HomeMy WebLinkAbout1027 RIVER ROAD - Health 1 D27 River Road
Marstons Mills P
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• THE COMMONWEALTH OF MA A Entered in computer: .
_ SS CHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ;_,_Yes
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ftptiration for Misposal 6pstem Construction Permit N)
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Application for a Permit to Construct( ) Repair(jupgrade( ) Abandon( ) ❑Complete System [individual Components
Location Address or Lot No/0,2 k,4 f Owner's Name,Address,and Tel.No. 0
Assessor's Map/Parcel L4,YA43 rlwskuN M� \S k C% 6
Installe 's Name,Address,an Tel.No. Designer's Name,Address,and Tel.No.
Sc� . t� %c.. ��3 O�� �tHrr,o� �c� Ji-�c�-e. i�lic,c, .f oZ�j3 C�nUi �,�,.9 tZ,�
a u s �� 5
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( 0
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3� gpd Design flow provided gpd
Plan Date �j S t Number of sheets Rdvision Date
Title
Size of Septic Tank Type of S.A.S. q :Tb 1) C c.L C Q C K
Description of Soil .e— f b)c k' Q4
f C -CV,o
Nature of Repairs or Alterations(Answer when applicable)P`��,� Q k f \.ram( L �V�
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 Board of Health.
Si Date 6,
�.
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. _2 d Z 3 Date Issued
o. 00 - 3 / Fee /10
THE COMMONWEALTH OF/!MASSACHUSETTS / Entered in compute4
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
` ' application for Disp, oral 6pstem Construction Permit �
Application for a Permit to Construct( ) Repair(��Upgrade( )` Abandons ) 0"Complete System [individual Comp rients
Location Address or Lot No.102'7 k,4 L{ Owwnne.,r ss,Naam�e,Address,and Tel.No. r
40
Assessor's Map/Parcel (, -71 3 (�lcsSk"\-\ Ln
Installe 's Name,Address,an Tel.No. Designer's;Name Ad ress and Tel.No.
Q J J� 19
C(`t'AA%J t C.W i
e of Building: V v
TYP -
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( j 0
Other Type of Building No.of Persons Showers( ) Cafeteria( )
a
Other Fixtures
Design Flow(min.required) `} 0 gpd Design flow provided (, �[( gpd
Plan Date 4C� Number of sheets Revision Date
Title
Size of Septic Tank l ZM V Type of S.A.S. Ln 0e Lww"46r3
Description of Soil ,j
Nature of Repairs or Alterations(Answer when applicable) Sig
S /�� n 'f L.� `\.P-4�� A!"L� ems.. 1��1.�t`�._ .-•
v�
Date last inspected:
k
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 Board of Health.
A.
,,• Sig me d Date
Application Approved by ` (� S Date
Application Disapproved by Date
for the following reasons
t �
Permit No. .z L' Date Issued '� �/ Cj
J
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(am) Upgraded( )
Abandoned( )by h)A. M �=�r-OVAL
_at ) been constructed in accordance
with the provisions`(of Title 5 and the for Disposal System Construction Permit No. 90 t/ dated 7 / 4
Installer S CV 1 (n \r u p u, Designer SA J-<
#bedrooms , Approved design"fl w A '�'� gpd
The issuance of this it shall not be construed as a guarantee that the system willfunctio 1 i designed.
j� r
Date �J j Inspector 7� 2
No. o I l- t 3 Fee Id U-
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
]Disposal 6pstem Construction Vermit
Permission is hereby granted to Construct( ) Repairt Upgrade( ) Abandon( )
System located at l 7 (�• �r-'�r (�cJ r'- _4 �h�_
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. 4
Date Approved by
►� r��y mtd s�,y�� s4r,n 0,� c- 5,,Jl , ��� �7 T"J� P a
r
- Town of Barnstable
Regulatory Services
Richard V. Scali,Interim Director
+ iARd+iBTABi$
him, Public Health.Division
•e3�
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
1 Installer&Designer Certification Form
Date: l�`� Sewage Permit# Qsessor's MapTarcel
Designer: S:I EP REM A,. 1k A Ak$,_f>C Installer: 56,_ Nl- 'FP-4 1f-
Address: "�. 0. rkSok tip Address: LVS 00 Yi,WatTrf-( Rb
O ZCo(o0
On ° l` �. t=t�-- K was issued a permit to install a
(date) (installer)
septic system at d�� ��y�� �S n c es krnased,o``design drawn by
(address)
4AASrFrFdated (, 1 3 l k l
(designer)
V/ 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. Strip out (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. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed ', l' nce with the terms
of the IAA approval letters (if applicable) ,�1
nstaller's Signature) $ �
Al
(Designer's Signature) (Affix Designer's Stamp 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.
Q:1Septic\Designer Certification Form Rev 8-14-13.doc
1
TOWN nOF-IBARNSTABLE
LOCATION 1 ���� \<v SEWAGE# o C1
PILLAGE C F Vd n C-At J\S ASSESSOR'S MAP&PARCEL 3
INSTALLER'S NAME&PHONE NO. S p r F rzAK nK a GX4 dob 1
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) U NZO SOD G cL (size) /d
c�, s
NO.OF BEDROOMS ez n3_
OWNER �G•fn0
PERMIT DATE: COMPLIANCE DATE: O 1c1
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 W
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TOWN OF IBARNSTABLE
LOCATION 10 a 1 1 n V� SEWAGE# 2o I q
VILLAGE_� C( rN, t-A%ois ASSESSOR'S MAP&PARCEL Q3
INSTALLER'S NAME&PHONE NO. r.^y� , \)vK o�G y4 t)D 6
SEPTIC TANK CAPACITY — - (S
LEACHING FACILITY.(type) �4 N Z U G c,L (size) Ad x 4o k v
NO.OF BEDROOMS n3 c`-, b--fs 0 1 S
OWNER
PERMIT DATE: ( � r k q COMPLIANCE DATE: 4 ' lcl
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 (J W \
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Ivy ti
Town of Barnstable Barnstable
AI�Mft
Inspectional Services
BLE, ��ac
HARNf3T4 , r
H''
sGgq. Public Health Division
`g
a 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas A.McKean,CHO
FAX: 508-790-6304
CERTIFIED MAIL#7015 1730 0001 4988 2033
January 17, 2019
OREILLY, ROBERT J
1027 RIVER RD
MARSTONS MILLS, MA 02648
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located 1027 River Road, Marstons Mills, MA was inspected on
12/13/2018 by James D. Sears, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Static liquid level in the distribution box above outlet invert due to an
overloaded or clogged SAS or cesspool.
You are ordered to repair or replace the septic system within one (1)year from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
�A�om�sc n', R.S., HO --
Agent of the Board,of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\1027 River Road Marstons
Mills.doc
I
Town of Barnstable
� M
� snarrsr�►s�, •
Regulatory Services Department
Public-Healtfi_Divisiori-
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Richard Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 5/11/16
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An"x"marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground _
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
ONE (1)YEAR DEADLINE CRITERIA
.Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
o Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2)YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
❑ Leaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline: ,
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
Jan 04'2019 08:41 HP Fax page 22
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments N.
t� 1027 River Road
L
Property Address
Bob O'Reilly
Owner owner's Name
information Is Marstons Mills MA 02648 12-13-18 -
required for every
per• CitylTown 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.
