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HomeMy WebLinkAbout0046 SPUR LANE - Health 46 SPUR LANE,MARSTONS MILLS F A= 027033 4 i I i —d Commonwealth of Massachusetts D 033 h Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information ! on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road � Company Address Teaticket Ma. 02536 Citylrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails r 05-05-2019 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not.address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/201.8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 F . 1 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Spur Lane V Property Address Victoria Tufts Owner Owner's Name information is Marstons Mills MA 02648 05-01-2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This 3 bedroom home has a H-10 1000 gallon septic tank a H-10 D-Box feeding a trench. At the time of the inspection the leaching was dry and there were no visible signs of past hydraulic failure. 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 ` o Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. Citylrown 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: 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. Citylrown 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less_ than '/2 day 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 a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Ala Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. 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"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) Was the facilityor dwelling inspected for signs of sewage back u ? 9 P 9 9 P ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 plus GPD Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: In 2018-40,000 gallons were used and in 2017-39,000 gallons used Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2019Date 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts S Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. City/Town 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): 3. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: On 12-17-1998 a new leaching trench was installed. Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 23 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 14"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: Standard 1000 gallon Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 32 Scum thickness lot Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form h Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Spur Lane V Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. 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 from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity:. gallons Design Flow: gallons per day t5insp-doc,•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. Cityrrown 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.): At the time of the inspection there were no visible signs of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. 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: ❑ leaching pits number: ❑ leaching chambers number: El leaching galleries number: ® leaching trenches number, length: Appx. 30' El leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 „ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection the leaching was dry and there were no visible signs of past hydraulic failure. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 114 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form (I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,V 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. Cityrrown 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Y Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. 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: ® hand-sketch in the area below ❑ drawing attached separately r 3 � 3 � a 3 do S t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts �= Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Spur Lane Property Address Victoria Tufts Owner Owner's Name information is required for every Marstons Mills MA 02648 05-01-2019 page. Citylrown 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: 10 feet plus 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: I augered a hole to 10 feet to show a 4' seperation Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 118 Commonwealth of Massachusetts Title 5 Official Inspection Form �I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Spur Lane Property Address Victoria Tufts Owner Owners Name information is required for every Marstons Mills MA 02648 05-01-2019 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included 9J1 ��w� d� S, ►�. �a N� fez t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN OF BARNSTABLE LOCATION SEWAGE # VILL "Gt-4c;4n4ills ASSESS 'S MAP&LLOTOD_�S_ NAME&PHONE NO'-.A 6`��d�-0�i o--'J fl, SEPTIC TANK CAPACITY ( LEACHING FACILITY: (type) (size) / -eo NO.OF BEDROOMS BUILDER PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility .3Co Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) I Feet . Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of lea hing faci}�' ) /- r¢ Feet Furnished b /�I �91�i L i'.tp7YCeC�i�4�, -271/C. C� _ _ . tb�9 ' � O �� s n' � � �.� � _ a a :� TOWN OF BARNSTABLE : 1� LG.