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Home My WebLink About0525 RIVER ROAD - Health 525 River Road J Marstons Mills P A 060 014004 r � TOWN OF BARNSTABLE LOLA't'ION `� � �� SEWAGE # VILLAGE L S ASSESSOR'S MAP & LOTO ;STA c R'S NAME&PHONE NO. SOP- rl7s—o2�o0 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 140.OF BEDROOMS BUILDER OR OWNER I�®PA/U C o✓P�P £�C /NSPZ e7laAol P1✓RMITDATE: t �4t '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 of . 4 C q a3r } U O ' c ' TOWN OF BARNSTABLE LOCATION mI ��Ss ) kJ�1 SEWAGE # �� o VILLAGE � eUA— ASSESSOR'S MAP & LOT 660-lh�-may INSTALLER'S NAME PHONE NO. -LSEPTIC TANK CAPACITY ,' 0 1,000 v1.ACHING FACILITY:(type) B (size)_ 0 OCR a0. OF BEDROOMS ��PRIVATE WELL OR PUBLIC WATER C' BUILDER OR OWNER ex N DATE PERMIT ISSUED: 3 -6 —9 ! DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� , 7 `�� ?� � ��s i , . �: � . .. . � . �Ll� �. c _ .' / •` � � .S �'� '. z� . . ��— o )ASSESSORS M3�ue RLl�(1 c No.. .....'...--....... ' PARCEL NO: 6/� D k F�B.......��...._ THE COMMONWEALTH OF MASSACHUSETTS BOARP OF HEALTH ......r6; ---------......0F... . .. . .a..,f1 t Appliration for Uiiipusal lVerkii Tomitrnrtion Famit Application is hereby made for a Permit to Construct ( �or Repair ( ) an Individual Sewage Disposal ystem at �__L�ue� ( �� L�at'o -Address or Lot No. 0��Aa.).t_La`rY. . ra 1. ..- aew _0$_Aa ................................. W wne Address Installer ...-------•................•---•-• Address U Type of Buildis S feet g Size Lot��.J.�____..__ q. �-, Dwelling No. of Bedrooms............�-��........________________Expansion, Attic ( ) Garbage Grinder ( ) 4 Other—Type T e of Building No. of persons..........G.51 P� YP g ---•---•-•-•-•----•-••------ P -•----------- Showers ( ) — Cafeteria ( ) G4 Other fixtures W Design Flow...........n .........................gallons per person per day. Total daily flow...��5_b...........................gallons. w !�_ � W Septic Tank—Liquid capacltyly.�.CX?gallons Length....a....__ Widtlr4.. �___ Diameter________________ Depth�.._... ........... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..�.0__b_..... Depth below inlet.U.Ja.. Total leaching area.62(....)....sq. ft. z Other Distribution box (✓)" DosinLy tank aPercolation Test Results Performed by. _�. 111� Test Pit No. 1....2......... > Z" minutes per inch Depth of Test Pit-.1.�'1...__..._._. D pth to ground water....�'�___-............. fT4 Test Pit No. 2................minutes per inch Depth. of Test Pit.................... Depth to ground water........................ ------------ ----------------•---••-------•-••--------.-----------------.--------•----------•-----------------•------------------------ Description of Soi1v.A.'.q&11...• ----------------------------------------•--•- W ---------------------------"--------------------------------------------------------------------. -----------------------------------------------------------•---------•----------------........---_.... V 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 iITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been .ssy�Sl by the a of h�� Sig --- • --- ••----........... . . J` /o?•! JPOP j - - ------------ ----------------••------------ .......................... e Application Approved B = . .--. . ......................... .�?� -f � --•--•--- Date Application Disapproved for the f ollo ing reasons-------------------- ------------------------•-------------------................................................ ••-•-•----------••--•---------------------•----------------------------------------------...-------..............................I................�"'�-��' ...................... Date Permit No... . .. •-•-------------•--- Issued._--�-o - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..�.. . .L...................OF..` a.....::?.:. Appliratinn for Biapnsttl Workii Towitrur#inn Prruld Application is hereby made for a Permit to Construct ( /or Repair ( ) an Individual Sewage Disposal System at, , _ n Location—Address or Lot No. L.1r'r/t r-r c Y 1' . . ..1 f <_j i�((t_Il .� �.t};�- �l rt i rc.�c�! !_� . ............................................... Owne` Address a .............................. .... ....