\\lull I I1I UI!
Important When A. Inspector Information vet# J35�f�-- Ss��''-,,,
filling out forms
on the computer,
use only the tab James D Sears �� JAM Il
key to move your Name of Inspector r v i SEARS
cursor-do not Capewide Enterprises
use the return
key. Company Name �,,��j� .FRT1FN�•G�o�:'
153 Commercial Street
ICY Company Address lrrinnnu�r�c
_Mashpee MA 02649
Cityrrown State Zip Code
508-477-8877 S 1623
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system Inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above;the information reported below is true, accurate and complete as of the time of my
Inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ® Fails
1-2-19
spector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP,The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
tWap.doc-rev.7126(2018 Title 3 Official Inspection Form:SubsuAa®Sewage Disposal System•Page 1 of 18
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
1_) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
w � 1027 River Road
Property Address
Bob O'Reilly
Owner Owners Name
Information is Marstons Mills MA 02648 12-13-18
required for every
page. CltylTown Stale Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary:Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
❑ 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:
Failed system-pit The system is a 1500 Gal.Tank D Box and pit.
2) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes","no"or`not determined" (Y, N, ND)for the following statements. If"not
determined,"please explain.
The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
a
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Jan 04'2019 08:41 HP Fax page 24
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form •Not for Voluntary Assessments
1027 River Road
Property Address
Bob O'Reilly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 12-13-18
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes(cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
Observation of sewage backup or break out or high static water level in the distribution box due
❑ 9 P 9
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 ❑ NO(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ NO(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (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 ❑ NO (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1027 River Road
Properly Address
Bob O'Reilly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 12-13-18
Page. City(Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspooi or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, If any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
® Cl Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.712 612 01 8 Title 5 08icial Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form •Not for Voluntary Assessments
r
1027 River Road
Property Address
Bob O'Reilly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 12-13-18
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cunt.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or dogged SAS or cesspool
® ❑ Liquid depth in a®sepoet is less than 6" below invert or available volume is less
than '/a day flow Pl'r"-
❑ ® 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 160 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® 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 2000 gpd-
10,000 gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails.The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 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 C.4.
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
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
ISOI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1027 River Road
V. -
Propeny Address
Bob O'Reilly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 12-13-18
page, Citylrown State Zip Code Date of Inspection
C. Inspection Summary (coot.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed.The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for aR inspections:
Yes No
❑ ® Pumping information was provided by the owner, occupant,or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
Cl ® 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 NIA)
® ❑ 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)]
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1027 River Road
Property Address
Bob O'Reilly
Owner Owners Name
requinform
r on is Marstons Mills MA 02648 12-13-18
requiredd for every
page. City(Town State Zip Code Date of Inspection
D. System Information
1. 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
Description,
1500 Gal. Tank D Box and pit.
�I
Number of current residents: 4
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes,discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2016-174,00OGa
g ( y g (gp ))' 2017-144,000Gal
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: PresentDate
I
Jan 04. 2019 08:43 HP Fax page 29
Commonwealth of Massachusetts
fn Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1027 River Road
Property Address
Bob O'Reilly
Owner Ownees Name
information is required for every Marstons Mills MA 02648 12-13-18
page C4/Town State Zip Code Date of Inspection
D. System information (cont.)
2. Commerciallindustrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(9pd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancyluse: Date
Other(describe below):
3. Pumping Records:
Source of information: NA
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
I!
'Jan 04' 2019 08:44 HP Fax page 30
Commonwealth of Massachusetts
Title 5 Official Inspection Form
: Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r
1027 River Road
Property Address
Bob O'Reilly
owner Owner's Name
information is required for every Marstons Mills MA 02648 12-13-18
page. City/Town Slate Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow p cesspool
❑ Privy
f
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
1987 Permit # 87 -132
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 5'-10"
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.):
4" PVC Pipeing
15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 cd 16
Jan 04' 2019 08:44 HP Fax page 31
Commonwealth of Massachusetts
�Uy� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1027 River Road
Property Address
Bob O'Reilly
Owner Owner's Name
information is Marstons Mills MA 02648 12-13-18
required for every
page. City>?ovm State Zip Code Date of Inspection
D. System Information (cont)
6. Septic Tank(locate on site plan):
5'
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain)
If tank is metal, list age:
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500 Gal. Precast
Sludge depth: NA
Distance from top of sludge to bottom of outlet tee or baffle NA
Scum thickness 2
Distance from top of scum to top of outlet tee or baffle NA
Distance from bottom of scum to bottom of outlet tee or baffle NA
How were dimensions determined? Tape
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage,etc.):
Tank and outlet cover at 5' below grade wlinlet cover at 10". Tank is full up into inlet.
t5inW.doc-rev.1126/2018 Inde 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 10 of 18
Jan 04' 2019 08:44 HP Fax page 32
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1027 River Road
Property Address
Bob O'Reilly
Owner Owners Name
information is
required for every Marstons Mills MA 02648 12-13-18
page_ CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions;
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.);
8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
t5insp.doc•rev.7/26/2018 Title 5 011clal Inspection form:Subsurface Sewage Disposal System•Page 11 ar H
f
Jan 04' 2019 08:44 HP Fax page 33
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1027 River Road
Property Address
Bob O'Reilly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 12-13-18
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank (cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened)(locate on site plan):
Depth of liquid level above outlet invert na
Comments (note if box is level and distribution to outlets equal,any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D Box not located.
15insp.doc•rev.7/26/2018 Title 5 Official inspection Form'Subsurface Sewage Disposal System-Page 12 of 18
i ---
Jan 04: 2019 08:45 HP Fax page 34
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1027 River Road
Property Address
Bob O'Reiiiy
Owner Owner's Name
information
equiredfo is Marstons Mills MA 02648 12-13-18
required for every
page. CitylTown state Zip Code Date of Inspection
D. System Information (cost.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No'
Alarms in working order: ❑ Yes ❑ No"
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
If pumps or alarms are not in working order,system is a conditional pass.
11. Soil Absorption System (SAS)(locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
® leaching pits number: 1
s
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number,dimensions:
❑ overflow cesspool number:
❑ innovativelalternative system
Type/name of technology:
t5lnsp.doc•rev.7l2512015 Title 5 Official Inspection Form!Subsurface Sewage Disposal System•Page 13 of 18
Jan 04' 2019 08:45 HP Fax page 35
Commonwealth of Massachusetts
Title 5 Official Inspection Form
19v) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1027 River Road
Property Address
Bob O'Reilly
Owner Owner's Name
information is Marstons Mills MA 02648 12-13-18
required for every
page, City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching is a 1000 Gal.Tank w/2'stone per permit. Pit at 5'below grade wlcover at 15". Pit is
Full up into riser. Pit not leaching need to replace.
