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HomeMy WebLinkAbout0032 SEA ROBIN ROAD - Health 32 Sea Robin Road Marstons.Mills - --- A =. 122 040 - - ---- - -• - r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y,N, ND)for the following statements.If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exffltiration 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a mannerwhich will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh wins•f ifiG Me 6 Official inspection Foiin:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 1w-a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soft 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 flank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic flank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form_ 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool a ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6 below invert or available volume is less ❑ ® than day flow t5ins•1 MO Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,perforated at a DEP certified laboratory,for fecal colifonn bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ z The system fails.I have determined that one or more of the above failure criteria e)dst as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following,in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(interim Wellhead Protection E] E) Area—IWPA)or a mapped Zone ll 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 faded.The owner or operator of any large system considered a significant threat under Section E or faded under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department, t5ins•11/10 Title 50H'cal inspection Form..Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Flame information is required for every Osterville MA 02655 03/01/13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recenfly or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information.For example,a plan at the Board of Health. ® ❑ Determined in the field(f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•11110 Title 5Offiicial Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's(dame information is required for every Osterville MA 02655 03/01/13 page. City/rown state Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[f yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings,if available(last2 years usage(gpd)): Detail i Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins-11/10 Title 5Offciat Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes,attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 04/09/02 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3.5 feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: 2.7 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: 1,500 gal Sludge depth: 3" t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. C4rrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6„ Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title fi Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of W Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11110 Title 5 Otriciat Inspection Form:Subsurrace Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. Cityfrown .State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert even 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 box was level and fight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located,explain why: t5ins•11110 Trite 5 Official inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number,length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): This system has two 500 gallon drywelis surrounded by three feet of stone.The chambers were dry with no sign of ponding or failure. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Me 5 Official inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): t5ins•11110 Me 5 Offiiciat inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owners Name information is required for every Osterville MA 02655 03/01/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately front 20 14 26 20 24 26 28 33 t5ins-11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every Osterville MA 02655 03/01/13 page. Cityfrown state Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0 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: USGS maps show an elevation of over 20.0 feet. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owners Name information is required for every Osterville MA 02655 03/01/13 page, Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A,B, C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins 11110 Tice,5 Official inspection Forth:Subsrtrace Sewage Disposal System-Page 17 of 17 I _ U l.OL Q Z. s art9re• ou ---------------------------------------------- am, CD 10 g 1 1 I I Vl ------------- i , I I I I -------- I.,1 a -- -------------------- m 1a I 3Y KON p Nu' 'u A i :.�.. 3:; � V��V � 4:ya y_• ���'t[ff�•fV� VA � !" Y S T ♦ •4 a AS Yt"I�t• v 1 ill ^ 0 7. p M ib y -k- 4- ... OR -� ...":'^;�',,;;�.�p,e9v° .::%GRri'A`.f.3.z'F�"T+?..,.,.. �y ,;+*w.N?w..aw-a;un:.an.:hr..✓ar.H. F a) \IV E 3a secpobt,gCini51 ' ca , s , olfb s Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Sea Robin Road Property Address Nicholas Matas Owner Owner's Name information is required for every ale, els MA 02655 03/01/13 page. City/Town State Zip Code Date of Inspection rZZ " oy� Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms J14 �� on the computer, use only the tab 1. Inspector: U key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections ,0Q Company Name PO Box 896 Company Address few East Dennis MA 02641 City/Town State Zip Code 508-385-7608 S13742 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that tt�e, information reported below is true,accurate and complete as of the time of the ins 'on.The Sr'pec was performed based on my training and experience in the proper function and mairit Hance of,on sitl sewage disposal systems. I am a DEP approved system inspector pursuant to S tion 15.3:4�of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority I �o 03/03/13 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. `*"*This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11/10 Title 5 Offiffiction rface Sewage Disposal System•Page 1 of 17 ' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.FORM PART A CERTIFICATION Property Address: 32 Sea Robin Road Owner's Name: Bob Luongo C).y Owner's Address: ' Date.of Inspection: February 14, 2008 Name of Inspector: (Please Print) James M. Ford , :Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 " Telephone Number: (508) 8624400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience.in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system.inspector pursuant to Section 15..340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally.Passes Ne s Further Evaluation by the Local Approving Authority F 1 Inspector's Signature: Dater February 26 200 8 The system inspector shaysubaa ,of this inspection report to the Approving Authority(Board of Health.or DEP)within 30 days of cnspection. 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 r time. This,inspection does not address how the system willperform in the future under the same or-different conditions conditions of use. f,A cr, r Title 5 Inspection Form 6/15/2000 page 1 i Page 2 of 11 .r OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 32 Sea Robin Road Osterville, MA Owner's Name: Bob Luon-ao Date of Inspection: February 14, 2008 Inspection Summary: Check A,B,C,D or.E/ALWAYS complete all of Section D A. System Passes; ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15:304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,.upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following.statements, If"not determined",please explain: The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with 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: 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.systeni 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 I 1 h Page 3 of 11 OFFICIAL INSPECTION FORM-NOT.FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 32 Sea Robin Road Osterville. MA Owner's Name: Bob Luongo Date of Inspection: February 14, 2008 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with.310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will.fail unless the Board of Health(and Public Water.Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank,and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS.and the SAS is within a Zone 1 of a public water supply. _ The system has aseptic 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.coliforn 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 r OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 32 Sea Robin Road Osterville, MA Owner's Name:. Bob Luongo Date of Inspection: February 14, 2008 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due town overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than %rday flow ✓ Required pumping more than.4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ ` Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of asurface.water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool.or privy.is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water, supply well with no acceptable water quality,analysis. [This system passes if the well water analysis, performed at.a DEP certified laboratory,for 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:] No (Yes/No)The system fails. I.have detennined 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 System: 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 the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 II f Page 5 of 11 Y OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 32 Sea Robin Road Osterville, MA Owner's Name: Bob LuonQo Date of Inspeetion: February 14, 2008 Check if the followinghave been done: You must indicate" es"or"no"as to each of the following: Y g Yes No' ✓ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out.in the previous two weeks? ✓ _ Has the.system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system mcently.or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for.signs of sewage backup? ✓ _ 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:. Yes No ✓ Existing information. For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310-CMR 15.302(3)(b)]. 1 5 z Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 32 Sea Robin Road Osterville, MA Owner's Name: Bob Luonzo Date of Inspection: February 14, 2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN.flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied - C OMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings; if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped after inspection for maintenance Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution.box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe):_ Approximate age of all components,date installed(if known)and source oNnfonnation: Date of installation 311102-per as-built Were sewage odors detected when arriving at the site(yes or no): No 6 - y Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 32 Sea Robin Road Osterville. MA Owner's Name: Bob Luongo Date of Inspection: February 14, 2008 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _tither(explain): Distance from private water supply well or suction line Commments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 24" Material of construction: ✓ .concrete _metal ._fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmedby a Certificate of Compliance(yes or no): (attach a copy,of certificate) Dimensions: 1600 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,.liquid levels'. as related to outlet invert;evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. The tank was pumped for maintenance. The inlet cover was 10"below grade. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete. _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from.top.of scum to top of outlet tee or baffle: Distance from,bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recomniendations, inlet and outlet tee or baffle condition;structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.):. 