HomeMy WebLinkAbout0047 TANBARK ROAD - Health 4746Tanbark'Road
Marstons'Mills
A.= ,099 °053001
ti
Commonwealth of Massachusetts 09 I ,053-001
Title 5 Official Inspection Form
� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�-,.•� 47 Tanbark Road
Property Address is
John and Antoinette Sordillo �n
Owner Owner's Name
information is ✓ "
required for every Marston Mills Ma. 02648 02-15-2019 r#
page. City/Town State Zip Code Date of Inspection w?f
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 61*- j 3 u R q
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
Co
Company Address
jeaticket 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
02-18-2019
In pector'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.
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I
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® 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 and a H-10 D-Box feeding a precast
leaching pit. At the time of the inspection there was two plus feet of available space and no visble
stain lines above that.
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.
El Y ❑ N ❑ ND (Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. Cityrrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
-y
3)� further Evaluation is Required by the Board of Health:
d ❑ 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:
t5insp:doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
c�!% 47 Tanbark Road
V�
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. Cityrrown 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
Commonwealth of Massachusetts
�- Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u-
47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
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
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 'h 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
Elthe system is located in a nitrogen sensitive area (Interim Wellhead Protection
El 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
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u
47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. Cityrrown 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 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:
E ❑ 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
i, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u
47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. Cityrrown 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
Seasonaluse? ❑ Yes ® No
Water meter readings, if available (last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
occupied
Last date of occupancy: Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
v
47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
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 0 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
�n p Title 5 Official Inspection Form -
�I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
............ 47 Tanbark.Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. Cityrrown 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:
05-05-1989
Were sewage odors detected when arriving at the site? ❑ Yes ❑ No
5. Building Sewer(locate on site plan):
21"
Depth below grade: 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
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
47 Tanbark Road
u-
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
Depth below grade: 12"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 H-10 1000 gallon
Sludge depth:
4"
Distance from top of sludge to bottom of outlet tee or baffle
32"
Scum thickness
2"
Distance from top of scum to top of outlet tee or baffle 4"
11
Distance from bottom of scum to bottom of outlet tee or baffle
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 tank on a maint. plan with a local septic pumping co. based on
the age and 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
�- p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form = Not for Voluntary Assessments
��!% 47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
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
c� Commonwealth of Massachusetts
�- ,� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u—
47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
At the time of the inspection there were no visible signs of leakage or visible signs of past hydraulic
failure.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is Marston Mills Ma. 02648 02-15-2019
required for every
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: one
❑ leaching chambers number:
El leaching galleries number.
❑ leaching trenches number, length:
❑ 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
47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
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 there were two plus feet of availble space with no stain lines above that.
The cover is raised on the leaching pit.
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 14 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u
47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
�= Title 5 Official Inspection Form
lip Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
. � 47 Tanbark Road
V�
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. Cityrrown 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
���,,�,� �,�, ►� �f ��, e �� Nam ,
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
�/ 'PgA'PL OF BARNSTABLE /
LOCA110N/c ���A.'� �nI SEWAGE#
VILLAGE n�kjfS�U,Yi }1li Os ASSESSOR'S MAP& LOT I
INSTALLER'S NAME& PHONE NO.
SEPTIC TANK CAPACITY M60 c rw
LEACHING FACILITY.(type)-C G
NO.OF BEDROOMS-;),- _PRIVATE WELL.OR PUBLIC WATE
BUILDER OR OWNER k-, Z. e- C,�n
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No ! _
ld� �i0
`f
3� e
r r
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
47 Tanbark Road
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. City/Town 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: 14 plus feetfeet
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 at a lower elevation and I shot it with a transit to show 4 plus feet of seperation.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Y
Commonwealth of Massachusetts
Title 5 Official Inspection Form
"I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
c, 47 Tanbark Road
V�
Property Address
John and Antoinette Sordillo
Owner Owner's Name
information is required for every Marston Mills Ma. 02648 02-15-2019
page. City/Town 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 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
1 1 pj-) F e e
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
ZI
q= Ail FEB...... $ .........
THE COMMONWEALTH OF MASSACHUSETTS
PARCEL. ;�®5�00-` BOAR® OF HEALTH
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..OF.......................................------------------•-------------._._..._...........
