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HomeMy WebLinkAbout0239 REGENCY DRIVE - Health 239 Regency Drive Marstons Mills A= 064-043 S M EAD No.2-153LY UPC 12934 smead.com • Made in USA ?f-cYc Pm usW w YM PROWU NG SFIMEMn4Es«,KMW,s OFU*SR PROCaM SOURCJNG wwWSipibGR4WOW s w Lr.=' Commonwealth of Massachusetts Title 5 Official Inspection Form F; Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd !4, Owner Owner's Name information is Chestnut Hill MA 02461 7/21/2012 required for every page_ Cityfrown State Zap Code Date of Inspection D. System Information (cunt.) 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. Wand-sketch in the area below Ze�o--, _ acl-i drawing attached separately J C r• O yt —�J 1��• =Y=d DvjoJ66: R �I r v 1N 1 -3=: q7 �,' 63=17 , I 1 O (Ve' j o o 4-0 t5im•11/10 T d 1e 6 Cffidiel Inspection Form Subsurface Sewage Disposal System-Page 16 of 17 T r c Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out I forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name tIIIIQ P.O. BOX 145 Company Address c µ7 CENTERVILLE MA ' 02632 �I Cityrrown State 4 Zip Code`.-` 508-420-4534 S14297uw -� Telephone Number License Number Xz sa B. Certification C-1 iDr 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority C 10-1-14 Inspector's&gnature 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 notaddress how the system will perform in the future under the same or different conditions of use. W I l5ins•3113 Title 5 Official Inspection o :Subsurface Sewage Disposal System•Page 1 of 17 i' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owners Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A B C D or E/always complete all of Section D P rY Y P 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: SYSTEM MET ALL MINIMUM PASSING REQUIREMENTS AT TIME OF INSPECTION SYSTEM APPEARS TO BE ORIGINAL RECOMMEND PUTTING RISER ON PIT ACCORDING TO PREVIOUS INSP REPORT COMPONENTS ARE H-20. CAN NOT PREDICT FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USE B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y '❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, II safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or El ® obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 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? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: r Number of bedrooms(design): 3 Number of bedrooms(actual): ? DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. City/Town State Zip Code Date of Inspection D. System Information Description: ACCORDING TO PLAN SYSTEM CONSISTS OF A 1000 GALLON TANK D-BOX AND A LEACH PIT6' DIAMETER Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes' ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: WELL Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract - P ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM s 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1986 PER PLAN Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 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.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLON Sludge depth: VARYING MODERATE AT INLET END t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness LIGHT Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): RECOMMEND PUMPING EVERT 2-3 YRS Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): i Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M yt 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): box level no leakage or solid carry over at time of inspection Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments yy< 239 REGENCY DRIVE M Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) 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.): pit should have a metal cover and riser installed, at time of inspection there were no evident signs of failure.can not predict future performance under the same or increased use system was installed in' 1986 Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owners Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privylocate on site plan): ( P ) Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/1/14 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 high ground water: none encounteed at perc 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. attached 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: attached design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 REGENCY DRIVE Property Address SAKELLARIDES Owner Owners Name information is required for MARSTONS MILLS MA 02648 10/1/14 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA. FroPe►h/Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owner's Name information is required for every Chestnut Hill MA 02467 7/21/2012 page. City/Town State Zip Code Date of Inspection D. System Wormation Description: /OD� Q /jam //,?,aJeP1,91k 7—,v7k • 7 X�-lO� 4 er Ili Z o ZPCtGl+ W Number of current residents. Does residence have a garbage grinder? Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes x No Laundry system inspected? Al ❑ Yes ❑ No Seasonal use? 9?11y�es ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Wall I Sump pump? ❑ Yes No Last date of occupancy: n-- -7 r L- Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallo r day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank sent? ❑ Yes ❑ No Non-sanitary was ischarged to the Title 5 system? ❑ Yes ❑ No Water eter reacings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts 171 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments P Y 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owner's Name information is Chestnut Hill MA 02461 7/21/2012 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters the building. Check one of the boxes below. Wand-sketch in the area below ❑ drawing attached separately C p ! "� P, ve'o �ts tx Q V �.