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HomeMy WebLinkAbout0473 ROUTE 149 - Health 473 ROUTE 149 MARSTONS MILLS A= 079 - 082 _ r f i 11J1 �;;;cvct�a� UPC 12934 i Commonwealth of Massachusetts z �ga-- N u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GqM , 473 Route 149 f Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9, 2020 City/Town State Zip Code Date of Inspection h � 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. A. Inspector Information 1. Inspector: Nicholas Geneseo Name of Inspector Wind River Environmental Company Name 46 Lizotte Drive Suite 1000 Company Address Marlborough MA 01752 City/Town State Zip Code (973)830-6126 SI 13988 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: Z Passes ❑ Conditionally Passes ❑ Needs Further Evaluation by the Local Approving Authority ❑ Fails 1 � /I j January 9,2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. 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. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 20 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9,2020 Cityrrown State 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: Q 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: The system is working properly at this time. Pumped 1000 gallons during the inspection. 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) t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System a Page 2 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9,2020 Cityrrown 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 to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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: t5ins.cloc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 20 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M a`' 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9,2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 ❑ 2 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool I I� I t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Gq'W SVO,.� 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9,2020 Cityrrown State Zip Code Date of Inspection C. Inspection summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ z Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ❑ Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped:_ ❑ z Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Q Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Q Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Q 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.] ❑ Ri The system is a cesspool serving a facility with a design flow of 2000gpd-10,000gpd. ❑ Q 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 CA. 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 t5ins.doc rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 20 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o M . 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9,2020 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat,or answered"yes"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 all inspections: Yes No Z ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Q Were any of the system components pumped out in the previous two weeks? Q ❑ Has the system received normal flows in the previous two week period? ❑ Q Have large volumes of water been introduced to the system recently or as part of this inspection? Q ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Q ❑ Was the facility or dwelling inspected for signs of sewage back up? Q ❑ Was the site inspected for signs of break out? Q ❑ Were all system components,excluding the SAS, located on site? Q ❑ 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? Q ❑ 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: Q ❑ Existing information. For example,a plan at the Board of Health. ❑ Q 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)] t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System*Page 6 of 20 f Commonwealth of Massachusetts N W Title 5 Official Inspection Form m a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9,2020 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 GPD Description: See attached letter from the Board of Health. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes Q No Does residence have a water treatment unit? ❑ Yes 2 No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes Z No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonaluse? ❑ Yes Q No Water meter readings, if available(last 2 years usage(gpd)): 145 GPD Detail: Usage: 106,000 gallons/730 days= 145 GPD. Usage date provided by COMM Water. Sump pump? ❑ Yes Q No Last date of occupancy: Current Date t5ins.doc 9 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System*Page 7 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9, 2020 CityfTown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No 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 occupancy/use: Date Other(describe below): General Information 3• Pumping Records: Source of information: Wind River Environmental—See attached. Was system pumped as part of the inspection? Q Yes ❑ No If yes,volume pumped: 1000 gallons How was quantity pumped determined? Quantity measured by pump truck Reason for pumping: Check structural integrity of the tank t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 473 Route 149 Property Address Owner Heidi Smith information is Owner's Name required for every page. Marston Mills MA 02648 January 9, 2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: Q Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1992 Were sewage odors detected when arriving at the site? ❑ Yes Q No 5. Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron Q 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): All the plumbing is clean and the joints are tight. No obstructions are observed. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 20 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9, 2020 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 5" feet Material of construction: Q concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8' x 5' x 4' Sludge depth: 7" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Tape Measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The liquid level is normal.The tank appears to be in good structural condition. Both baffles are intact. Recommend installing a filter and pumping the tank annually. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 20 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9, 2020 City/Town 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 fromi 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 t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 0 Page 11 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9,2020 City/Town 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box,etc.): The distribution box is watertight and level with a single outlet taking flow.There is minimal corrosion and some carryover. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System o Page 12 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9,2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Q leaching pits number: 1 @ 6' X 6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5ins.cloc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 20 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9, 2020 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.): The leach pit has 6"of liquid in it with no signs of ever being at a higher level.There are no signs of hydraulic failure or groundwater infiltration.The soil is dry gravel and sand. 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 solids 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.): t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System*Page 14 of 20 Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9,2020 City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 20 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9,2020 City/Town 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: 0 hand-sketch in the area below ❑ drawing attached separately Lfol o 3.1 L s W t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 16 of 20 Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9,2020 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12' feet Please indicate all methods used to determine the high ground water elevation: Q Obtained from system design plans on record If checked, date of design plan reviewed: 02/05/1991 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: The soil logs on the design plan show 4'of separation from the groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 473 Route 149 Property Address Owner Heidi Smith information is required for every Owner's Name page. Marston Mills MA 02648 January 9, 2020 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Q A. Inspection information: Complete all fields in this section. Q B. Certification: Signed&Dated and 1,2,3, or 4 checked Q C. Inspection Summary: 1,2, 3,or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed Q D. System Information: For 8:Tight/Holding Tank-Pumping contract attached For 15: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 16: Explanation of estimated depth to high groundwater included t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 18 of 20 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 473 Route 149 Property Address Owner Heidi Smith information is Owner's Name required for every page. Marston Mills MA 02648 January 9, 2020 City/Town State Zip Code Date of Inspection Letter from the Board of Health Starstort, David From: Stanton,L}w4 Sant- Tuesday. rarcvrnber 03_209 3:31 Pr,4 To. 