES tconnn;,ed Sewage backup or breakout or high static waver level observed in the istribution box is due to broken or obstrucsad pipets) or due to a broken, settled or uneven distribution box. The s tem will pass inspection if(with approval oiVie Board of Health;. Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year d e to broken or obstructed pipe(s). The system will p..: inspection if(with approval of the Board of Health): broken pipe(si are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF H TH: Conditions exist which require further evaluation by the and of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH D ERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MA%AfR WHICH WILL PROTECT THE PUBLIC HEALTH AN SAFETY AND THE ENVIRONMENT: Cesspool or prig,\ is within 50 feet of a rface water Cesspoo!.o: pri%) is \,+;thin 50 feet of a ordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES INAT THE SYSTEM IS FUNCTIONING IN A MAN ER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank an soil absorption system (SAS) and the SAS is within 100 feet to a surface water ssi�oy.-or tributary to a surface water su 1%, The system has a septic tank nd soil absorption system and the SAS is within a Zone I of a public Hater supniv v*t The system has a septic tan• and soil absorption system and the SAS is within 50 feet of a private water supply weII!. The system has a septic to and soil absorption system and the SAS is less than, 100 feet but 50 feet or more from private water supply well uniess a well water analysis for coliform bacteria and volatile organic compounds indiatlesdiX the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equd.w or less than 5 ppm. Meth used to determine distance (approximation not valid). 3) OTHER / (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Propert,. dress: Owner. � Date of Inspection:2r't ; Check if the following have been done: You must indicate either "Yes" or "No"as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. None of the systerr 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 recentl. or as pan of this inspection As built plans have been oD:a:ned and examined. Note if they are not available with N/A. The facdi-; or d%.e'l;ng %%as inspected fo, signs of sewage back-up. _ The sstem does not receive non-sanitan• or industrial waste flow. The site vas inspected for signs of breakout. t x _ All s\ste r components, exclud:ne the So-1 .Aosorpt:on System, have been located on the site. The septic tank rnar;hoies Here uncovered, opened. and the interior of the septic tank was inspected for condition of bafhes or tees. mater;a, o-construction. dimensions, deptn of liquid,.depth of sludge, depth of scum. —The size and location of the Soi: A,bsorpnon Svsiem on the site has been determined based on The facda% o\%ne• :;ano occupants. r different trorn owner were provided with information on the proper maintenance of Sub-Surface Disposal Svsterr. Existing information. Ea. Plan at B.O H. _ Determined in ine field of am of the failure crter;a related to Pan C is at issue, approximation of distance is unacceatab,e [t S.302.3;b J !revised 04/25/57i Page 4 of 10 P � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: DJ SYSTEM FAILS: You must indicate either "Yes" or "No' as to each of the following I have determined that the system violates one or more of the following fail re criteria as defined in 310 CMR 15.303. The bans for this determination is identified below. The Board of Health should be ontacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an verloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground r 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 Liouid depth in cesspool is less than 6" below invert or av ilable volume is less than 112 day, floe. Reeuired pumping more than 4 times in the last year N T due to clogged or obstructed pipes . Number o, times pumped _. Any portion o`the So!l Absorption System, cesspool r privy is billow the high groundwater eievation Am portion of a cesspool or privy is within 100 f of a surface water supply or tributar to a surface water supple. And pornon of a cesspoo' or prn) is "ithirt a Zoe I of a public well. Am po-,jo- e-a cesspool or prn-• is within 50 eet of a private water supple well Any por,,or. o-a cesspool or pricy is less than 100 feet but greater than 50 feet from a private water supply well with no acceotabie water qualm analysis li the well has been analyzed to be acceptabie, attach cope of well