� _37 1ti i o we. t 7 i v 0 --v LPAC. �. t5in5-11/10 Title 5 Officral Inspection Form Subsurface Sewage Disposal system-Page 16 of 17 vv trv...... � �v-� w C.d L raij yA s�c la.f Al tc)vtLr— .--o��' VA . 2 f,VW-D � �LL ���y i Message Page 1 of 1 Miorandi, Donna From: Rudziak, Jeff Sent: Wednesday, April 23, 2014 3:34 PM To: Miorandi, Donna Subject: RE: ??? bedrooms Hi Donna, Welcome to my world of frustration. Everything held in our assessing records has come from historical actions, by previous field inspectors, assessors, sales questionnaires, etc., and some of that information is wrong. I don't know why in most cases, we just correct them as we find them. The issue of bedrooms and/or bathrooms is a particularly vexing one since we very seldom gain access to houses during our cyclical inspections. So, we live with what the record currently says until we have good reason to change it, as I have just done on the 239 Regency property in our records-The record was changed in 2001 from 3 bedrooms, 2 '/ baths & a total of 6 rooms to 5 bedrooms, 3 '/ baths and a total of 9 rooms. I have no record of who made the change or why and no one who currently works here was a Town employee before 2006, including me. In short, this problem is not going to go away. The data that exists is what we have until better data becomes available. This is one reason I do not use the number of bedrooms as a valuation component in my assessing model. Sorry I can't give you a better answer but I'm not a magician. Jeff Rudziak Director of Assessing P.S. And if the realtors inspected the houses, as they should, they could set the proper listing numbers themselves. -----Original Message----- From: Miorandi, Donna Sent: Wednesday, April 23, 2014 2:47 PM To: Rudziak, Jeff Subject: ??? bedrooms Good Afternoon Mr. Rudziak: I have a quick question and am hoping that you or someone in your department may help out the health department and the building dept. as well. In addition, it will most likely help out the frustrated realtors that we deal with everyday on the phone. This is a constant source of problems that is ever so time consuming. For starters, today we have a property that is in question from a realtor and as a result of investigating our files and building dept. files that it was only approved as a 3 bedroom permit. It is forever restricted to a 3 bedroom due to the fact that it is in all our zones of contribution on just 1.09 acres. The address is 239 Regency Drive, Marstons Mills and was built in 1987 as a 3 bedroom per building and health. The town's website has it listed as a 5 bedroom house. House does that happen without any building permits to go from 3to4to5? I hope you can understand our predicament and we constantly tell realtors and septic inspectors to not go by the website but unfortunately they do. I thank you for your time and understanding on this type of question that is a constant bone of contention among so many of us. I eagerly await your response. Donna Miorandi, R.S. Health Inspector Town of Barnstable 508-862-4639 i I 4/23/2014 i 2 �� G T a 4^� 6A � IV\ —vccl- oco VA �J �-Ll LL - 3M ALL chy s.—ems � ,� Message Page 1 of 1 Miorandi, Donna From: Rudziak, Jeff Sent: Wednesday, April 23, 2014 3:34 PM To: Miorandi, Donna Subject: RE: ??? bedrooms Hi Donna, Welcome to my world of frustration. Everything held in our assessing records has come from historical actions, by previous field inspectors, assessors, sales questionnaires, etc., and some of that information is wrong. I don't know why in most cases, we just correct them as we find them. The issue of bedrooms and/or bathrooms is a particularly vexing one since we very seldom gain access to houses during our cyclical inspections. So, we live with what the record currently says until we have good reason to change it, as I have just done on the 239 Regency property in our records-The record was changed in 2001 from 3 bedrooms, 2 % baths& a total of 6 rooms to 5 bedrooms, 3 'h baths and a total of 9 rooms. I have no record of who made the change or why and no one who currently works here was a Town employee before 2006, including me. In short, this problem is not going to go away. The data that exists is what we have until better data becomes available. This is one reason I do not use the number of bedrooms as a valuation component in my assessing model. Sorry I can't give you a better answer but I'm not a magician. Jeff Rudziak Director of Assessing P.S. And if the realtors inspected the houses, as they should, they could set the proper listing numbers themselves. -----Original Message----- From: Miorandi, Donna Sent: Wednesday, April 23, 2014 2:47 PM To: Rudziak, Jeff Subject: ??? bedrooms Good Afternoon Mr. Rud'ziak: I have a quick question and am hoping that you or someone in your department may help out the health department and the building dept. as well. In addition, it will most likely help out the frustrated realtors that we deal with everyday on the phone. This is a constant source of problems that is ever so time consuming. For starters, today we have a property that is in question from a realtor and as a result of investigating our files and building dept. files that it was only approved as a 3 bedroom permit. It is forever restricted to a 3 bedroom due to the fact that it is in all our zones of contribution on just 1.09 acres. The address is 239 Regency Drive, Marstons Mills and was built in 1987 as a 3 bedroom per building and health. The town's website has it listed as a 5 bedroom house. House does that happen without any building permits to go from 3to4to5? 