'erin.cameronfgrav{;i.;rorn Subjrcl: RE:473RI 149.tvl:3rs1c.3sh1';"ls-septiClt,erdoorns 1-UPDATE-1 Eno, 1 huce S OMe l;rEyit rewa ? I spoke wim Sharor"regarding this property,she hid actually pulled the Original septic permit from thr back archives and was%•ailing for somewic ill make a street file(or the t rniit to Co irl. She grabbed the ptralit from slaCk form(-. I revieveed the perrnil and oie septic actually Jim a capacity for bedroors! The ptafls shoal a short pit(3.S'deep;with 3'of none which has a Car)icity of 44.:3 gallons per day(110 gaItons per bedroom per day,sa it could handle a 4 bedroom(rouse wilh a floss;of 44.0 gallons per dayj Thanks. David From:Stanton,David - Sent:Tuesday,December 03, 2019 9:06 AM To:'erin.cameronQraveis_com' Subject:473 Rt. 149r Marstons Mills-septic�bedraoms Good morning Erin, In follow up to our phone conversion yesterday: 3 bedrooms are allowed at this property(pending a passing Title V Inspection if this is(or a property transfer.) According to our records,a septic permit was issued in 1992,permit 1992-425,to install a Septic system at 473 Rt, 149. In researching the property,we have an asbuilt card(attached)which states it Was a 3 bedroom septic. I al'SO went back into our permit log book to confirm the correct septic permit number was placed on the asbuilt card,which it was. The original septic permit was not located(1 searched the back archives by permit number as well as at least a dozen other street files for Rt,149 that may have had the permit misfiled tender them as they were also called "lot 2,At. 149") According to tee Town Assessor,the lot is 2.65 acres,which can easily handle a 3 bedroornl septic based On even the most restrictive septic zones we have in Town and the State, Any questions,please let me know, Thanks, David W,Stanton,RS Chief Heath Inspector (Town of 82m5table 200 Main Street :Hyannis,MA02601 Qirect phone:(508)862A647 stealth Dept.phone:(508)8624644 Health Dept.fax(So84 790-6..304 i t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 19 of 20 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o 473 Route 149 Property Address Owner Heidi Smith information is Owners Name required for every page. Marston Mills MA 02648 January 9,2020 CityfTown State Zip Code Date of Inspection Pumping Record Work Orderg 0217076054 CustFF 1244588 Customer Since:2002 Tax:6.2500 B Job Comments Tech Comments 0219/2020 r5 Inspection/ tack to be cervioffi 1000 galo / Ocvarto) accurod... big safe ti 2020-020-0751 119/29 after Conso"t torn In orrice j Wi11. bave Mans and Water /,Hine 1.0::2n: R&c0UMQ1X=No Reoofmandatlam.. Crock/ bd Norval water level. Haaxy top oolido. Heary bottom oludga. Inlet.baffloo are Intact. Main 11m Clear. No filter in Pro got on the tank. Recommended Boot additiva, CCLS :additive. Cover(ol Secured. F.acwmanl bio boost ccl.o top Solid m.lavy button Sludge beavy main line clear corer Secured.Dynten working film. 9/25/05 norviced Septic ex0a7111vo oclldo raccamoed narvice every 2 yeam. Heidi emltb System Gamer Drinary Mane System Location . 473 Route 149 473 Route 149 Karstmu N111o, MA 0264E Haratmnc Hills, MA 02648 t5081 737-6214 amitb Heidi a 1.505) 737-6214 Service Date: THU 01/09/2020 1200 30 Ad Frequency: Call to Confirm:. ! Service Type: Standard Previmis Service:. 05/20/2D1.7 i ARNOx. GaAs: 1000 COLS: LoetiDn'Details: Depth Below Grade: Custom Clean: Cust Home: Yea Filter: Township: Inspection,75: County: BataStable Build up: ®... gnQjy unitPrke &tPrioe Inspection ritla 5 toot including pugpingr 1.DO $ 365.aaaa $ 365.00 I,nspoctldo. LLabor/Brpboure Feeclpor br. O.DO S 164..9930 8 0.00 Sorironoactal CCapliamw - Raoidantaal 1.00 $ 3..0000 $ 3.00 Fuel / snargy Rocoiery 1.Do $ 56.7863 $ 56.79 Inspection Title 5 BOB.Fend 1.00 $ 25.0000 $ 2.5.00 , Dining 1000 1.00 $ 232.7485 g 132.75 f 1: iurmtki_S 682.54 Wesu3rWftse3kgssbVsto keep your system ha5EUSr Zee _$ o.ao 'Rego sw i g •the Ul S batte9a addItW `rein $ 682.54 .tpg aflaw Disposal Site.. 0t4imaai yDt,lirek Payment 0eeaiL Waste Code, 0.0000 Check Sale510ep: MB_Rapa ro installs CSN: Barbara wcouta Die on Raoaipt Truck: Technician:Nicholas canamoo On Site k 10:50 AN P O Number: Tech Notes k 8ydtem operating Fine. 3inxmal water level. Nzdarato top oolids. Nodorato bottom Sludga. Roth baffloe are intact. Main 11132 clear. No tiltor SS prasont,on the 6 tank: current tank. is not dealgoaa to be uoQd W1tb a tiltar. C+ r[oj mo rad. Customer notonSite Title 5 SS a pacts., tack is at operating level WStb toms Sb.pl,ace.. Dbox la Water tight with 1 outlet taking flow.. Tha loath pit ban 6" of liquid In it with no X Signs of hydraulic failure or ground Water Infiltration. Tbank you�. - P.ecolm:mded Ioota111ng a filter. Customer Signature 1`Q-N-DRTWR ENVIRONMENTAL t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 20 of 20 7 I�T/&WN Og BARNSTABLE F, , LOCATION RU�� /y9, SEWAGE # 9;L- VILLAGE-Z2,±,U7,VAJl 04f1// ASSESSOR'S MAP & LOT _Q INSTALLER'S NAME & PHONE NO. etlA44f SEPTIC TANK CAPACITY 111000 LEACHING FACILITY:(type) IT (size) lrov�b NO. OF BEDROOMS PRIVATE WELL PUBLIC WATER BUILDER OR DATE PERMIT ISSUED: �� 1b DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I PW ?o ip A e J� 7 t No.... /�©........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7Z S 0- TOWN OF BARNSTABLE App irFation for Dispoii al Marks Tonitrurtion 1hrutit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: 117 ..--.. 14 .................. -•----•-----------•---------------•--•--r------•------------•----------------..............--- Location-Address or Lot No. .!�l.......... •• .�............................................. I... ..v.vs �.....ems Owner Address a ................... 