--r-•--------...........__--- Installer Address r—- -. Type of Building Size Lot% ---------Sq. feet -, Dwelling—No. of Bedrooms__ ...................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of ersons_________(4Z............. Showers • .a YP g •-•--•-•-•---•----•-------•• P - ( ) — Cafeteria ( ) I Q Other fixtures ... -------------------------------------- •------------------ W - Design Flow.........._ _............................gallons per person per day. Total daily flow..__ __._.___.__.._._______._..gallons. WSeptic Tank—Liquid capacityl_' r..gallons Length'L_'_c ____ Width Diameter................ DepthG:"___)__`... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.................... Diameter._�_�.�.h-••___ Depth below inlet ... �__.____ Total leaching area_'uf.__-)__._sq. ft. z Other Distribution box (V1 Dosing tank ( ) aPercolation Test Results Performed by. �_t. )�__�:-_1,_�a 4't(_�_�_ i�!'t_jttk (d: Date_�.....t`_i_?......_�__.__.__.. Test Pit No. I...l:........minutes per inch Depth of Test Pit 0_ 1,?- __.. _ Depth to ground water..- .................. fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ -----------•----•--•---------•-----•---•-------------- Description of Soil - .. ---•- --- •-••-------- -- --- V ............................................W................................................................••- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 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 boar; of.health. rJlr_.<.�,.rt ✓Y��c "tit Signe - ->—a Dat is-� - Application Approved BY = ------------------------ •-• -----------• --•••••- Date Application Disapproved for the following reasons---------------------------------------------------•-------------------------------------------------------•---- /-_ Date Permit No. = (�� ............. ._. Issued__ i Date r THE COMMONWEALTH OF MASSACHUSETTS 1a --�- BOAIUDDOF HEALTH dr Quatifirair of Tnutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) b)..................... nstall at..... o�.. /.� �r / /C¢ 'y�...------..f: r..--I`a ._:_�.�:ri �I 1-! h - -- F-m .�-- has been installed in accordance with the provisions of _ I " 5�f- .he-_State Sanitary Code as H-6scr �n the application for Disposal Works Construction Permit No.-_r _� a- ------ dated---/7 :' '- O THE ISSUANCE OF THIS CERTIFICATE SHALL, 0,T1E � GUARANTEE§JRUE® AS A GUARA THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �`� DATE....r. - ._ ..... �L .........-•..............• --, Inspector....- : .......... �- - THE COMMONWEALTH OF MASSACHUSETTS BOAF OF HEALTH ......./. FEE......Z- ......... �iu�nu�1 nrku nu�rinn .eruti� Permissionis reby granted....................................................------------•-------._..._...-------••••--•--•--•-•••.... .............................. to Construct (V Repai at ( ) CIndividual a rage Dispo!� tgm •------ ----------• - ... ....... Street as shown.-on the application for Disposal Works Construction Permit No.v ,; Dated_ . ...... .. ' _____._...__ / .............•----•--^ Board of Health DATE'-- ---------------•---•--•--------- FORM �255 H068S &''WARREN, INC., PUBLISHERS ' f AP 'ARCEL. . C) I JCL)IE COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Z W Y a DEPARTMENT OF ENVIRONMENTAL PROTECTION AV— - a ��'aM cV0"e4 NOV 2 4 2004 350 MAIN STREET WEST YARMOUTH,MA TOWN OF BARNSTABLE 508-775-2800 HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 060—PARC 014 Property Address: 525 RIVER ROAD MARSTONS MILLS,MA 02648 ..a Owner's Name: CORREIA,FRAN Owner's Address: PO BOX 157 MARSTONS MILLS,MA 02648 - Date of Inspection NOVEMBER 10,2004 - 3 � tr1 Name of Inspector:(please print) JAWS D.SEARS Company Name: A&B Canco �f Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 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: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails 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 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 tot he buyer,if applicable,and the approving authority. Notes and Comments "*'*This report only describes conditions at the time of inspection and under t p y r he conditions of use at that time. p This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form-6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 525 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: CORREIA,FRAN Date of Inspection: NOVEMBER 10,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: .