1 hope you can understand our predicament and we constantly tell realtors and septic inspectors to not go by the website but unfortunately they do. I thank you for your time and understanding on this type of question that is a constant bone of contention among so many of us. I eagerly await your response. Donna Miorandi, R.S. Health Inspector Town of Barnstable 508-862-4639 4/23/2014 I . 22 TOWN OF BARNSTABLE ' ,LOCATION "`� ��Q^ i7 SEWAGE# (i:1 L?-AGE M 4.,t&f M l((S ASSES OR//��'IIS MAP&PARCEL Ip INSTALLERS NAME&PHONE NO. .� O`e 14 a✓t I D S SEPTIC TANK CAPACITY 1000 0O LEACHING FACILITY:(type) ?Qd— t (size) W S A-6 NO,OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: `7 i Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f Feet Private Water Supply Well and Leaching Facility(If any wells exist r on site or within 200 feet of leaching facility) -Q'� ,/,t� I ft Feet Edge of Wetland and Leaching Facility(If any wetlands e ist // h'NS within 300 feet of le ac ' facil' S ''� 17 S Feet FURNISHED BY r •t Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owners Name information is required for every Chestnut Hill MA 02467 7/21/2012 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. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: vl key to move your cursor-do not use the return key. Name of Inspector .7oe Martins Company Name 17 Northside Dr. Company Address S. Dennis, MA 02660 ra�a a Cltyrrown �O^ — 38r�e q State / V( � Zip Code Telephone Number j License Number B. Certification r 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- Title 5(310 CMR 15.000). The system: µ , a/Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority - 9 Ins tor'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 ale at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal po System•Page 1 of 17 Lai d 0 ZoI v /b Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owners Name information o r e Chestnut Hill MA 02467 7/21/2012 required for every page. Cdyfrown State Zip Code Date of Inspection B. Certification (cunt.) 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: 5to,7 7 TO, 4 /6 L//MH 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 replace or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltratio exfiltration or tank failure is imminent. System will pass inspection if the existing tank is re ed with a complying septic tank as approved by the Board of Health. "A metal septic tank i pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indic g that the tank is less than 20 years old is available. ❑ Y N ❑ ND(Explain below): t5ins•11/10 T'Ale 5 Official Inspection Form:Subsurface Selvage Disposal System•Page 2 of 17 6' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owner's Name information o r e Chestnut Hill MA 02467 7/21/2012 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N . ❑ ND(Explain below): ❑ The syst required pumping more than 4 times a year due to broken or obstructed pipe(s). The syst wi.l pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Ev ation is Required by the Board of Health: ❑ Con i i ns exist which require further evaluation by the Board of Health in order to determine if the system,is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Trite 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA w Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owners Name information is required for every Chestnut Hill MA 02467 7/21/2012 page. Clty/rown State Zip Code Date of Inspection B. Certification (cunt.) 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 certifi ratory, for fecal coliform bacteria indicates absent and the presence of ammonia n. n and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria riggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No" to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ rur'\ 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 Y day flow t5ins•11/10 Title 5 Official Irrs pection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owner's Name information is required for every Chestnut Hill MA 02467 7/21/2012 page. Cityfrown State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ Required pumping more than 4 times in the last year NOTdue to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high groundwater elevation. ❑ [)Q Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality p q y 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 wi design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the ing, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 40 et of a surface drinking water supply ❑ ❑ the system i "thin 200 feet of a tributary to a surface drinking water supply the tem is located in a nitrogen sensitive area(Interim Wellhead Protection rea—IWPA)or a mapped Zone II of a public water supply well If you have ered"yes"to any question in Section E the system is considered a significant threat, or answ d°yes" in Section D above the large system has failed. The owner or operator of any large syS considered a significant threat under Section E or failed under Section D shall upgrade the stem in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Selvage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r' 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owner's Name iequiretiore Chestnut Hill MA 02467 7/21/2012 required for every page. City/Town State Zip Code bate of Inspection C. Checklist Check if the following have been done. You must indicate" es" or"no"as to each of the following:Y owl ng: Yes No Z( ❑. 