12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of sclids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
tSlnsp.doc•rev.7128/2015 Title 5 Official Inspection Form,Subsurface Sewage Disposal Syslem-Page 14 of 18
Jan 04 2019 08:45 HP Fax page 36
Commonwealth of Massachusetts
ITitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
f -
1027 River Road
`mil Property Address
Bob O'Reilly
Owner Owner's Name
information is required for every Marstons Mills MA 0264E 12-13-18
page. CityfTown State Zip Code Date of Inspection
D. System Information (cant.)
13. Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
15tnsp.doc•rev,712612018 Title$OBlaal Inspecdon Form:Si Sewage Disposal System-Page 15 of 18
Jan 04 2019 08:45 HP Fax page 37.
Commonwealth of Massachusetts
Title 5 Official Inspection Form
( Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1027 River Road
Property Address
Bob O'Reilly
Owner Owners Name
Information is requlred for every Marstons Mills MA 02648 12-13-18
page. CityfTown State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
i insp.doc•rev.7126120iS Title 5 Offidel InspecNan Farm:Subsurface Sewage Disposal System•Page 16 of 18
r
Jan 04 2019 08:45 HP Fax page 38
AsBuilt Page I of 1
TOWN OF BARNSTABLE
-/LOCATION 7027 /71veA Road 8112103 41
SEWAGE p
• VILLAGE l�aaefona /'l�.P�.�,l?ade.
ASSESSOR'S MAP&
I��` �P3'If;A� iYO�tP�(�X �. I.(7acow�eR aa.
SEPTIC TANx cAPAcrrY 1500 a.@2on.e
LEACKNCj FAC1LrrY: (type)1-LP-1000 1500
(site) yaP.tona
NO.OFHEDROOMS 3
BUILDER OR OWNER Bea#. 7 inwi n
PERMITDATE: A/12)61 ..rCl��ft�3 i 'USX r� Ins ection
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (Ir any wells exist
on site or within 200 fee(of leaching facility) Feet
Edge of Wedand and Leaching Facility(if any wetlands exist
widtin'100 feet f leaching f �tv'I� Fact
Fturtished by� �.
b `
. l
http:l/issgl2/intranet/propdata/prebuilt.aspx?mappar=045043&seq=1 12/7/2018
Jan 04 2019 08:46 HP Fax page 39
Commonwealth of Massachusetts
It Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form •Not for Voluntary Assessments
1027 River Road
Property Address
Bob O'Reilly
Owner Owner's Name
information Is required for every Marstons Mills MA 02648 12-13-18
page City/Town State ZIP Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
15'+
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health• explain:
❑ Checked with local excavators, installers - (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Lot is High to abutting property.
Before filing this Inspection Report,please see Report Completeness Checklist on next page.
t5insp.doc rev.7126QO18 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 18
Jan '04 2019 08:46 HP Fax page 40
<L,\ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
f
,.� 1027 River Road
Property Address
Bob O'Reilly
Owner Owner's Name
information is required for every Marstons Mills MA 02648 12-13-18
page. CitylTown state Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form Inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4(Failure Criteria)and 6(Checklist)completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.dx-rev.V2612018 Title 5 0fiiial Inspection Form:SubaurWce Sewage Olsposal system•Page 16 of 18
it
ESSORS MAP
cJ~ .3S ff11 .� p ♦.r
No- . ^....5� ~�~ Y Fxs -
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
----......_.Ta w..i......_.....OF...BsT.9 ............................................
Appliration for Dispati ai Works TvaT tratrftoat Vantit
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal
System at:
162-7 /2iV 2 �eiV-----h s'Toms 14Ls ...........................4eT t(Z
_... .... .......... ..------------...---------------------------.........._...--------
,/ J� _Location-Address or Lot No.
....K-----. •• ��------........!Ci ...
------------------
-•-----------•-------- !✓' _..............................................
r ner _-__- -Address
a ----- ------------------------------------------- ---------------------------------- -------------------------------------------
` Installer Address
� Type of Buil g Size Lot_ "7 S�______ q. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons................_----------- Showers ( ) — Cafeteria ( )
a' Other fixtures ..................................
W Design Flow..........S�'__ ________________________gallons per person per day. Total daily flow.._.._.______33 ..................-gallons.
W Septic Tank—Liquid capacity e _gallons Length.®X.'.... Width_ Diameter................ Depth_!;�!'C v_.
Disposal Trench—'.`To. .................... Width.................... Total Length.................... Total leaching area--------------------
sq. ft.
Seepage Pit No-------/----------- Diameter-------lo------- Depth below inlet.......4.......... Total leaching area---Z47-.__--sq. ft.
Z Other Distribution box ( ) . Dosing tank ( )
Percolation Test Results Performed b �?!`lr .__ ._ �°`LL.. _...... _.. Date_`�'��__23
a Y ,� -r--•----••-------
a Test Pit No. l.-L__Z....minutes per inch Depth of Test Pit.... � __. Depth to ground water....^---------_-.
G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water---------...............
-----------------------------------•-----•---------•----............--------•---•--........-----_............................................................
O Description of Soil.... '-/8" Woo�Loj�-rr_..i _S'uB-SeiL �8~_-�4--z•�4rAP,4VI
V ...................................'` 'F,-96 o 84"_/08" cz ✓107 .....................................................` - s�►/o
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 T'jE ;of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate o- Compli nce has bee issued by the-board o health.
i ned•-- -..........--
.. . -------.••--- ................................
ApplicationApproved By................ . .... .................................................. --------8-4 --------
ate
Application Disapproved for the following reasons---------------••----•--•-------•----•-----------------------------------------------------------•-•-••..._----
...........................................•------••---......-----------...---
Date
PermitNo-----------------....I................................ Issued.......................................................
Date
� Lj ,
R I �
No. ................... FEs -
_ THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
------.....�'" ^�................0F.. .' �.��sila13G.G
Applira#inn for Dispaii tl Works Tonstrn.tiun ramit
Application is hereby made for a Permit to Construct (.,-) or Repair ( ) an Individual Sewage Disposal
System at:
4'I V4-72 '��' /a-i� �c�s To�v 1 /`1/G� �.7
-•-•---•--------------•-•---•-•-------------•-----...........-------......................; ..... ------•-•----------------•-----•----.._...•--------•--•-------•---....--••----•---•-••......-•-••-
�• / Location-Address or Lot No.
/`sC: �1/........ ................................. ...........................s�✓.,� !2: in.............................................
Owner Address
W
Installer Address ��
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms--------3................... .....Expansion Attic ( ) Garbage Grinder ( )
............... No. of ersons....._....__........_....... Showers — Cafeteria p., Other—Type of Building ............. p ( ) ( )
P-4 Other fixtures ------------------------------- .
W Design Flow......... __________________________gallons per person per day. Total daily flow.._.__.____.M'__` ....................