4�nstaller Address /� U Type of Building ,Z Size Lot_??4/ .Sq. feet f .. Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '_l Other—T e of Building No. of persons............................ Showers — Cafeteria A4 Other fixtures ---------------------------- - 63- W Design Flow............................................gallons per person per day. Total dail H flow.._.....•.ZZ .........................gallons. WSeptic Tank—Liquid capacity.P�Q.gallons Length--- Width..¢-... Diameter................ Depth..S_.. .._. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........./.--------- Diameter......4;�_'..... Depth below inlet.... :!a.... Total leaching area-.?��.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..___G !N ! ..._0':._45V44__. Date. '� _S_ ,.a Test Pit No. I____n_Z_minutes per inch Depth of Test Pit...../ .. Depth to ground water........................ n Test Pit No. 2..L.Z"_._minutes per inch Depth of Test Pit..... .".. Depth to ground water------ p+ ..; ...... ............................ 0 Description of Soil----••••O'!- a�� fc�octXtaf}-°`1 ! =s©iL $�-_CL 6a "—1G.i........... -------- v _....G`obi'��--•-.S.,A ..D------------- ----•+-� Ct'°'92SL-r ;A- ® - /2gt.......L 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sue—the board of health. Signed -(s 6v ............................... Application Approved By--------------Z��n_----- —) - = 1° 9�-- - Date Application Disapproved for the following reasons- ------------------------------ ----------------------------------------------------------------------------------------- --- ---------------------------------------------------------------------_------------------------ ...--------. . --------------------------------------- --------- - -------- - Date Permit No. ra..'.... �..�..................... Issued - - ------------ Date G79 -�� �... No.... .... .�:. FEB 7Z, S BOARD HEALTH S r . TOWN OF BARNSTABLE Appliration for Roposal Works Tonotrudion Vrrutif Application is hereby made for a Permit to Construct (�or Repair ( ) an Individual Sewage Disposal System at: ;t *' Lr,T Z Location-Address or Lot No. D4o,772/-I /�'1•a lZ.s7TiNS M�LL S • ....._....-------............... ..... ................................ ..........-•...................................................................................... a � Owner Address................................ --•--•--......r.................................... .......•••. „ ....._........------......................•.... Installer Address Q Type of Building Size Lot.-�.:����. 3'�.Sq. feet ,4 � — U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Pa Other fixtures -----•-------------------------•----•-•-•-..... w Design Flow..............-5.�.........------..--..gallons per person per day. Total daily flow..........7-2o.....................gallons. WSeptic Tank—Liquid capacity-!O.gallons Length.. . _..... Width..'¢.._.. Diameter________________ Depth... _/' x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_________________ Diameter....__ Z'._._ Depth below inlet.... --.. Total leaching area...?�.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed ------!'.n----- _ ...................:.... ... Test Pit No. 1....An .minutes per inch Depth of Test Pit..... '!. Depth to ground water.._._.=----------. (i Test Pit No. 2_.A.._Z-...minutes per inch Depth of Test Pit----- Depth to ground water........................ a •-••-••••-•••----------------•----•-•-•-••••---...-•---•-••-•••-••--------------•----------------•--........................................................ O Description of Soil..------- '!-_�o-'�_..l.VooD4aA sv! -SoiC. CL'4 I� �. w UNature of Repairs or Alterations—Ariswer when applicable............................................................................................... \ 0 / ---------------------•------•--•-------••---•-•------------•------------•-••---....................-•---......--------------------•------------------.........................---•--------....-----••-•- Agreement: , The undersigned agrees to ¢ install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE�5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issuedtbythe board of health. Signed . �. c _$ - - T Z........................................... `< .. Application Approved BY --- ...... Application Disapproved for the following reasons- ---------------_--------------------------------------------------------------------------------------------------....---...------------ . . . -------------------------------------------------------------------- ------------- 1 . Dare Permit No. 1 a. ----VI�..re---------------------- Issued .------------------...---............------------.... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cger#tf rate of (fantylinur.e THIS 4_4 TO ERTIFY, That the Individual Sewage Disposal System constructed (r/' ) or Repaired ( ) by ---------� C.,........ ----------------------------------------------------------------------------------- T /I�nsraller at ................ 'f" -----�•--------- ........�.<1-...g......--.�-a�--r-.P,....,--.......