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HomeMy WebLinkAbout0572 RIVER ROAD - Health 572 RIVER ROAD` _ Marstons Mills A = 060 - 0119 SMEAD v R. I 1 No.2-153LY UPC 12934 emead.com • Yade In USA FM US®N M FOODUCT IM SOURa SFI M SR PROC" D LSPPROGRAALOOD - i l/'� l/ �.� l V � I { r r ot�-a�9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments M 572 River Road Property Address Michael & Kristin Ehrhart ; Owner Owner's Name ' information is X required for every Marstons Mills Ma 02648 5/31/2017 e page. Cityrrown 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: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection r� Company Name 74 Beldan Ln. IMM Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 Telephone Number License Number B. Certification 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 16.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation b p Local Approving Authority 5/31/2017 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 to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page`1 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D Y p A) System Passes: i ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The dwelling located at 572 River Rd Marstons Mills is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 3 500 gallon leaching chambers. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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 ,.•''y 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. Cityrrown 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, 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 w r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. City/Town 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 ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•3/13 Title 5 Official Inspection 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 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 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 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 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: Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd t5ins-3113 Title 5 Official Inspection 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 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 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: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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 M 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. Cityrrown 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 ❑ 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System installed 4/2012 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 5 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 4 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: 1500 gallons Sludge depth: 6" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °t 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. City/Town 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 3" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not reed to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Inlet and outlet coverts are on risers. Outlet tee intact. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 L_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. Cityrrown 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 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. Cityrrown 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.): Distribution box was video inspected and found in good condition, no rot, water level was even with outlet invert. 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: 15ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 L. f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 572 River Road Property Address Michael & Kristin Ehrnart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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,): No signs of past.hydraulic overloading. 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. City/Town 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.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 572 River Road Property Address Michael &Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. City/Town 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 �t F „ 45 yd, Z 1 i ?mappar=06001%seq=2 t5ins•3113 Me 6 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 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 page. Cityfrown 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: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 572 River Road Property Address Michael & Kristin Ehrhart Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/31/2017 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 EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAULCELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 572 RIVER RD. MARSTONS MILLS Name of(Tuner JUNE JEFFERSON RANDOLPH Address of Owner: SAME Date of Inspection: 416/99 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: John Graci Title V Septic Inspection Mailing Address: P.O.Box 2119 TeaTicket,Ma.02636 Telephone Number: (608)664-6813 CERTIFICATION STATEMENT I certify that I have personalty inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: Passes The