1:4 Septic Tank—Liquid capacity?!oe..gallons Length•G___..... Width-l'?..""_....... Diameter................ Depth ._
Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No------,L------------ Diameter......i�o........ Depth below inlet...... .......... Total leaching area.. .` ......sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
'-' Percolation Test Results Performed by.-- �:K.... /?4...... Date` 4... ...................
,al Test Pit No. 1.!;�.._Z.....minutes per inch Depth of Test Pit...''`''._.__ Depth to ground water.....................f
fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -•••--••--••------------•---•-•--••-••-•----••••--••••••......_..---•-•................•----••---•--.........................................................
0 Description of Soil...0 /8" t cwoD Lo.�t ... ..5 u _Sa{ / SOz "CkZ,Q 114-Z'
U 9Z 84 '14 -S-A-ns7> 15�, /08 Cle,4,/e- - F.
............................ ---•--......----_.: :.........�uV —I....... .......>
W
'..............................................................•....•..•.......................••..-•.....•••..........•----.........•..................••...•••••..........._.._....................•
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
---------------•. .........................................................-••---•----------------••••--•....-•••••......-••••-•-•----•••-•-----•••••••••--•••-••-•••-••--•••--••••-•...---......-•--
Agreement:
The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with
the provisions of T ITS„E ;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 boardpf health..
V
Dame
Application Approved By....... -
�- ., D- �'r �' . .. .....---•-------•-•-•---------•-------
y all
� I
Application Disapproved for the following reasons:................................................................................................•••--------...
-•------------•----------------------------------------------------------------------------•---........--•----•-•----•---------•--•---••----•-•-----------•-••--•••--••-••-----•--•-••••--••--••----•---
Date
PermitNo.... = - ".............. Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Trrtifirttte of Toutplianrr _
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (/) or Repaired ( }
by---------------------------------------------------------------------------------------------------------------------------------------------------------------•-------...
[[ Installer
at......... 1----•---- r-•----.pl-
L...... � "\ -� ---------------------------------------------•------------------------------------
has been installed in accordance with the provisions of i1111: 7 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit ........ dated _ _ j
._... �------------------------
THE ISSUANCE OF THIS CERTIFICATE SHA NOT BECONSTRUED AS A GUARRTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY. /'
DATE................................................................................. Inspector.........................................'
THE COMMONWEALTH OF MASSACHUSETTS
i
BOARD OF HEALTH
c:vsf.'.'/.........OF......... .vsT-4eG G�
..-.... .............•-••-••••--•••••••••••••......--•--•---••••.........
--e"Ti-.-••-�•�y-Z FEE. �.�.
Disposal Wor #rudion famit
Permissionis hereby granted.............. .................. --------------------•---.........----------------.._....------.....•••••......•---......--
w to Construct (4-) or Repair ( } an Individual Sewage Disposal System
at No....L_ 4--- Z-••-------�'� w3c.f }
as shown on the application for Disposal Works Construction Permit -1,2 Dated- ... .� ------------------
,� ;• ealth -----------------
- q�oa{d
DATE................................................................................ L_-._ �oti�
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
1
TOWN OF BARNSTABLE l�
LOCk TION 1027 Rivet Road SEWAGE # 8112103
VILLAGE ' (�a2� ' .. ASSESSOR'S MAP & LOT
N¢comae z as.
SEPTIC TANK CAPACITY 1500 ga e e o n,6
LEACHING FACILITY: (type)�—L��- 1000 (size)1500 y¢teonz
NO.OF BEDROOMS 3
BUILDER OR OWNER Be2� 7.cnw.cn
PERMITDATE: R/92/()3 Snz/?ec.-ion
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 30/,feet f leachin faci' ) Feet
Furnished by
;.
i::,.
- � ��'-� i
� � � � .
1
� � � 2 �� J�' ���
_ b
_,
f
_r
,. � �
OWN OF TABLE
LOCA-71 ON el� t SEWAGE #
VILLAGE ASSESSOR'S MV�LOT
INSTALLER'S NAME&PHONE NO. J
SEPTIC TANK CAPACITY / C�
LEACHING FACILITY: (type) (size)
0
NO.OF BEDROOMS
BUILDER OR OWNER i
(d
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
v
tit
Atpek ka
�3
TOWN OFF B�ARNSTABLE
LOCATION �A � �`��� .'° SEWAGE # �7— 13a
�_
VILLAGE 10. C5195 � a°�`S ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY /Soo
.° LEACHING FACILITYAtype) X/ L I ' size) / g
NO. OF BEDROOMS 3 PRIVATE WELL OR UBLIC WATER
ol
BUILDE OR OWNERe'f'
DATE PERMIT ISSUED: �i r
DATE .COZIPLLANCE ISSUED: y
VARIANCE GRANTED: Yes No
b 1
y
`y�
�nr �
OATE8/12103 -_---
PROPERTY AOORESS1027 Rivet Road
_Mazztonz Niiiz, flazz.----
- 02648 ------------------
On the above date, I inspected the septic system at the above 7RECEIVED
Tnis system consists of the following:
1. 1- 1500 ga.2.Pon .ae�t.ic tank.
2. 1-Dizta ifut.ion &ox. 3 2003
3. 1- 1000 gaiion �2ecazt ieach.ing /tit.
Baseo on my inspection, I certify the following conditions: TOWN OFBARNSTABLE
HEALTH DEPT.
4. 7h.iz .iz a t it2e live ze/?t.ic zy.ytem. (78 Code)
5. The ze/2t.ic zy.6tem -iz .in /?2o/2ea wozk.ing oadea at
the /22eZent time.
6. Pum/zed tank at time of .ins/2eet.ion.
7. Oazte watea 1.6 18" &eiow the .inveat /2.i/2e of
of the .Peaeh.ing /tit.
ti SIGNATUR
'Fame _ J__ P__Macomber Jr .
- -- - - - --- -- -----
CorTipany : jgjQQh_p M�rgm�pr b_ Son, Inc .
�ad(eSS :__@Q ------------
YLLLP-,- ^Ja --Q.Z.632- 0066
--------
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
)OSEPH P. MACOMBER & SON, INC.
Tanks-Cess pool s-Leachllelds
Pumped & Installed
Town Sewer Connections
P 0 Box 66 Centerville, MA 02632,0066
)753338 ))56412
COMMONWEALTH OF MASSACHUSETTS
= EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
i
TITLE 5 i
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:
1027 Rivea Road
Na2.6ton.6 fi2.Pz Nazi.
Owner's Name:Be-/tt 7inwin
Owner's Address: Same
Date of Inspection:8/12/03
Name of Inspector: (please print) aozel2h P. ('lacomee2 Ia.
Company Name: I. %. facom e2 & Son Inc.
Mailing Address:Lao x 66
rpn#va»i PVn, l'lri��. 02632
Telephone Number: 5 0 8-77 5-33 3 8
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
trairting and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
\ �/Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: JDate:
The system inspector shall bmit 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.
Notes and Comments
,****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 page 1
Page 2 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address:1027 R-ive2 12oad
/la/tz.tona NUi-6, t'a.a,s.