-------------------------------------------------------------------------------------------- ----...-----.... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in . the application for Disposal Works Construction Permit No. ......�P. Zt- ....?........... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. = Inspector -..;. ----------------------------------- --------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...��-:•-�-t-�--� FEE....I/`)r!).--...-- Disposal Works TI-Ins#rudiun 11trntit Permission is hereby granted........ ___. :....._..�. . _, � to Construct (V,") or Repair ( ) an Individual Sewage Disposal System atNo. Z�r —%... - 1._ ..ra` //h. ---••-•-----------------•--------.-------.---•---.---•-•--•---------------------- Street as shown on the application for Disposal Works Construction Permit No.r.J.�� r W---�,1. Dated.......................................... . (� (� Board of Health DATE `.... .. ` / 'l FORM 36506 HOBBS 6 WARREN.INC..PUBLISHERS r l CTO'WN O BARNSTABLE t/ LOCATION 46710 .1- SEWAGE # 9X' VILLAGE /+7iq .�^��tJ1 / � ASSESSOR'S MAP & LOT S INSTALLER'S NAME & PHONE NO. e'OA146 SEPTIC TANK CAPACITY_ Ll 00 U LEACHING FACILITY (I type) h �� (size) k NO. OF BEDROOMS PRIVATE WELL y PUBLIC WATER BUILDER OR =0 DATE PERMIT ISSUED: p{ 1 \n 19 Z- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ix 3 n o 3-s a a a Stanton, David From: Stanton, David Sent: Tuesday, December 03, 2019 3:31 PM To: Ierin.cameron@raveis.com' Subject: RE: 473 Rt. 149, Marstons Mills-septic\bedrooms ***UPDATE*** Erin, I have some great news! I spoke with Sharon regarding this property, she had actually pulled the original septic permit from the back archives and was waiting for someone to make a street file for the permit to go in. She grabbed the permit from stack for me. I reviewed the permit and the septic actually has a capacity for 4 bedrooms! The plans show a short pit (3.5' deep)with 3' of stone which has a capacity of 443 gallons per day (110 gallons per bedroom per day, so it could handle a 4 bedroom house with a flow of 440 gallons per day.) Thanks, David From: Stanton, David Sent: Tuesday, December 03, 2019 9:06 AM To: 'erin.cameron@raveis.com' Subject: 473 Rt. 149, Marstons Mills- septic\bedrooms Good morning Erin, In follow up to our phone conversion yesterday: 3 bedrooms are allowed at this property(pending a passing Title V Inspection if this is for a property transfer.) According to our records, a septic permit was issued in 1992, permit 1992-428,to install a septic system at 473 Rt. 149. In researching the property, we have an asbuilt card (attached)which states it was a 3 bedroom septic. I also went back into our permit log book to confirm the correct septic permit number was placed on the asbuilt card, which it was. The original septic permit was not located (I searched the back archives by permit number as well as at least a dozen other street files for Rt. 149 that may have had the permit misfiled under them as they were also called "lot 2, Rt. 149") According to the Town Assessor,the lot is 2.65 acres,which can easily handle a 3 bedroom septic based on even the most restrictive septic zones we have in Town and the State. Any questions, please let me know. Thanks, David W. Stanton, RS Chief Health Inspector Town of Barnstable 200 Main Street Hyannis, MA 02601 Direct phone: (508) 862-4647 Health Dept. phone: (508) 862-4644 Health Dept. fax (508) 790-6304 1 i • L. . .7Z. D.o ... . \ \ , TOP OF FOUNDATION CONCRETE COVER . CONCRETE COVERS i `->�, ��,• k/,yo �9' lA3' 4"CAST IRON 12"MAX. .12"MAX. OR SCHEDULE 40 4"SCHEDULE 40 PVC.(ONLY) P.V.C. PIPE PITCH I/4"PER,FT PIT PITCH I/4"PER.FT PIPE- MIN. . LEACH PRECAST < LEACHING 113� `D a EL. IINVE5 7 INWERT INVERT o . PIT OR /71 w\ , _ e SEPTIC TANK GS/ DIST. . w EQUIV. /oav .. GAL. INVERT stia. • 7 _ • INVERT EE BOX �.. EL.C -3�.: L� INVERT w W a ... 3/4 TO I i/2 rpl� WASHED STONE �, vls'�• Pt,� �� �./ � � � r o, Jam• B _�,.. Ez�,L/.�a ;.: B°x . / i1.4 PR4F1 LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM \ L N0 SCALE SOIL LOG WITNESSED BY : DATE Iri`?4.��J TIME.�o:oo.4ry 7.b. A /�ivr / BOARD OF HEALTH / \ TEST HOLE 1 TEST HOLE 2 .Ey. ENGINEER r / ELEV. 7/,30. . . . ELEV. .7a.,/o 1 LZ�Gy T7�P W"rml Ary % WooDLaMy : '11' % .c, _ sue$-s ' / s��fso t DESIGN DATA : Qpv yj)c \ M Gn C fh� FE O Z EZ C�fp Lb" NUMBER OF BEDROOMS 7e,87 7��r- N �aT- '�'j �-G Gl,3v Wiz.�5,/0 7L, Cs�vA� TOTAL ESTIMATED FLOW .22o GALLONS/DAY �' / c '.BOTTOM 'LEACHING AREA , ? \ ohs l SO.FT. /PIT/e,i,D. wfl S n pp 3z 9.5 _ EZ,G3.3a wires SIDE LEACHING AREA /3A. !.~;. SQ.FT./ PIT/G.P.D, �} G'oA77Sl' SNd11 C� GARBAGE DISPOSAL .,M0�-lE.`.'(5O% AREA INCREASE) 71 , aF TOTAL LEACHING AREA Z�-S..G. . SQ.FT czA� z-7 Cfl, '2�?All 0 , � ..: PERCOLATION RATE 4E3�4 MIN/INCH — — — LEACHING AREA PER PERCOLATION RATE �:dSQ.FT.jC,i?P WATER ENCOUNTERED - f NUMBER OF LEACHING PITS ONE ,r-P!rk/d'r APPROVED . :. . . . BOARD OF HEALTH ��`.� L7•�..5�►N� . ;,�/V'.���. . __ , C ,; °• DATE AGENT OR INSPECTOR lk OF EDWA v -e-iFLLEY �' a.e w I f No. 26100 0 CyS7EROs �OISreA�`� �L L1� SOITAM o _ r r 17-i /7'!1_S M n � F / n � r r s 7- 7-- /!F �!'/-ALE it/a 7 arz� b