Appliration for Digpaii al Works Tomitratrtinat Frrutit
Application is hereby made for a Permit to Construct (e/) or Repair ( ) an Individual Sewage Disposal
System at
16T_ 1l AN3RK 6P). /lAsfy.u5' !u 5
he -------------- ----- ------------------ ------------> ------------- •---------------------------------------------- -------------------------------------------
Locatio Add ess or Lot No
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..................:......... ............... /........................................
-----------•••---•---•-•......-----•-•----. .. ........---------------
-O; ner Address
fZiSC6C_C 0'1
a jr. _ .............. ........
Installer Address
d Type of Building � Size Lot_J1,19a-------------S q. feet
Dwelling—No. of Bedrooms................?..........................Expansion Attic (Y) Garbage Grinder (14)
Other—T e of Building ............... No. of persons...._....................... Showers — Cafeteria
Q' Other fixtures _______________________________ __
W Design Flow.............-? �......._.._........__.gallons per person per day. Total daily flow.........._.� .46_._..................gallons.
WSeptic Tank—Liquid capacity.1.0.0.a.gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosin tank ( )
a Percolation Test Results Performed by.7 �i Ec new G .__�0_.._G✓/�f±vc�3Z . Date__. �5.................. .......
t-•--- r
1.4 Test Pit No. 1____-__-'--__-_.minutes per inch Depth of Test Pit--- e. ....... Depth to ground water____Mu
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ..............................••--••---••--------•••---••-•----------.....•--•-•-•--------------------•-----•------•--------•--•----•---•----•-•-••-•••-----
0 Description of Soil_._.....Ff6.0_............q•ni'_5_.______�^!I PERg�c�
... ----•---•---•------------------•-------------••-------------•---------•-•-•---•-----
x
•-•-----------------------------------------•-•--------------------------------------------- ----------------V
W
VNature of Repairs or Alterations—Answer when applicable____________________------------_..............................................................
-------•-•-•.--•---.•--•--••••-•------•-•--------•-------••--••--•--•••--•-•-•-••--•--•-•---••-••-••-•-•----•••------•------•-------•------•---•--•••--•----------••-------••---------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
TTr'1R^
the provisions of 11:1.E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issued y t board of 1 ealth. /�
Signed.--• :_._ ......................... •--•-vrj-----------
ate
Application Approved By.. t se! - -------------------------•-•------- - D'a'te
Date
Application Disapproved for the following reasons-----------------••-•------•--------•---••-•---•--...------•---•-•--------------•----------•----••-•-•........._
........................................................................................................
p Date
PermitNo............A--T: �--------------------_---- Issued--------------------------------------------------------
'T WTI OF BARNSTABL.E
LOCATIO _� �7Ad � SEWAGE # " (O
VILLAGE r5-6/�-i )�11 i I)5 ASSESSOR'S MAP & LOT /
INSTALLER'S NAME & PHONE NO.
SF,PTIC TANK CAPACITY ��6sLCT�L
LEACHING FACILITY:(type) (size)_ 6C3
NO. OF BEDROOMS—PRIVATE WELL ORIPuBLic wATE
BUILDER OR OWNER ��)
r."
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED__ • s ' �
VARIANCE GRANTED: Yes
t
��� � 1 �
I
`�� �
�� �� �
i '
��� ���
No. .IL _..._.. F>�f.�?`............._
THE COMMONWEALTH OF MASSACHUSETTS
,-- BOARD OF HEALTH }
i r3rw ' r,� 'e N 3r rl 4 c (.
.. -•------- --OF.............................•--.....
ApplirFatinn for,Bhipnaal Works Tomitrnrtinn Wrmff
Application is hereby trade for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at: _
i�L� //U /�*''3RKrt sA), jarr. sfG.vShl
s tr i
f Locati Add ess. pj or Lot No.
/Iu rZ; t1 s�'Ss: J I U ;° ev.t`K.V1
..........................
.... ........
r .........._..__......-_--._._..__._.._...._._.._... .. ..