Inpection is based on criteria defined in Title V `Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further Evaluation By the Local Approving Authority performing at the time of the Inspection.My Inspection does _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: g Date:4/6/99 The System Inspector shall ubmit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. f 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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS. THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY YEAR TO PROLONG THE SYSTEM'S USEFULL LIFE. RECOMMEND MOVING GROWTH THAT IS NEAR THE OVERFLOW TO PREVENT ROOT DAMAGE. revised 9/2/98 Page 1 of 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 572 RIVER RD.MARSTONS MILLS Owner: JUNE JEFFERSON RANDOLPH Date of Inspection:4/5/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which Indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: na One or more system components as described In the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. na The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,Is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. na Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced _ obstruction is removed distribution box Is levelled or replaced na The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9098 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 672 RIVER RD.MARSTONS MILLS Owner: JUNE JEFFERSON RANDOLPH Date of Inspection:4/6/99 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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,Method used to determine distance nla.(approximation not valid). 3) OTHER n[a revised 9/2198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 672 RIVER RD.MARSTONS MILLS Owner: JUNEJEFFERSON!RANDOLPH Date of Inspection:416/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool Is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped nLa. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy Is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS Is over the invert pipe,Is In Hydraulic Failure. E. LARGE SYSTEM FAILS: You must Indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further Information. I revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 572 RIVER RD.MARSTONS MILLS Owner: JUNE JEFFERSON RANDOLPH Date of Inspection:4/6/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)) X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 672 RIVER RD.MARSTONS MILLS Owner: JUNE JEFFERSON RANDOLPH Date of Inspection:4/6/99 FLOW CONDITIONS RESIDENTIAL: Design flow:AM g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual):4 Total DESIGN flow: n& Number of current residents:2 Garbage grinder(yes or no):MQ Laundry(separate system)(yes or no): NIQ If yes,separate inspection required Laundry system inspected(yes or no)M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): n& Sump Pump(yes or no): NQ Last date of occupancy: n& COM M ERCIALIINDUSTRIAL Type of establishment: n& Design flow: n&gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):JSIQ Industrial Waste Holding Tank present:(yes or no): MQ Non-sanitary waste discharged to the Title 5 system:(yes or no):l,I.Q Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) nLa Last date of occupancy: nla GENERAL INFORMATION PUMPING RECORDS and source of information: NONE System pumped as part of inspection:(yes or no):IM If yes,volume pumped 2000 gallons Reason for pumping: MAINTENANCE TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: THE SYSTEM IS APPROXIMATELY Y 26 YEARS OLD Sewage odors detected when arriving at the site:(yes or no), MQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 672 RIVER RD.MARSTONS MILLS Owner: JUNE JEFFERSON'RANDOLPH Date of Inspection:4/5/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 2 Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: n& Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: II EVFI Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nla If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No n(a Dimensions: 6'Xli'BLOCK GSSPOOI Sludge depth: d_ Distance from top of sludge to bottom of outlet tee or baffle: 2k 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: M How dimensions were determined: M AS R D Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) MAIN CESSPOOL AND ALL COMPONENTS AR RUCTURALLY SOUND- RECOMMEND PUMPING Y TEM EVERY tFAR GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) Wa Dimensions: n& Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:_n& Distance from bottom of scum to bottom of outlet tee or baffle n& Date of last pumping: n(a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n& revised 9/2198 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 672 RIVER RD.MARSTONS MILLS Owner: JUNEJEFFERSON RANDOLPH Date of Inspection:4/6199 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n& Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) n/a Dimensions: n/A Capacity: n/a gallons Design flow: n/a gallonstday Alarm present: NO Alarm level:jil& Alarm in working order:Yes_No—: NQ Date of previous pumping: n/a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:n/a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER: NO (locate on site plan) Pumps In working order:(Yes or