7 F Page 8 of 11 ti. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 32 Sea Robin,Road Osterville: MA Owner's Name: Bob LuonQo . Date of Inspection: February 14. 2008 TIGHT or HOLDING TANK: None (tank must be pumped`at time of inspection)(locate on site plan) Depth below grade:. Material of construction:. _concrete._metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): .DISTRIBUTION BOX: ✓ (if present must.be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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 D-box was clean. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps.in working order(yes or no):. Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 jr Page 9 of 1.1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 32 Sea Robin Road Osterville, MA Owner's Name: Bob Luonzo Date of Inspection: February 14. 2008 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: - 2-500 gal.'chainbers leaching galleries,number: Teaching trenches,number,length: Teaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Commments(note condition of soil, signs of hydraulic.failure,level of ponding,damp soil,condition of vegetation, etc.): The Chambers were dry. There did not appear to be any signs of failure The bottom to grade was S S' The cover was 18"below .erade: CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic.failure,level of ponding,condition of vegetation, etc.): PRIVY: None (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.): 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: 32 Sea Robin Road Osterville, M,4 Owner's Name: Bob Luongo . Date of Inspection: February 14, 2008 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. �f O nT G�rra c, O p . Q l 139 185 3. 2 ao 3AS9 ��' p y ay any 10 7 Page 11 of 11 OFFICIAL INSPECTIONFORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 32 Sea Robin Road Osterville, MA Owner's Name: Bob Luongo Date of Inspection: February 14, 2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 35 +/- feet . Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ . Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 35'+1-to groundwater at this site. This report has been prepared only for the septic systent and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,.written or implied, relating to the septic.system, the inspection;.this report and/or any components.of the septic system which have note been located.and inspected; 11 I. Town of Barnstable �p THE T� Regulatory Services ,LAMSjxS Thomas F. Geiler,Director 269. Public Health.Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/co of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a articular property would-be ' " PP P P P Y listed on the"Disposal P Work Construction Pen-nit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. I� ` i TOWN OF BARNSTABLE LOCATION 3�- SEWAGE# 0l' Co�a- VILI=AGE IY) ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY �SUO LEACHING FACILITY:(type) CW4n size) NO.OF BEDROOMS 3 OWNER LUOns 0 PERMIT DATE: 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=-ASpc6 Mn FOr� L IY II i r i G4(A c. A 0 0 a 1 13°' 19 F03� ao /y s 3 a59 11 ' o LOj y ay9 T-7 y !9� � 3a _)) _ TOWNiO.F BARNSTABLE rc O LOCATION L � •�C�L�LC,¢ 1 SEWAGE 11W6/ a ya VILLAGE. '�L�I LQ -l-�b ASSESSOR'S Maps&T OT./06)- INSTALLER'S NAME& NE NO/.J� ,7 0.