�`NTION qt <7p r SEWAGE # 7 ?j- VILz AG ASSESSOR'S MAP& LOT© -0 INSTALLER'S NAME dt PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �d� lQC. (size) NO.OF BEDROOMS BUILDER OR OWNERLG tD " PERMITDATE: / -17-`� COMPLIANCE DATE: I a--1 q Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by A /-� d " a 6 • n �_,,.. a P;.._ No. -7 a'3 /<0 Fee _ L THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for ni-4pogal *pttetn cCongtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) El Complete System individual Components Location Address or Lot No. 4(a Sp C s Owner's Name,Address and Tel.No. Assessor's Map/Parcel Q� 033 ` vV� _ o-GC—k 01VF_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. I(D-L SE P"Kc 0 $40i Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow r3 Lt9 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Lk-4�1 1000 Type of S.A.S. ��a 9,�Cs.�c'cT�L�iT LT✓�� Description of Soil EtD .S14A_0 Nature of Repairs or Alterations(Answer when applicable) ' TPA` dp 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 t to place the system in operation until a Certifi- cate of Compliance has: issue y o ealth. �"� Signed Date 10,4` Application Approved by Date. _, 7 Application Disapproved for the ollo 'ng reasons Permit No. Date Issued TOWN OF BARNSTABLE LOCATION SEWAGE # z- _ VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. t O—C`16 SEPTIC TANK CAPACITY ('Cx� c+ C LEACHING FACILITY: (type) r U (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE:_ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Snwai loom b hT €� G No. 9b 7,c Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Yes 01pprication for Migpogal *pMem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System NZIndividual Components Location Address or Lot No. q(g S)Dv r-lr a.t_� S Owner's Name,,Address and Tel.No. o 033 Assessor's Map/Parcel � , �, C3�Iv� 1�G�w-��NF. a� - Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 0 3Tc� , F+ l Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) A Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 y gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank '-47 X7 S%-)FzA.- %o4C ! j 1411 Type of S.A.S. ��l`�Ch�Lt��1 - �L f✓� Description of Soil %A^F_'> S 14 a--! Nature of Repairs or Alterations(Answer when applicable) = -I;yPA ` opt- o -��� f`w�- ,1 .c i X= C~tva"c o c,c., 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 Ot to place the system in operation until a Certifi- cate of Compliance has&-e—nissued by this o - iealth. '\ Signed d Date I Application Approved by Date (,) -1 -7` l Application Disapproved for the ollowt g reasonsr Permit No. ff - 7l0 Date Issued t 7 - -- --- - - ---- ,c r THE COMMONWEALTH OF MASSACHUSETTS?71 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by YV\t C:) -L�4f 1=- SF (C- at 5 V V' LZ,V-0 _ I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -79? dated Installer Designer The issuance of this}permit shall not be construed as a guarantee that the system will function as designed. Date ! Inspector 0 --------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS MiOpogal *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade 1/f`��bandon( ) System located at S YAl �!"CCL-�_ c�\ S and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date: e< - l ~q�i Approved by �., 3r 1019197 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only: a CERTIFICATION OF SKETCH AND APPLICATION FOR A _ DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) , 7A " r hereby certify that the application for disposal works construction permit signed by me dated �� �`l� , concerning the property rt located at LA U J e— -_C "P__ `EAU 1\ meets all of the following criteria: There are no wetlands located within 100 feet of the proposed leaching-facility There are no private wells within 150 feet of the proposed septic system 9 l/ • $ / / There u no increase in flow and/or change in use proposed There are no variances requested or needed. t If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will OZ be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) t-�--2 well map) B)Observed Groundwater Table Elevation (according to Health Division ShGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER ig Q (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan,. this plan should be submitted). ° s q:health folder.art C�t� q � G W� �Pur �� ��rsfo�e_t ,r��;11>, �, � . � � 0 J �a��, i , � _ � z � � / -►. �� i �� � � o ��� � � O �� �� ® ��� \ y lV��w� xl` P 1. I 0� DATE:12/1.4/98 PROPERTY ADDRESS: ,46 S•puT Lane Mars•tons Mills ! Mass , . On the above date, I Inspected the s•eptic system at the above address. This system conalsts of the following: 1 . 1-1000 •gallon septic tank. 2. 1-distribution box. 3. 1-1000 'gallon precast leaching pit . Based On my Inec-action, I certify the following conditions: 4. This is a title five septic systemv-,(r78 • Code. ) 5. The .'septic system is •in failure . Waste water is over the in.vert pipe. to the leaching pit . 6. Pumped system at time of inspection . 7. System must be repaired , ' to 8. System An :hydraulic failure . , SIGNATURE: / Name : J P,H_acomberr .:: - 13 Y� ComP an J• P.Macoigber & ;on"Ync • -------------- ---- • ' . , �,, , Address: 66---- iVEO \!' __Cent_e�rvlLeLM,4,s.