No): NQ Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 9/2/98 Page 8 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 572 RIVER RD.MARSTONS MILLS Owner: JUNE JEFFERSON RANDOLPH Date of Inspection:4/5/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: WA Type: leaching pits,number: nLa leaching chambers,number: _n/a leaching galleries,number: -n& leaching trenches,number,length: n& leaching fields,number,dimensions: n& overflow cesspool,number: 6'X5'BLOCK CESSPOOL Alternative system: n& Name of Technology: _n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE OVERFLOW IS STRUCTURALLY SOUND,THERE WAS 12"OF LEACHING LEFT AT THE TIME OF THE INSPECTION, CESSPOOLS: - (locate on site plan) Number and configuration: n/a Depth-top of liquid to inlet invert: nla Depth of solids layer: n& Depth of scum layer. n/a Dimensions of cesspool: n& Materials of construction: n& Indication of groundwater: n(a inflow(cesspool must be pumped as part of inspection)n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: _ (locate on site plan) Materials of construction:nla Dimensions:n& Depth of solids: nla Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nla revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 672 RIVER RD.MARSTONS MILLS Owner: JUNE JEFFERSON RANDOLPH Date of Inspection:4/6/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a pet . O� A6 �S QQ revised 9/2198 Page 10 of 11 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 572 RIVER RD.MARSTONS MILLS Owner: JUNE JEFFERSON RANDOLPH Date of Inspection:4/5/99 NRCS Report name: xdA Soil Type: n& Typical depth to groundwater: n& USGS Date website visited: WA Observation Wells checked: NQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: - Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _ Checked with local Board of health Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS AND VISUAL-12+FEET revised 9/2198 Page 11 of 11 TOWN OF BMZNSTABLE LOCATION SEWAGE # VILLAGE I L S ASSESSOR'S MAP & LOT �tiSf,fc7�Xes f NAME&PHONE NO. � /-C® 7 7f_ r f SEPTIC TANK CAPACITY - £ / /A"01 5,0f c 7/,&A- ,I LEACHING FACILITY: (type) (size) NO.OF BEDROOMS f�J' BUILDER OROWNER /tiSJIE c 77aA- DATE: '3 'U COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by __ a o, �os � ��'� �. , r� �� �s o COMMONWEALTH OF MASSACHUSETTS 6 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r RECEIVE® 350 MAIN STREET WEST YARMOUTH,MA 0 508-775-2800 F E B 1 9 2002 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A MV Q ' CERTIFICATION MAP 060 PAR 019 PARCB. : Property Address: 572 RIVER ROAD ((7)T MARSTONS MILLS,MA 02648 Owner's Name: DENTON,RANDOLPH Owner's Address: 572 RIVER ROAD MARSTONS MILLS,MA 02648 Date of Inspection JANUARY 30,2002 Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco 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: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: z'Gc6y Date: �61— 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 SYSTEM PASSES. SYSTEM IS TWO OLD CESSPOOLS. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 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: 572 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: DENTON,RANDOLPH Date of Inspection: JANUARY 30,2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X _ 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. rA 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 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 572 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: RANDOLPH,DENTON Date of Inspection: JANUARY 30,2002 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 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 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: 572 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: RANDOLPH,DENTON Date of Inspection: JANUARY 30,2002 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 X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/x day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply X Any portion of a cesspool or privy is within a Zone I of a public well X Any portion of a cesspool or privy is within 50 feet of a private water supply well X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (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 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: 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 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 572 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: RANDOLPH,DENTON Date of Inspection: JANUARY 30,2002 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No X Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? N/A Were as built plans of the system obtained and examined?