Owner: Beat 7.tnw-.n
Date of Inspection: 8112103
Inspection Summary: Check A,B,C,D or E/ALWAYS-complete all of Section D
A. ystem Passes:
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
7/Lz P- A O,9 i,l r A g A 711
0 m J/ J n n n n T O n l�n n k i n g n a�oa
rt i ih o nap AO nT i m¢
B.- System Conditionally Passes:
Ad 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.
0117he septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
'A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
,t10 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:
2
Page 3 of 1 I
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:1027 kive2 1�oacl
flan'3tonz ('I.L.p.ee.
Owner: 2elt.t Tinw in
Date of Inspection: 8112103
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:
4JD Cesspool or privy is within 50 feet of a surface water
.70 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
40 The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
;lid 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 ]QO feet but 5 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:
3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1027 /2.ive�z /toad
a2z onh .6,3.
Owner:/3eat 7inwtn
Date of Inspection: 8/12/0 3
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No /
_ ackup 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
_ squid depth in=&peel is less than 6"below invert or available volume is less than �4 day flow
_ �equirecl pumping more that times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped 1 ,rf r
Any portion of the SAS,cesspool or privy is below high ground water elevation.
OAny 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.
y portion of a cesspool or privy is within 50 feet of a private water supply well.
y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_✓the system is within 400 feet of a surface drinking water supply
$11the system is within 200 feet of a tributary to a surface drinking water supply
I-"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.
4
Page 5 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPO
SAL SYS
TEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 1027 RIVE/2 /toad
¢/M one 7 , a.3.s.
Owner: Belti- T inwen '
Date of Inspection:77T=
Check if the following have been done. You must indicate' s"or"no"as to each of the following:
Yes No /
,/ umping information was provided by the owner, occupant, or Board of Health
/P
_ v 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 ?
2Have large volumes of water been introduced to the system recently or as part of this inspection ?
v Were as built plans of the system obtained and examined?(If they were not available note as N/A)
-Z _ Was the facility or dwelling inspected for signs of ?
P g sewage back up .
-/_ Was the site inspected for signs of break out ?
Y \
Were all system components,-A,,AA,,luding the SAS, located on site ?
_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of-thhee baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ?
v Was the facility owner(and occupants if different from owner
maintenance of subsurface sewage disposal systems ? )provided with information on the proper
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no
Existing information.For example,a plan at the Board of Health.
Determined in the field(if any of the failure criteria related to P
art is unacceptable) (310 CMR 15.302(3 C is at issue approximation of distance
5
Page 6 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address1027 Rivelz Road
2 , •6b.
Owner: 8112103
Date of Inspectlon: Peat 71 tzw.irz
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):.L Number of bedrooms(actual):.
DESIGN now based on 310 �EC .203 (for example: 110 gpd x N of bedrooms):= 441495,�
Number of current residents:
Does residence have a garbage grinder(yes or no)y
Is laundry on a separate sewage system_(,ye or no)•_ (if yes separate inspection required)
Laundry system inspected(yes or no): �
Seasonal use: (yes or no):
Water meter readings, if available (last 2 years usage(gpd)):200 7— 117, 000 yai.2on.3-320. 25 9/1D
Sump pump(yes or no): fb 2002- 172, 000 ga.2.Pon.6-477. 24 q1-1D
Last date of occupancy:
COMM ERCIALINDUSTRIAL
Type of establisbment:
Design now(based on 310 CMR 15.203): god
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no): A/�
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): 11-14
GENERAL INFORMATION
Pumping Records 1 um p ed at time o inspection,
Source of information:
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: 7allo -- How was%wory pumped etermined? �
Reason for pumping:
f
OF SYSTEM
ptic tank,distribution box, soil absorption system
gle cesspool
erflow cesspool
vy
ared system(yes or no)(if yes, attach previous inspection records, if any)
ovative/Altemative technology. Attach a copy of the current operation and maintenance contract(to be
ob atned from syste owner)
,JXTight tank W11 Attach a copy of the DEP approval
A)Other(describe): '0
Appr xima a aee of all components,date installed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):A�0
6
Page 7ofII
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C •
SYSTEM INFORMATION (continued)
Property Address1027 R-iz)e/z Road
(7a2,6ton,s aa,s.
Owner0e/tt 7inw.in
Date of Inspection: 811 z/03
BUILDING SEWER(locate on site plan)
Depth below grade: for /
Materials of construction:4cast iron 1,,"40 PVC4Lother(explain):
Distance from private water supply well or suction line:A01Y
Comments(on condition of joints, venting, evidence of leakage, etc.):
�o1n-Y i nf212vrin Ylghf+ No fl»,ir/vnro o-,O' Zenkngo 7ho ii4AY M i 6
Vented thaOUgh the aOO/ vent,6.
SEPTIC TANK: Zoocate on site plan) %✓mod�l�' U'S
Depth below grade: 1^4"�/
Material of construction: YconcreteZ46 metaW,l fiberglass polyethylene
/Vd other(explain) .Ile
If tank is metal list age:_ is age confirmed by a Certificate of Compliance (yes or no);, Q(attach a copy of
certificate)
Dimensions: .t- 69,F
Sludge depth:—, —
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:_�
Distance from top of scum to top of outlet tee or baffle: _ Q
Distance from bonom of scum to bolt of outlet tee or baffle:
How were dimensions determined:
Comments(on pumping recommendations, inlet and outlet tee or baffWconditi n, structural integrity, liquid levels
as related to outlet invert, evidence of.leakage, etc.):
Puma .t�12Lir .tank epa.?U P— 3 •UonnA Tnkof R aul Poi too,s rinv
i_n�nOnro 7ho (rink iA Atniir{_114000e111601141d GRGL 6h0.1-16 20 Bl idonrn
o)e leakage.
GREASE TRA (locate on site plan)
Depth below gradc:/Ji
Material of construction:AAconcrete j/ metaW4 fiberglass,f!, polyethylenf e4 other
(explain): 144
Dimensions: �lA
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: -1"
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 IeveLs
as related to outlet invert, evidence of leakage, etc.):
�I?Pn.to tnnn !A not �Q7oAoni
7
Page 8 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1027 Rivet RocLd
723 on .c , Nazz.
Owner: Beat -cnw.cn
Date of Inspection:
TIGHT or HOLDING TANKA&Le(tank must be pumped at time of inspection)(locate on site plan)
Depth below grader
Material of construction: AV concrete metal_&&_flbcrglass P-i4 polyethylene.ey10 other(explain):
A/A
Dimensions: _ AM
Capacity: _gallons
Design Flow: AIA allons/day
Alarm present(yes or no):
Alarm level: Ze-41 Alarm in working order(yes or no): Rlht
Date of last pumping:__,d18
Comments(condition of alarm and float switches, etc.):
7-.Uht o2 hoiding tankz ate no p2ezen .