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? Z ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) LvJ ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of brerk out? [�K ❑ Were all system components,!014uTing the SAS, located on site? 23 ❑ 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? K/ ❑ 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: 2 0 Fill" Existing information. For example, a plan at the Board of Health / aK/LTO/UL� ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: /Y -s Number of bedrooms n desi : — ( 9 ) Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): -3'0 —, t5ins•11/10 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owner's Name information is required for every Chestnut Hill MA 02467 7/21/2012 page. City/rown State Zip Code Date of Inspection D. System Information / Description: Jel9lk 7-,,, Xf Z V//V ` Number of current residents: 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? A//o — ❑ Yes ❑ No Seasonal use? 53-,*Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: /N— 7 (r l ?-- Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallo rday(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tan sent? ❑ Yes ❑ No Non-sanitary wa ischarged to the Title 5 system? ❑ Yes ❑ No Water eter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface sewage Disposal posal System•Page 7 of 17 Commonwealth of Massachusetts W_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w r` 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owners Name information is required for every Chestnut Hill MA 02467 7/21/2012 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: We 4510e�, �U� /�/t- d�iUl�yt1L Was system pumped as part of the inspection? ❑ Yes No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, distribution box, soil absorption system ❑ Single cesspool .. ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts -- Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owner's Name information r e Chestnut Hill MA 02467 7/21/2012 required for every page. CltylTown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known)and source of infor tion: Were sewage odors detected when arriving at the site? ❑ Yes (K No Building Sewer(locate on site plan): `� Depth below grade. .3 / feet Material of constructiV40 ❑ cast iron PVC ❑other(explain): Distance from private water supply well or suction line: �d ! feet Comments(on condition of joints, venting, evidence of leakage, etc.): wets VU C'Ax Septic Tank(locate on site plan): Depth below grade: feet Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) El Yes ❑/No Dimensions: d V /�� X '6 /7 x Sludge depth: t5ins•11/10 Title 5 Official Irrspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 :Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owner's Name information is required for every Chestnut Hill MA 02467 7/21/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle �° �y�`j��ye� Scum thickness —PI n (� Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle /�0�0�,��✓�q How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle conditi n, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): P fK 49 Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain).- Dimensions: Scum thickness Distance from to of scum to top of outlet tee or baffle Distance fro bottom of scum to bottom of outlet tee or baffle Date o�la pumping: Date t5ins•11/10 Title 6 Official Inspection Form:Subsurface Sevnge Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owners Name information is required for every Chestnut Hill MA 02467 7/21/2012 page. Cltyfrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffl ndition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tan nk must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑pol eth len y y ❑other(explain): Dimensions: Capacity: gallons Design Flow gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pu ing: Date Comme (condition of alarm and float switches, etc.): 'Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No (Sins•11l10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA 4 Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner owners Name information is Chestnut Hill required for every MA 02467 7/21/2012 page. Cltylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert �/Z I /, P`�J 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.): O� i 19 Pump Chamber(locate on site plan): Pumps in working order: ❑ No Alarms in working.order: ❑ Yes ❑ No Comments(note condition of pump cha condition of pumps and appurtenances, etc.).- Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 Title 5 0lridal Inspection Form:Subsurface Selvage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner owners Name reg fired f r every Chestnut Hill MA 02467 7/21/2012 required for page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Type: I� leaching pits number: ❑ leaching chambers number: / — - ❑ leaching galleries number: / S�0� C. ❑ 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.): 2-0 l�u , �Pv a)�e_ s 7;4-14 2 , ��— �i h a ac hommQ'-P lzdhed -3 �a s f S' ' ' Ar:7/e00 At_ CP,i A- ILO Cd4 ,per,. 