(if they were not available note as N/A) X Was the facility or dwelling inspected for signs of sewage back up? r X Was the site inspected for signs of break out? X Were all system components,excluding the SAS,located on site? X Were the manholes uncovered,opened,and the interior inspected for the condition of tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum. X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No X Existing information. For example,a plan at the Board of Health. X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 572 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: RANDOLPH,DENTON Date of Inspection: JANUARY 30,2002 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 440 Number of current residents: 0 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)): 2000 155,000/2001 919,000 Sump pump(yes or no) NO Last date of occupancy: UNKNOWN COMMERCIALANDUSTRIAL 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 X Cesspool X 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: UNKNOWN Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 572 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: RANDOLPH,DENTON Date of Inspection: JANUARY 30,2002 BUILDING SEWER(locate on site plan): N/A Depth below grade: 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): N/A Depth below grade: 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: Sludge depth: Distance from top of sludge to the bottom of outlet tee or baffle: 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: 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.): 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 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 572 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: RANDOLPH,DENTON Date of Inspection: JANUARY 30,2002 TIGHT or HOLDING TANK: N/A (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• N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.,): 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 f Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 572 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: RANDOLPH,DENTON Date of Inspection: JANUARY 30,2002 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: X overflow cesspool,number: 1 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 7' BLOCK POOL WITH COVER 6"BELOW GRADE.OVERFLOW IS DRY.NO OUTLET LINE,WALLS CLEAN.NO OVERLOADING SEEN,OVERFLOW IS WORKING BUT IS OLD. CESSPOOLS: X (cesspool must be pumped as part of inspection)(locate on site plan) MAIN Number and configuration: 1 Depth—top of liquid to inlet invert: DRY Depth of solids layer: DRY Depth of scum layer: DRY Dimensions of cesspool: 8'6"DEEP Materials of construction: BLOCK Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): MAIN POOL IS DRY,ONE INLET NO TEE.ONE OUTLET WITH TEE.CEMENT COVER AT GRADE.NO SIGN OF OVERLOADING SEEN. 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 Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property.Address: 572 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: RANDOLPH,DENTON Date of Inspection: JANUARY 30,2002 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 1 P£AR, i 0 Title 5 Inspection Form 6/15/2000 10 Page 1 I of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 572 RIVER ROAD MARSTONS MILLS,MA 02648 Owner: RANDOLPH,DENTON Date of Inspection: JANUARY 30,2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 25 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: Observation site(abutting property/observation hole within 150 feet of SAS) X 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: G.I.S.AT BARNSTABLE BOARD OF HEALTH.25' TO GROUND WATER. 7 ,B a/ oM OvF.0 Low g Title 5 Inspection Form 6/15/2000 11 CB/DH FNDLAJ h°j •`o ' c Y fm f 77063 + S. F. , {. a CBYDH Asa C 1 . 77 f AC.. FND p c:-f� �-l / X W�Soo oLe Al DECK, - r � a 0572 cae hh•eh\' ti CD/DI! ?B,r FND O1 CONCRETE FOUNDATION LOCATED, BY SURVEY ON.NOV. 27. 2007 6 CB/DH J.M. O'Reilly & Associates, Inc. LETTER ( P Engineering& Land Surveying Services 1573 Main Street,2nd Floor,P.O.Box 1773. TRANSMITTAL Brewster,MA 02631 (508)896-6601 . Fax(508)896-6602 TO: DATE: JOB NUMBER: Town of Barnstable 02/21/2012 F6538 Board of Health 367 Main Street Hyannis, MA 02601 REGARDING: Map 060 Parcel 019 Locus: 572 River Road, Marstons Mills, MA Shipping Method: Regular Mail ❑✓ Federal Express ❑ Michael &Kristen Ehrhart 572 River road Certified Mail ❑ UPS ❑ Marstons Mills, MA 02648 Priority Mail ❑ Pick Up Express Mail. Hand Deliver COPIES DATE DESCRIPTION Original-Soil Suitability Assessment for Sewage Disposal Report For review and comment: For approval: As Requested: For your use: REMARKS: cc: John M. O'Reilly, P.E., P.L.S. Matthew T. Farrell, E.I.T. From: Patricia M. Desjardins/MTF If enclosures are not as noted,kindly notify us at once TOWN OF BARN STABLE LOC!XhON 572 ky"O 2 1Z AZ? SEWAGE # ?012 -" A02 VILLAGE e— ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �� C�^/l �`TD,,�S I-Vez, . SEPTIC TANK CAPACITY 150 i�/✓ � � LEACHING FACILITY: (type) 4�ON L'6 ) � � NO.OF BEDROOMS BUILDER OR OWNER PERMITDA i4E: D/. 2O. 2012 COMPLIANCE.DATE: Separation Distance Between the: Ir w , Maximum Adjusted Groundwater Table and Bottom of Leaching Facility F � 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 Al �iU� 77 IN- dos' { y y 7- • • 1f' 132 -61, A Pb •A5. 