� SEPTIC 'YANK C AC 9 / �� LEACHING FACILITY: (type) I ) NO.OF BEDROOMS BUILDER OR OWNER- Hnmi4on �4ofyrs PERMITDATE: 3,T/ T D 2 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by L L/ - c� •� ` t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: "Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zi pprication for ;W5po.5ar *pgtem Con.gtruction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) WComplete System El Individual Components Location ddres . [_Q Si Owner's Name,Address and Tel.No. 5 s or Lot No Assessor's MaLIel /44 � —z. P�c� `qqI 0 $ MIu'S Installer's Name,Address,and Tel.No. 50 l J �� Designer's Name,Address and Tel.No. v ss iocS 1 6. �.a R-a. (3evi lc�c�uc� �c»5ivwcTio/l j 64 Kee} Le- 6*TLT #:�AVM®Vim/ ' Po p r30 628 02�Y Mob0 0� V tr Type of Building: Dwelling No.of Bedrooms Lot Size q.ft. Garbage Grinder(#JQ Other Type of Building S /" E No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow :3 ® gallons per day. Calculated daily flow 17D gallons. Plan Date ��o// O Number of sheets Revision Date Title E.0"F 4-1-1 Pao PO C C-7-0 v-Y S s Size of Septic Tank I S0d CA"S. Type of S.A.S. 6 -i.L oi-j C, f Description of Soil: ®—.?® si Z0AMY f Awo �/ 30---*78 L-04MY 347yo Q J?Z I" " SfLi Lj0.gM G_3 /O046 Nature of Repairs or Alterations(Answer when applicable) AI�51J C"a i-T-&0 C 7-10/4 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 t ern in operation until a Certifi- cate of Compliance has been iss d b s Bo f Health.' ^ Signe Date Application Approved by C-- '"�� Date VQ5 Va , Application Disapproved for the following reasons Permit No. c��� r �c�� Date Issued drL i� F Fee t TE'COMMONWEALTH OF MASSACHUSETTS R Entered m computer. : PUB.,IC-HEA,LTIi-bi" ION TOWN OF BARNSTA`B'CE., MASSACHUSETTS Yes --� 0[ppYication for )Digoar *p5tem Construction Permit Application for a Permit to Construct( Repair(5 )Upgrade( )Abandon( ) WComplete System ❑Individual Components Location dress or-Tsui No. 1—07 7- � ` Owner's Name,Address and Tel.No. d ��1�" I 1 v t .5CAkvlaIN RD. 321 Assessor's Map/Parcel Y4 p ! 2 Z P+�C aL 40 1'I�NS.Mile S Installer/'$�Name,Address,and Tel.No. Sod � �Nff, Designer's Name,Address and Tel.No. Q S'r Qe S � � AyJ,/ ,`` R.3. IJCVI jActrlC� (for)SlrcaC I rOr't 164 Kon,, 14 C..E� F 6ATU F✓1e:/titU t//fit o -57 A G28 .5`U O g®-Fore s;1u i� � 02�Y F Type of Building: Dwelling No.of Bedrooms-3 Lot Size 2 IL q.ft: Garbag&Grinder(4Q) Other Type of Building F- Ld No.of Persons " F ' x Showers.,O . ) Cafeteria( ) Other Fixtures Design Flow �30 gallons per day. Calculated daily flow gallons. Plan Date /Q^/f O / Number of sheets Revision Date Title Pt OT P L 11-.l Pn o PO S G1D Ho v S E__ S SS 0 S a Size of Septic Tank /_' -00 G A C S. Type of S.A.S. Description of Soil — ?6 '*" e!O Am�j f i4,v 0 ok . 20-- 3 8 L-OAS Y S,-47Vo Q 28—(e t�lezDit�Mt SA-N0 C / , 6�— 1 3i /S'U SIC-su_ -r L ©gh✓t C 3 Oo 4,5 Nature of Repairs or Alterations(Answer when applicable) Mall e-d n/ .S TR e>C _r 10 4 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 t e, y tem in operation until a Certifi- cate of Compliance has been iss d b s Bo of Health." -„� Signed- �} Date.i.. 2 Application Approved by xts, C. Date Application Disapproved for the following reasons Permit No.= L U, ` �n� Date Issued 1 l rp ----------------- THE COMMONWEALTH OPMASSACHUSETTS ? BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed )Repaired ( )Upgraded( ) Abandoned( )by at `-.mac^ «v\ �+ '(Z �`� • l��.�\� j has been constructed ip acco dance with the provisions of Title 5 and the for Disposal S�s&Construction Perm�t,No�;, (�� `�r>,:�dated I . Installer y Designer"" The issuance sA perrmt.,shall-not tie construed as a guarantee that the sys ill f ctign as si e Date Inspector W --�------------------------------------- No. al ��� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ]0igpo5a1 *p5tem Construction Permit Permission is hereby granted to Construct( Repair( )Upgrade( )Abandon( ) System located at _� � and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following locihi� ovisions or special conditions. Provided: Construction must be cum ete three years of the date oft s erm' . Date: Approved by BSS D E S I G N .April 9, 2002 LAND SURVEYING CIVIL ENGINEERING .Barnstable'Health Department LANDSCAPE ARCHITECTURE 367 Main Street BSS Design,Incorporated Hyannis,MA 02601 164 Katharine Lee Bates Road Falmouth,Massachusetts 02540 RE: SSDS Inspection 508.540.8805 Fax 508.548.8313 #32 (Lot 25) Sea Robin Road, Marstons Mills, MA To whom it may concern: On April 9, 2002, BSS Design inspected the subsurface