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HomeMy WebLinkAbout0656 RIVER ROAD - Health Marstons Mills `�♦ A=044026 TOWN OF BARNSTABLE ✓ :-OCATION //���i�r �� SEWAGE # VD 00-el 2 VILLAGE 101,0WS7'O1ZS .11 ASSESSOR'S MAP & LOT Ql -026 INSTALLER'S•NAME&PHONE NO. g z C/f� 9, /3a 16 S SEPTIC TANK CAPACITY IW42 LEACHING FACILITY: (type) 2-5'00�o�� ��� Leif I�S (size) 2 f X' /3.2 NO.OF BEDROOMS 3 BUILDER OR OWNER 14114 t2aOAI�--41 PERMTTDATE: 2- -U 0 COMPLIANCE DATE: 2 /0 -O 0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet. Furnished by ��. . , a r,�vt f ,�� �q� 'Y�' ��` �. . `:4 .. �/ / � �- " � K,fVFsY �G( - OWN OF BARNSTABLE LOCATION 5G ,�ii r SEWAGE # VILLAGE 5' %fig lZ-15 ASSESSOR'S MAP & LOT .�f f 67=� INSTALLER'S NAME&PHONE N0. 177 Z/2. SEPTIC TANK CAPACITY i0✓.. LEACHING FACILITY: (type 6%'la =;%%` (size) " S^X /3 I. NO.OF BEDROOMS I B'BUILDER OR OWNER�. �7 i PERMITDATE: °1 1 -02. COMPLIANCE DATE: Z 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.. Feet on site or within 260 feet of leaching facility) I Edge of Wedand and Leaching Facility(If any wetlands exist within.300.feet of leaching facility). . Feet 1 Furnished:by b� 4V11 i ♦v I i 1M\ 1r nj: { F h THE COMMONWEALTH OF MASSACHUSETTS f 4Entered in computer: ��Z Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zipprtcation for Mtzpaaf *pztem Con!aruction Permit Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (�S(P /2�y/`y� �e�i C Owner's Name,Address and Tel.No. q2 O-- Assessor's Map/Parcel ®Vt 10 9 6 G SG I v/- /lam/ l Installer's Name,Address,and Tel.No. q`7%- O,j�l J Designer's Name,Address and Tel.No. JDS�f l U°� 6.1911PVS 6 .' Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures " Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 5 "J"Z Nature of Repairs or Alterations(Answer when applicable),) E1:1 4 r14 4,115-4i Q -AeW . 2 -SOO 61121 H-26 . j?emu W15114 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 Certifi- cate of Compliance has been issued by this Board of Health. Signed ". � — Date 2 -f- 00 Application Approved by Date 1 - 2- De/ Application Disapproved for the following reasons Permit No. ��o — d R °� Date Issued No.1/&- 0 9�- t._ 4. Fe� THE COMMONWEALTH OF MASSACHUSETTS -Entered in computer: t Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 3pprication for Mizpogar *pgtem Construction Permit Application for a Permit to Construct(U')Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.�5-6 9'Vl.e Owner's Name,Address and Tel.No. 412 0- vn,ar5roris Ali/s �Oohn f2oov�ey Assessor's Map/Parcel OVX 026 Installer's Name,Address,and Tel.No. q-77- 5'9 Designer's Name,Address and Tel.No. ' Jos-_w/i U, 6v?,,AoS ,/o5'ep'h O-` 1 s�N.nvS /l 1 "1 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan\Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil b�s�e-Z Nature of Repairs or Alterations(Answer when applicable) ?i-/s rw�� 4/1.461 & -de2x . 2 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 Certifi- cate of Compliance has been issued by this Boaro of Health. Signed 1 f Date 2 -,9- 0m Application Approved by X�c�.......� Date i Ocv Application Disapproved for the following reasons Permit No. 1020 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance ;THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(4--y Repaired ( )Upgraded( ) Abandoned( )by a at S-6 - 1,0 eA; o S f/S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ,41Z-©R1 dated Installer s/,05 4144 a,- djol"a5 Designer %Ans e- .- /).-- �3,ays�ro t The issuance of this permit shall not be construed as a guarantee that the syst Will furnction as d d. Date Inspector No. o ----------------Oyy 02�i -----Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS li5po5ar *pgtem Construction Permit Permission is hereby granted to Construct((/Repair( )Upgrade'( )Abandon( ) System located at ro 4-(0 /?r V/i 1- and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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: 1- 9- ©6 Approved by�� 1/6l99 1� NOTICE: 'This Form Is To Be Used For the Repair Of Failed ;Septic Systems Only. - CEIFI RTCA7:ION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMrT (WITHOUT DESIGNED PLANS) I, J0.5f-P4 t?-'-' Soi-r,r s , hereby certify that the application for disposal works construction permit signed by me dated 2— 8 - pD , concerning the property located at G SG A t t/I-Oh 1�o41 meets all of the j following criteria: The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling.'