6 AP 6 5 No. o�G ' Fee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for bisposal bpstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(X Abandon( ) P/Complete System ❑Individual Components Location Address or Lot No. 579 R/yt-R 90*D Owner's Name,Address,and Tel.No. Assessor's Map/Parcel oko Installer's Name,Address,and Tel.N . C� 588 385- Designer's Name,Address,and Tel.No. i�K/n COA&M �� J"3 -,JAIPMay- /537 M�jAv Si Type of Building: Dwelling No.of Bedrooms Lot Size "7-7060 sq.ft. Garbage Grinder( ) Other Type of Building 2a/XA-)/?42- No.of Persons Showers( ) Cafeteria( ) Other Fixtures / r Design Flow(min.required) Y V© gpd Design flow provided -5- gpd Plan Date 211710o)a- Number of sheets ) Revision Date AJOI Title SEWA69 2 WWdA'L 4Y/ ZfM MSfL�U Size of Septic Tank 1&49 &W/ Q/J Type of S.A.S. J-D&X 3 CNA-Mj5Wd Description of Soil tdft V �7Nlc SA 7l/D •- �'! f sAm/D zA!j rl ►/ )Jit/,r-114g2///A4 4+.,vD jF Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B rd Health. Signed li Date Q m ffl/x Application Approved by 1 Date Application Disapproved by Date for the following reasons Permit No. J G 0-- 6 Z Date Issued r y— ��-- f - i�.r....M. ..�w _ `n....si..1aW f� y ....v.-�.. .. , �! ..✓ .. Z� f=-y No. f Fee - r. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:PUBLIC HEALTH DIVISION - TOWWOF BARNSTABLE, MASSACHUSETTS Yes 2ppYication for Misposal 6pstem Construction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade X Abandon( ) Complete System ❑Individual Components ' Location Address or Lot No. ,57 1-91 Y Owner's Name,Address, �and -rTel.No. Assessor's Map/Parcel Oki /� I IChW4 Instal er's Name Address,and Tel.N C� JCS 3 5' Designer's Name Address,and Tel.No. �' 6•G+�O/ k'� ��ti �N 3993 �1M ©���iy- /5 37 /�1A�,5T7. � 2 ,3/3 -Havom Or9� PE771,1 Type of Building: (� 4 Dwelling No.of Bedrooms / Lot Size -77060 sq.ft. Garbage Grinder( ) Other Type of Building,,. �CS�DFnI��Z No.of Persons Showers( ) Cafeteria( ) Other Fixtures r Design Flow(min.required) �� gpd Design flow provided J gpd j Plan Date 2 17 ov/,:�— Number of sheets Revision Date Title SE WA4f XS14 /V Size of Septic Tank Type of S.A.S. Description of Soil L d Ally) r-1mr _s"o - F!Alf ..SA7+/O /,a/ n'I y - r-),✓r/MEN/UtL9 = "•✓1� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: •�l The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this B14/4"lar Hea4th. Signed Date a like/'r Application Approved by DateZ- Application Disapproved by Date for the following reasons Permit No. C� 6 — 10 2 Date Issued ��` k2_ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded I Abandoned( )by Fe M Con l-'ACIV il'o , 106 f at 572- 121 w-g RoA-c�, i'y). m/LL5 has been constructed in accordance �J with the provisions of Title 5 and the for Disposal•System Construction Permit No.do 1) - IU� dated f� a � t � Installer PNM r01_)7�i�/V Designer JM npf7aa— W)6, jc/,019� . #bedrooms "( Approved design flow elgG gpd The issuance of this permit shall not be construed as a guarantee that the syste�w fitnc�on s gned. Date/ *. Inspector --------------------------- --- = == -------------- No. �-6 1)- — 16')-- /� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Bisposal *pstrm (Construction Vrrmit Permission is hereby granted to Construct( ) n Repair( ) Upgrade(V/ Abandon( ) System located at 571 /<i y, 2- K�{� m. m ats and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date L(- D y Approved by ^'� /- ' j' i Town of Barnstable P��n+e lO�ti Regulatory Services ' Thomas F. Geiler,Director UXNFMB % Public Health Division y MA88. Eb 9.A�� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 O�Assessorls Fax: 508-790-6304 Date: 5- 6— 12) Sewage Permit# A _ Map/Parcel t Installer&Designer Certification Form e 5 0C- W C. Installer:Designer: �IN1, ® (Zl;✓Il.l.�' � S T V-M CDtiITI'ZprM(ZS Address: ` o SM 1!73 Address: P6 �0) 1 j O?_., I On VVJ C6 PT-eA C=A 0L, was issued a permit to install a (date) (installer) septic system at 672 'P,%VM based on a design drawn by (address) M• 0 iZS-t_L_,t/ Ash.W dated 2 (designery I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was,inspected and the soils were found satisfactory. 0 cy a JOHN M. c�I s er gn 40 O'REILLY ``�+ CIVIL c1 A NO.36200 igner's S ty e) (Affix Desi'gne V9l nfp,Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsldesignercer ification form.doc J ILE COPY J.M. REILLY &AssodATES, Nc° PROFESSIONAL ENGINEERING,LAND SURVEYING.& ENVIRONMENTAL SERVICES � a Site Development•Property Line• Subdivision Sanitary• Land Court•Environmental Permitting April 30,2012 Job#6538 Thomas McKean Barnstable Board of Health 200 Main Street Hyannis,MA 02601 Re: Assessor's Map 060,Parcel 019 572 River Road,Marston Mills,MA Michael&Kristen Ehrhart-Owner Dear Mr.McKean: As per the requirement of the Massachusetts State Sanitary Code 310 CMR 15.021(3), J.M. O'Reilly & Associates, Inc. has conducted an on-site inspection of the newly installed sewage disposal system at the above referenced-property. At the time of our inspection on 4/25/12, the system installation had been completed with the exception of backfilling and final grading. Our observations were limited to the top of the Soil Absorption System (S.A.S.), the observation manholes for both the septic tank and distribution box,and the soil conditions above the S.A.S. Based on our observations,the sewage system was installed within substantial compliance with the approved plan completed by J.M. O'Reilly & Associates;Inc.dated 2/17/12,as filed in your office. This letter represents J.M. O'Reilly&Associate's inspection prior to backfill. No warranties or guarantees are expressed or implied for the future operation of this system. Please contact my office directly with any questions, comments or for any additional information you may need. Very Truly Yours, J.M. Asso i • ,may Ma ew Farrel c .) s w Civil Engineer cc:Client -=„o John M.O'Reilly;P_E;;P.L:S. sue'+ 1573 MAIN STREET]P.O.Box 1773,BREWSTER,MA 02631 ' PHONE: (508) 896--66oi ° FAX: (So8) 896-66o2 WWW.JMOREILLYASSOC.COM J.M. O REILLY &ASSOCIATES, INC. PROFESSIONAL ENGINEERING'LAND SURVEYING & ENVIRONMENTAL SERVICES O Qaod Site Development•Property Line• Subdivision• Sanitary• Land Court• Environmental Permitting April 30,2012 Job#6538 Thomas McKean Barnstable Board of Health 200 Main Street Hyannis,MA 02601 Re: Assessor's Map 060,Parcel 019 572 River Road,Marstons Mills,MA Michael&Kristen Ehrhart-Owner Dear Mr.McKean: As per the requirement of the Massachusetts State Sanitary Code 310 CMR 15.021(3), J.M. O'Reilly & Associates, Inc. has conducted an on-site inspection of the newly installed sewage disposal system at the above referenced property. At the time of our inspection on 4/25/12, the system installation had been completed with the exception of backfilling and final grading. Our observations were limited to the top of the Soil Absorption System (S.A.S.), the observation manholes for both the septic tank and distribution box and the soil conditions above the S.A.S. Based on our observations, the sewage system was installed within substantial compliance with the approved plan completed by J.M. O'Reilly & Associates,Inc. dated 2/17/12,as filed in your office. This letter represents J.M. O'Reilly & Associate's inspection prior to backfill. No warranties or guarantees are expressed or implied for the future operation of this system. Please contact my office directly with any questions, comments or for any additional information you may need. Very Truly Yours, J.M.O' Asso ' es., Ma ew Farrel Civil Engineer cc: Client John M.OReilly,P.E.,P.L.S. MTF/eoo 1573 MAIN STREET,PO.BOX 1773,BREWSTER,MA 02631 • PHONE: (508) 896-66oi • FAX: (508) 896-6602 WWW.JMOREILLYASSOC.COM I i i CB/DH FND N a s 6qo �O N .�G CB/DH FND DN I CB/DH FND hA \p •� ti 77063 + S. F. CB/DH 1 .77 + AC. FND o� DECK 1� ti o� #572 ' c ; CB/DH AUG �41DD FND 2e'� 0' N '-By Ap °i CONCRETE FOUNDATION LOCATED BY SURVEY ON NOV. 27. 2007 0. '2? l ovo 00. CB/DH FND TOWN OF BARNSTABLE ZONING I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL KNOWLEDGE. INFORMATION AND BELIEF THE DWELLING ZONE R -F SHOWN HEREON CONFORMS TO THE HOR/ZONTAL SETBACKS SETBACKS : OF THE ZONING BY-LAW FOR THE R-F DISTRICT. FRONT - 30' SIDE - 15' m REAR - 15 � l s��ss PLOT PLAN IN THE DWELLING DEPICTED ON THIS �����^��,'� �� I-, BA��VSTABLE, MA . PLAN WAS LOCATED ON THE GROUND " BY SURVEY ON JUNE 18. 2007 AND �a w an SCALE: l "-40 ' JUNE 21. 2007 EXISTS AS SHOWN AS OF THE DATE ��•SIEt��O a� �aJb�� Sys REVISED JUNE 27, 2007 OF LOCATION. REVISED JUL Y 12. 2007 THIS PLAN IS FOR PLOT PLAN ZY/zov7 REVISED NOV. 29, 2007 PURPOSES ONLY AND NOT FOR EAGLE SURVEYING , INC RECORDING. DEED DESCRIPTIONS 923 Routs 8A OR ESTABLISHING PROPERTY LINES. Yarmouthport, MA. 02873 (308) 382-8132 (308) 432-5333 THIS PLAN /S VOID IF NOT STAMPED AND SIGNED IN RED. 0 20 40 BO ' PROJECT N0. 07-059 r tl\\V\Oe �Y O/ 0 241-011 v `v Lu � W Q �] z LO O Q m gym ° NEW DECKLn EXISTING 2—CAR GARAGE Z Q� w 2� 2'-011 o Ot J I � v � _ - A w_ 4X4 p T --- 1_/4' X 11 1/4" LVL 4X4 POST _ l9 RIDGE C4 NEW MUD P400M Q - 3T N� v EXISTING 32 �� :. E RESIDENCE NEW WALLS (] J �I� EXISTING WALLS fi (Y W N Z > Z PROPOSED MUD ROOM FLOOR PLA 0. SCALE: 114" m I1-011 4 a�lgj1 ILA 241-011 1 "'J SHEET A'I 1 r' u JOB: 1002 DRAWN BY: KW I DATE: 7/9/10 _ O Z Q o ROOF OVERHANG O 6 1 1 ROOF OVERHANG m � CID cl 12 W° -- LI J 1 4=C --- „ W W --- __-- —_--------— -- Q Q --- 12 ° 0 12 4C:--' a m F- W ROOF OVERHANG GZI Q COPPER CRICKET `r Q 4 J _J W Z PROPOSED ROOF PLANCL Q'- Sr-ALE- 1/4" a V-0" In Q SWEET A JOB: 1002 DRAWN BY: KW DATE: 7/9/10 Town of Barnstable P#� .Department of Regulatory Services eAtwsreer� ' Public Health Division Date �" Z ► � NABS. wlE019. 200 Main Street,Hyannis MA 02601 Date Scheduled /r)6/>__,nMe` Fee Pd. —A pAW �I Soil Suitability Assessment for Sewa `e osal Perfmned.By: Witnessed By: - LOCATION& GENERAL INFORMATION Location Address 572 River Road Owner's name Michael Ehrhart f. Marstons Mills, MA Address. 572 River Rd,Marstons Mils ' Assessor's Map/Parcel: 060019 Engineer's Name Matthew T. Farrell J.M. 0'Re y Q Inc. NEWCONSMUCTION REPAIR Telephone# � _409sb8Y, =•.a . Land Use• �, `O� Slopes 7 LSurface Stones Distances from: Open Water Body t 9; ft Possible Wet Area Ad 00 ft Drinking Water Well 5O ft Drainage Way T. - 7© ft Property Line ±7Z5 ft Other ft - SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands�n proximity to holes) � t Parent material(geologic) _ / IImo'' ' Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Pit Race Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE qA Method Used: Depth Observed standing in obs.hole: _ __._In. Depth to soil mottles: Depth to weeping from side of obs.hale: in. Groundwater Adjustment fir. Index Well# Reading Date:. Index Well level�. .a._., Adj.faetor_ Adj.Oroundwater Level— ]PERCOLATION TEST bate, , Time- \ � Observation Hole# Time at 9" .�..�. Depth of Perc Time at 6" . Start Pre-soak Time @ T m`(91'4") End Pre-soak Rate Min./Inch ' Site Suitability Assessment: Site Passed Site.