Owner Address
Installer Address
UType of Building Size Lot-�_ 9$�_____________Sq. feet
�-1 Dwelling—No. of Bedrooms..............3._.........._.............Expansion Attic (.V ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures .._..------•--•-•-------•-•----------•-••--••--------.---•---------•--•-•----••-•-•---------•---------------•----------------.....-•--------------•-•
Design Flow.............. ....................... per person per day. Total daily flow--_-........ M........ gal
W ••- - ----••-------- Ions.
WSeptic Tank—Liquid capacity 1.tl u_.gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
`-' Percolation Test Results Performed by- !'�9..! i!? 1 .�.: ... $^' � ......... Date_- .' .
a
Test Pit No. L.. -.! .._-_minutes per inch Depth of Test Pit...f�_:. ....... Depth to ground,water---.� -----------
Test
LT. Pit No. 2................minutes per inch Depth of Test Pit............-------- Depth to ground water------..._--._-_--_-_--.
P4 -----------------------------•-------•---•-----•-••-------------••----;;:---------------------•----------------------------------------- ._._...
D Description of Soil........ c` = 5 r0,v!? t-t� PC
#3 6 L c
V •---•-••------••-••--•-••••-••--••-----•------•----•-•--••••-••-•--•-••--•.......................••---•---••------••-•--••-•--•--....--•-•-•-•••--•--••--------•••••--;-•- ---------------
------•--------------------------------------------------------------•-•----------•------•-------------------------------•-•-----••---.----•----------------------------•-------------------------------
U Nature of Repairs or Alterations—Answer when applicable.-------------------------------------------------------------------------------------------•_-.
---------•-•--.••..••--•••-•-••-•----------•••---•-••---•-••-•-••-•-•-•------•----••...-•---••-•••••------•-•••......---•-•------•--•--•----•-•--------------••••----•--•-•--••••-•-•••......_..........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TTTLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b n issued f y t board of health.
Signed-.__.'f ° .: ................................. �/ [ .
Date-
AppliApplication r
cation Approved By__..lk_- =�..... .,t,s .- .........................................j ----f_ �r�.. a� ------------
APPlieation Disapproved for the following reasons:---•-----•----•-------•-•-----------•----•-------•--------•--••--•-----------••-•----------•••-•................
.................•---------...---------•-----•-•-------•-•--•-----------•-----------------...------.........---•-------...-----•-•-----•-----•-------------------------•--•----•----.--•-•-••---------...
GG Date
PermitNo.---- _C• -n /----------------------------------- Issued.......................................................
THE COMMONWEALTH OF MASSACHUSETTS
f, BOARD OF HEALTH
�...e+..! j t1$?-J S�1/S G q4
OF.....................................................................................
C9rdifirFa#r of Tumplitanrr
THIS IS TO C RTIFY, That the Individual Sewage Disposal System constructed (s ) or Repaired ( )
lily te(C. �S7-,
Installer
r 1'".sV6.4r?ct at 0Ao , ,
-•---• --•--- ------...
at. „
s
has been installed in accordance with the provisions of T I T IE 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.-_--.`L-...�................... dated-.----------....................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE......................5:...... - ................................ Inspector..-•----------......-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
........<.t}.G .1....................OF..-- i�or w s.........................................' , ..............................
Disposal rks Tnnotrud an antic
Permission t hereby granted.•-•-•4......-•------•--•-•-••--•••------ •-••-•------•. .
to Construct ( ) or Repair ( ) an- Individual Sewage Disposal System
atNo .-6-r•---..�L)........................................................rin /5�.. cU ) ...-�•',.s-....................�• . ...4_--..•----•---•---------•--•----..............................
Street
as shown on the application for Disposal Works Construction Permit;) 5 Dated.................................•........