DISTRIBUTION BOX: Z(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:_mod
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.):
Di.6t2.c&ution &ox ha.6 one iateaai. No evidence oZ zo. idz caaay
ove2. No evidence o ea aye into oa out 57 zae tox.
PUMP CHAMBEI14"(1ocate on site plan)
Pumps in working order(yes or no): 40
Alarms in working order(yes or no):-zi
Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.):
limn rhnmPva .i..s not �2eeent.
8 '
i
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1027 R-L)e2, Road
Naaatonz hash.
Owner0eat Tinwin
Date of Inspection: 8112103
SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required)
1- 1000 anlPpnn DROrnAI Ponrhinrrj r)
If SAS not located explain why:
Lor¢#vr/ • CooParto 9n
Typeleaching pits, number:
1J10 leaching chambers,number: O
4&leaching galleries,number: 0
leaching trenches,number, length: O
leaching fields,number,dimensions: O
AZ overflow cesspool,number: (I - >
AD innovative/alternative system Type/name of technology: r'��.
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
voamCj .6onrl l o mor/i ijm 4 n o Anud AlQ 6 6gq 4 o7 Ay4%&64#c-79c:'ii'te
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: AM
Depth of scum layer: AW
Dimensions of cesspool:_
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
l 0 A A Inn 0 A a n o n n f IQ q g A
PRIVYA'&Jf.(locate on site plan)
Materials of construction:
Dimensions: Abi
Depth of solids: / 11
Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C •
SYSTEM INFORMATION(continued)
Property Address: 1027 12.ivelz 12oad
tla/z,3.ton3 a,3a.
Owner:/3e2.t Tinw.in
Date of Inspection: 8172103
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.
I
A
B
o
i
10
-Page 11 of l 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1027 12.ivelz Road
aa.6 one Miiiz, Pla.6.6.
Owner: Beat T.inw.in
Date of Inspection: 8172103
.
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained m sus desi t lans on record-If checked,date of design plan reviewed: 144
served site abutting property bservation hole within 150 feet of SAS)
Iva Chec ce with loca oar o ealth-explain: 1f)
EChecked with local excavators, installers-(attach documentation)
Accessed USGS database-explain:hti-fl:Ili-Own, gainztagee. ma. u4.
You must describe how you established the high ground water elevation:
U.6ed: Gahaety & l'liPPe2 (7odeP. 12/16/94 Ci .ound wa.te2 e2eva.t.ionz a&ove Sea .Peve.P.
U,6ed. 0,1
j U.6ed: IZSC.S, 7vrha raP Rii.PPpJ.in 9?_()C)()_ 1 Pzlate #2 Annuai2anyeh oZ gaound
water eievat.ionz.
round
Leaching
Pit :eet
Gro
undwater: Feet Below Bottom
.. of Pt t High GroLn w ater Adjustment
ment 1.8 ft per Frimpter Method
Therefore, the vertical separation distance between the bottom i
Of the leaching pit and the adjusted groundwater table is 9
feet.
11
'rwtnr+.-n.•r►r'.1T� 'nrmr•ntrw.rrertr7n.+nrr:1'+t+n►r+A*�nrn�ns-�ti, .,-,.rro
'1'UNN OF WARD OF HEALTII
SUBSURFACE SF.NA(;R DISPOSAL T r Y,f INSPECTION FORM - PART D •- CERTIFICATION I
-TYPt CA PRINT CLEARLY-
PROPERTY INSPECTED
STREET ADDRESS 1027 Rivea Ro 7-z-3ton-6
ASSESSORS MAP, BLOCK AND PARCH-,', x r�`2t7"d'ZJ
OWNER' s NAME /3e2t 7.cnwZez
PART L) _'TRTIFICATION
NAME OF INSPECTOR Joseph P.Macomber , -
COMPANY NAME J.P.Macomber & Soya Tr:
COMPANY ADDRESSBox 66 Centerville. ; . 02632
Stravt Town or City $tat•
COMPANY TELEPHONE ( 508 ) 775 - 33: LIP
FAX ( 508 ) 790 -1 578
CERTIFICATION STATEMENT
I certify that I have persons. '.nspected the sewage disposaj system at
this address and that the inforrnat: , reported is
true ,- accurate ,
omplete as of the time of .inspect, The inspection was performed
and
recommendations regarding upgrade , .:.ntenance , and repair are consistentny
with my training and experience in Proper function and maintenance of on-
site sewage disposal systems ,
Check orie:
.w System PASSED
The inspection which I have co: .:cited has not found any information
which indicates that the syste : -ils to adequately protect public
healLh or, the environment as d : ned in 310 CMR 15 - 303 . Any failure
criteria not evaluated are as - :ted in the FAILURE CRITERIA section of
this form.
System FAILED* . \
The inspection which I have co;
ud has found that the system fails to
Protect the public health and t. environment in accordance with Title
5 , 3.10 CMR 15 . 303 , and as spec, . c: �11y noted on PART C - FAILURE
CRITERIA of this inspection for
V
n
Inspector Signature
Date ��,vr d
ne ere applicable )
of t1%is cert.tfication must ~rovided to the OWNER, the BUYER
C ( whe ) and the I30ARD OF .'FI ,
e If the inspection FAILED, the owr)( operator shall u
within one year of the date of the owed o re system
otherwise as on, unless allowed or required
provided in 3.10 CPIR 1 5 . .
partd .doc
I
COMMONWEALTH OF MASSAC14USETTS
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 PAUL CELLUCCI DAVID B.STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: 1027 RIVER RD. MARSTONS MILLS MAP 045 PAR 043 L 2
Name of Owner THE FIFTH THIRD BANK
Address of Owner: 38 FOUNTAIN CIRCLE CINCINNATI OH 46263 ATT.E DAVIDSON
Date of Inspection: 8126/99
Name of Inspector:(Please Print)JOHN GRACI
I am a DEP approved system inspector pursuant to Section 15.340 of Tifle 5(310 CMR 15.000)
Company Name: n/a E(/
Mailing Address: n/a to
Telephone Number: n/a 'ox. j
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported b w is true,accurate
and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper nction=and
maintenance of on-site sewage disposal systems.The system:
X 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 Eva uation 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: Date:8/26199
The System Inspector sha submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 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 EVERY TWO YEARS TO PROLONG THE SYSTEMS USEFULL LIFE.
revised 9/2/98 Page 1 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1027 RIVER RD.MARSTONS MILLS MAP 046 PAR 043 L 2
Owner: THE FIFTH THIRD BANK
Date of Inspection:8/26/99
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:
nla 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.
Wa 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.
nta 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
Wa 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 9/2/98 Page 2 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1027 RIVER RD.MARSTONS MILLS MAP 045 PAR 043 L 2
Owner: THE FIFTH THIRD BANK
Date of Inspection:8126/99
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 15.303(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 n&-(approximation not valid).
3) OTHER
n1a
revised 9l2/98 Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1027 RIVER RD.MARSTONS MILLS MAP 046 PAR 043 L 2
Owner: THE FIFTH THIRD BANK
Date of Inspection:8126199
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 n1a.