sewage disposal system at the above referenced location. The system was found to have been installed stcbstan iany according i.o plan. One small change was the system proximity to the foundation. The system is slightly closer than design plan by about a foot. The other noticeable change was the material used for risers on the septic tank, d-box, and chambers. Black corrugated plastic pipe (CPP) was used instead of "concrete"risers. The covers to go on the risers were standard H-10 concrete as per plan. If you have any questions please call me at 508-540-8805. Sincerely, BSS DESIGN, Inc �S Lawrence Perry, R.S., C.S.E. �ECIV APR 1. 2, ZO�z L LTH DEPT.BLE - t t 1 i J ..c -,. --'----.•__'.x=c__=�._-.—e—�._..a,_.ars.�s.:�:..m...s_,�-,,.vw:.-_�.:mw...,:e..x;....a,.rtm:,�,.:<,v,w.e.,m�,..re. -c,...a..',y. ,..a�...en�>,�-.v,.:..�n..�e 4,�.Y...�-...m...>,..__...._- .-_�_.__. --' � 1 .— ._-------'— - --- -.__-.— ---- L AL m— �9 a:a •:o1 t�.:moe_.... �. .....a.r..iicI. ;7�2{I-5. :IiQ.tP.1-w_L} It dt'L 1 - DAT E 508.428.6 CAl-1 19 1 evlin esigns copyright cc.1999 All Rights Re erled C2 un-n'T_9_ HqM1LToN NoM65 4Axt� -' � r r 3{ 1 _ I Preliminary plans and layouts by D.C.D.are for the use of their customers only.Any other use is strictly prohibits —AS s.NACT i i 1 p p _ I SO:. ..... I m o v Oj l0� G-:4` '6:4_. ._._.__._ ..._.___..__ _ ___ ___ jt rµ' I ___........ -_ 4°+HK.CONC.SLAB 1 m — i 1 — i � Cn.';.9 I..: L:9'. Co. 9.'...... t--! ° , I 281(2 O 6 x 1°iN1C.F7G.FOA 9 1/ � V,CONC.FILLEO LQLLV COL: O 508.428.6191 Devlin 0 LeOeCH_':PS.2`m-T_ISOFt=1.T..(1✓c: ,:c'.) r . I T TM X'Kwradtspwia°xe a.:4.._rosr.(cnsen):.:::.... C�USYOn1 nlx'KEYEOFrG. � (— !.. i _ -- , CEesigns oP 9n 2001 CONC Yn ON 2pX2� o LCE030N07 v - eser Right, I FTG. UBES - 'LSS 4:4 ':Fl:A7 ' All I II I f i r I i 3 ra o 'o 'o)- Ab, Q S Preliminary plans and layouts by D.C,D.are for the use of thelr customers only.Any other use is strictly L1 .'2 to 2rcr�c..::_.._..:._ to L .e- 209 a tSUL I I I i ' i m i 1 O` -":h1AS"CL•-1L_s.O.tTE_-. l � --SECT:I:Q.h.t II-:A-.. ' -1 4:C, a o' G: . S O c l _ 1 I i 1 1 e. 4.o p i L� : L ' i I i i I AT"tc- -! I L 2� 2� G�Ef1T2c�nA:- _ L. __ �} SH_NE2 lU I 4 I 3 I - 2.v fa CATtI.'ZAFYE25" l- rn 2� �t t QQQQ ' I 0 - 1 t tn E SCALEDA!: 2 _ K,I� _ie GO.h,-d__._-: _ ,n -..�-'.10. ':Q._...2.2 -.�23`•.,-.t:p`+ Ij 2-4:�7II- Nj.1O_ 7. TO ,_I . - ._— 508.428.6191S P.Q60SHEETROCK caTH. WALLS&rELUNG "S ttht t (EUStOnI- 9 V �/z �,Q a esigns I c). .0 copyright Cg 2001 �;n .I GAZAC,E-_..._.- I 1_ I All Rights �1� 1 Reserved I v.� 'o of ;I 1 -4•THK CONC.SCAR :.W;4'Ya-yIO'GA-WM. I b"— -- 1---- -- I .PITCH:_.:: Oi l } i 0.,p _. 10 p Co•0... __ _., �___. _.-7. 0 I I - Preliminary.pfans and layouts by D.C.D.are for the use of their customers only.Any other use is strictly prohibite 77777 q 7;,q4 OLD ag*4STABLE D S ' E MARSTONS ..... MILLS LEGEND: LAND SURVEkflNG' 42 LOCUS CIVIL ENGINEERING PROPERTY LINE SEA ROBIN ROAD Ce a LAND ,'PLANNING , CONCRETE BOUNI)i ROUTE 28 ­ D S 10 TE T,PIT 77 BSS Design, I SO077y oHi VV EXISTING OVERHEAD WIRES ncorporated 164 Katharine lee Bates Rd G TING GAS SERVICE 40 EXIS Falmouth Massachusetts 02540 EXISTING WATER MAIN W .8313 508.540.8805 FAX 508.548 WATER,SERVICE P EXISTING POLE LOCUS , IVIA X 33.5 SCALE: 1"= 2000' EXISTING SPOT GRADE PROPOSED SPOT GRADE j:zN0AI CID- -52- - - EXISTING CONTOUR 52 7EC- PROPOSED TEL, ELEC, CATV NOTES: LOT 24 O� 1. HOUSE No. 32 SEA ROBIN :ROAD LOT, ASSESSORS No. MAP 122 PARCEL ,40 25 50,222 SF 3. LOT 25 PLAN BOOK 522 PAGE� 79 4. ZONING DISTRICT. RESIDENTIAL RF 0 ZONE C 5. FLOOD ZONE: CV 6. SPOT' GRADE ELEVATIONS ARE BASED ON 0) HMARK; Lij MSL 1929 DATUM, BENC CIV < TOP OF MAG NAIL, ELEVATION 47.22 > 0 T ALL DISTURBED AREAS' SHALI BE RESTORED (y -7 WITH :4" OF LOAM AND GRASS SEED. .0,8:. LOCUS IS 'WITHIN A ZONE 'll OF A PUBLIC WATER SUPPLY - 39 0 0 M ('0 a- U) 0 ry < W GRAPHIC SCALE D PROPO E 1",200 PSI C/) SOIL ABSORPTION SYSTEM: 20 0 10 40 W 0+ co HDPE WA 7E*R LJ IIE3 PROPO%D SER WOE 2-500 GALLON LEACHING CHAMBERS ............A LLJ N 0 