�,;_42fi3.2 '� pa 199,q J� IV Phone:___Sag -7-7„5. �338------- -- I V�(� THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER '& SON, INC. T+nk4-C#s4pooh Le&chflelds • Pump*4 4 lnstillw Town Sewer Connections P.O. Box 66' Centerville, MA 02632.0066 77.5.33U 775-6412 COMMONWEALTH OF'MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF EN iRom&ENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION pmwtyAddress: 46 Spur Lane Na,neof0wwLisa Panaccione Marstons Mills ,Mass. Address ofownw: Box Date of Inspection: 12/14/9 8 gleans ,Mass . 02653 Name of Inspector:(Please Print)J.P.M a c o m b e r r . Cornpa1 am a DEP ovad system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) r,y : J.rMacomber & Son Inc . MadiingAddress: Box 66 Centerville ,Mass . 2632 Telephone Number: 5 n R_7 7 S_3,13 8 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Alfte Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner Shall submit the report to the appropriate regional office of the Department oREnvironmental protection. The original should'be sent to VW system owner and copies sent to the buyer,if applicable,and the approving authority. . NOTES AND COMMENTS revised 9/2/98 Pagel of11 �,Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 46 Spur Lane Marstons Mills ,Mass . Owner: Lisa Panaccione Daft of Inspection: 12/14/9 8 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: -� I have not found any Information which indicates that any of the failure conditions described in 310 CMR 16.303 exist. Any failure criteria not evaluated ars indicated Blow. COMMENTS: �..e )8—"* j,C ��l►) _�Ll'e �� + B. SYSTEM CONDITIONALLY PASSES: -Ca One or more system components as described In the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes,no,or not determined(Y. N,or NO). Describe basis of determination in all Instances. If "not determined", explain why not. jo The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance(attached)Indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank, whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration, or tank failure is Imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced - The system required pumphig•more than four-times in year due to broken or obstructed pipets). The vyatem wilhpaas-- Inspection if(with approval of the Board of Health): - - - broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddre": 46 Spur Lane Marstons Mills ,Mass . O1Mfer: Lisa Panaccione Date of trupection:12/14/9 8 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: A/O Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL.PRQIECT THE PUBLIC HEALTRAND SAFETY AND THE ENVMONMENT: Cesspool or privy is within 50 feet-of surface water /y[f Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: dj The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. Ag The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of-ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance -10. (approximation not valid).- 3) OTHER i1J revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 46 Spur Lane Marstons Mi11s ,Mass . Owner: Lisa Panaccione Date of Inspection: 12/14/9 8 D. SYSTEM FAILS: Y_oy must indicate either "Yes" or"No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yeses No 1/ Backup of•sewage irrtofeciRt�ner-eyeten+component due tto an overloaded or-clogged-SAS-,or-cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. _ Static liquid level inn the t distrib Lion box above outlet invert due to an overloaded or clogged SAS or cesspool. _ Liquid depth in eesspeo I less than 6" below invert or available volume is less than 1/2 day flow. 1/ 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 ithin a Zone I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for -coliform bacteria,volatile organic-compounds, ammonia nitrogen and nitrate nitrogen. - E. LARGE SYSTEM FAILS: You must indicate either"Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes N �� the system is within 400 feet of a surface drinking water supply the systemda-within 200 feet-O�t ary-toe suFfaoe Arjciag-watOr•supplY - • -- •• - - /4 the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 l SUBSURFACE SEWAGE DISPOSAI,SYSTEM INSPECTION FORM PART B CHECKLIST Prop-tyAddr"s: 46 Spurr Lane Marstons Mills ,Mass . Dwane: Lisa Panaccione Date of Inspection: 12/14/9 8 Check if the following have been done:You must Indicate either"Yes" or"No" as to each of the following: Yes 71/ Pumping information was provided by the owner,occupant, or Board of Health. 41- -None of the systemcompoaants hawaiman puPMwd4=atJeast two. weelm andthwirystem hasJmaraa+ecaisirrgwsia=al flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. — As built plans have been obtained and examined. Note if they are not available with N/A. — The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or Industrial waste flow. Z — The site was inspected for signs of breakout. — All system components, o*cluding the Soil Absorption System,have been located on the site. X — The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: — Existing information. For example, Plan at B.O.H. — Determined in the field(if any of the failure criteria related to Part C Is at issue,approximation of distance is unacceptable) [15.302131(b)1 e The facility owner. d.oaaupaats infnrmati tr, n ar ai t n — — y .-.--T--- dilferani frnawarner)awere.prauided.wish oacn �Jip--ra-n� a•,,. Qf Subsurface Disposal Systems. , j I' revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 46 Spur Lane Marstons Mills ,Mass . owner: Lisa Panaccione Date of Inspection: 12/14/9 8 FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d./bedro M. Number of bedrooms( esign):2 Number of bedrooms(actual): Total DESIGN flow Number of current residents Garbage grinder(yes or no):� Laundry(separate system) (yes or no):)ip. If yes,separateJnspaction.required --. Laundry system inspected (yes or45) Seasonal use(yea or no):avM Water meter readings,H available(last two year's usage(gpd):�..