/,The soil is classified as CLASS I and'the percolation late is less than or equal to 5 minutes per inch. of/ There a no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system •� The re itcrease in flow and/or change is use proposed There are no iranances requested or needed • The bottom of the proposed leaching facility will not he located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. Mill be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facil;,T will Mt be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: a f T'ST �i T A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the'MAX- High G.W. Adjustment. DU;TERF:riCE BETWEEN A and B _ SIGNED (Sketch proposed plan of DATE. q:�u rotea:cer� system on backj. 1 ,I I po Care (.��y Gv�v/f r�T 0 �T ao o TOWN OF ARNSTABLE LOCATION \�—t!✓-�� \�-CX # 5� :,`PILLAGE ur-70t)nS ASSESSOR'S MAR&PARCEL IN#W-&-L+4'S NAME&PHONE NO. `pTrt°L�— OnVIQ �'1 11 SEPTIC TANK CAPACITY f OOO qu LEACHING FACILITY:(type) k a.tM—LU"dS (size) s%0 NO.OF BEDROOMS OWNER On►t-C i PERMIT DATE: CfE DATE`Sin�P- 13 I 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 • t \+t \ i \ i t \ \ i i i ,5� f J f f F f f / f J F1J4fM1f F J 5 6 J . t \ \ t t t t \ 4+\ t t \ t t t 42 .River Road Commonwealth of Massachusetts Title 5 Official Inspection Form y a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 656 River Road Property Address . Rita Rooney _.. Owner Owner's Name information is Marstons Mills required for MA 02648 September 13, 2011 every 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 filling out A. General Information forms on the computer,use 1. Inspector: only the tab key (J} _to may a your r M. Patrick . O'Connell cursor-do not use the return Name of Inspector key. Septic Inspection Services Co. Company Name � 189 Cammett Road Company Address Marstons Mills MA 02648 few CitylTown State Zip Code 508-428-1779 S1 12855 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 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluatir r by the Luca!Approving Authority 1 V September 13, 2011 Job# 11-158 1 ector'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 approg-authority. t'- !-' 3. a 4J This report only describes conditions at t ee 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. 4 G dj t5ins•11110 t `.' } j ll 7W4 5'0 i eclion�orm Subsurface Sewage Disposal System•Page 1 of 17 n b V I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 656 River Road Property Address Rita Rooney Owner Owner's Name information is Marstons Mills MA 02648 13 2011 required for -September every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or.in 310 CMR 15.304 exist. Any fall,,lre criteria n t ev,?1u,2-;ed^re indicated below. Comments: Tank was not in need of pumping at time of inspection. Leaching chambers were empty with no sidewall stains. 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 "a connplyiny sceptic 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): l5ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments M 656 River Road Property Address Rita Rooney Owner Owner's Name information is Marstons Mills MA 02648 September 13, 2011 required for _ p � every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 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 15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts 9= ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 656 River Road Property Address Rita Rooney Owner Owner's Name information is Marstons Mills MA 02648 September 13, 2011 required for p every page. Citylrown 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--day flow 15ins•1 Ill 0 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 M 656 River Road Property Address Rita Rooney Owner Owner's Name information is required for Marstons Mills MA 02648 September 13, 2011 every page. Cityrrown 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. l5ins•11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 5 of 17 I r Commonwealth of Massachusetts T Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ww 656 River Road Property Address Rita Rooney Owner Owners Name information is Marstons Mills MA 02648 September 13, 2011 required for p every page. CitylTown 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•11110 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 656 River Road Property Address Rita Rooney Owner Owners Name information is September 13, 2011 Marstons Mills MA 02648 Se required for p every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 137,000 gal. _ 9 ( Y 9 (gpd)): 188 gpd. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. 