3 , 0 s -_ 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 c pool Mate ' s of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA Property Address Hartlaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owners Name information is Chestnut Hill MA required for every 02467 7/21/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 con on of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owner's Name information is Chestnut Hill MA 02467 7/21/2012 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 and-sketch in the area below ❑ drawing attached separately C c � . tlj, 1 P,4ve� t t v ,7 gL=16 ' C h-3= q7 r 63=1 9 hy _ o we-t1 7> tvo� t5ins•11/10 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy.H Sakellarides 186 Laurel Rd Owner Owner's Name require for is Chestnut Hill MA_ n?46742142012 required for every page. CityrFown State Zip Code Date of igp-&hon D. System Information (cont.) Site Exam: [Check Slope (Surface water [Check cellar [Shallow wells 1 � Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: -r- / 5 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: /. SysgE 4-haye- 4yS77 C 2 _ lira ze t 7D �17 �y7t7')'� 3 . l(Zt�-e M S 17c- Like Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11f10 Title 5 Ctficial Inspection Forth:Subswlace Senege Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Regency Drive Marstons Mills MA Property Address Harilaos T and Lucy H Sakellarides 186 Laurel Rd Owner Owner's Name information is Chestnut Hill required for every NA— —W e Al page. CitylTown State Zip Co3e Date of I W. E. Report Completeness Checklist inspection Summary: A, B, C, D, or E checked inspection Summary D(System Failure Criteria Applicable to All Systems)completed ystem Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessors.map and lot number ......... Bpi - T E T0� Sewage Permit number .7.:.cfJ ?.:.. ? �r��.. �o�Q� ♦� 2 ( t% / Z BABBSTADLE. i House number .......:...... ' .�J...! ....../.../ r �.�, 1 y� Mb 6 0 1 39. \e� o�a-ja' TOWN 'OF BAR NSTABLE " BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ .V!...................... ................................................................................... TYPE OF CONSTRUCTION OP.....t'-. 1fdA9L^ ........................19.x TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordin�gn to the following information: Location ... .. .�. �.. f�.� �i(., „� 1VC:.....1.F.! �z.S,TGr7.s.../y)!.�/:5...... �t .. �-- .. Proposed Use :..,. /.r.1.q�?�../ r� i ..1.��rvf' '? . .. `.I7% ..t.H�: :........ .................................. Zoning District .......... .F.........................:.......................Fire District ... .t/1/T� �..i.III°....O&!t�4!!., ...........:. r Name of Owner 1.�.! !� �l .�..i {/r`,...... r''r.T.��r1,...i .10:........ � .�.,,............<:-.1.r�"1..].1.�fJ.....................Address .... ..1/�1.!tJ. .. �1�..... � 14 Name of Builder / !� i I ?: �"...!yAddress .. ......:�� .'.t.L'............f}.��' r ,....,....... �... t..... ........ ...... Name of Architect .: 1(.� �C1�1.�1....r� .�.r1�..' . ..........Address 722;...... Number of Rooms R r�?f1p. �/�/�C�iPl1 .....Foundation ... ...�...�4Ji2�... ....•/......,.......]......� / L Exterior ....�^/OD„e !7.!:."K ��Roofing j�5. Ti!4 ...................................:.................... ,1 j... t. .,.[ Floors .............................................. )) P(/. '.`').................................................... Interior .•. �'7. F Heating �/ rr, .J /..: Jib? i �i .fr.. .......................... .Plumbing :. `!?,-� �r 1.................. .......,.�...'.' Fireplace �fj % .. .1r7: ... `1.!!?���(%c//jJf�9�(' r����<..�App oximate Cost ...sf. ` /�................................................�� - l,. Definitive Plan Approved by Planning Board ------19.7 Area F ....................................... i Diagram of Lot and Building with Dimensions (, �17 '� Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH V c, 1.27 rn J yo M �� OCCUPANCY-PERMITS-REQULRED-...FO.R_NEW_DWELLLNGS 7 _�. _ s� I hereby agree 41conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 9Ja/ Name .Y...6: &�r......::',. . -2::F::!: .. Construction Supervisor's License .it:?:. ........ �W Maximum Wastewater Discharge Allowed Based Upon Lot Size . *if one parcel is within multiple zones, use the more strict limitation for parcel (bolded below) State 1+1/3 1+2/3 Defined True Acres Acres 2 Acres Acre Acre 10,000 13,333 20,000 30,000 =33,334 =40,000 =43,560 50,000 58,080 60,000 =72,599 80,000 87,120 S.F. S.F. S.F. S.F. S.F. S.F. SY S.F. S.F. S.F. S.F. S.F. S.F. STATE , Red Title V: 310 - Diag. CMR 15.214 110 110 220 330 330 440 j 440 550 550 660 770 880 880 Lines *applicant can apply for a variance. STATE Red Diag. With I/A Lines Technology 110 220 330 440 550 660 660 770 880 990 1100 1320 1430 [I/A With 660/acre Credit] (+not in town ordinance) TOWN ORDINANCE Green Regulation of 330 330 330 330 330 '330 330 330 440 440 550 550 660 +Red Wastewater Zones Discharge " *can not apply for variance and doesn't allow I/A. BOH-Interim - Blue Saltwater Estuary, 330 330 330 330 330 440 440 550 550 660 770 880 880 Protection Regulation *call apply for variance, lit' QAOFFICE FORMS\Chart'rable ListingWWDISCHARGE MAXIMUMS3.doc TOWN OF BARNSTABLE � o e APPLICATION PROFILE Application ref 69181 Fee Effective Dt 06/02/2003 Department BUILDING DEPARTMENT Location 239 REGENCY DRIVE Parcel 064043 Cross streets Add'l loc desc Municipality MARSTONS MILLS Subdivision Lot Existing use SINGLE FAMILY HOME memo Current Zoning RESIDENCE F DISTRICT Flood zone Applicant Proj/ACtivitY ELECTRIC RES. ADD/ALTER Class of work OTHER Description REPAIR UG BREAK-NO POWER Proposed use SINGLE FAMILY HOME memo Proposed zoning RESIDENCE F DISTRICT Flood zone Non-conforming N Applic received 06/02/03 Estimated cost 0 Estim start/end 06/02/03 Actual start/end 06/03/03 Impervious Surf Assigned to Status COMPLETE Status Code desc CLOSED APPLICATION Multiple submissions N Next action Government owned N memo ordinance ref Reason for app Parent app Point in time fee effective date Fee expiration date Role Name/Address PROPERTY OWNER SAKELLARIDES, HARILAOS T & CID : 166328 186 LAUREL RD CHESTNUT HILL, MA 02167 GENERAL CONTRACTOR DREW ELECTRIC COMPANY CID : 811377 103-A MID TECH DRIVE Phone: (508)778-0723 WEST YARMOUTH, MA 02673 Tradesman Name LiC Type License number Class NAICS Expires DREW ELECTRIC COMPANY MSTR ELEC 13118 07/31/16 Uspeort generated:o5/o2r3ande14 13:21 Page 1 Program ID: pi.ppent Q� P �� ARNST . v _ TOW OF �B LOCATION VILLAGE ,' `�ws ASSESSOR'S MAP 6i LOT ..