__ ,,. �-t�"' af�• � , Sump Pump(yes or no) � Last date of occupancy th f /?e �45;1- fj /yf�,(j�'"/�S ✓9,o6o /lel COMMERCLAL/INDUSTRIAL: e-14fje mow/ A::W�Type of establishment: AIA Design flow: " aad 1 Based on 16.203) Basis of design flow Grease trap present:(yes or no)Aff Industrial Waste Holding Tank present:(yes or no)Alzp Non-sanitary waste discharged to the Title 6 system:(yes or no)-" - Water meter readings,if available: /!f Last date of occupancy: OTHER:(Describe) Last date of occupancy: AIR GENERAL INFORMATION PUMPING RECORDS ano source of information: Sya em pu npe• as part of'ns action:(yes or no) If yes, volume pumped: �� gallons , ��- Reason fowl g: pl fA4), V+ AMS?0 K�B1��, D 8Q ."= Ct tivl ¢- v sl TYP M E QF SYSTEM 1/ Septic tank/distribution box/soil absorption system Single cesspool A,1L Overflow cesspool IL Privy �'���••"��� Shared system(yes or no) (if yes,attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract _,dA6 Tight Tank ;!/ Copy of DEP Approval Other 14,111 C APPROXIMATE AGE of all components,date installed{if known)-and source of4nformation: D = >! Sewage odors detected when arriving at the site:,(yes or no)I—t1/ revised 9/2/98 Page 6orn r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 Spur Lane Marstons Mills ,Mass. Owner: Lisa Panaccione Date of Irupecd—: 1 2/1 4/9 8 BUILDING SEWER: (Locate on site plan) v Depth below grade: Material of construction:_cast iron 40 PVC_other(explain) Distance from private water supply well or suction line i�in u Diameter# Comments:(condition of joints,venting,evidence offeakage,-etc.) Joints ayyear tight No Pvir)Pnrp of laaknge ; System i SEPTIC TANK: (locate on site plan) If Depth below grade: Material of construction:Zoncrete_metal_Fiberglass _Polyethylene_other(explain) If tank Is[natal,list age �f' .1s..a/gge-confirmed by�Certificate of Compliance (Yes/No) Dimensions: ]'I/ Sludge depth: D Distance from top of sludge to bottom of outlet tee orfsaffle: —' Scum thickness:_ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bo m of ou t tee or baffle:L_ How dimensions were determined: Comments: (recommendation for pumping,condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert, structuroHintegrity, evidence of leakage,etc.) Yump tank every 2-3 years Inlet & outlet tee-, are in vlace The tank i s strrtrtnrnl 134 ennnd anrd ehgj.;c ^g @;r1d9^se GREASE TRAP: (locate on site plan) Depth below grade:,l-' Material of construction;Y_iconcret4pametal4)AFiberglass,VAPolyethylenq/lgother(explain) AA Dimensions: All Scum thickness: Distance from top of scum to top of outlet tee or baffle:." Distance from bottom of�s�dcum to bottom of outlet tee or baffle:/W Date of last pumping: N- Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Grease trap is not present revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARf C SYSTEM INFORMATION(cwWmmd) PropertYAddress: 46 Spur Lane Marstons Mills ,Mass . Owner: Lisa Panaccione Data of Inspection: 12/14/9 8 TIGHT OR HOLDING TANK:A&jy,(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:/ Material of construction;�concrete4�,*metaW,4 Fiberglass,dPolyethyleneAoother(explain) A A =—_ - Dimensions: AM Capacity: N gallons Design flow: gallons/day Alarm present N Alarm level: Alarm ip working order:Yes A NQV Date of previous pumping: if Comments: (condition of inlet tee, condition of alarm and float switches,etc.) iQ t or holding tanks are not present DISTRIBUTION BOX:_J/ (locate on site plan) Depth of liquid level above outlet invert: AI _ Comments: (note-if level and distribution is equal, evidenoe of solids carryover,evidence of leakage into or out of box, etc.) — is ri u ion box has one lateral . No evidence of solids carry over , No evidence of 1Pnksge intn nr n„t of the box . PUMP CHAMBER (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.) umD chamber is not present . revised 9/2/98 Page 8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:46 Spur Lane Marstons Mills ,Mass . Owner: Lisa Panaccione Date of Inspection: 12/14/9 8 SOIL ABSORPTION SYSTEM(SAS):W f0 PT (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits,number: leaching chambers,number. leaching galleries,number:_ leaching trenches,number,length: leaching fields,number, dimensions. overflow cesspool,number: Alternative system: Name of Technology: r Comments: (note condition of soil, signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.) -Loamy sand to medium sandLeaching pit is in hydraii1jr fnillirp Must be upgraded With a new laarhing Aran UPO[]t J-Jan :is nnrm;al CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: N Depth of scum layer: Dimensions of cesspool:_ Materials of construction: 44 Indication of groundwater: Ajig Inflow(cesspool must be pumped as part of Inspection) esspoo s are not present Comments: (note condition of soil,signs of hydraulic failure,.level of.pending,-condition of.vegetation, etc.) esspoo s are not present PRIVY:Aba- (locate on site plan) 9 Materjals of constru lion: /!