( I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A _ 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 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 525 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: CORREIA,FRAN Date of Inspection: NOVEMBER 10,2004 C. Further Evaluation is Required by the Board of Health:N/A 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 CAM 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 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 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 525 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: CORREIA,FRAN Date of Inspection: NOVEMBER 10, 2004 D. System Failure Criteria applicable to all systems: N/A You must indicate"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in pit is less than 6"below invert or available volume is less than%2 day flow —� Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS;cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CUR 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: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above.the large system is 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 CUR 15.304. The system owner should contact the appropriate regional office of the Department. f Title 5 Inspection Form 6/15/2000 4 Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 525 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: CORREIA,FRAN Date of Inspection: NOVEMBER 10, 2004 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)has been determined based on: Yes No ✓ 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(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 525 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: CORREIA,FRAN Date of Inspection: NOVEMBER 10,2004 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2004—37,000 GAL/2003—116,000 GAL Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIALANDUSTR IAL Type of establishment: Design flow(based on 310 CMR 15.203): 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 Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1996 PERMIT#95-250 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 f OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 525 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: CORREIA,FRAN Date of Inspection: NOVEMBER 10,2004 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 14" Materials of construction: Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 26" Material of construction: _ concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000-GALLON PRE CAST Sludge depth: 14" Distance from top of sludge to the bottom of outlet tee or baffle: 16" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: AS BUILT&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.): MAIN TANK AT WORKING LEVEL,TANK 26"BELOW GRADE W/COVER AT 6",INLET TEE,OUTLET TEE, NO SIGN OF OVER LOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A 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.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 525 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: CORREIA,FRAN Date of Inspection: NOVEMBER 10, 2004 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/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: (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.,): D BOX IS 16"X 16"-30 BELOW GRADE,ONE LINE IN—ONE LINE OUT.BOX IS CLEAN&SOLID. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (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.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 525 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: CORREIA,FRAN Date of Inspection: NOVEMBER 10,2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type •/ leaching pits,number: 1 leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS ONE 1000-GALLON PRE CAST PIT,PIT IS 4'BELOW GRADE WITH COVER AT 16". 