� E INSTALLER'S NAME & PHONE NO.-\1,oS' 4 i ;/Q i 40a SEPTIC TANK CAPACITY LEACHING FACILITY:(type) J (size) 4 Q' 40 NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER c - BUILDER OR OWNER e U b • DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ,� ��& � '' <- cc..Q��f ;!" JJ � r �� . � t i \ 1 1 '�. Err • //�► ys. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH O. J.. ...................OF............. �An-'r s /�. .��..........-- Apptiratiou for Uiipv,i al Works (funfitrnrtion ranfit Application is hereby made for a Permit to Construct (`vor Repair ( ) an Individual Sewage Disposal tem Sys s' at* .. __............... L i ddres r Lot S .....�. �`�i� � C���Cs�... _�(.Y�...................... � Owner Address w � o_m � .................•-•••--••---- _.. ----------------------------------------•- - 5 - Installer Address �, ) d Type of Building Size Lot._Il�__!__-3.............._Sq. feet V Dwelling—No. of Bedrooms............ ............. .Expansion Attic ( ) Garbage Grinder ( ) U 1� Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ................................... W Design Flow.......... - _...................gallons per person �r/d�y. Total daily flow....._._.__��___.��..............._..._gallons. Ra Septic Tank—Liquid capacity/itftgallons Length__ .__S�____ Width..!. ./'d..__ Diameter................ Depths___g-__. Disposal Trench—No..................... Width.................... Total Length_____..__.____..... Total leaching area----------__.__ ...sq. ft. Seepage Pit No.---------j....... Diameter-----�9.___.__.___. Depth below inlet........ Total leaching area, �J' ....sq. ft. Z Other Distribution box ( � Dosing to ( / aPercolation Test Results Performed b -•--- `- ---.------.--------•---. ----- Date.A/M._�_.���'9 Test Pit No. 1___e ..c?� minutes per inch Depth of Test Pit..../ .--..... D h to ground water...._._...".......... ri, Test Pit No. 2r4.A...minutes per inch Depth of Test Pit___ i2-- ____-- Depth to ground water........................ . :.._...a --- p - - � -;' �escnptoo -- ---- x = = ------ V Nature of R pairs or Alterations—Answer when applicable.___________________________________________•-•-____-•_--__________------_----------_--•-_--___. •-----------------------------------------------------•---••------------•---•-----•-•--...._...-•-•-••----•••••--••••---------------------------------•------._...--------•------------•-•---•----•---. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L-I i of the State Sanitary Code— The undersig e fu .er agrees not to place the system in operation until a Certificate of Compliance has en issued y the oar ili r Signe .......... ..... --- -----------------------------•-------•. ............................... Date Application Approved By------... Date Application Disapproved for the following reasons----------------•-----•-•-------------------------------•----------------------------------------------------.._ ----------•---------•--•-------------•--...-----••--•--------------------•-------•--•-•-•-...••---------•._...-----------------•-------•••----•-- Date Permit No........ J.r....142-g'-...................- Issued-....................................................... Date ,:Mara owl 7 5 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --- .--------------OF................, R. .............. Appliration for llhiposal Works Tonstriartion tirrutit Application is hereby made for a Permit to Construct Nll�or Repair an Individual Sewage Disposal System ..............a..t............... .......................I A k........... !.O.....k.....e...................................... ................. ......... ............a -- - ...................................... ... Locati dress or Lo . I ........................ Owner 49 �d .................................................................................................. ................... A..f4 ..... ................................ 1.4 Installer Address Type of Building Size Lot.� , ?------ -----Sq. feet Dwelling—No. of Bedrooms...........1.y..........................Expansion Attic M/r_bage Grinder ( ) P4 Other—Type of Building ............................ No. of persons.....__--......_.....__.__._ Showers Cafeteria ( ) 04 Other fixtures ....................................................................................................... -----------** **------------ Design Flow......___ ...............gallons per perso d T . fl ..... O.....................gall e ay. otal daily ow.. ............ -ons. 1:4 Septic Tank Liquid capacity/.t"...gallons Length. .__. ...... Width_-_V'M..... Diameter________________— De. Disposal Trench—No,.................... Widt ..i................. Total Length......._ Total leaching area... sq ft. Seepage Pit No--------- .......... Diameter....bf............ Depth below inlet......7.......... Total leaching are 4-d.4. . ../_ q. ft. Z Other Distribution box (%,,)O'o Dosing to'4k A Percolation Test Results Performed by._.....�V. ....... ................ ......f Test Pit No. s 1 ground----minutes per inch Depth o Test Pit../.P?.......... D th to water.................... rX4 Test Pit No. 24ig'._minutes per inch Depth of Test Pit., .