/ Dimensions: JL/� Depth of solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation;etc.) rivy is not present revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 Spur Lane Marstons Mi11s ,Mass . Ownw: Lisa Panaccione Data of Inq-160n: 12/14/9 8 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) �6 SPv� �N MArS1�o�vs m��ls f A O � 1N0J j revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 Spur Lane Marstons Mills ,Mass . Owner: Lisa Panaccione Date of In�:12/14/9 8 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM . Slope Surface water Check Cellar Shallow wells i Estimated Depth to Groundwater IK Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record bserved.Site u ng pro bservation hole basement ump etc.) k Determined from local conditions Checked with local Board of health Checked FEMA Maps /e/Checked pumping records / / Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Used Gahrety Miller Model 12/16/94 revised 9/2/98 Page 11of11 a•r.+snrw.-nt•r��11�enraR+ntsn,rRRa7nrye.*rr.T+l�erR►�*RORttt@'f7Iff17n�iOT ���.�,��.�..r-••� 'I'OWN OF Barnstable I30ARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION I �, �:^•rrt�••. ::.—n.�-�rmm�+nrr.•.r.raamera�.+rrr-t��turwnt .e+w.ve�rew•+er� t+m .:.+vrr•r.-ter—..1 -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 46 Spur Lane Marstons Mills ,Mass . ' ASSESSORS MAP, BLOCK AND PARCEL # OWNER' s NAME Lisa Panaccione PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J. P.Macomber & S6W 'INc . COMPANY ADDRESS Box 66 Centerville ,Mass . 02632, Street Town or City St LIP COMPANY TELEPHONE (508 ) 775 - 3338 FAX ( 508 ) 790 -1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposaj system at this address and that the information reported is true, accurate , and complete as of the time of ,inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: System PASSED _ The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 , 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of is form. System FAILED*,- The inspection which I have con acted has found that the system fails to Protect the public healtli and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date ` One copy of this certification must be provided to the OWNER the BUYER ( where applicable) and the BOARD 08' HEALTH. ' * If the inspection FAILED, th*e owner or"" perator shall u within o'ne year of the date of the inspection, unless allowed dortrequiredm otherwise as provided in 3.10 CMR 16 . 305 . partd .doc S BORTOLOTTI CONSTRUCTION, INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop ,L Date of Inspec}yL/�-� .- MapD2— PART A -L CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. AS-BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. 1--'THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK-UP. THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. t/ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. ✓THE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON-INTRUSIVE METHODS. THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B - SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL No of Bedrooms (13 No of Current Residents d Garbage Grinder 1�y Laundry Connected to System b Seasonal Use NON RESIDENTIAL: Calculated flow WATER METER READINGS,IF AVAILABLE: GALLONS Plumping Records d Source of Information: a 0 SYSTEM PUMPED AS PART OF INSPECTION? IF YES,VOLUME PUMPED= GALS Reason for Pumping: TYPE OF 3 TEM: Septic tank/distribution box/soil absorption system 1 Single Cesspool Overflow Cesspool Privy Shared system (if yes,attach previous inspection records, if any) -Other(explain) Appr Amato age of all components. Date installed,if known. Source of Information. SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: Depth below grade: ,.�� Dimensions: Material of constructlon: oncrete Metal FRP / Other} Sludge Depth Distance from top of s u e�to bottom of outlet tee or baffle Scum Thickness // Distance from Top of Scum to top of outlet tee or baffle Distance from bottom of Scum to bottom of outlet tee or baffle d i Co ents. G // e—0►L ,14 DISTRIBUTION BOX: DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: PUMP HAMBER: Pumps in working order? Comments: SOIL ABSORPTION SYSTEM SAS IF NOT PRESENT,EXPLAIN: TYPE: _ Comments: �rJ� tee. CESSPOOLS: Number and configuration Depth—top of liquid to inlet invert Depth of solids layer T Depth of scum layer Dimension of cesspool Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: PRIVY• Materials trf construction Dimensions Depth of solids Comments: . r< `SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO-AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN ioo' I� Q O vl ro- DEPTH,tTO O NDyVA R:.. DEPTH TO GROUNDWATER k METHOD OF DFTEF NVATI.04 OR APPROXIMATION; v 'gold a, s Al 57 s a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA -Al (Indicate Y-yes N-no ND-not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? IVI Required pumping 4 times or more in the last year? Number of times pumped Septic tank.is metal?cracked?structurally unsound?substantial infiltration?substantial exfiftration? tank failure imminent? Is any portion of the SAS,cesspool or privy,below the high groundwater elevation? Within 50 feet of a surface water? Within 100 feet of a surface water supply or tributary to a surface water supply? / Within a Zone I of a public well? 1 Within 50 feet of a private water supply well? Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D — CERTIFICATION I INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 CERTIFICATION STATEMENT I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON-SrTE SEWAGE DISPOSAL SYSTEMS. CHECK ONE: v I HAVE NOT FOUND ANY IN FORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA.NOT EVALUATED ARE AS STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I HAVE DETERMINED THAT THE SYSTEM FAILS.TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE: DATE: ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(d applicable),APPROVING AUTHORITY ^i �ay�',¢,��s'Ld��r?t �a e�A,.;�✓'t�'s^SJ� �. x4y Tad;01.1 . ».",�.�,�3ky,�{ y, 1TA, 0,:Ay Town of Barnstable • � Department of Health, Safety, and Environmental Services IMRNSTABM 6'9. � Public Health Division �DN1P�� 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: A5 a t-C)One r�Ux z2 DATE: 2/ �2d J ��qq cC G ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at AOL,,f�?�s was inspected on , �� i�,�4v� , by Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • a<�v D C ^^5^^— Fr M L.0 UP- You are ordered to bring the septic system into compliance within two (2) years of the date of discovery. Therefore, the construction of replacement septic system component(s) must be completed on or beforec� First, you must hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of proposed replacement septic system component(s) to the Town of Barnstable Public Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5. In the meantime, you shall ensure that no raw sewage discharges onto the surface of the ground or into any surface waters. You must maintain the system by hiring a licensed septage hauler to pump the septic system whenever it is necessary. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health gUteelNWbfilaWtldi.da - °�TME Town of Barnstable Department of Health, Safety, and Environmental Services + BARNSTABM Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A-McKean,RS,CHO FAX: 508-790-6304 Director of Public Health December 21, 1998 Ms. Lisa Panaccione P.O.Box 2278 Orleans, MA 02653 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 46 Spur Lane., Marstons Mills was inspected on October 14, 1998, by Joseph Macomber, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into component due to clogged leaching pit. You are ordered to bring the septic system into compliance within two (2) years of the date of discovery. Therefore, the construction of replacement septic system component(s) must be completed on or before December 14, 2000. First, you must hire licensed Town of Barnstable septic system installer to submit a sketch diagram of proposed replacement septic system component(s)to the Town of Barnstable Public Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5. In the meantime, you shall ensure that no raw sewage discharges onto the surface of the ground or into any surface waters. You must maintain the system by hiring a licensed septage hauler to pump the septic system whenever it is necessary. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. P ER(�F THE BOARD OF HEALTH goms A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable Department of Health, Safety, and Environmental Services BARN]MASS. ; _ 139 Public Health Division P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health December 21, 1998 Ms. Lisa Panaccione P.O.Box 2278 Orleans, MA 02653 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 46 Spur Lane., Marstons Mills was inspected on October 14, 1998, by Joseph Macomber, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into component due to clogged leaching pit. You are ordered to bring the septic system into compliance within two (2)years of the date of discovery. Therefore, the construction of replacement septic system component(s) must be completed on or before December 14, 2000. First, you must hire licensed Town of Barnstable septic system installer to submit a sketch diagram of proposed replacement septic system component(s)to the Town of Barnstable Public Health Division Office (Town Hall, 367 Main Street, Hyannis)that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code ' e 5. e54cd In the meantime, yo shel ensure that no raw sewage into the surface f the ground or into any su ace waters. You must maintain the system by hiring a license septage hauler to pump the septic system whenever it is a Any person aggrieved by any order issued by the local appro u orrty may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health e-9/- 5yp L DCA`'iION j j SEWAGE PERMIT NO- VILLAGE �Pd � LOF--�- - fN'1, INSTAL ER'S NAME i ADDRESS . J (OA _I+Y)� i C iUILK R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r, °1 Go,Nc!L ere' olu L—)O L 4, PIT , v>SRQ L 6 2arvT 1 n 7 t No..11.� s .... Fxs............................_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 46 .................. ... ........... ........OF........k............................ ............................................ Appltration for UhiposFal Works Towitrurtion Errant Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .....1.. . . ' ►� 5--........ Lo_r_......`...:a�..... '-/10.h......�AvAe.................. Location-Address or Lot No. M 1 �.d. !U��, !l!,/vL '_..,... .A,...................................... ...-�'���...�.---•-- •- -----•---.4.1.�1.�.......................•------ - -•-- Owner Address Installer "Address Type of Building Size Lot..9_ 10 ._-_Sq. feet U Dwelling—No. of Bedrooms....�................... . .Expansion Attic (A01' Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.....................