PIPE BtrNEEN & 4' STONE ON ENDS IN FEET < AND 2.58' STONE ON SIDES (10',x 29) SLAB 405, 1 inch 20 ft. _J LL- C A8 rL TRIP OUT TOP AND SUB SOILS TO 0 M OF THE B LA YER FOR 7HE BOT70 0 5' ALL AROUND AND BELOW 7HE SA.S. M --i LO REPL A CE W IN CL EA N SA NO Y SOIL PER 777LE V 1JJ V) C2 PA�ED WA rER WA Y 0 :- -b Q AND,=VVE A r 0- < DRIWWAY AND Z 0 < 500 WA 7ER WA Y D 1500 j;A SEP fIC A PROPOSED LOT , 19 EPHONE, ELECTRIC, GENERAL NOTES A, + scale All system components shall be installed in accordance ' 20 with the: State Environmental Code'TitI6 V: Minimum -01 6 date Z50. J�b Requirements for the Subsurface Disposal" of 'Sanitary a e OCT 12, - 2001 --- - - - Sewage, :and any local rules which m y ,b' ap' ficdble. p 7 2'. The Barnstable Health Department & BSS Design Engineer rawn %K .0 when the system is installed, and prior must be notified to ackfilling for inspection' ARG C;p 3. The stone; around the leaching chambers shall consist of washed C hecked c e 'in 'Size and be free -1/2 in li S stone ranging 'from 3/4 to, 1 D n PROPOSE of iron, fines, and dust i place. The stone shall ,be covered TOP 46 t least a 2 inch layer of washed stone ranging from CURS S '0 with a job number 1/8 to 1/2 inch in, size, 0 e - , ROBINr . and be free �o,f ir n, fin' 's, and dust. Sf,A 1162 -48 D 10 in place.: L=1-57. 30' F-240*00 19 4. The grade above and adjacent to the leaching focility' shall slope revisions WA 7FR 4AIN :2% to prevent accumulation of surface water. at least M y TOWN SO diameter schedule, 40 PVCor 5.. Sewer pipe shall be 4 equal P/9 at 1/4 1 er foot (2%) slope min. p 6,.- Flow','6' qualizers shall be installed on -the --ends of 'all outlet pipes inside the distribution box, + !:�2+ -- - - - - - - -- - + 7, Contractor shall notify the Engineer if he/she encounters soil Alt conditions other than those shown on the sail log. - - - - - - - - - - BENCHMARK TOP OF MAG NAIL ELEVATION 47.22 FF ELEV, 49.0 INSTALL CONCRETE RISER AS STRIPOUT REQUIRED PROFILE IS NOT TO,SCALE REQUIRED TO BRING COVERS SEE SITE PLAN SEE SiTE,PLAN FOR �ACTUAL ORIENTATI ON WTHIN 12`oF FINISH GRADE NS ' CALCULATIO , DESIGN . CRITERIA TEST HOLE DATA 47.0 4�.8 SEP-TIC TANK *6.7 46.6 MAX. 46�2 IN minimum 2% slope FiNlISH GRADE NUMBER OF BEDROOMS 3 bedrooms PERC. RATE: <2 min./inch 'PVC PIPE DESIGN FOR USE WITHOUT GARBAGE GRINDER 110 gpd/brm 45.3 ALL FIRST 2' SHALL DESIGN FLOW CLEAN BACKFILL 30 - al/day x 200% :&,FTTINGS TAKEN BY: L. Perry, C.S.E., BSS Design. 3 g 660 gal 1/4-,,per BE SET LEVEL fol I t -CONNECT CHAMBERS TOGETHER w/4" SCH.40 IPVC PIPE TOTA L DAILY FLOW 330 gpd WITNESSED BY: Lee McConnell, Health Department go 43.10 1/4' DATE: September 27, 2001 1,500,,gal H10 SEPTIC TANK PROVIDED p 44.5 CONCAETE LIQUID LE" 1/8* per ft. min. __-----2 RISERS 44.57 , FOUNDATION 2*(1/8"-1/2")peastone SOIL LOG: P#10048 14 44.21 E=3 E=1=1 -4 §4 E=1 C=1 C:3 C= 43.96 - E=1 C=1 TION -SYSTEM: ELEV: 40.5' 4 .77 t=1 C=) SOIL ' ABSORP =1 CO=3=1 1=1 CELLAR FLOOR SOIL LOGS 41 STONE, Z 2-500 GALtON LEACHING CHAMBERS 2.6' 10 2.6' SEE NOTE 3. TH#1 TH#2 END TO END 4' APART, WITH CONNECTOR y '0 HGW EL. 36.3 4 0 0 8. low- -0 -.00 1# 0. 0 41.5 O/E PIPES BETWEEN 4' STONE ON ENDS 11111110m 6 1 No 207' 39.7 LOAMY SAND 22"FRIMPTER) O/E LOAMYSAND 37. )U AND 2.58' STONE ON SIDES. RYT CR SEP11C TANK ­' : I I LOAMY SAND DISTRIBUTION BOX SOIL,,ABSORPTION SYSTEM 36.8 8 LOAMYSAND 38" STATE TITLE V 8.3, 37.5 48" LEACHING AREA PROVIDED. USE 1,500 GALLON-AASHTO H10 H10 PRECAST LEACHING CHAMBER H10 3 HOLE AASHTO PRECAST SEPTIC,TANK C1 M. SAND '(2(1O.O')+2(29.O'))x2.O' (0.74) (DB3) 36.3 62" SIDEWALL x ELEV 28.0 C1 M. SAND C2 FINE SAND 115.4 gal/day :,..SUBSURFACE ' KWAGE DISPOSAL SYSTEM OBSERVED 34.3 69" 34.4 85' C3 SILT LOAM 33.5 BOTTOM AREA 10.0' x 29.0' x (0.74) 96 NOT TO SCALE 214.6 gal/day C2 FINE SAND title 31.9 115"' TOTAL LEACHING CAPACITY 330.0 gal/day , 29.0 1 1132 CS SILT LOAM, SITE PLAN C3 SILT LOAM 30.5 132"" AND DETAILS GW 8.0 - - - -- - - 144: 2 7.5 1 OF 1 , 2 150 GW 28.0 - -- - - - - 162" drawing number B1 0-86, . , ..........