+ .......... Depth to ground water....._.............._... i.......... ............ ,escriptio ..... .. .. ---- ---------- - ............................ h 0 f 4 Descrip i o .. .... ------- ........ .. .. ...... ----------- ---------- - ------ -------------- ;Oil jo... . ..................... ---le .. . . .......;i�.... ................ ....................................... U Nature-oi-Aepairs or Alterations—Answer when applicable_________________________- -- ................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T'jE 5- of the State Sanitary Code—The under i fu her agrees not to place the system in I-� s"g ,.er sg operation until a Certificate of Compliance has,,b en issued, y the oar h I ..................... Signe ..................... ............................... Date Application Approved By........ ........................................ Date Application Disapproved for the following reasons:.............................................................................................................. ........................................................................................................................................................................................................ . Date PermitNo._.... ..;?-------3--a-------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH FEB 041237 ....... .........�OF..... N Tntifiratr of Toutphaurr iT. 0 'W " THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( by- ...... ...................................................................................................................................... Installer at--- .............................................................................................................................. has been installed in Jordanc with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.--6.;?.......;L&-e............... dated.__...._........._..__._.__..._.__..._.___.._... THE ISSUANCE OF THIS CERTIFICAT SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. )'.6 - 7- - N - DATE............. . ..........I.......U k. ............................. .... ... Inspector................. ------- --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEALTH ...... .......OF...... ................................. Disposal Morks Tonstrurtion "JArrutit Permission is hereby granted....9"M'�......yk'_4'4.�. ............................................................................... to Construct 0>6 or Repair an Individual Sewage Disposal System at No...... -------4.7------- �D_f------------------------------Street eet-------------------------------------------------------------------------------- as shown on the application for Disposal Works Construction Permit No?L7.__9,av... Dated.... ...... ...... ----------------------------------------- DATE.......... ..................................... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS =- Depar'ment of Emionmentall Management/Division of Water Resources rw WATER WELL COMPLETION REPORT WELL LOCATION Address 10 4 /7 APGrry/Are, I)AP. 11 City/Town 4 2120-y'b" "� 4�"45 G.S.Quadrangle Map Grid Location / Owner 44k-OITA; 19L.D_s. I Address°V5C.'n5—rodrC 3-t>PC's 6%tr'ni WELL USE CONSOLIDATED WELL Domestic®Public ❑ 'Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones 1) From To Method Drilled (trAor 2)_From, To - Date Drilled �"' Y�b j 3) From To 4) From To CASING Depth to Bedrock Length 6 ! Diameter Type 01 I C' UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface to Sand: fine Q,medium R/Coarse❑ Date measured --)(4 V7 GraJel: fine❑ medium❑ coarse[] e Screen: GRAVEL PACK WELL J Slot# to length from to Yes ❑ No ©� Split Screen (or 2nd screen) WATER QUALITY TESTS MADE S lot;# length from to. Chemical�© Biological ❑ Depth To Bedrock PUMP TEST Drawdown o feet after pumping days -! hours at U GPM. How measured 640EVAII Y.I Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To t d `D r � DRILLER 1b S Firm /YIF I+f4A( 1d at 17OeA 1 IAA( ° Address V-Ca. Ary CSC?() \ City k*�d't r 37�1 Via✓ Registration No. a �Operator's ignature Please print firmly BOARD OF HEALTH COPY 2sm to ss sonar s:r,s::ss s:sss:sspsss:::ss:s::::::s::::ssssiss:s st::s:;;:s::ssns:ss{:r.::s:s::psss:::s::sss t n:tss:::sg::e:•ss:s:::r.:stttn::s:s:s:s:ss:sss::s:s:s s:n::sssn :•sn :snr.s snn::::in::::::s::nsn:sss:s:ss:::sssr.: ti:i ss;ss,aas:asssa:;sssasssassss:::ass::::=s,::::ss,sas,:sa:.:::a ss......:s,s,s;ssisi:;ssssssss ::.:€t:: ::€•::_::,,•::#•:, ,#,::: :_:_##__€ ,#,,,,::#,{,•:,:�:_::__:�:•,:#,::., _ __.. ... _. _... ... . .._ .. . . .... . ......... .. ...s:, { a, .as ENVIROTECH LABORATORIES 66 Lewis Bay Road • Massachusetts 02601 • (617);771-7265 it CLIENT: lI€-it:age—Builders LOCATION: Lot 17 Regency f)r ADDRESS:clo Sc-upgat Group Box l001 M2r2tonss Mills, MA Sandwial}TM.A 02563 COLLECTED BY: Ed Mogb.ap. SAMPLE DATE: .3/96 87 TIME: 8.45AM DATE RECEIVED: 3 26 87 SAMPLE ID: Et4A JOB #: New Well WELL DEPTH: 83 ft RESULTS OF ANALYSIS: Parameter Units Recommended limit Result _ . Coliform bacteria/100 ml (MF Method) 0 0 _ ;E pH pH units 6.0-8.5 7.10 Conductance umhos/cm 500 214 Sodium mg/L 20.0 35.3 Nitrate-N mg/L 10.0 . 18 Iron mg/L 0.3 .11 •` Manganese mg/L 0.05 Hardness mg/L as CaCO 3 500 =� Sulfate mg/L 250 Potassium mg/L 20.0 —Alkalinity -- - rng/L Chloride mg/L 250 COMMENT: Sodium level is not considereed a health hazard Water is suitable for drinking purposes for parameters tested. a» DATE 02f ltr�7 f. .. _:..:: : : :::::::::::::::::::::::::::::: : :::::::::::::::: :t::::stt::t:::s::::s:::sss:::::s:s:ts::t::::s::::::«:::s::«ssss::s:t:: ...... ......