--.--.. Showers ( ) — Cafeteria ( ) Q' Other fixtures ...................................................... W Design Flow........ 5�........................gallons per person per day. Total djily flow----4 3••0.....................gallons. WSeptic Tank—Liquid capacity.1 allons Length--.dP__-_ Width. ..-_/-11-- Diameter--.----.-. Depth...�f...l ./�• Disposal sposal Trench—No. --------_-----.--- Width_..__i.............. Total Length.................... Total leaching area....................sq. ft. 41 Seepage Pit No-------/........... Diameter......1.4......... Depth below inlet................ Total leaching areagl.61.o--_sq. ft. z Other Distribution box Dosing t ( ) `-' Percolation Test Results Performed by-_...._ `lr L(ee�_�_...AA--- L ... Date..... /e :71"�-9---_. Test Pit No. I...a2.-.......minutes per inch Depth of Test Pit.................... Depth to ground water-----..---..-..----.---- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ i ------------- O Description of Soil.--•-- �N'!_. ' �/ Q �--r� �---.• - P............ -"-j6r.----- p -�+ x -------------•------------- 1� ' ��"'9�'+ � .......re..... .400 � 1�1C ,�� U W --------------------------------------------------------------•----•--------------•- •-----------------••-------•----------....---------•---•---•-------------------------•••••-•••-••-•----•-•-' UNature of Repairs or Alterations—Answer when applicable................................................................................................ ....--------••---------------------------------------------------•----------------------••--••-•---------......-----------------•-•--•-•---.----••••-••---•------•••••--•••-•--•--•--•-•-••-----------•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i?Tl,'• 5 of the State Sanitary Code— The undersigned further agrees not to place the system in p p board oealt Si d._.._... A by the 'operation until a Certificate of Compliance has been issued I / ei Application Approved By.•••• ••-•-- .••• ••-•................................................................... --_ .. ..ff ................. Date Application Disappro or t following reasons-----------------------------•-----------------------------------------------------------------•-----•--------••- Date PermitNo......................................................... Issued....................................................... Date ........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... ................................OF............................-.-........ Appliratiun for Bhgp a al Works Towitrnrtinn rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..... -- -4,,T- 4------ '°` --t '------------------------ !=q- : :._..: tr e......�tAd .......----.....-- tLocation-Address or t No ..._.. t ..f.. ..._... -•.......... ......... �'` r. .1�. .......__ -a Address ........._. '✓f 4 .e 3..... _'.�•; I _5 ......... .......t A`7 h!� y .:__. ................................ Installer Address Type of Building Size Lot. .1f_:mlev: Sq. feet �-1 Dwelling—No. of Bedrooms:... ............:...................Expansion Attic_ (&OOTI Garbage Grinder ( ) 114 Other—T e of Building ............................ No. of ersons.....__..........•._ ... Showers — a --P-••-•-•--------••--•--•-••---•-••---•••-••---•... ( ) Cafeteria ( ) Other fixtures . r r °°' ........................ ... Y .. W Design Flow...........__..___.. gallons per person per day. Total d ily flow_-_-- .....................gallons. g �--.b0_ Diameter. ............ Depth_.... . W Septic Tank—Liquid capacity,:._: allons Len thA :_. .... W>dth.. x P -- --i------ ---p g � ! g • sq. ft. Dis Disposal Trench—No. ............... Seepage Pit No.......,�......�..... Diameter.._.. Depth below inlet. ............. Total leachin ar Width..... .......... Total Length Total leaching area:...................� sq. ft. Z Other Distribution box 00- 1 Dosing tankOIL( ) Percolation Test Results r Performed inutesm ed by r inch ) h off Test, #--- D . Date.. .. ►a 14 • Test Pit No. 1... .-------- p pp to, ground water........................ (Z, Test Pit No. 2----_-----.---minutes per inch Depth of Test Pit.........:.......... Depth to ground water........................ pl .......................................................... ® Description of Soil---.... _ _A'.".1... -k -• - -` W --•----•------------------ ------------------ ----------------- ----JK•• ---•---•-- U Nature of Repairs or Alterations— s� en applicable____________________ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of` 'LT-TZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board'o ealt . Sig ---•- ... l......................................... Application Approved BY........... •. .-•••-•. . 1 ' --------...•----- .ate Application Disapprove'f or t. following reasons:-----•--•---------------------•••-----------------•------------•-----------•••---•----•••-.. ---.....------ --•------------••------------•-----•-, ---- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD�..ge ...................OF......... Ii . �p ifiratr of Tuntpli'anrr TTO CE I at e Individual Sewage Disposal System constructed orRepairedbY-•---•. ......•-••--.... ..----.-•--- ----------•-------------•--....------------•-------------------......-----..........------•...-------- Installer has beled in accordancf ith the provisions of TILL. 5 of The State Sanitary Cod as d cribed in the application for Disposal Works Construction Permit No---kt.