................................................•-•-•-----------•--•-----•--------•------
. ... Board of Health
DATE............ •=�� `�-
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS x
i
i
tMARSMNS
SHEET 7 OF 7LOT 1J0
mM s
LOT 129
LOCATION MAP f / \ i 1 + r 1 1
lil \
q10� d OT32
: *C `. 6 a LOT 12t 'A
.� .7 +t 91e 1en4 sr
GNIV �taae �4 18 `
LOT 31 �. \
+awel
LOT 137 ti ;^� ++ �, ♦P
1a7M 7 ty ! �i LOT 124
"'°`
..� r44r ti - � " ( q• ��4 well , 5���' ��
,mod LOT 106 ' 11 •!h '+
/ /• _ 1/ r fi? n it LOT 123
Ir LOT 126 116m w
l_ t4• a>s 14.4 lot LOT 13 1a•u s y� 01r
\\ r� LOT 149lop
/ `� un•: y ' .7 a LOT 138 •sue IS. p••d ��_Lg 1
LOT 134 L 13S •sd 1 1 �, � '' -'/�+I I LOT 122
1 1am fr 4n \� a•�w� -40111 S.
L07 121 \ M 1
+ LOT 107 �' LOT 148 e / \ l / ryd .�11ti M -A �,\ ~ta - w +tom Y !of • •°a` 1 I o
\ \\\ n.S aa•sr '' J �i 1 .. 5 , y\O '\�jk_0 �
0 \ Ji.or °l0T 147 y �� a -\ C
\\ td •_ yt ,\/, "��\ 5 LOT 119 %
+\ i' 'a �l .. �y.S �i'� LOT 1141 \ \� +�•+ tame= � 1A. ' !•5let
�.
tOT
r.tr �yok 1 1.1y \�� ~ '�Y'� 10 'i t e ypatoo w d �' ,. LOT 120
\ t / ? '\; •�1\ ''''\ , LOT 117 & si »u•a
xsr u ` o + �, j% LOT 43` 4 + •+ w•oo sr \N. "SL
rI _ y� i6r' � .a 4 \ � !� �fls �1'� � RY Y 1��1 � t' M•o ,d `�
� _ rr �'�r0 � 1t•o ��� ''L01,14d' .$ d \ +• ..KIC7CS �.
r �' ��� t•oio sd ��''�' ►° L� i. I.56C I NW"r 7A Or- 7 for- so/tI vos wNb
145 \� r 4 LOT 115 to .$ �- -.�o1•A11•+J -Misr. All!"wrc.
r 1�11 LOT 146 ',107fJ'SI �L' +�s� •�tmo°s '$ Ir �6.0 ` ,e !,taG s14sQT 7A o/7 Mr- •6.1l+sND'.
1 Lot 1 na�1�' /��i .. r 15•� \ �°• lei
•' LOT 116
\. 'o r' LOT Ill ,t & �` 1m••s
`4" \$. LOT 111 iamllg 'L••d •• 4' �Lo 114 -
r A
``° 10.••• A .a 1 t41� -, •b .O.P a.{ tb#b E "4w"*'t.
Ir 11 I 1 j, AaJ
3 11 29 88 FINAL BLDG. AND SEPTIC LOCATIONS PAL
r L ►LO \ BUILDING
�p \ w>� 4. 1 10 2 88 INI PLAN DON
TIAL 1 ON El►(
\ d.• yob .p•• i3 / NO. DATE DESCRIPTI BY
BUILDING LOCATION PLAN
` LOT 110 `. MARSTONS MILLS WOODLANDS
LOT 109 11.9110 11< BARNSTABLE, MASS CHUSETTS
-OD LANDS ASSOCIATES
SCALE: 1" a 50' 1 JOB NO. 1338/41w•1° p•' ,y4
IEPP, EIDRBDGE TAGNER ASSOCUTh INC. ^
�+ uleerr,pe� name. uM»u�
eea wzn mAm 311RUI Calm MV= MA NOW
. SHEET 7A OF 7
OL A0 M M OR AS wwM w wAM
Wq
r rwa rwAeAa owsa rq r A�
wq 410 PLAN •a
a
a
ee.�rr
MARSTONS MILLS
1 A 1 �- ® DESIGN CALCULATIONS:
wugr or ewes
GA Ma umvm MOT
w0•s W ON rt r as w rr0 w0 TOTAL ammin woe
L"Im YAP �� ra war TT A R P AOL w PW wf as rA wg1�00�1�IC 1AAY X-L.WL) �epAALL./OAT
AI/rAA! an Al R. r un!a AC1Yw aR w Os16 low
sKLwL AwrA 24_aAL./s►.
_ r-r ■ ��(sr�)�w ems
4010
r•M ■ -MT KtesTl 1fAa01r0 armo • SAL.