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.
revised 9/2198 Page 4 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 1027 RIVER RD.MA'RSTONS MILLS MAP 045 PAR 043 L 2
Owner: THE FIFTH THIRD BANK
Date of Inspection:8/26199
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: 1027 RIVER RD.MARSTONS MILLS MAP 045 PAR 043 L 2
Owner: THE FIFTH THIRD BANK
Date of Inspection:8/26199
FLOW CONDITIONS
RESIDENTIAL:
Design flow:-M g.p.d./bedroom
Number of bedrooms(design): 2 Number of bedrooms(actual):2
Total DESIGN flow: 22ft
Number of current residents:11
Garbage grinder(yes or no):NQ
Laundry(separate system)(yes or no): NQ 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): nLa
Sump Pump(yes or no): NQ
Last date of occupancy: 2/11198.
COM MERCIALIINDUSTRIAL
Type of establishment: nta
Design flow: nLa gpd(Based on 15.203)
Basis of design flow: n&
Grease trap present:(yes or no):M
Industrial Waste Holding Tank present:(yes or no): NQ
Non-sanitary waste discharged to the Title 5 system:(yes or no):No
Water meter readings.if available:n&
Last date of occupancy: nta
OTHER: (Describe)
Wa
Last date of occupancy: n&
GENERAL INFORMATION
PUMPING RECORDS and source of information:
nla
System pumped as part of inspection:(yes or no):YE;i
If yes,volume pumped 1000 gallons
Reason for pumping: MAINTENANCE
TYPE OF SYSTEM
XSeptic 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:
1988
Sewage odors detected when arriving at the site:(yes or no): NQ
revised 9/2/98 Page 6 of 11
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1027 RIVER RD.MARSTONS MILLS MAP 046 PAR 043 L 2
Owner: THE FIFTH THIRD BANK
Date of Inspection:8/26/99
BUILDING SEWER:
(Locate on site plan)
Depth below grade: 6'6"
Material of construction:_ cast iron _40 PVC X other(explain)
Distance from private water supply well or suction line: TOWN
Diameter: n/a
Comments: (condition of Joints,venting,evidence of leakage,etc.)
n/a
SEPTIC TANK: X
(locate on site plan)
Depth below grade: T
Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain)
n&
If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No
nta
Dimensions: L8'6"H 6'L W 4'10"
Sludge depth: 7"
Distance from top of sludge to bottom of outlet tee or baffle: ZZ"
Scum thickness: V
Distance from top of scum to top of outlet tee or baffle: T
Distance from bottom of scum to bottom of outlet tee or baffle: nLa
How dimensions were determined: MEAMEn
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.)
SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM EVERY TWO YEARS.
GREASE TRAP:
(locate on site plan)
Depth below grade:
Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain)
nla
Dimensions: nta
Scum thickness: WA
Distance from top of scum to top of outlet tee or baffle:llfa
Distance from bottom of scum to bottom of outlet tee or baffle n(a
Date of last pumping: nta
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.)
Wa
revised 9/2/98 Page 7 of 11
---- AW
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1027 RIVER RD.MARSTONS MILLS MAP 046 PAR 043 L 2
Owner: THE FIFTH THIRD BANK
Date of Inspection:8/26199
TIGHT OR HOLDING TANK: NQ (Tank must be pumped prior to,or at time of,inspection)
(locate on site plan)
Depth below grade: nIA
Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain)
nLa
Dimensions: n/a
Capacity: nh gallons
Design flow: nLa gallons/day
Alarm present: NQ
Alarm level:jila- Alarm in working order:Yes_No_ NQ
Date of previous pumping: n&
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
nla
DISTRIBUTION BOX: X
(locate on site plan)
Depth of liquid level above outlet invert:LIQUID LEVEL WITH BOTTOM OF PIPE
Comments:
(note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.)
DISTRIBUTION BOX IS STRUCTURALLY SOUND
PUMP CHAMBER: NQ
(locate on site plan)
Pumps in working order:(Yes or No): NQ
Alarms in working order(Yes or No): NQ
Comments:
(note condition of pump chamber,condition of pumps and appurtenances.etc.)
n/A
revised 912198 Page 8 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1027 RIVER RD.MARSTONS MILLS MAP 045 PAR 043 L 2
Owner: THE FIFTH THIRD BANK
Date of Inspection:8125199
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:
nLa
Type:
leaching pits,number: 1000 GALLON LEACH PIT
leaching chambers,number: _n/A
leaching galleries,number: -Wa
leaching trenches,number,length: n/a
leaching fields,number,dimensions: n&
overflow cesspool,number: nLa
Alternative system: n/A
Name of Technology: _WA
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
THE LEACH PIT IS
STRI CTUI ALL SOUND AND FUNTIONING PROPERLY THE PIT WAS EMPTY AT THE TIME OF THE INSPECTION.
CESSPOOLS: _
(locate on site plan)
Number and configuration: Wa
Depth-top of liquid to inlet invert: WA
Depth of solids layer: nLa
Depth of scum layer. n&
Dimensions of cesspool: n/A
Materials of construction: n/a
Indication of groundwater: nLa inflow(cesspool must be pumped as part of inspection)D/a
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
nLa
PRIVY: _
(locate on site plan)
Materials of construction:nLa Dimensions:WA
Depth of solids: n/A
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
n/A
revised 9/2/98 Page 9 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1027 RIVER RD.MARSTONS MILLS MAP 046 PAR 043 L 2
Owner: THE FIFTH THIRD BANK
Date of Inspection:8/25/99
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
occ[.
�a
s
revised 9/2/98 Page 10 of 11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1027 RIVER RD.MARSTONS MILLS MAP 045 PAR 043 L 2
Owner: THE FIFTH THIRD BANK
Date of Inspection:8/25/99
NRCS Report name: n/a
Soil Type: n&
Typical depth to groundwater: n/a
USGS Date website visited: n&
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
_ 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
revised 9/2/98 Page 11 of 11
l -
Town of Barnstable
Regulatory Services
�Mi►tnssB '� Thomas F. Geiler,Director
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
NOTICE
TO ALL STABLE / HORSE OWNERS
In the Town of Barnstable
Your current stable permit was originally printed with a June-30; 2005
expiration date.
However, due to recently adopted stable regulations, your current stabler,;
permit will automatically be extended until November 30, 2005. rN
Please complete and return the attached application form beforeugust�0,
2005. Ck
Z
The fee is:
• 5 horses or less $25.00 (" rn
• 6 horses or more $35.00
0&-/Je remit payment with your application.
Sincerely,
omas A. McKeel an -3�3�` �0
Health Agent
6fi Town of Barnstable
Q:Stable-memo-appl.doc f
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ACCESS COVERS MUST BE WITHIN 9" MINIMUM. / N VER T EL E VA T I DNS : DESIGN CR I TER / A : GENERIC L NO TES
6" OF FINISH GRADE 3' MAXIMUM COVER
FIRST 2' TO . INVERT OUT SEPTIC TANK: 98.9 (DESIGN FLOW:
FI
FI LEVEL MIN 2" OF PEASTONE INVERT /N DIST. BOX: 94.97 3 BEDROOMS AT 1/0 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION
BE OR F I L TER FABRIC INVERT OUT DIST. BOX: 94.8 (BEDROOM EQUALS 330 G.P.D. OF THE SEWAGE D 1 SPOSAL SYSTEM ONLY.