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: 15ins•11/10 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 •' 656 River Road Property Address Rita Rooney Owner Owners Name information is required for Marstons Mills MA 02648 September 13, 2011 every page. City/Town State Zip Code bate of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Tank pumped July 2006 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Irispection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 656 River Road Property Address Rita Rooney Owner Owners Name information is Marstons Mills required for MA 02648 September 13, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information.- Leaching system installed 2/10/00 tank is original. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site pian): Depth below grade: 6' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 5' 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: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 2° t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 656 River Road Property Address Rita Rooney Owner Owners Name information is ,arstons Mills MA 02648 13 2011 required for M -September _ every page. Cityrrown 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 28 Scum thickness Trace 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 14" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert tees were intact Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene y El 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M •'" 656 River Road Property Address Rita Rooney Owner Owners Name information is Marstons Mills required for MA 02648 September 13, 2011 every page. City1rown 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 El 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•11110 Title 5 Official Inspection Form:Subsurface Sewage P g Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 656 River Road Property Address Rita Rooney Owner Owner's Name information is September 13, 2011 Marstons Mills MA 02648 Se - required for p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan).- Depth of liquid level above outlet invert 0 1. 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(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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts = 51Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 656 River Road Property Address Rita Rooney Owner Owners Name information is Marstons Mills required for MA 02648 September 13, 2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: Two 500 galdrywells. ❑ 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 chambers had no standing water and no sidewall stains. Cesspools (cesspool must b�� 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 l5ins•11110 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 17 Comm onwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 656 River Road Property Address Rita Rooney Owner Owners Name information is Marstons Mills required for MA 02648 September 13, 2011 every page. Cityfrown 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.): l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 656 River Road Property Address Rita Rooney Owner ----.-__.------------------- Owner's Name _..---------- -- ..._._.. -- --- — information is MarStons Mills required for ---_.------...--------------._....._...---------._._..._--------._..-. MA - 02648 September 13, 2011 eve page. Cit /Town _..---_---___-- ry P 9 y 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 ❑ drawina attacheri Sannrafz1%/ / , / / ! , , ! , ! , • / , J56 42 14 14 River Road i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 656 River Road Property Address Rita Rooney Owner Owner's Name information is Marstons Mills MA 02648 September 13, 2011 required for _ p every 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: 15+ 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: Elevation of bog at rear of property is considerably lower than SAS. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-11110 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 656 River Road Property Address Rita Rooney Owner Owners Name information is Marstons Mills MA 02648 September 13, 2011 required for p every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposa System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE "i bCATION GAG ��v e-r 10T4 c _SEWAGE #T`77 $ VILLAGE M, M�\\S ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.Cn e (7p& 6 SEPTIC TANK CAPACITY \LEACHING FACILITY:(type)9,re T (size) (_JDO QR\ NO. OF BEDROOMS 3 O UBLIC_W_ ATER BUILDER OR U i DATE PERMIT ISSUED: Y DATE COLIPLIANCE ISSUED: i 'VARIANCE GRANTED: Yes No r �L R 47, M `o r\ L ASSESSORS MAP NO: '--� �f PARCEL NO: -- I No..... Fx$.......... ............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 1-/-'Y.....