«:a::saao.:s«::stst«• .:s:ts:::s:s:::s:. 1 SOII L O'-G x. N 0. 1 a 7s 7 • • SO/L ' SO/L 3 4 6 /v 0 7 ' 9 - COVER - 2 COVER 1/8 3:8 WASHED :STONE /vo -✓�Ir fe G28 /vo y✓Ar 3/4 11/-2 WAS'HE0 STONE 13 14, PE,RC TEST, R`ESUITS_ PERC RAT PRECA.l LEACHING PITS L � Fes- of ry H ITN ESS 1 BY • NO.� 2 SIZE /y /r/vE Q/A W/ 2' O•� s raNE .4.eDvi�/D ,a/9R/ysTB6 B 0A R Dt , 0 F" H E A L T H —�• 2� OF STaNE Ex/sriv�ARO!/ C�D AT E ALL ND wE�� , PROPos E� / o I I 72-:S7- / / ® oiT �0 / %Ss JU� `-gam EX/s riivG "g YSTl( NOTE: BE�t/c,y /7:9R�. '_ .�CoJ2i�%P OF CoNCR�'7 t 7RAn/SFOR/`-fE,Q ��.q D• ' A 55Ui/EIS .EG EV. _ f "BOARD OF HEALTH ''/Z>z14,v SCALE 40` i r.E B 0 41987 SITE AND . SEWAGE PLAT FOR : -1Z BEDROOM SINGLE FAMILY DWEILING • n ���i. .;'� L DT T.tlCikL r� DATE dE Eiya� �e i7 �98� --�°�" IDj;� DOYLE ASSO.CtATES FALMOUThv MA TOP OF FOUNO:AT10N El . : Bss IN El710 177 7S0 I N E L 72 5`I i ram- T 2 '+-- — ^M 'I N. E L. 4 IIQUI-D LEVEt, .M O/ B W/ 6" SUMP E F F O'E PRECAS,T'' S,EPTIC`. TANK WITH _ CAST IN PLACE IN AND OUTLET ,T `.S P:ER TITLE V S I Z E' 000 Gwl Z-oti D I A D I PROrl,LE . ' OF PRO POSE D EWA E - SYSTEM ... B��eNs T�8 L � _ .. SYSTEM DESIGNEp OY THE TOWN OF „ REGULATLONS ANQ ' STATE TITLE' V FOR SUBSUUFAC;E DIrS.ROSA1 OF SEWAGE S:CA'lE s R, N . B . i . 1 . All PIPES : SHALL BE SCHEDULE 40 PV::C SEWER° PIPE 2, Ala PIPESr`S'H9All B,EA3 fS �0`PE'D 1/4 PER::_ FOOT EXCEPT FOR THE FIRST 2 ` FEE=.TOUT OF THE 0 / B W:HIGH SHALL BE ;LEVEL > 3. DESIGN FLOW 3 BEDROOMS AT 110 GAIDAY PER BR 33o GAL DAY 8EPT`IC TANK SIZE t .X / : �- 9s, GAl USE ioao w ;�yl`avT, fiAR ,6: D°ISPOSAI LEACHING SYSTEM'' USE ,lid ' D%q .4E4c1/1rG /T W14 D 5PTN i ,1 JrVD 2" OF<. .STDN AG.G -9R0 U^/I>, EFFECTIVE `AREA . I;D°E s S BOTTOM. 78 614LIP.4.y Ex�sri�/G 1✓EL L T O TAa F IO:W 392 SAL /0-9 Y TOTAL R'EQ 'D FLOW 3.3o X / � 3.3o Vyjoy - GARBAGE DISPOSAL RES liVE. FLOW S90 T3O G2 GAL / DAY Iry . fsfev,'!F REFE RENNCE. PLAN:`S z. c. or-'I,gw 'i -,4z7 01' �3 i . I APPROVED BYI B��NST�'8G DATE : PROPERTY =.OWNER f . . � �f;$rivil•�1.:.�.V:i�. •�f` '/r ip,?,IIS�//f'r 1w *"knOAM S31VI30SSV 31AO a -37 3 1 v 0 -��7 -k Imo( X J1/--7---9--72/ 00L/ 9Ni113MO AlIWd3 319NIS W0038 f�d1�7S S 3�� V1d D9V S (I NV 8' i N� 7.=71 H1MH J0 08tl0H: .. i 7,, !/ 7 / , � � � .""^•.ram.,,.;.;�� ) 9 000/ / / 7.7 6 I 0 -7 / � � O 73M ) I H 11V 3 H QNno / N �.9 0 I,S S 3.N I I H OVI h�-r �o ���,� xdro, 3ZI:S . ON .E: 83d S1Id 9NIH0d31 1 d03Hd S�1 flS3{0 l S31 0.8�3d Hlr VI 3.N01S 03H"SVM Z/l l b/£ £ l 31 n//I07/Y 3NO1S 03HSVM B' £ 9/1 H3A00 Z 29 �I is �I -7/oS' i os s d2 8�s �01 L 5L Z ON l ON J01 . ltOS I A N -- TOP 0.F . ='00N.O:AT10N EL . : Bss - ' f°1;'' N. CO VIER IN EL 7.5:0 s . e o- IN EL. 7,/ Z �T,� 'iN El W.. O N E L 72 1: tom— 72-Z �-- — 'I N. E L. 708 i O/ B W/ 6' SUMP 4" LIQUID LEVEL - ` f ¢" E FF. RE rT PREGAS.T SEPTIC TANK WITH _ CAST- I.N PLACE INLET AND EL. GGB OUTLET T �S PER TLTLE V I � , �aoo G���Z-oti f— DIA O I A.:, . PROHLE O F PROPOSED . S EWAOE SYSTEM. _ SYSTEM 0E,SI6NE0 HY THE TOWN OF A:EGUTAT10N $ :STATE TITLE V FOR . 'S-U.BSUA.FACE DISPOSAL OF SE?WA, Gt SCALE 1/4: l' 0" r. N . g�a 1 . :ALL PIPES SNAIL BEx''$`CNEDULE 40 P_V.C . SEViI:ER' P1PE 2 ALL PIPES SHAII BE, SloOPED 1L4 PER FOOT EXCEPT FOR THE FIRST. 2` FEE',Tr'fi�50UT OF THE D / B WHICH SHALL BE ,LEVEL. } `u"�'EDROOMS ATG:A'IDAY PER BR GAL / DAY 3., ` DE-,SIGN F1'0W .3 �30 SEPTIC TANK SIZE "T � . X: /. 9 GAL . USE f000 Gkt W'/ oV7 GARBAGE 015P0SAI LEACHING ' : SYSTEM USE lid 4' bA L .9Ch//iVG PiT /� ° E�,� ��PT�/ O Uit/Q. EFFECTIVE AREA 'S+IDE BOTTOM rt'�s> Lx 0 79 GAL./,,4 y EX/ST/n/G 1✓FL L T O T;A l FLOW T:GTAI REQ 'D FLOVII -�o X / D = 330 Wj oy - GARBAGE DISPOSAL RE.SEHVE FLOW 392 - ,5.3d = G2 6AL / 0AY REFERENCE ' PIAN`S: ' 4c. �Z �� � A:; APPROVED BY , DATE PROPERTf. ` OWNER i ..Y t Q r S0 I � C0G , j N0 : 2 1 NO GP - LAN � a 1 s 7 ; T E Tom sv8 I O G 2 O/L i 3 r E 5 -✓mil _ B P OF FOUNDATION r EL. . c1�iv , 7 S ,.,.. r GG 8 a 9 10 UN ER IN EL sue' B a s , 7 A/ CO ER .. IN El 71 IN 'El T _ .� WA ESQ TONE .vo ATE . ` , y � ER 1/8 3 8 WASHED S 408 IN-EL M-5 .. pp t 1 1/ WASHED STONE 14 4L1 U D LEVEL , : 4 i 5 ¢ T T RESULTS PERC INLET , _ PRECAST LE A NlNG PITS PRECAST ; SEPTIC TANK WITH �i TNWHITNESSE NO.. SZCAST IN PlACE I LET AND El E 0/1 s_ ov a �iy TABLS B aA R a 0 *116 F HEALTH T IT LE V011TIET T S PER N DIA . E ATE X T PRoP s E� �l 0 Wei SYSTEM " . ., - , PROFILE, , OF:, PR O P S E D SEWAGE : , �2NST�r 81. ' RE LATIONS N E DESLGNED BY THE .'TOW 0 I SYST M _ ; SCALE 4 E , DISPOSAL F S R SUBSURFACE ISPO 0 STATE T I TLE V F 0 , _ N . B . a : 1 A l l PIPES :SHALL BE SCNED,U.....I E40 P.V.C _''SEWER , PE ti i l 0 ti SHALL BE SLOPE D D 114 PER f 00 EXCEPT 'F FOR U ALL PIPES, S `l B E l E V /OD / WN1CH SHALL T T OF THE 0 B � FIRST S T 2 : F E E O U i , � � 'T H E _F P C_ / ► GAL / DAY Y T R 6 G .3 110 :GAtOAY PER R .. _ . DESIGN FLOW BEDROOMS_ AT � � �z � A.A Ii , 33oX GAL .TANK Si t E � o W / rfell o o ov GE DISPOSAL �. 7 FUSE i o GAl W/ GARBAGE s.. LEACHING S P/T ✓YSTEM USE < GiALE.9� /NG I� 9 ,r F :SIN AG L 9�OU.�/ , - i SIDE EFFECTIVE AREA,: S s . ,4 6BOTTOM 3 3 Z GAL / �9 Y , 1 TOTAL FLOW' �9 8 D :33� GARBAGEz 0 3.30 / _ ' w�oyr D DISPOSAL TOTAL REQ D FLOW X 3 RESERVE FLOW s9z 3.30 _ ,.G2 GAL/ DAY {� oov ysrlG J L L.C. f'LA �` / 4 � REFERENCE PLANS 3 NOTE. BEit/Ch' ✓7.9RK. Coh'ic%R OF COnr'CR T- TRA�ISfOR/�-fE,2 �R� A U Eli GE . APPROVED BY I: / S7--�aL'� BOARD DF HEALTH f4fAl 4 %7 DATE . a ` AN 1 T E A ICJ D SEWAGE PLAN PROPERTY OWNER : FOR BEDROOM SINGLE FAMILY W LL NG UP ell LOT : ,S L CJ � 287e <� _.� . �� 195 6 T A DOY E ASSOCIATES FALMOU t�. MASS .