4" DIAM PIPE INVERT IN LEACH CHAMBER: 94.5
3/4" - l i/2" DIA. NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS
98.9 9 T2 �' DOUBLE WASHED STONE BOTTOM OF LEACH CHAMBER: 92.5 SET. SEE SITE PLAN.
` * US 4.5 $ 92'S ADJUSTED GROUND WATER: N/A
BAFFLE SEPTIC TANK REQUIRED:
3 OUTLET 4-500 GAL LEACHING CHAMBERS OBSERVED GROUND WATER: NIA87. 330 G.P.D. X 200% - 660 GAL. 3. ALL CONSTRUCTION METHODS AND MATERIALS AND
EXISTING D-BOX W/2.5'* STONE AROUND. 10'w x 40'1 x 2'd BOTTOM OF TEST HOLE *I: 87�5 SEPTIC TANK PROVIDED: 1500 GAL. EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL
1500 GAL H-20 CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
SEPTIC TANK 6' CRUSHED STONE OR SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS.
COMPACTED BASE
DES l GN PERC RATE ! 5 M/N/l NCH
PROF I L E : NOT TO SCALE $OIL TEXTURAL CLASS - ! 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
EFFLUENT LOADING RATE 0.74 GPD/SF AREAS SUBJECT TO VEH i CULAR TRAFFIC OR GREATER
330 GPD / 0.74 GPD/SF - 446 S.F. REQUIRED THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH-
STANDING H-20 WHEEL LOADS.
N
\ i PROVIDED: 4-500 GAL LEACHING CHAMBERS
5c L ST \\ � W/2.5'1 STONE AROUND, A-600 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR
\ 600 S.F. x 0.74 - 444 G.P.D. APPROVED EQUAL.
-CO DH FNO `�.\
SOIL TEST P l T DATA* 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED
ot, Q '� PRECAST CONCRETE OR APPROVED POLYETHYLENE.
INDICATES INDICATES BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER
PERCOLATION _ OBSERVED
TEST _ GROUNDWATER TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE
\ �
LOCUS 1 \\ ` 9 TP •1 TPT + 19-4 TP .2 OUTLET.
HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR
0" s7.s o" 97.5 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE".
\\ \ FILL FILL 1-888-DIG-SAFE AND THE LOCAL WATER DEPT.
HrD .�„ 20" - - - - - - - - - - - - - - 95.8 20• - - - - - - - - - - - - - _ - 95.8 FOR LOCATION OF UNDERGROUND UTILITIES.
LOAMY IO'YR LOAMY IOYR
o \ \ I \ A SAND - _ - - -2 '� SAND 2/2
�\\I \ \1 1\ \� \\\ 1 ,4 ?J 'D �.. 25" - LOAMY- - IOYR 95.4 24- - - - - - - - - - - - - - - - 95.5 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
/\ I \ \ 1 SO �. B - B LOAMY IOYR DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION
a�J / �•q ®\ ? SAND 413 SAND 4/3
40- - - - - - - - - - 94.2 36" - - - - - - - - - - - - - - - 94.5 OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE
0Q / \\ \ I\\ �I LOAMY M-C /0YR CI LOAMY M-C IOYR CONSTRUCTION INSPECTIONS.
�'(\ \ \ \ \ 1 1 SAND AND 5/6 5AND AND 5/6
LOCUS MAP 1 1 I I 60" GRAVEL GRAVEL
- - - - - - - - - - - - - - - 91.5 9. EXISTING LEACH PIT TO BE PUMPED DRY AND
MED I UM IO YR MED I w IOYR
\ RAVED DR I VEWAY \ \ \ 1 C2 SAND 6/,6 C2 SAND 6/6 BACKF l L,L ED.
\ NO WATER NO WATER 0. ALL UNSUITABLE MATERIAL (A A HORIZONS)
95.4 I20" 87.5 i20' d7.5 JJ
\ 97,7 / l # / ENCOUNTERED BELOW THE INVERT OF THE LEACHING
VATE: MAY7. 2019 / FACILITY TO BE REMOVED FOR A DISTANCE OF 5'
TEST BY: STEPHEN HAAS
\ I L EACH,
WITNESSED SY: DAVID STANTON AROUND AND REPLACED WITH SAND IN ACCORDANCE
\ PIT -_ \ I I ` PERC RATE: ! 2 MIN/INCH
WITH TITLE 5.
I I. SLEEVE SEWER LINE l 0' EITHER SIDE OF WATER
04,6 i n `\ I 1 I _�° i I/ LINE SHOULD IT BE OVER OR LESS THAN /8' BELOW.
102.17 / $EE IIJOTE Ill. 9 .51
\ Qt EXISTING `r / J 95.5
SEPTICTANX Ix' I �/ I//� ' / / POSSr �j� S-��`pG✓�
' Y:::.:. :: I4-500 GALLON,'
104.5 LEACHING/CHAMBERS 2G�✓+PPG' Scu
DECK Wl2.5't//STORE AROUND
D-BOX ,;. .;..-6
BM. ORANGE SPOT J '� 1,f -rO.-/�
-
/ 97.
' / r9
EL.I05.60 1 DECK ,._. �j \ f 4p��Of ,
pw
EXISTING DWELLING 5-8
va
FOUNDATION 1 I 30, a
1
~ PATIO \\\ \\i i97!I/ ` /n�l4i
CIJ
4> \ PATIO
f SEPT l C SYSTEM C. ) ES / ON
1 027 RIVER ROAD . MAP 4 .5 PARCEL 43
BARNS TABL E . ( MARSTONS MI LLS ) MA .
' LEGEND PRE'PARE'D FOR
5. 464r S.F.
■ CB CONCRETE BOUND "]"" U , /� l'`1 �? /
WATER L I NE l ! , A �J I
S 83°D8'36'W J JJ CS FND p HYDRANT
-- - /J ,� /J ' /J 74.70' J' ,� -G GAS LINE S CA L E . I - 2 0 ' J UNE l 8 , 2 O l
/ OH�' OVER HEAD WIRES
,. I� % LIGHT POST STEPHEN A . HAAS RE
'--E-- UNDERGROUND ELECTRIC LINE
2 9 3 C r cx re v i e w R o o d
--T-- UNDERGROUND TELEPHONE LINE
-.. -: r MA 026,31
--�CTV UNDERGROUND CABLEVISlON LINE B r ews t e
/'� - ( 508 ) 367-- 1 69 1
+40.4 SPOT ELEVATION
........40-... EXISTING CONTOUR `'" III
F4M _ PROPOSED CONTOUR
0 /0 20 40 JOB NO: 19-005
1