-----..OF.....-2FI-47 n/S�i?9../'.�.._G ............... ............ Appliration for Disposal Works Tomilrurtinn Prrntit Application is hereby made for a Permit to Construct (&j or Repair ( ) an Individual Sewage Disposal System at: ,eivc�z Z14V /`�i�-izsrz�,r s h�Gcs ZO7- Z •...............--••----------- --.....------------------------------------- ...------------------•-----------•-------------------_---------•--•---------------------•---•---- oration-Address or Lot No. ....................../CL/�yr2 ......... s !F"o e�7+ Imo- !q s S ...................................... Owner n Address Installer Address �i��� Q Type of Building Size Lot____________________________Sq. feet f Dwelling—No. of Bedrooms.......... .............................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q, Other fixtures ----------------------------------------- W Design Flow...............-15 ......................gallons per person per day. Total daily flow__._........33®.....................gallons. Ri Septic Tank—Liquid capacityZ® ..gallons Length.O-6.'•-..... Width_'4 6._-... Diameter________________ Depth..s-B.-... W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No.___---�.__-_-__._ Diameter....__ ` _.___. Depth below inlet.....:7:� .... Total leaching area._:o7.8...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '�' Percolation Test Results Performed b 9P! .....&=-..................................... Date. "'v .._.7 /y87 aTest Pit No. L.4_.L.._.minutes per inch Depth of Test Pit---- -'fi....... Depth to ground water.......—_......__._. (� Test Pit No. 2... .. .._._minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a •-•-------------------------•---••--................................•----•-----••-----......._---- 0 Description of Soil.....- '•-.36' 1�l®ate lo%1rj----- ' ---st,,8-.Soi G _T6 --------------- ---••---•--•---•--....--------••-•---•-----•---••••--••-•--•--- V ---•- ..............---��------•---QF---6.e.<I✓�L........./-� /.SZ` G� �-----•-------•----------------•----------------------.....-------- W ---•---------------------------------------•-------------------------•----------------•-•-•----•-•-----•-•••----•----•-------•---------•--------------••-----•-•--------------------------••----•--..... UNature of Repairs or Alterations—Answer when applicable._______________________________________________________________________•----_____.------------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i i f.1�. ;of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. • -------------------•-•-•• ................................ � Dat Application Approved BY --------- � •-.' =" ::............... � F D tE e Application Disapproved for the following reasons:----I J.... .............................................. -------•--•---•.............••-•------.....--•--••••----•-•-------•-•-•-•-••--••••-••••-••-••-••----••....-•--•-•----•--.......--------•-••-•-•••---------------••------•-------------•-----•----------•- Date PermitNo...., ........................................... Issued....................................................... Date Nd................�_14-.— It `7 Fms ............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7 W OF..... f�-i2�ry S7'.9.13G .... Appliration for Disposal Workii Cfontrurtion ramit Application is hereby made for a Permit to Construct (4--) or Repair ( ) an Individual Sewage Disposal System at: ,��vE�z l4;, /Llrrrzs .ems �-i�ccs 7- z......................................................... -•--•••-•---......-•••••......-•-•-••---- ••- ...................................... - - ........ •.Location-Address or Lot No. �y,c.�/�..-z EOM.-x.-�• I�G;Irx aL 7 04, -�S_....................................... Owner Address Installer Address Q -Type of Building Size Lot_ 14 _--------Sq. feet Dwelling—No. of Bedrooms.........3..............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ................................... W Design Flow............. 3....................••__gallons per person per day. Total daily flow____.._...33s........................gallons. WSeptic Tank—Liquid capacity!°....gallons Length.`............... Width` 6."..._ Diameter________________ Depth_�.'d".... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.___.-....._...... Diameter._._?' Depth below inlet---:3t4E�...... Total leaching area3&?.7-R....sq. ft. Z Other Distribution box ( ) Dosing tank '-' Percolation Test Results Performed ►'??��......4—r- .le�_ Zie�y................. Date%!Z_---.= ,aa Test Pit No. l -/_..L-...__.minutes per inch Depth of Test Pit..lsX!....... Depth to ground water------------------------- Prq Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ••--•-•-•----------------•••-••-•-••..........._....