water analysis for coloorm baccena. volatile organic compoun s, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes' or "No" as to each of the fol owing: The foliw,%;ng criteria app,,. to large systems in a ' 'ition to the criteria above: The system ser-es a facilin with a design flow 10,000 god or greater (Large System; and the system is a significant threat to public hea!th and safety and the environment cause one or more of the following conditions exist: •Yes No the system is within 400 feet of a surface drinking water supply p' the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area • IWPA) or a mapped Zone 11 of a public water supply well) / The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/91) Page 3 of 10 J . SUBSURFACE SEWAGE DISPOSAL TY M SSE INSPECTION FOR.tit PART.0 p p SYSTEM INFORMATION Propert, ddress: r�1 �tL1l Owner: Date of Inspection:'IttLA" FLOW CONDITIONS RESIDENTIAL: Design floe. �.p.d./bedroorr. for S.A.S Number of bedrooms Number o:current residents Q � Garbage g•, der (yes or no-: Laundry C07—ected to system (yes or no' Seasonal use (yes or no,:� Water meter readings, if available (fast two ;21 year usage (gpdf:l`Y� Sump Pump (ves or nor Las; date o-'occupancy CONIMERCIAL'INDUSTRIAL Type of establishment Design fio%N _gahonvda% Grease trap present ryes or no' Industna! %Taste Holding Tani: oresen,. -Yes or no Non-sanitarn %%zste d,scnargec to the Ta,e 5 system ,ves or no_ 1%ater meter readings, if a,ailabie Las;pa,e o; o -:panc, OTHER: .:)escnbe Last oafe of occudanc, GENERAL INFORMATION PUMPING RECORDS and so rce of informauor. System pumped as par, of on5 clon. .;Yes or n Pe 0 If yes, volume pumped ¢allons Reason for purrmping TYPE OF SYSTEM ?r\ _ Septic tank/distribution box/5oil absorption system Single cesspool Overflow cesspool Pnn.), Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technologv etc. Copy of up to date contract? _ Other APPROXIMATE AGE of all components, date installed (if known) and source of information: -A,. t0 V Sewage odors detected when arriving at the site (yes or not (revised 04/25/91) DaQ• S o1 20 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ;Lei �I¢ Owner: Re �l Date of Inspection:��N` '� BUILDING SEWER: A (Locate on site plan) Depth below grade. Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction li-t Diameter Comments: (condition of)o)nts, venting, evidence of leakage. etc.) SEPTIC TANKA103 (locate on site plan Depth below grade �r material of construction: concre:e _meta _Fioerglass _Pclvethvlene _othertexplam If tank is metal, Lis: age _ Is age con;irmec b% Cen.fica:e of Compitance _(lesNo Dimensions Sludge depth 14 tl Distance from top of sludge to boron of outie: tee o• ba^;e a Scum thickness Distance from top of scum to top o' outlet tee or bade G� Distance from bottom of scum to bo, or o, outlet tee o° bane How dimensions were determined /St/QQ Comments trecommendanon for pumping condition of inlet -no outlet tees or baffles epth of liquid level in relation to outlet inve�structural in gnty, evi rice o leaks e. e;c.t �C 1 GREASE TRAP: (locate on site plan; Depth below grade Material of construction: _concrete _metal Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of i,,let and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.; (revised 04/25.17) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C A ( SYSTE.M INFORMATION (continued) Propertm Address:xi (�( ON ner: P� ` Date of Inspect ion-ef � 47 �i TIGHT OR HOLDING TANK:, lank must be pumped prior to, or at time, of inspection; (locate on site plan, Depth below grade. Material of construction. _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions. Capacity gallons Design floe, gahons,da, Alarm level Alarm in „orkmg order_ Yes: _ No Date of previous pumping Comments (condition of inlet tee. condauor o- ala,m and float switches. etc.t DISTRIBUTION BOX:(�S (locate on site p:zn �tt De,;:,, of hcuid le,e' aoo.e ou;le: in,e,C RX 4(hU ,1 Comments mote leve! and d:sr1b:;'or is ea a' evidence of solids cam over, ,idence of eakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan. Pumps in working order: (Yes or No, Alarms in working order (les or No Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (reva*ed 04/25/9,) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertN Address:Owner: p.(R alLk e t a s . Date of Inspection: 84f 9 SOIL ABSORPTION SYSTEM (SAS): (locate on srte.plan, if possible, exca,a ion not required, but may be approximated by non-intrusive methocisi If not determined to be present, explain: Type, leaching pits. number. k.