-Failed: Additional Testing Needed(Y/N) ' Original .Public Health Division s=% Observation Hole Data To Be Completed on Back---- -- ' ***If percolation test is to be cogilueted within 1001 of wetland,you must first notify the Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEPTICVERCFORM.DOC DEEP-OBSERVATION-HOLE.-LOG Hole:# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) aTG� 1 I (USDA) (Munselq Mottling (Structure,Stones,Boulders. l� ICo i t nc ritvel � — c_ q- • IFS �� �i , , , , G� 7 ter, ffe& �. DEEP OBSERVATION HOLE LOG Hole# ,r �+ Depth from Soil Horizon Soil Texture Soil Color Soil Other ` Surface(in.)- (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# 7 . th from Soil Horizon Soil Texture Soil Color. Soil er -'"�� �► �L* ' :Surface(in.) (USDA) (Mansell) Mottling (S re,Stones,Boulders. c' z - r sw - si to c Gravel) 00, y..:- } t l DEEP OBSERVATION HOLE LOG Hole# De om Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) M4ttlin g (Structure,Stones',Boulders. C-0003JIMUCY,%GERVID Mt Flood Insurance hate Map: ' Above 5W year flood boundary No Yes Within 500 year boundary No Yes ' Within 100 year flood boundary No Depth of Naturally Occurring Pervious MaterlJ Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? NIN' r If not,what is the depth of naturally occurring pervious material? Certification C I certify that on 4 ` l J L(date)I have p e soil.evalua urination approved by the 5•.,, Department of Environme otection at the ove ana is w performed by me consistent with ) the required trai`'. xper' and a erience de ibed i 15.017. Signs Datef D MARSTONS MILL5, MA GENERAL NOTE5 : 501L TE5T LOG5 : 5Y5TEM DE51GN CALCULATION5: IC SYSTEM TEST HOLE 1 : EL=30,2± SEWAGE DESIGN FLOW: A.) NEITHER DRIVEWAYS NOR PARKING AREAS ARE ALLOWED OVER SEPT 4 BEDROOM DWELLING @ I 10 GPD = 440 GPD DEPTH FROM SOIL SOIL SOIL SOIL OTHER UNLE55 H-20 COMPONENTS ARE USED, SURFACE HORIZON TEXTI)Rff COLOR MOTTLING LEACHING CAPACITY REQUIRED: 42 1 .4'± To Exi5tincj WILL NOT 13E RESPONSIBLE FOR THE SYSTEM AS DESIGNED UN- (INCHES) (U51DA) (MUN5ELL) B.)THE DE51GNEP 4 BEDROOMS (MAXj @ I 10 GPD = 440 GPD REQUIRED Well Parcel 00 1 Map G I LE55 CONSTRUCTED AS SHOWN. ANY CHANGES SHALL BE APPROVED IN WRITING. 0-5" A LOAMY FINE 5AND I OYR 4/1 NONE SEPTIC TANK CAPACITY REQUIPED: 5"-20" B LOAMY FINE SAME I OYR G18 NONE C.)CONTRACTOR SHALL BE RESPONSIBLE FOR VERIFYING THE LOCATION Of ALL DAILY FLOW= 440 GPD @ 200% = 880 GAL. REQUIRED 2011-G011 C I FINE SANDY LOAM I 0YR G/I NONE I I RM LOCUS UNDERGROUND AND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT Of WORK. GQ`-140" C2 FINE/MEDIUM SAND 1 OYR 7/3 10%GRAVEL SEPTIC TANK CAPACITY PROVIDED: �ff RC @ 7 1 (BOTTOM) 1500 GALLON SEPTIC TANK(MIN. ALLOWED) CON5TRUCTION NOTE5 : LEACHING CAPACITY PROVIDED: TEST HOLE 2: EL=38.9± ONE (1) 33.5'X 12.83'X 2,0' LEACHING CHAMBER CAN LEACH; DEPTH FROM SOIL SOIL SOIL -901L OTHER Vt=[(33.5 X 12.83) + (33.5 X 2.0)2 + (12.83 X 2.0)21 X 0,74 1 SURFACE HORIZON TEXTUPE COLOR MOTTLING 1 .)ALL CONSTRUCTION SHALL CONFORM TO THE STATE ENVIRONMENTAL CODE, 455 GPD>440 GPD REQUIRED TITLE 5, AND THE REQUIREMENTS Of THE LOCAL BOARD Of HEALTH. (INCHES) (USPA) (MUN5ELQ Z_ 0-14" Cf FILL I OYR 4/1 NONE NOTE: A GARBAGE DISP05AL 1-9 NOT PERMITTED WITH THIS DESIGN, 2.)SEPTIC TANK(5), GRE A5E TRAP(5), D05ING CHAMBER(S)AND DISTRIBUTION 14"-24" B LOAMY FINE SAND I OYR GIB NONE INSTALL: BOX(E5)SHALL BE SET ON A LEVEL STABLE BA5EWHICH HAS BEEN MECHANICALLY 24"-G8" C1 ILOAMY fiNE 5AND I CYR G1 I NONE ONE,(1) - 1500 GALLON SEPTIC TANK COMPACTED, OR ON A G INCH CRUSHED STONE EASE. I ONE (1) - 3 OUTLET DISTRIBUTION 13OX(H-20 Ratea) Flo Gf-134" C2 FINE/MEDIUM SAND I OYR 7/3 NONE THREE (3) - 500 GALLON LEACH CHAMBERS WITH 4' Of STONE ALL AROUND 120 1 A!10 3.)SEPTIC TANK(5)SHALL MEET ASTM STANDARD C 1 127-53 AND SHALL HAVE AT LEAST THRE E 20" DIAMETER MANHOLES. THE MINIMUM DEPTH FROM THE BOT- CL NOT TO SCALE TOM Of THE SEPTIC TANK TO THE f LOW LINE SHALL BE 48". DATE Of TESTING: 0 1/20/12 0 PERCOLATION RATE: LE55 THAN 2 MIN/INCH IN 'C2` LAYERS. 24 GALLONS GONE 5 MIN 40 SEC. 4.) SCHEDULE 40 PVC INLET AND OUTLET TEES SHALL EXTEND A MINIMUM Of G" A50VE THE FLOW LINE Of THE SEPTIC TANK AND SHALL 13E INSTALLED ON THE WITNESSED BY: MATT FARRELL, EIT, J.M. OREILLY�ASSOCIATES, INC. PLAN BOOK 2GG PAGE 4 DAVID STANTON, AGENT, BARNSTABLE HEALTH DEPARTMENT CENTERUNE Of THE TANK DIRECTLY UNDER THE CLEANOUT MANHOLE, NO WATER ENCOUNTERED DEED 1300K 14829 PAGE 333 5.) RA15E COVERS Of THE SEPTIC TANK AND DISTRIBUTION E30X WITH FRECA5T USE A LOADING RATE Of 0.74 GPD/5F FOR 51ZING Of SOIL ABSORPTION SYSTEM. ASSESSORS' MAP OGO PARCEL 0 13 CONCRETE WATER TIGHT RISERS OVER INLET AND OUTLET TEES TO WITHIN G"Of : D_ FIN15H GRADE, OR AS APPROVED BY THE LOCAL BOARD Of HEALTH AGENT. G.) PIPING SHALL CONS15T Of 4"SCHEDULE 40 PVC OR EQUIVALENT. PIPE SHALL LEGEND BE LAIC) ON A �INIMUM CONTINUOUS GRADE Of NOT LE55 THAN I%. EX15TING CONTOUR 7.) D151 KIt5U I ION LINES FOP,501L ABSORPTION SYSTEM (AS REQUIRED)SHALL BE 4" DIAMETER SCHEDULE 40 PVC LAIC) AT 0.005 fT/fT. LINE SHALL 13E CAPPED 32 PROP05ED CONTOUR AT END OR AS NOTED. X 12,34 EX15TING SPOT GRADE 8.)OUTLET PIPES FROM DISTRIBUTION BOX SHALL REMAIN LEVEL FOR AT LEAST 24x5 FROP05ED SPOT GRADE 2' BEFORE PITCHING TO SOIL AI35ORFTION SYSTEM, WATERTE5TD15TRIBUTION ff LOOK PLAN W_ WATER SERVICE LINE BOX TO ASSURE EVEN DISTRIBUTION. DENChMARK,: 21,5 OVERHEAD UTILITY SERVICE ED BELOW