30" WATER STAIN LINE AT 32.NO HIGHER STAIN LINE—NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionXIocate 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: N/A (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.) Title 5 Inspection Form 6/15/2000 9 f Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 525 RIVER ROAD MARSTONS NULLS,MA 02648 Owner: CORREIA,FRAN Date of Inspection: NOVEMBER 10, 2004 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. 0 • C d 1 J/ ;Y yj 8 i Tide 5 II1sFc _,,1 rorm 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 525 RIVER ROAD MARSTONS MILLS, MA 02648 Owner: CORREIA,FRAN Date of Inspection: NOVEMBER 10. 2004 SITE EXAM Slope Surface water, Check cellar Shallow wells Estimated depth to no groundwater 13 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: 7 Observation 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 groundwater elevation: TEST HOLE 13' NO WATER. TEST HOLE Y BELWO BOTTOM OF PIT. 3� �a i GL/ i .4' Title 5 Inspection Fonn 6/1 5/2000 11 �I S YS TEN PROFILE NOT TO SCALE TOP EON. FINISH GRADE-5jO.S FINISH GRADE OVER ` EL • � FINISH GRADE OVER DIST. BOX �'�_ FINISH GRADE OVER SEPTIC TANKS LEAICHING PIT 2a.O 12" MAX. 'SIT o,•o:o• •.c •o• .•�.;Q. .•e a.e••..°•.•.e:•t•.e..:p,...o:.d;a.;e•.o•.:.• •e:• 'e'.y; •.e•a: - 12 MAX .. .o o•:8• :d. . . o•:e:. .• o z.e:...e:. .•:•. . .o. :o.. e:• ...e':. e:d•'°:e:::0 9" OF 1/8" 1/2" PRECAST CONC. OR ASHED PEA STONE : ?-=a.`: ,• .:o.:.d. 3„ a" BRICK 6 MORTAR •'' ° OUTLET PIPE L EVEL TO 12" BELOW GRADE o . FOR 2 FT. MIN. a . •c:rQ,os. � •a .. _ .O.•• .O. ".. •.°:0.40: .o• ,'o• •a. •o:o.� . . 28 U a: L . 0•... 0.0 i 6.: 'o JZ.OJ 51 93 '°:::s:e••Y..•e,•,✓ -- •O p.•Q::e..,e.p.o: ,� •'G-,p'e•,• D;'4'o C. I. OR PVC TEES S� .7a'o °p o. 'a '.4 •s I'•p • o•.'' o• e� D,o. ':0.::d'. � .4 Opp., •• s. •A:I .�O'G•D .0. u4 � •O..Q' •,e SI �Z GALLON ( .. EsMr. FLR. DISTR..IBUTION BOX EL . o; D :O'• ':e b. ;� •; :o INSTALL ON LEVEL BASE ►, 6 ' PRECA S T CONCRETE 3/4 ro 1-1/2 ° PRECAST p° p .e•..0 0: A. o-.•e'. o: o:o: e WASHED o y_ CONCRETE /Q REINFORCED o :4 CRUSHED ;I 'b0*b4'!:o STONE r :ft H /4 52.50 r Wy• �00 SEPTIC TANK INSTALL ON LEVEL BASE NO•rF• EXCA VA TE TO EL EV V. 41.6"t OR r O LOWER TO REMOVE ALL IMPERVIOUS — - �_ MA TERIAL BENEA TH THE L EA CHING AREA 2 '-0 " 2 '-0 " S� REPLACE EXCA VA TED MATERIAL WITH . Q CL EAN. CL A Y FREE SAND 10 '—0 " .S� LOT � EFFECTI VE DI METER ,r LEA CHING PIT 1 PRECAS CONC TE '1000 GALLON GENERAL_ NO TES .,: CZI' PRECAST CONCRETE EACH G PI ASSUMED INSTALL ON LEVEL BASE . SEPTIC _TANK 1. ALL ELEVA TION5 SHOWN ARE BASED ON 2. AL L PIPES IN THE S YS TEM MUST BE CAST IRON OR SCHEDULE 4r7 .PVC. 049.9FRVA TION PI T _ 3. THE BOARD' OF >EA'L TH MUS7 BE NOTIFIED Z e WHEN` CONSTRUCTION IS COMPLETE PRIOR •; �� - � - s0 � TO BA CKFIL L I�"G -. PERCOLATION RA TE.' 2 MIN./IN. 4. ANY CHANGES ,IN,:,THIS PLAN MUST BE APPROVED - �T ---- SZ BY THE BOARD OF HEAL TH AND CAPE 6 ISLANDS WITNESSED BY G. DUNNING S.� SURVEYING CO., INC. 5. MA TERIALS AND INS TALLA TION SHALL BE IN BAP ISTABLFgRO. OF HEALTH--- COMPL LANCE W1 TH THE S TA TE SA NI TAR P DESIGN DA TA �- CODE - TITLE V - AND LOCAL APPLICABLE DATE.- ,A`��y 1M W RULES AND REGULA TIONS • 3 -- !• NUMBER OF BEDROOMS 6. NORTH ARROW IS FROM RECORD PLANS AND' 0 N0- Coo IS NOT TO, BE USED FOR SOLAR PURPOSES' TOPSOIL 6 GA RBA GE DI SPOSA L �� GA L ' 7. FL DOD HAZARD ZONE'" SUBSOIL DAILY FL ON �� ~✓ --- -_� 8. WA TER SUPPL YNA- 48" SEPTIC TANK REO 'D. 0 GAL . _--- -. • • SEPTIC TANK PROVIDED �UU GA�L. . GPD. LEACHING RECJUIRED MEDIUM L07 4 SAND SIDI ALL APSA,: 18BS. Fd71 Cv�o S4 3�8 5� 22 . F. X G/ F. = GPO LOT 3 - --------------�.- --._.._. ._..__ B03�OM AREA GS. F. Cob' LEGEND S. F. X 1' GG%S.F. = 79GPD L EA CHING PROVIDED ffc16PO 3 192" NO GROUND WATER EL. 59. 9' ro0 PROPOSED ELEVA TION — GO —— EXISTING CONTOUR SINGL E FA MIL;Y RESIDENCE 6 OBSERVA TION PIT ❑' DISTRIBUTION BOX PROPOSED SEAA GE DISPOSAL S YS TEM L��ACHING PIT PREPARED FOR Y' 74 - - __._.,; ---- �^ o o SEPTIC TANK s :' GORDON T. CORREIA RJR. E.- FRANCELINA AMARAL.. _ LOT 4 RI VER ROAD ,RP 1 RESERVE ,�` ,: ;: BA RNS TA BL E — MA SS. 52.50 PIPE INVERT ELE4�A TION DA TE.' -C. 2, 19 8 8 CAPE 6 ISLANDS SURVEYING, INC. PLOT PLAN , SCALE AS NOTED P. 0. BOX 334 SCALE:• 1 "_ 40 GO -- 14 4 ,� PLAN NO S21 O 88 TEA TICKET, • �7 � MAC .l 1 O T P v o