� leaching chambers, number: leaching galleries, number: leaching trenches. number,tength: leaching fields, number, di)e%ions oveiflow cesspool, number Alternative system Name of Tecnnoiog\ Comments. t to condr ion of sod. s rs of hydraulic farlur level of ponding condition of v etatron tc st t in W CtAr CESSPOOLS: (locate on site plan Number and config;;ra:�on Depth-top or liquid to inlet Inver, Depth of solids layer Depth of scum layer. Dimensions of cesspool Materials of constructior Indication of groundwate- inflory (cesspool mus De pumped as par, of inspection; 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 condivon of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (ravaeed 04/25/97) page I of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property ddress: Owner: �,SZ.2�c Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reierences landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) zkZc AM 21 i (zavised 04!2515') page 9 of 10 ;. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: d�k Owner: 4W"Cr%A �--i Date of Inspection: skit Depth to Groundwatert 14'%Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record ` a Observation o! Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Cnec'K %%ith local Board o• newt^ Chec, FE..MA maps Check pumping records Check local eacavato�s. installers lase LSAS Datzi Describe in %our o% %+ores .n.o•,% �o:; estabL<_hed the ^ E^ Ground"ater Elevation. (Must be completed- J.g c, .W � 10 l,C -'DNV�S� tJY1 Z ` � 1 (zev:iod 04,25'9-. Page 10 of 10 G BENCH MARK t TEST SOLE BELTS P t DATE : i �r°r/ G 7 W I T N E S S E D BY ,7 rz,re. > . v"v //A/Gl, '2, 2-Al' a TEST HOLE zFL.- TEST HOLE E'L 47.E 7— M .Eta i v/Vi � � G• �` T n 2 60 , _ I �- c or QnoQ D �K O_ ✓ „r/� Q,o,l• A/�GROUND WATER GROUND WATER 46 N D I 4� . •� GBR.si� - t7 I ENCOUNTERED ENCOUNTERED +/ o MANHOLES AND COVER TO BE BUI LT TO ELEV. TOP OF WITHIN I?" OF FINISHED GRACE FOUNDATION o i� F I N I MIN, 2 /o SLOPE 0 SHED GRADE PE DIA. PIPE FI S 12M1 _ „ ,�► <�-s � E� PIPE -. „"°"^� ' _.. _4 :� - r __ .. - MIN , 2 LAYER 0 F �( v R I •t �� ACC A `!� —a NI;N. MIN . PITCH �,. FT. r'"' 2� LEVE ,.f I�g'+•I 2' P E A S T 0 N E 1 `V MIN PI - k •� T C H �a .��.�. 1� --• '- • � a • ' /000 • p a ,� ♦ INVERT :. . 4 GALLON IN'YFF' T C",sw�tG lip«VERY r R t� 4'7f.� `,`S F r T 1 C T A K K 1 � �d T ( ,I S T, � `,};.� •.' `�' c�� .` 4 I Y2. DPI A. .' __• R ` ' g 0(� A M . ,a1M UM OF ) 8C 0I- _ . iN E T �--.--• __..._ _. - OX N ✓EPT y . , f L - �QRj. FOOTING TO BE PLACED ; � R B V - WASH � D — P I ACE : A L -A Ft O� D 3 to -=-� - BG.,Z ' �� + ` ' V 1 R G ( N OR COMPACTED J_` 0' M l N. FI F? M SAS - .... ---•.-{ --1� I cL?► . Oh;( AT ELEV. "d°q L} 2 S AIN D _ c e 0•T T S I .. /o GARBAGE ( 2 Q° MIN.) ' GRIN DER l y- ,3d7- ELEV. L- or PR O F I LE OF GROUND WATER TABLE 40 iff-40, SANITARY DISPOSAL SYSTEM ( NOT TO SCALE ) DESIGN DATA 0 CONSTRUCTION OF SANITARY DISPOSAL BEDROOMS SYSTEM SHALL CONFORM TO THE MASS. DESIGN FLOW 330 GAL./IDAY ENVIRONMENTAL CODE TITLE 77LEACH RATE c MIN. INCH (REVISED 7- 1- 77 ) AND THE T 0 W N HEALTH DEPARTMENT REGULATIONS REQUIRED LEACHING CAPACITY : ` 27�'hP (-7- „vv, 0 SEPTIC TANK, DISTRIBUTION BOX AND LEACH - PROPOSED •� GAL/bAY ING UNIT TO BE OF REINFORCED CONCRETE ; 2.S' Z.Is r2) +- /,car7"'(��"`_`-' MIN. CONCRETE STRENGTH = 3000PS.I. REQUIRED SEPTIC TANK /000► GAL. MIN. STEEL STRENGTH $, 20,000 PS- I. MIN. DESIGN LOADING : PROPOSED SEPTIC TANK : /000GAL. 0 DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM UNLESS HZO DESIGN LOADING IS USED 0 ALL PIPES AND FITTINGS TO BIB WATERTIGHT AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL DATE " I "' E 1 PL.. AN , SHOWING PROPOSED CONSTRUCTION ZONING DATA LEG E N D L0CATI0N �9, S7 ,1—�.32- Z /Y /ZsTom.✓.� ,m �) ,/. .ss, FOR : LESEL— SOLLOVIS DEV. CORP- DATE Z 0 N E ._._ _ _._. TEST HOLE LOCATION 4- ,q ,C3 L� oC REFEREN CE • LOT AS SHOWN ON REVISIONS : REQUIRED AREA _ '�'3J G Q EXISTING SPOT ELEVATION 17.6 N 11 canIG � REQUIRED FRONTAGE :— zoo EXISTING CONTOUR — 16 4"D0:=�- REQUIRED FRONT SETBACK : 3Ca PROPOSED CONTOUR 16 tL i ��'SCALE r ° • • / �: REQUIRED SIDE SETBACK : � ` PROPOSED WATER SERVICE W _ at REQUIRED - REAR SETBACK : �'� PROPOSED GAS SERVICE G PROPOSED ELEC. a TELE E a T C - 0 R T , P. E . PRO FESSIONAL C IV I L EN G I N E E R BUILDING INSPECTOR APPROVAL DATE 131 OLD ROUTE 132 , HYANN IS , M, A. 02601 FILE NO. ,r- �3 � (. TELE . (617 ) 36 2 - 9411 )