Box
OIS110lN110N ►� www
66 NOTES:
® r. ALL WWMYMOA AM••T XIMS S A{L eoeowl 11 LL&L
1000 GALLON SEPTIC TANK MATMM rear IM a va w.Aa esmAL ar M
Am
r I r I If t ALL COir•w INWA ROMweAw w ro sL K Nran To
MnTiG eys o F I w I • a AM•AKr ATr w UMTO Mwn GWAM Te WMK
R 94AIL K W01411O M PLACL
Aa is on" SOTTOI OF TEST HOLE T, ♦ ALL croons v TM[SAMMY trtlar ONALL K GrAat
•L.IL...J or awarAlOw M-Te LGNNW 1Awa1 lir AK UOOr al
a , a rr er rsw a•Avow Aw1AL M-M LeAeOw
tFAQIM6 PIT PANUM use una a awM ro n:Or @ AAS so
. L MORMTAL am tlawCAL OM1wL.Q uw.111 K �.
•Maw rMe weOOa(�$Imn PLAN 9730-10
i
LOT
NO. ELEVATIONS
LEGEND:
aEV. 106 107 108 109I110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 128 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 WFU TAM vwr0°e� co
LOCATI P I�
.O.FOUND. I woont Woaw wT
A 76.0 7t.s 71.0 ,*0 �*.o)+Ito s•• 740 740 lf.s 71„p r7.o 7r•b be•e io.b •L• AMo ooroawTraw Tar �r
b s No f1,b •0• - Dl.o •l.o Vs 770 74.s 7f.6 1io 74.• 74.0 7y,t 1b•o 7>4e N1.e A wms r anion wr ,
1I 7•.0 76•S yi,f 7y.o 14i0 lt.o 7f,T.0 7LS 7'/• TJO A/w t�sesarrwTrM TKl
B 7n•9 4to A►•e "1�;44.1�I M•o b1J Io6 'ft.0 7b•• 734 744 7r.o ,bs 71•s 77 7�d 1•.I 104 al - 7•,0
S 75-0 7?G f 91.10 714 7l.4 7e•0 x,s 7se 71.0 70,01 If•6 741 7;1 r1.1 IWA 7A4 1 Y1.4 bb.S bAs ff1.o ib0 B
c 70.1 s A6.T 6160 bf.•I �621 64s 7oZ al 79.7 7f.7 74•2 7t.7 16•t• 77. 71•t 70, 77•+
7x2, x.t - 77.7 77.1 7t.2, 74 -10) lib 71.3 70.+ �r.l 11-1 Its 7;b
11 7ft 746 71L1, l:.ip 7t.1 71.1 6q4 i*.s eft 60•7 c
D 70•0 H, 6'9•D bsL �bo.4l jT.f K• 7t• 71.0 7114 U'S 74.0 791•3 71.0 •p 71.0 76.0 Tiff 774, 700 - 7E3 77f 7f.e o 7I•I /i.4 �GI 71e0 7e.o 7Gf -mo 77.4 1so 74.4 7", 1t.1 71.1 *.1 6.01 v6•o 0.0 offs Ina D
E LRT► 4e•b bS'� bt.4 'KA,��At! bSSI bs• 7b3 7s) 7s.; 73 f 71.3 Ts•• !i.{ 7i.e 7t1 77.s n3 7s•• - T7� 77.3 7 73. 7nA 7s.1 Te.l b1•S ,$# 7t4 is.* Tt. T4. 74.e 73.3 7Y•S 71•• • N.4 bf.b /4.6 N•3 7M3 E
F 146 •es bo.l bi•ti ffst �Ts H,b 70.6 71•I 7e1 7o.1v 7t,1 IMP 1i7 77,1 71.1 71Ro . 77.1 77.1 a 7i.b 70.1 7 . 70.1 b4•b 44•1. 71•L 7t•I• 734 74.1 744 fix.1 Ij.jf 64JO 69.1 Ina F
�I � I
G N.s bbf 66.0 bb•O b/.el 6%0 0/.0 70.5 7Le 71.0 ,1.0 79,s 79.0 7t.0 7••s S.9 715 77.0 77.0 W.s - 77•10 7I.0
74 f T3.f 7•i 7i,o 7o•S b1•S b4.S 11.0 0 7!S 74e Tt• 7s.o 71•f -rot At S bs.