---•----•--......_._.....•--••........-•••----••......................................................... 0 Descri ion of Soil-- a 3G' ..�Naud Go/ ,•-,.......4....�"f-ee= '1"z ............. x W�........................ ..........0,..G.��✓�L--....../`/� /Sa ---mil?- 1y�= ......-•--------------•----•--------------------------••-•------••---- U 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 TTTE, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. _ _�.'__Signe�d------. Date -•................•---•-•••. APPlication Approved BY -- _..._ to Application Disapproved for the following reasons:_...� ---------------- ---------------------- D - -- .......................................................----•---•---•----•-•-••-•--•--._...._........._..._............................................................................................ Date PermitNo. ........................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �..'..'?/N 1�2n/_ST. dG. ...... .....................OF......... ............................... Tnrtifiratr of Tontplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( } bY...........................................................................................I ---Iler----............................................................................................... nst at.......... r l r_,i l7_ c�'L7_�. ._....... ! ✓ri......'�'� 1-'.1.1.4� has been installed in accordance with the provisions of T1 T 5 of The State Sanitary Code as d cribed in the application for Disposal Works Construction Permit No._ ..�_. Z. dated__��E�.��.�------.-_-_..- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE.••-••-•....._...�..:-..1.1.42_................................ Inspector.... ------•-----------•-•-----.--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. ..... No. ------...... FEE....::.: ........ �i��o��1 orko �ontrnrtuan rrntit Permissionis hereby granted.............................................................................................................................................. to Construct' ) o Repair ( an Individual Sewa ispos�l System�� atNo. -------- ........................................................................ •--- ----•-•............... Street Y•?�1/as shown on the application for Disposal Works Construction Permit Nam,._..__: __ _._ Dated �......... �__�/�i_._�...._.. •---••........_••••-••---�---- . . ....A�"'�"----------------------•............._ Board of Health DATE................................................................................ FORM 1255 HOBBS 11 WARREN, INC.. PUBLISHERS D ly 00 10 O b� j Lti LOCATION BAvsTl3BG �yRrsrays,h/GGs) SCALE . ..!.��'.`''.�.... DATE :To�yE X /./l87 PLAN REFERENCE &---71v ,..�o, T "YL OF EDWAR . . .. .. . . . . .. .. . . . . . . . . . . . . . . . . . . . g E ' y o. 26100 �Q 1 CERTIFY THAT THE ..... .. . . .. . .. SHOWN ON THIS PLAN IS LOCATED ON THE GROUND ISTER��C� AS SHOWN HEREON; O I LAMS S DATE ... . ..... . . . . . . C9 e ZlZZ 7 T/DNe-T?- REGISTERED LAND SURVEYOR Ui r� L. . .7'�• oo. . ... . TOP OF FOUNDATION CONCRETE COVER o,. CONCRETE COVERS 9.71 0 4, CAST IRON 12"MAX. r IF12"MAX. ' OR SCHEDULE 40 4"SCHEDULE 40 PV.C.(ONLY) P.V.C. PIPE PIPE- MIN. LEACH PITCH 1/4"PER.FT. PITCH 1/4"PER.FT. PIT PRECAST ° -� LEACHING o' INVERT = Q`.; PIT OR ` o EL.G�• 9.. INVERT DIST. INC3R.¢g �% w ; EQUIV. SEPTIC TANK EL..c.7.77, SOX EL...�..... ' : >x ,.o INVERT /odv . .. GAL. INVERT .3.�~a EL t3,6s: INVERT W w o ::►: 3/4"TO I Id �� v; WASHED w STONE 6 /8'--- —WDIA.DIA.—�I veNE a• • . ., ' PROFI LE OF GROUND WATER T+ABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE BOARD OF HEALTH �^!F.3i !1�.87 TIME.�o;oo�j / . . . TEST HOLE I TEST HOLE 2 ENGINEER ELEV. . e8..L z . . ELEV. .. .. . . . . . . 11/4 . . . . . . . . . . . . . . . . . . . . . WOO ' DESIGN DATA : EL.GLZ NUMBER OF BEDROOMS '3 . . . . . . . . . Cos�� TOTAL ESTIMATED FLOW . . . . GALLONS/DAY Sl�n r' BOTTOM LEACHING AREA S'' �. . . SQ.FT. /PITIG,P,D, Wt72/ SIDE LEACHING AREA . . .��3 9. . . . SO.FT. PIT/.3R48G.RD oT 62AV GARBAGE DISPOSAL .A/4V4r. .(5O%o AREA INCREASE) .�Lz TOTAL LEACHING AREA . .307-.8 . SQ.FT PERCOLATION RATE ?WO MIN/INCH /-�a Ems.SS.GZ _ _ _ LEACHING AREA PER PERCOLATION RATE SQ.FT./,-,PP. .... . .WATER ENCOUNTERED D.v6 /�iT lt/i NUMBER OF LEACHING PITS . . . . ^ . . . . . . ?t'�. . . APPROVED . .. . . . . . . . . BOARD OF HEALTH of Syv^� 4- DATE . . . . . . . . . . AGENT OR INSPECTOR -------- -q-- LoT , EDWA s HA N CD "o 26100 ,o lSTEP�� O N�L�SLAN�S� S9NRAR�P� PETITIONER fNN Cul�G