NOT TO SCALE Top of(onc.rete,Bouncil 9.) DISTRIBUTION E30X SHALL HAVE A MINIMUM SUMP Of G" MEASUP, (A55urnea catum) LOT 2 _U_ UNDERGROUND UTILITY SERVICE THE OUTLET INVERT. G 10.) BASE AGGREGATE FOR THE LEACHING FACILITY SHALL CON515T Of 314"TO Area= 77,OG05ff± TIP GAS SERVICE LINE 1-112" DOUBLE WASHED STONE FREE Of IRON, FINES AND DUST AND SHALL BE I RST FLOOR BASEMENT FLOOR TEST HOLE/ BORING LOCATION INSTALLED BELOW THE CROWN Of THE DISTRIBUTION LINE TO THE E30TTOM Of THE ST SEPTIC TANK 501L ABSORPTION SYSTEM. BASE AGGREGATE SHALL BE COVERED WITH A 21' PLAY X 23,55 DE, D15TRIBUTION BOX ,EE Of IRON, FINES AND DUST. �DINING LAYEROf 1/8"TO,1/2" DOU15LE WASHED STONE fP ROOM 5AS SOIL ABSORPTION SYSTEM 1 1.)VENT 501L A55ORPTION SYSTEM WHEN DISTRIBUTION LINES EXCEED 50 FEET; ROOM WHEN LOCATED EITHER IN WHOLE OR IN PART UNDER DRIVEWAYS, PARKING AREAS, FAMILY Re5erve RESERVED FOR FUTURE TURNING AREAS OR OTHER IMPERVIOUS MATERIAL; OR WHEN PRESSURE DOSED, ROOM/ cia3 UTILITY POLE ?< 23.2 LIVING 13ED 12.)501L ABSORPTION SYSTEM SHALL BE COVERED WITH A MINIMUM Of 9"OF EG CATCH BA51N CLEAN MEDIUM SAND (EXCLUDING TOP501L). ROO I M ITCHEN 'EX15tincj Septic Component5 f I RE HYDRANT 13.) f IN15H GRADE SHALL BE A MAXIMUM Off 3G"OVER THE TOP Of ALL SYSTEM UTILITY BED SEE NOTE 20 x 25,68 WELL AREA COMPONENTS, INCLUDING THE SEPTIC TANK, DISTRIBUTION BOX, DOSING CHAMBER DRAINAGE MANHOLE BAT BED OF 911. ORCH N D R`; CONCRETE BOUND, FOUND AND 501L A155ORPT ION SYSTEM. SEPTIC TANKS SHALL HAVE A MINIMUM COVER CREEN A,-V LAU P REA 14.) FROM THE DATE Of INSTALLATION Of THE SOIL ABSORPTION SYSTEM UNTIL TOP Of BANK BED PARCEL 035 RECEIPT Of A CERTF ICATE Of COMPLIANCE, THE PERIMETER Of THE SOIL AB5ORP SERVED BY TOWN WATER 0 _X_X LIMIT Of WORK TION SYSTEM SHALL BE STAKED AND FLAGGED TO PREVENT THE USE OF SUCH FENCE AREA fOR ALL ACTIVITIES THAT MIGHT DAMAGE THE SYSTEM, '�/EATH 0 15.)THE BOARD Of HEALTH SHALL REQUIRE INSPECTION OF ALL CONSTRUCTION F3-2] EDGE Of CLEARING BY AN AGENT Of THE BOARD Of HEALTH (OR THE DESIGNER If TH15 SYSTEM RE- J302 QUIRES A VARIANCE)AND MAY REQUIRE SUCH PERSON TO CERTIFY IN WRITING THAT ALL WORK HAS BEEN COMPLETED IN ACCORDANCE WITH THE TERMS Of THE PERMIT AND APPROVED PLANS. 48 HOURS ADVANCE NOTICE 15 REQUESTED. 5 31, x 26.94 7.3 GARAGE 3 3G ING WASTE LINE INLE I G.) INSTALLER TO VERIFY INLET INVERT Of LEACH PIT BY UNCOVEP T INVERT ANID/OR VERIfY1 NG AT THE PIT, PRIOR TO SETTING AND SEPTIC COMFONITS. x 35,53 �2.4 EL=37.50± 17.) OWNER TO APPROVE VENT LOCATION. SEE NOTE I G 18.) 501L REMOVAL: ALL Cf, 5, 4�C 1, LAYERS TO BE REMOVED TO EL=33,0±, 411 AND/OR THE CLEAN SAND (C2 LAYER) LAYER FOR A LATERAL D15TANCE Of 5'. AREA 131 TO BE FILLED WITH CLEAN SAND, COMPACTED TO MINIMIZE SETTLEMENT. 39,9 0 Lawn 19.) 40 MIL HDPE LINER: PLASTIC LINER TO BE INSTALLED FROM EL=37.0 TO EL=33.0 3,3 AT THE EDGE OF THE 501L REMOVAL. LINER SHALL BE INSTALLED AS SHOWN ON PLAN VIEW, APFROXIMATELY85 LINEAR FEET. < 35.81 20.) EXISTING LEACH PIT AND CE55POOL TO BE PUMPED< f ILLff D�/ITH CLEAN SAND EXI 43A x 42, VIEW, APPROMMATELY59'. x 32,58 oo/ AND AbAN 'ONED IN [LACE. 00 0 co, ff�5tincj 37 Leach Pit INSPECTION NOTE: C6 43.4 PROPOSED LEACH CHAMBERS (SAS) x 4\7 4 4117k > CO 33,5' X 12.(53' X 2.00' 5A.9 DETAIL PRIOR TO FINAL INSPECTION BY THE ENGINEER, SYSTEM NEfD5T0 BE COMPLETE INCLUDING [3UILDUFfOR COVERS. 001 PROPOSED 40 MIL HDPE LINER 43.C2 C ", NOT TO SCALE -k,-, - ­ I'll SEE NOTE 15) X 4a^ j5?t- 43.00 X 52 PROPOSED 5' 501 REMOVAL Irricjation Well 3, 0 1. 4 0 D-Box Per- Home Owner SEE NOTE 18 ,7� 7� �Vl X/ -F 7 3.2 'Z 5,0 e11117 007a 57 N\ 3530 z �"vj, 49.2 40 MIL HDPE LINER W SEE NOTE 10 +1 Exi5tin own Water Service m 43,3 m X 40.49 7 19 'E, 4 111��VOU VOU El 4j4,86 X 41.2 N, 0 PARCEL 02� 40.39 5ERVED BY TOWN WATER 4�,8 4A 31 49,5 48,0 4 (55 -8.51 8.5' 41111 4t)' *7 492 2 49.7 QUF < 49.9 �9 45.7 JOHN Z-6 x 4 3 'iU- 1iEIL Y r 49.5 A-9.9 'eg Z� f LOW PROf I LF 50,2 NOT TO SCALE 51X (G)TOTAL '02 24"DIAMETER CONCRETE COVERS VENT 5WEET AIR' PA15ED TO WITHIN G"Of fINI5H C� TOP Of fOUNDATION SEE NOTE 17 GRADE (OR AS NOTED) 50.3 EL=50.9 (SEE NOTE#5) Propo5ed EL= 4 1 .4 ProP05C6i EL=40.0 Propo5eci EL=40.00 MAXIMUM V/ Y \1, ave riveway PLAN N 47, 3G' Prop05eJ 38.7 50A T.0_9.=43,5±��'- (E)" Min- 30 Max) 37.00 A Michael Krisiten Fhrhart FL_ <7 Dirt Driveway 572 River Road, Mar5ton M1115 MA 02G46 2"LAYER Of 1/8" - 112"STONE 0 49.7 PRE-EXISTING 3 7.L.L/ '011 1-1/2"STONE 14" \37.25 3/4" 50.2 0 6 UNDER SLAB 3 3G,33 3G.15 0') �.9 5EWAGE D15,P05AL 5Y5TEM DE51GN .4'0" T 2" DROP -4,0 612-7_,--�iver Road, Marston Milb, MA GAS BAN L, 3- 0/ THREE(3) H-20 3sl .8 USE 5HOREY FRECA5 0 500 GALLON LEACH CHAMBERS 15.5' J.M. OTEILLY AssOCIATES, INC. WITh 4'Of,5TONIF AROUND 491 40 Professional Engineering & Land Surveying Services 1500 GALLON 14' (END VIEW) /C 0- 20 GO D15-3 I ;I MAX EL= 18,50 BOTTOM TEST PIT I Loncjc5t Run LEAC_�I[NG CHAM15ER 5EFTIC TANK 1573 Main Street - Route 6A D_E3OX SCALE 1 `=20' 33.5'x 12.83'x 2.0� CC), P.O. Box 1773 e Brewster, MA 02031 (508)896-6602 Fax 57270 (508)896-6601 Offic INSTALLER SEE NOTE I G k-201 IR DATE: SCALE: BY: CH ECK: J05 NU M DER: 46.1 G:\AAJoL)I 5\F-hrhartG538\aw�j\G5385D,'3,clwcj 2- 17-12 AS Noted MTff/k JMO JIVIO-G538 ffAM'LY n) p ,QOW NONE f NONE q BED 0 UTILITY AREA LAUN A /41,1 4 4/3 4 3,0 0 -------------- ------- -77