711.s 64.5 b•.o 14,0 G
H 63.0 4L5 01•0 67•o Is1.eI ►I•o b4•9 b40 bea oo.o Ito 67.5 611e 1143 7.3 70. 71.7 7L0 71.e H•6 _ 71.0 71.0
60.9, j7.4 b4•s b6•e b4e (,V% y;s bf,e rb•S I,jp b•f b•e TA rbo bt.f 16 ?A.f ffL.o 64o H
II bs.6 04.5 6 APPROVED: BOARD OF HEALTH
J s4s sss fs•o ss S3 Y �sao s• bws bW bt•o 6L• 63,3 69,0 bf.5 bs.0 bbf NS oxf N•'e _ o
axe 7e is•5 Atis b3.5 AA•f bt.• I.o•s s1•s 51•s bl•0 bt.s ►#e 64C µ.o 6TA• J
bt.o M•S be.s S•4 413 I.o .o be.o
K 7s•b 7C6 70.0 b4e��µ• j7o.e Ill. 73.3 736 7A9 7t.s 7b•D 17.r !Io 746 7fi or.• •a .Mn
1 to. bee 71.5 _ 6Ro 4w• .5 7i.3 Tiff•74•• 7tA.o 7!•o t!
7a~b 7ls.e 7i. 7r•>► 77.0 1s,b 71ti !k3 1; 1. 61•0 7e.'J ts.e lK.o K
L 7t.• 71.s beo ii Ihi N.e 7e.7 Ise 7i6 t44 7l.0 71f•s 77.0 A.0 71.0 ".9 746 Me 74.s ".o - 71•d 7�•b 7Le �.• 7►f 71.f ,H 7
Yy t4 71.01 73•s 14.7 .0 70.e 7t.b lf.s I 7Vrf 74e 7b.o 76e 70.0 7A4 71.5 L
m 72.0 � I f , Iwo 7t•s 71.0 7r • e 7
7••fa7A, 7tt 7t.b,o7 •sNo rwb 7sa 7s9 7 e t 7e,4 74.4 7" 644 7o 11.S
M
N 7t.0 7Io b70 be0�ild A0 7ta 7�19
. 74•o 12.9 7ss 71.0 1t•t 744 19.0 A.S ILLTf.S l4.3 li.o 7s.o 7w6 b•.e b4.0 *..f ls.S N
1 12 Bb INITIAL ISSUE MCI
HE OAIE DESCRIPTION BY
PERC TEST 1 PERC TEST 2 PERC TEST 3 MC TEST 4 PERC TEST S SEPTIC SYSTEM DESIGN
LOT 116 LOT 125 LOT 131 LOT/49 LOT 146 eLw MARSTONS MILLS WOODLANDS
sAa_ woL.�ea_♦Ar OA,���T w OAA
AIM l~��o a M` w e a_ ,•M M e BARNSTABLE, MASSACHUSETTS
mto
wwAw are wwAAw M w+wL wl
d i WOODLANDS ASSOCIATES REALTY TRUST
A a wew
are•Aa•a Me fa•rre■wrTr• nwAM wL own One wawe AKA q venal
ar •u low awe r•1 w ww.raves �an mom 0 Ralf•as SCALE: 1" 40' JOB NO. IM11/up= ,�v
aq req •q •q /q ot r AU
w 0 w OD i
01n[a e.Tar 3LLM OAR O/eL laT Tf • MR or am?w a" MR S am la1
1 1 BY ewe ET143M er ice• �W MR Q 7K,laT TM1Ar L yr -•
ra100lATla1 RAN Z(_ML/MCM rp1CMAl10M RATE.L.L_nMAlar POWMAMn MTLIL a lKt/Mer �A1M0 RAN�rt1MOr r0001A110w Ml[SLMt/Owll •« .AO,v f
PERCOLATION SOIL TESTS LIM, MMGI TAGM MOM INC
imim mm atmeLT ear m case
Sao T zm9T 2"M 0RUMvau HA o�eaz