-_.�4'Q__________________ dated :_�� .._ . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. ......... .......... ��j! {�.--•-•---. Inspector.......A�.f_.•--•---- THE COMMONWEALTH OF MASSACHUSETTS - BQA OF H A I" OF.. . NOAU.�TY ... O FEE�...---............... Bigpuu 1, urk iun pandt Permissionis bereby granted----- .............. ............................................................................................................ to Construct or Repair ) an Indivi Sewage Disposal System atNo...... - - ....-4VI- ---- ........ ---- -----•--•---.....4.-ftle.................................................................... .. ................ Street as shown on the application for Disposal Works Construction Permit NoT 7:'-01')_ Dated. ................ _r Board of Health Z (: DATE........................................ ........... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS i 20FT. (Minimum) _Outlet pipes from,Dist.BokshalI be 10 FT (Minimum) leve.Lfar at least 2feet from box ,;a•F. . = ass Removable. F Floor Elev. Tight �• — — soo0i concrete covers •_' ' e Removable conc.covers " 43 -p I~inish rode-%min.sloe of 2° ' f , /o awo firom s stem p TlG O �'P%W Wj17 I 12 mpx. r v ;.. 2 5 vacant tot Liquid Level -ooT ` =0.0�'' 0�0 ,. ' ° 'S = 0.07 s :0 2 layeroti/8-Va D 'had /8B Existing ° , e •• , w ti washed stone. ,� ` ��; 9 Leaching stem L 6 . . e c e bo -� 0 -SEPTIC TANK_ II -"1000 GAL.- , M m `o ' E'ffective dep?h' ° o. o 44 : iif ; �e C0 � a •• • 0e 6 - S.F. 1 W a�i a) m `.e • . • • 0 , ,M• C.$asin W Precast co Pit to s� - T i0oo Qal. o� ntLeaching est hole c c c c c 6ft. diameter /� 86 Loa2 S® c t 61 ' ... — -io' �•- Box t f. , .' 24 p sed 24 CD SECTION OF SANITARY SEWA6E -DIS'POSAL. SYST M house d�• 4 NOT TO SCALE Hof3%4 to I V2 washed stone 4a� a' "` r .• , r r all around precast pit providing 34 Existing $ Proposed Well 135', 5 3 : ` 45 ` # ` otr'effective diameter of JIL Weil 225 �sg� o AESkGfJ CRI•TE IjiA' - <-. 6'd' , x 6'depth Leaching`Pit with h �� .m�id PrpPoled wel m i�tS� 2ft.of vuashed st8 all brQu�ld. � Nbmber of .be droorns - - '• . - d ..�-(�equivaleiatato 330 gal.per day). . Garbage disposal unit None GENERAL NOTES u'- 50 s Reserve area Leaching dreampacity required 330 gal. per day. 1) No change to this system shall be made unless Side Area proposed 188 square feet. approved in writing by Philip D. Holmes. _ p s9 s4n64_� '` �" I1000� 84 3 e rf 2) Subject to inspection during construction by --_ 84 2 . a3c>67 Bottom Area rgposed - 78 square feet. C:6asin P theBoard,of Health adid PHILIP fl'HOLMES. (.PriANE vote 40 wide ) =r'-. L~, Proposed Leaching-Capacity_�,�.`�s ;gallons per day. 3) Heavy. construction equipment sho I I not travel SPUR over Heavy. sal system durin or after construction. �r f Water sy PPIy Qr1va��►e It `- �`•, Po Y 9 . Precast concrete units, H-10 loading. SO 1 L LOG 4) Disposal system to be constructed in accordance - with Title 5 of the State Environmental Code. Surface No I 5) Flood Plain Hazard Zone C 1 o\y`� 37 _ .38 Surface 87.0 vacant lot NOTE : loom 6) Zoning District R D—2 — 1) A COPY OF THESE PLANS MUST BE KEPT ON THE SITE DURING CONSTRUCTION. a + 2) A COPY OF THESE PLANS MUST BE FURNISHED TO CONTRACTOR,C"TRUCTING SEWAGE DISPOSAL,SYSTEM. subsoil 3) BEFORE BACKFILLING THE SYSTEM,THE CONTRACTOR SHALL NOTIFY PHILIP D.HOLMES AND E: 8OAR0 r 7)Bench Mark center of catch basin at intersection of OF HEALTH AGENT TO INSPECT THE SYSTEM AS CONSTRUCTED.) HIGHPOINT RD. Elev=84.64approx.sea level datum coarse sand PLOT PLAN �. OF PROPOSED SEWAGE QISPQS�A� SOIL TEST REFERENCE: FOR 20TH CENTURY B ' R`S x gravel Date of soil test SEPT. 27, 1978 Land Court 'Plan 34846Bsheet 2 Test taken by PHILIP D. ,HOLMES LOT 44 MARSTONS�MILLS BARNSTABLE, .MASS. f� Results witnessed b Paul Paul Gardner SCALE.�4� DATE. SEPT'• IS, 178 Y DRAWN BY R.S.J. CHECKED BY •Percolation rate 2 'minutes per inch PHILIP D. HOLMES . ' 75.0 round water encountered. Assessors Sheet a Lot N CIVIL ENGINEER LAND SURVEYOR No 2 9 301 MAIN ST. FALMOUTH MASS. JOBN- 78298 DWG.NQ A 694 I SHEET I i 8' - 6" Outlet belset 1 eveiIpfor at leas te2) fr muthe box shall Knockouts i - - - - — — Tom- �I '° ::b! ::: •Q ;. All access Manhole covers for Septic Tank, ET --�- Outlet O Distribution §ox and/or Leaching Pits set INLET . Knockout cv = ( I more than 12 below finished grade shall be r� INLET ) OUTLET raised towithin 12''of finished grade. UWU ! _I Outlet Metal frame 8c cover or concrete cover Knockout over "T's" where required. o Concrete block masonry 2'-0" 1'-2" STEEL REINFORCED PRECAST CONCRETE — or 3" Brick masonry 3" Removable covers — — Concrete'•cover'<< <, 2" ;Cone`:cover *2 --�''-•3N min.clearance required:---*' n r-INLET'Y 'o a b I�iLET ��, 8 ,2 min.inlet to outet 6 min. 13 r INLET—s. , 0 ' �— OUTLET I (� Outlet E:0 UTLET Knno�ckouts- 1o"min. Liquid level 14' �1 Knockout 2 min. —min. T i� In A.. n 6 min. 6— -' 6 min. _ `4 �tQ U') — Cr TYPICAL DISTRIBUTION BOX J SCALE' I " = I'-0" it TYPICAL 1000 GALLON SEPTIC TANK SCALE: 3/8' = 1'-0" A LOT 44 SPUR LANE & HIGHPOINT RD. PLOT PLAN - DETAIL SHEET ` OF PROPOSED SEWAGE CISPOSAL SYSTEM FOR 20TH CENTURY BLDR'S �����x Q 4 IN x H I MARSTONS MILLS BARNSTABLE,MASS. SCALE. as shown DATE SEPT.19,1978 9 DRAWN BYE— CHECKED BYE;/�' I PHILIP D. HOLMES. ' CIVIL HS01MAIS FALMOUT ,SURVEYOR [40113~N°, 6298 DWG.Ne A 694 I _ SHEET 2